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

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.