Return on investment in public mental health and substance use systems: Does it lead to reductions in suicide rates?
Methods: We analyze state-year time-series-cross-sectional data on the per-capita number of suicides per 100,000 persons for 50 states and D.C. for the years 20012009 (N = 459). Main independent variables include (a year-lagged) state Mental Health Agencies' spending on mental health programs (first for total and then separately for inpatient and community settings) and the per-capita number of public hospital beds used for substance use treatment. We control for state spending on mental health and substance use treatment in community-settings, private substance use beds, public and private hospital psychiatric beds, unemployment rates, per-capita income, and proportion of residents on Medicaid and welfare. To minimize bias from unobserved state-level confounders, we control for state and year fixed-effects and time trends specific to each state. Standard errors are adjusted for detected violations of panel heteroskedasticity, contemporaneous correlation and autocorrelation.
Results: Consistent with prior research, we do not find a statistically significant effect of per-capita total state mental health spending on suicide rates. However, a 100-dollar increase in per-capita state spending on mental health treatment in inpatient settings is associated with a reduction of 2.2 suicides per 100,000 persons. A one-bed increase in hospital substance use beds per 1,000 persons is significantly associated with a reduction of 3 suicides per 100,000 persons.
Conclusion: States' investment in the mental health and substance use treatment systems appears to reduce suicide rates.
Learning Areas:Biostatistics, economics
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research
Social and behavioral sciences
Analyze the effect of public mental health expenditures and the capacity of inpatient substance use treatment system on suicide. Discuss public health policy implications from the identified relationship between public mental health and substance use systems and suicide.
Keyword(s): Public Mental Health, Suicide
Qualified on the content I am responsible for because: I am a mental health policy/economics researcher, and have conducted research on mental health policies issues and suicide, including deinstitutionalization policy and evaluation of community mental health programs.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.