Online Program

Suicide rates in California following the implementation of full service partnerships under the mental health services act

Tuesday, November 5, 2013

Jangho Yoon, MSPH, PhD, College of Public Health and Human Sciences, Health Policy and Management Program, Oregon State University, Corvallis, OR
Tim Bruckner, PhD, MPH, Public Health & Planning, Policy and Design, University of California, Irvine, Irvine, CA
Candice Beathard, PhD, MA, Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
Objectives: Full Service Partnerships (FSPs) of California represent the most comprehensive and well-funded county-run programs for persons with severe mental illness, especially unserved or underserved persons at an elevated risk of homelessness and institutionalization. This study evaluates whether FSPs lead to reductions in county suicide rates.

Methods: We analyze county-level, monthly panel data for 58 counties in California from January 2000 to December 2008 (N = 6,264). The outcome is suicides per 100,000 persons. We employ a quasi-experimental approach that capitalizes on county-month variation in FSPs approval dates. We obtain difference-in-differences estimates of the effect of FSPs on suicide rates, controlling for unemployment rates. To minimize bias from all unobserved county-level confounders, we control for county fixed-effects, general time trends in suicide rates, and time trends specific to each county, as well as month indicators to capture seasonal variations in suicide rates. To ensure correct statistical inference, we diagnose and correct standard errors for violation of usual error assumptions.

Results: We do not find that FSPs lead to a reduction in suicide rates. However, our most rigorous analysis suggests that the rate of suicide declines by approximately 5 percentage points as FSP funding increases by $1 per person. Using our estimates and FSP funding data, we predict that FSPs reduce suicide rate in half of counties in California.

Conclusion: Comprehensive community mental health programs such as California's FSPs can lead to reductions in suicide rates. However, it is crucial to secure sufficient levels of funding.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
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

Learning Objectives:
Evaluate the effect of the implimentation of comprehensive community mental health programs in California on suicide rates. Discuss public health policy implications from the identified relationship between public funding for intentive community treatment and suicide.

Keyword(s): Suicide, Mental Health System

Presenting author's disclosure statement:

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.