COMPARATIVE-ANALYSIS OF NATIVE ADMISSIONS AND REGISTRATIONS TO NORTHWESTERN ONTARIO TREATMENT FACILITIES - HOSPITAL AND COMMUNITY SECTORS

Objective: To study Native and non-Native admissions to acute psychiat ric care in the northwestern region of Ontario in 1992. Method: To rep licate a 1986 to 1987 study comparing Native to non-Native admissions to acute psychiatric care in the northwestern region of Ontario in 199 2 and examine Native registrations to community mental health agencies in the first 6 months of 1993. Results: The comparative analysis of h ospital admissions revealed that. Natives are still being admitted at 33% more than the rate expected on the basis of population; depression appears to be underdiagnosed for Natives, they continue to be admitte d mainly for reasons other than major psychiatric conditions, substanc e abuse and forensic history are commonly involved; they stay in hospi tal for twice as long as their non-Native control; they more often com e from rural settings; and they are less likely to be followed by the outpatient service and more likely to be followed by the criminal just ice system. The examination of registrations to community mental healt h agencies revealed that. the same overrepresentation of Natives, mood - and thought-presenting problems of Natives in this sector were ident ical to non-Natives; and their length of stay was similar. The psychia tric hospital appears to be providing acute care treatment, not for th e serious psychiatric illnesses for which it is mandated, but for atyp ical admissions that result from economic, social and cultural disloca tion. There may be underdiagnosis of a typical depression in the Nativ e hospitalized population. When asked what they are being treated for the diagnostic profile of Natives and non-Natives is identical on mood and thought dimensions. Conclusion: No appreciable change has occurre d over the 5 years in the way hospital psychiatric services are used b y Natives. Cultural stereotypes may be influencing the diagnosis of Na tives in inappropriate ways. Enhancing Native control of treatment pro grams and community development may provide a partial solution. Proper ly mandated and accountable community agencies (both generic- and cult ure-specific) will help reduce unnecessary hospitalization.