Manitoba First Nation peoples’ use of hospital-based mental health services: trends and solutions

Abstract

Objectives

The objective of this article is to document patterns and trends of in-hospital mental health service use by First Nations (FN) living in rural and remote communities in the province of Manitoba.

Methods

Our sample included all Manitoba residents eligible under the Manitoba Health Services Insurance Plan living on FN reserves and those living in rural and remote communities from 1986 to 2014. Using administrative claims data, we developed multi-level models that describe hospitalization for mental health conditions shown responsive to primary healthcare interventions. We aggregated the results by First Nation Tribal Councils and remoteness to derive rates of hospitalization episodes, length of stay and readmission rates.

Results

Rates of hospitalization for mental health are increasing for FN males and females. This is particularly evident for those affiliated with the Island Lake and Keewatin Tribal Councils. The length of stay has increased. Changes in rates of readmissions were not statistically significant. FNs are admitted for mental health conditions at a younger age when compared with other Manitobans, and trends show that the FNs’ average age at admission is decreasing.

Conclusions

Our results raise serious concerns about the responsiveness of community-based mental health services for FNs in Manitoba, because of both increasing rates of episodes of hospitalization and decreasing age of admission. Given the documented lack of mental health services accessible on-reserve, levels of social distress associated with a history of oppressive policies, and continued lack of infrastructure, current trends are alarming.

Résumé

Objectifs

L’objectif de cet article est de documenter les caractéristiques et les tendances de l’utilisation des services de santé mentale en milieu hospitalier par les Premières nations (PN) vivant dans les collectivités rurales et éloignées de la province du Manitoba.

Méthodes

Notre échantillon inclus tous les résidents du Manitoba admissibles au Régime d’assurance-maladie du Manitoba vivant dans les réserves des PN et ceux vivant dans des collectivités rurales et éloignées de 1986 à 2014. À partir de données de réclamations administratives, nous avons mis au point des modèles à plusieurs niveaux décrivant l’hospitalisation pour des problèmes de santé mentale qui se sont montrés sensibles aux interventions en soins de santé primaires. Nous avons agrégé les résultats par Conseil de Tribu pour obtenir les taux d’épisodes d’hospitalisation, la durée du séjour et les taux de réadmission.

Résultats

Les taux d’hospitalisation liée à la santé mentale augmentent pour les hommes et femmes PN. Cela est particulièrement évident pour les membres des conseils tribaux d’Island Lake et de Keewatin. La durée du séjour a aussi augmenté. Les changements dans les taux de réadmission n’étaient pas statistiquement significatifs. Les PNs sont admis pour des problèmes de santé mentale plus jeunes que les autres Manitobains, et les tendances montrent que l’âge moyen des PNs continue de décroître.

Conclusions

Nos résultats soulèvent des inquiétudes quant à la réactivité des services de santé mentale communautaires pour les PNs au Manitoba, à la fois en raison de la fréquence croissante des épisodes d’hospitalisation et de la diminution de l’âge d’admission. Étant donné le manque documenté de services de santé mentale accessibles dans les réserves, le niveau de détresse sociale associé à des antécédents de politiques oppressives et le manque continu d’infrastructure, les tendances actuelles sont alarmantes.

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Acknowledgements

We would like to acknowledge the unique and invaluable contribution of our community partners: Birdtail Sioux Dakota Nation, Berens River First Nation, Cross Lake Band of Indians Pimicikamak Cree Nation, Ebb and Flow First Nation, Northlands Denesuline First Nation, Pinaymootang First Nation and Fisher River Cree Nation. Also, we thank Mr. Matthew Dahl, data analyst at the Manitoba Centre for Health Policy, for running the analysis.

Funding

This study was funded by the Canadian Institutes of Health Research (Study 292821; grant no. TT1-128267).

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Correspondence to Josée Gabrielle Lavoie.

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Ethical approval was received from the University of Manitoba Health Research Ethics Board. Approval for data access was received from the Government of Manitoba Health Information Privacy Committee and the Manitoba First Nations Health Information Research Governance Committee.

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The authors declare that they have no competing interests.

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Lavoie, J.G., Phillips-Beck, W., Kinew, K.A. et al. Manitoba First Nation peoples’ use of hospital-based mental health services: trends and solutions. Can J Public Health (2020). https://doi.org/10.17269/s41997-020-00328-z

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Keywords

  • Indians, North American
  • Canada
  • Social marginalization
  • Health equity
  • Access to health care
  • Primary health care

Mots-clés

  • Indiens d’Amérique du Nord
  • Canada
  • Marginalisation sociale
  • Équité en matière de santé
  • Accès aux soins de santé
  • Soins de santé primaires