Does Deinstitutionalization Increase Suicide?

Abstract

Objectives. (1) To test whether public psychiatric bed reduction may increase suicide rates; (2) to investigate whether the supply of private hospital psychiatric beds—separately for not‐for‐profit and for‐profit—can substitute for public bed reduction without increasing suicides; and (3) to examine whether the level of community mental health resources moderates the relationship between public bed reduction and suicide rates. Methods. We examined state‐level variation in suicide rates in relation to psychiatric beds and community mental health spending in the United States for the years 1982–1998. We categorize psychiatric beds separately for public, not‐for‐profit, and for‐profit hospitals. Principal Findings. Reduced public psychiatric bed supply was found to increase suicide rates. We found no evidence that not‐for‐profit or for‐profit bed supply compensates for public bed reductions. However, greater community mental health spending buffers the adverse effect of public bed reductions on suicide. We estimate that in 2008, an additional decline in public psychiatric hospital beds would raise suicide rates for almost all states. Conclusions. Downsizing of public inpatient mental health services may increase suicide rates. Nevertheless, an increase in community mental health funding may be promising.

Changes in community mental health services availability and suicide mortality in the US: A retrospective study

“…Ongoing discussions about mental health care accessibility factors related to suicide have been focused on hospital-based psychiatric supply (3,4,6). Our findings add information regarding the potentially important role of community mental health services on the increasing trend of suicide rates.…”

“…In accordance with variables described in previous literature (4,6,20), we calculated the following covariates using U.S. Census Bureau data to control for relevant population-level characteristics:…”

“…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). Yet, the most recent evidence indicates that, within states, changes in the number of psychiatric beds was not associated with changes in suicide rates (3).…”

A reexamination of medical marijuana policies in relation to suicide risk

“…Tobacco control policies also likely influence the prevalence of marijuana use (Chaloupka et al, 1999; Farrelly et al, 2001; Williams et al, 2004), and may influence alcohol use which could be an important determinant of suicide risk (Kaplan et al, 2014; Krauss et al, 2014; Young-Wolff et al, 2013a, 2013b). We also included measures of state political orientation, per-capita mental health spending, and health insurance coverage, all of which may be associated with suicide risk (Kposowa, 2013; Tondo et al, 2006; Yoon and Bruckner, 2009) and are plausibly related to state policy environments. If these factors changed concurrently with adoption of medical marijuana policy, lack of explicit control for them could lead to biased estimates of the association between medical marijuana policy and suicide.…”

Modelling the dynamics of suicides in the population of the Russian Federation for the period 1992—2012

“…Раннее выявление и адекват-ное лечение психических расстройств (особенно аффек-тивные и злоупотребление психоактивными веществами) во многих странах [1] составляет основную часть про-грамм предупреждения суицидов. Имеются конкретные данные о том, что улучшение финансирования внеболь-ничных служб сокращает уровень суицидов [31] до опре-деленного уровня.…”