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 psychiatric care in the northwestern region of Ontario in 1992. METHOD: To replicate a 1986 to 1987 study comparing Native to non-Native admissions to acute psychiatric care in the northwestern region of Ontario in 1992 and examine Native registrations to community mental health agencies in the first 6 months of 1993. RESULTS: The comparative analysis of hospital 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 admitted mainly for reasons other than major psychiatric conditions; substance abuse and forensic history are commonly involved; they stay in hospital for twice as long as their non-Native control; they more often come from rural settings; and they are less likely to be followed by the outpatient service and more likely to be followed by the criminal justice system. The examination of registrations to community mental health agencies revealed that: the same overrepresentation of Natives; mood- and thought-presenting problems of Natives in this sector were identical to non-Natives; and their length of stay was similar. The psychiatric hospital appears to be providing acute care treatment, not for the serious psychiatric illnesses for which it is mandated, but for atypical admissions that result from economic, social and cultural dislocation. There may be underdiagnosis of atypical depression in the Native 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 occurred over the 5 years in the way hospital psychiatric services are used by Natives. Cultural stereotypes may be influencing the diagnosis of Natives in inappropriate ways. Enhancing Native control of treatment programs and community development may provide a partial solution. Properly mandated and accountable community agencies (both generic- and culture-specific) will help reduce unnecessary hospitalization.

Record linkage in a regional mental health planning study: accuracy of unique identifiers, reliability of sociodemographics, and estimating identification error.

Assembling information about individuals over time allows health managers and researchers to describe the progression of diseases, the care history of individuals and the sequences of care episodes that potentially result in improving individuals' health status. However, current mental health statistics generally focus on sets of events rather than groups of individuals making it impossible to distinguish between two different persons being admitted and the same person being admitted twice. Accurate figures on treatment prevalence cannot be generated and multiservice users across time or across agencies will inflate the statistics used to plan needed services. The capacity to link consistently defined bits of information together is critical to developing a reliable information system. This article examines the adequacy of using unique identifier codes to accomplish linkage by focusing on one example of record linkage that incorporates mental health information from both community and institutional sectors in one region of Ontario, Canada. Findings indicate that unique "cradle to grave" identifiers do not guarantee accuracy if manual transcription is involved.