Comparisons: Indian and non-Indian use of psychiatric services

Ethnic minority status and adolescent mental health services utilization

Adolescents who are members of ethnic minority groups constitute a large and ever increasing proportion of the population. While the information base regarding mental health problems and mental health services utilization in adolescents in general is slowly increasing, relatively little knowledge has accumulated about the particular needs and practices of youth of color. The purpose of this article is to review the available literature about adolescent mental health needs and service utilization as well as literature regarding adult ethnicity and mental health service utilization. The conclusion of this review is that significant gaps exist in our knowledge base regarding ethnicity in adolescents and its implications for the utilization of mental health services. The limited data available suggest that significant numbers of adolescents of color have multiple needs for mental health care and that a complex set of barriers exists to prevent them from obtaining appropriate services. A variety of suggestions are offered to improve the opportunities for and the quality of mental health services for ethnic minority adolescents.

Cultural barriers to mental health care delivery in Alaska

Geographically diverse providers from all mental health disciplines attended a recent conference in Anchorage and discussed cultural barriers to the delivery of mental health care in Alaska. Based on their knowledge, experience, and perceptions, this article describes barriers contributed by the mental health care delivery system as well as those contributed by the American Indian and Alaska Native cultures. American Indians and Alaska Natives are experiencing deculturation, outmigration, alienation, distrust, and despair. The difficulties at the interface between Alaskan mental health care providers and consumers indigenous to Alaska have implications for administrative and clinical endeavors in culturally diverse settings elsewhere. Progress in this area will require special administrative skills.

Gas sniffing as a form of substance abuse

The authors review the existing literature on inhalation of gasoline fumes, highlighting the acute and chronic physical and psychological effects. The clinical picture of gas sniffing includes visual hallucinations, changes in consciousness, euphoria, nystagmus, dizziness, weakness and tremors. There is the possibility of rapid recovery, sudden death or brain damage with chronic abuse. When leaded gasoline is abused then blood and urine lead levels and erythrocytic delta-aminolevulinic acid dehydrase (ALAD) levels may be helpful. Although the treatment of acute and chronic gas sniffing syndromes is often supportive and non-specific, when lead levels are high chelated therapy is indicated including British anti-lewisite, calcium disodium versenate or D-penicillamine. We also report our findings on an isolated native Indian population where intentional gas sniffing has reached epidemic proportions. Ten percent of the total population and 25% of the children between 5 and 15 years of age had been identified as gasoline inhalation abusers. In this population, the most important etiological factors included environmental, family and cultural components. The authors emphasize the need to correct the family and social deficiencies in such communities if the incidence of gas sniffing is to be decreased.