Association Between Changes in Community Mental Health Services Availability and Suicide Mortality in the US

Tuesday, June 25, 2019: 2:00 PM
Jefferson - Mezzanine Level (Marriott Wardman Park Hotel)

Presenter: Peiyin Hung

Co-Authors: Susan Busch; Shiyi Wang

Discussant: Julia Raifman

Importance: Despite an overwhelming majority of mental health services being delivered in outpatient settings, how changes in non-hospital-based mental health care is associated with increased suicide has been left unanswered.
Objective: To examine the association between changes in community mental health center (CMHC) supply and suicide mortality in the United States.
Study Design: Retrospective analysis was performed using data from National Mental Health Services Survey and the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (2014-2016). Population-weighted multiple linear regressions were used to examine within-state associations between CMHCs per capita and suicide mortality. Models controlled for state-level characteristics (number of hospital psychiatric units per capita, number of mental health professionals per capita, age, race, and percent low-income), year and state fixed effects.
Setting: All 50 U.S. states and DC.
Exposure: State-level number of CMHCs per 100,000 persons.
Main Outcome: State-level number of suicide deaths per100,000 persons.
Results: From 2014 to 2016 the number of CMHCs nationally decreased by 11% (from 3,406 to 3,024). Suicide increased by 4% (from 15.4 to 16.0 per 100,000). We find a small but statistically significant negative association between number of CMHCs and suicide deaths (-0.81, 95% CI -1.44 to -0.71; P=0.013). Results suggest that declines in the number of CMHCs from 2014 to 2016 were associated with approximately 16.7% of the national increase in suicide, representing 358 additional suicide deaths. In sensitivity analyses, an increase in the number of outpatient suicide prevention services (-0.42, 95% CI -0.80 to -0.04; P=0.031), but not inpatient (0.45, 95% CI -0.25 to 1.14; P=0.21), were significantly associated with decreases in suicide mortality rates in a state.
Conclusions and Relevance: State governments should avoid the declining number of CMHCs and the services these facilities provide, which may be an important component of suicide prevention efforts.