A mental health system in transition: profiles of change

These profiles of the changing Saskatchewan mental health system reveal that there have been increases in the number of admissions, readmissions, discharges, and outpatients in both the public and private sectors. Divergent patterns in the utilization of services in the public sector occur among the Indian and non-Indian populations. Over the past several decades there have been considerable changes in the types of psychiatric problems treated in the psychiatric care system. The social, demographic and admission characteristics of the people receiving treatment in the system have changed substantially. The data presented here imply that the status of mental illness is not solely a function of a physical or psychiatric condition but has elastic features capable of being expanded or restricted by the prevailing organizational structure which has evolved to handle the "problem" of mental illness. The advent of community psychiatry plus attendant changes in the health system has altered the nature of mental illness treated in the province. Consequently, concerns about ways of evaluating the effectiveness of current programs, of choosing between alternate service delivery systems, of establishing criteria for equitable resource allocation, and of understanding the forces for change need to be raised and explicitly dealt with.