In Fiji the magnitude and burden of mental health disorders today is increasing with more than 75% of people admitted to the St Giles Psychiatric hospital for the first time suffer from mental or behavioural disorder. Moreover, more than 50% suffer from an alcohol-or drug-use disorder. This growing burden amounts to huge cost in terms of human misery, disability and economic loss. The purpose of this paper is to look at the mental health service provided at the St Giles psychiatric hospital and the utilisation of these services focusing exclusively on first admissions for year 2002 with the view to identifying characteristics that may suggest that patient may have benefited from a community based service, thereby avoiding the stigma of a psychiatric admission. Recommendations arising from the data will be presented on the role of other health promoting alternatives to hospitalization, which may be more health promoting. These recommendations may help to meet the diverse needs arising from the community, and strengthen the ability to respond to new cases in homesettings and rehabilitate people within their own communities.