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

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.