Hospitalization for mental health related ambulatory care sensitive conditions: what are the trends for First Nations in British Columbia?

Josée G Lavoie,Michael Green,Naser Ibrahim,Darrien Morton,Amanda Ward,John D O’Neil,Sabrina T Wong

doi:10.1186/s12939-018-0860-7

Abstract

BackgroundIndigenous peoples globally experience a disproportionate burden of mental illness due to forced policies and practices of colonization and cultural disruption. The objective of this study was to provide a baseline profile of hospitalization rates for mental health-related Ambulatory Care Sensitive Conditions among First-Nations living both on and off reserve in British Columbia, Canada, and explore the relationship between local access to health services and mental health-related hospitalization rates.MethodsA population-based time trend analysis of mental health-related Ambulatory Care Sensitive Conditions hospitalizations was conducted using de-identified administrative health data. The study population included all residents eligible under the universal British Columbia Medical Services Plan and living on and off First Nations reserves between 1994/95 and 2009/10. The definition of mental health-related Ambulatory Care Sensitive Conditions included mood disorders and schizophrenia, and three different change measures were used to operationalize avoidable hospitalizations: 1) rates of episodes of hospital care, 2) rates of length of stay, and 3) readmission rates. Data were analyzed using generalized estimating equations approach, controlling for age, sex, and socio-economic status, to account for change over time.ResultsOur findings show that First Nations living on reserve have higher hospitalization rates for mental disorders compared to other British Columbia residents up until 2008. Those living off reserve had significantly higher hospitalization rates throughout the study period. On-reserve communities served by nursing stations had the lowest rates of hospitalization whereas communities with limited local services had the highest rates. Compared to other British Columbia residents, all First Nations have a shorter length of stay and lower readmission rates.ConclusionsThis study suggests that despite reduced rates of hospitalization for mental-health related Ambulatory Care Sensitive Conditions over time for First Nations, gaps in mental health care still exist. We argue greater investments in primary mental health care are needed to support First Nations health. However, these efforts should place equal importance on prevention and the social determinants of health.

Highlights

Indigenous peoples globally experience a disproportionate burden of mental illness due to forced policies and practices of colonization and cultural disruption
Our study focuses on mental health outcomes which we postulate can be improved by the provision of community Primary health care (PHC)-based mental health services
We modeled the rates using an offset = log(population) to determine whether access to different levels of care in First Nations communities is associated with a change in hospitalization rates for mental health related Ambulatory Care Sensitive Conditions (ACSC)

Summary

Introduction

Indigenous peoples globally experience a disproportionate burden of mental illness due to forced policies and practices of colonization and cultural disruption. The forced removal of Indigenous students from their families and communities to attend residential schools (1884–1996), where Indigenous languages and cultural expressions were banned, and where malnutrition and abuse were prevalent, has been implicated in multigenerational trauma [2,3,4,5]. Combined, these have gravely undermined Indigenous communities’ capacity to be self-determining [1, 6,7,8,9,10]. While concerted efforts are being undertaken to ameliorate these alarming outcomes, disparities in mental health outcomes continue to persist between Indigenous and non-Indigenous populations in settler-colonial nations [12]

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