Mental health and alcohol abuse indicators in the Albuquerque area of Indian Health Service: an exploratory chart review.

Estimating the epidemiological patterns of mental illness among various groups of American Indians has been a continuing problem. Only a few studies of prevalence and treated prevalence are currently available for any tribal groups. Most data which are available are aggregate data which do not provide estimates of the experience of particular individuals with alcohol and mental health problems. In this exploratory, random, chart review study, a profile is presented of individual episodes of alcohol and mental health problems which were presented to the Indian Health Service (HIS) in New Mexico and Southern Colorado. Both medical charts and mental health charts are reviewed to estimate treated or clinic prevalence. The results indicate that 21% (±9.4%) of all individuals using IHS medical facilities m the study area come at least once for an alcohol or mental health episode over a 10-year period. These episodes account for an average utilization of 1.8 visits to medical services and an average of 3.9 visits for mental health staff services. Much of the data gathered in this chart review yield unique insights on the individual's experience of mental and alcohol problems. Further, this study raises questions which call for further use of chart review methodologies or individual-based data systems to estimate the impact of alcohol and mental disorders on the IHS system and for new estimates of treated prevalence. Establishing the epidemiology of mental disorders in any community has been a difficult, if not elusive, task. From the earliest studies of Fans and Dunham (1939) in Chicago, to the work of the Leightons and their associates (Leighton, 1959; Leighton, Harding, Macklin, MacMillian & Leighton, 1963) in Canada, Srole, Langer, Mitchell, Opler, and Rennie (1962) in New York, and Hollingshead and Redlich (1958) in Connecticut, the task has proven to be most difficult (Dohrenwend & Dohrenwend, 1974). Much of the difficulty centers around conceptual and methodological issues. First and foremost are problems of definition for mental health/mental illness. With the publication of DSM-Ill, (American Psychiatric Association, 1982) one at least has been provided a standardized (yet imperfect) set of definitions with which to work. Second is the problem of where and how to access data. Some access their data by studying diagnoses given by hospitals and clinics (Faris & Dunham, 1939; Hollingshead & Redlich, 1958), but others have taken a broader view, looking at a variety of social and cultural conditions which may influence both the rates and presentation of mental disorders in a population (Leighton, 1959, 1963). Dunham (1966) reminds researchers that, if possible, the entire social and medical ecology should be considered in the study of mental disorders in any population; within the social, physical, and cultural conditions of a group are found the roots of both health and illness. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH VOLUME 2(1), pp. 33-46 American Indian and Alaska Native Mental Health Research Copyright: Centers for American Indian and Alaska Native Health Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)