Abstract
For ten years University of Toronto psychiatrists have made regular visits to isolated Indian villages in remote Northwestern Ontario, offering a clinical psychiatric program. Initially, two non-Indian social workers provided ongoing service between the psychiatric visits. Recognizing the difficulty in providing psychotherapy cross-culturally, the members of the treatment team developed the skills of local persons who were not formally trained in the treatment of mental health problems. The paper describes a significant shift in the psychiatric program beginning in 1981. At that time in certain communities local people took over the service, resulting in an increased ability to provide a preventative psychiatric program. Community based workers have dealt more with early marital difficulties, grief reactions, transitional depressive states, and less with major mental illnesses. In the areas which have community based treatment teams, the emphasis in psychiatric service is shifting from direct clinical work to formal teaching and case consultations with the indigenous counsellors. The evidence indicates optimism that the service is reaching more persons before the emergency stage than it did in previous years of the program.