Abstract
BackgroundDespite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mortality in the United States.MethodsRetrospective analysis was performed using data from National Mental Health Services Survey (N-MHSS) and the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) (2014–2017). 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 (i.e., number of hospital psychiatric units per capita, number of mental health professionals per capita, age, race, and percent low-income), year and state.ResultsFrom 2014 to 2017, the number of CMHCs decreased by 14% nationally (from 3406 to 2920). Suicide increased by 9.7% (from 15.4 to 16.9 per 100,000) in the same time period. We find a small but negative association between the number of CMHCs and suicide deaths (− 0.52, 95% CI − 1.08 to 0.03; p = 0.066). Declines in the number of CMHCs from 2014 to 2017 may be associated with approximately 6% of the national increase in suicide, representing 263 additional suicide deaths.ConclusionsState governments should avoid the declining number of CMHCs and the services these facilities provide, which may be an important component of suicide prevention efforts.
Highlights
Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown
For the 4 years from 2014 to 2017, these changes amounted to a 14.27% decrease in the number of community mental health center (CMHC) and a 9.63% increase in suicide mortality rates
Despite the increasing trend in suicide rates nationally, 6 states have improved suicide mortality rates between 2014 and 2017; still, changes in suicide mortality rates varied substantially by state with percentage changes ranging from − 18.9% in DC to + 32.0% in South Dakota
Summary
Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. From 1999 to 2017, the average age-adjusted mortality rate attributable to suicide in the U.S increased from 10.5 to 14.0 deaths per 100,000 [1] This is in contrast to suicide rates in other Organization for Economic Co-operation and Development (OECD) countries, which fell by more than 10% during 1999–2015 [2]. This dramatic increase in suicide has led some to speculate that reductions in hospital-based psychiatric beds may have contributed to the rise in suicides [3,4,5,6]. Few studies have considered whether changes in access to non-hospital-based mental health care is associated with increased suicide, even The most recent evidence indicates that, within states, changes in the number of psychiatric beds was not associated with changes in suicide rates [3].
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