Fewer public psychiatric hospital beds may lead to higher suicide rates
Research Activities, January 2010, No. 353
The process of deinstitutionalization has led to the massive transfer of severely mentally ill persons out of institutional care in favor of community treatment. From 1970 to 2000, public psychiatric hospital beds dropped from 207 to 21 beds per 100,000 persons. This reduction in public psychiatric beds may lead to increased suicide rates, concludes a study by Jangho Yoon, Ph.D., M.S.P.H., of Georgia South University, and Tim A. Bruckner, Ph.D., M.P.H., of the University of California at Irvine. They examined State-level variations in suicide rates in relation to psychiatric beds and U.S. community mental health spending from 1982 to 1998. They calculated that a decrease of 1 psychiatric bed per 100,000 people (approximately 1,818 beds nationwide) would result in 45 additional suicides per year.
The researchers also found that greater expenditures on community mental health could offset the effects of a reduction in public psychiatric beds on suicide rates. They estimated that once the per capita community spending was greater than $107 (in 2008 dollars), a decrease in public beds no longer had a significant effect on suicide rates. In 2008, only two States, Pennsylvania ($120) and Vermont ($109), had per capita community expenditures above $107. States that have mental health parity laws (i.e., laws requiring that health insurance policies give equal coverage for mental and physical health conditions) had lower suicide rates. Higher unemployment rates and a greater proportion of residents aged 55-64 correlated with higher suicide rates. The substitution of private beds for public beds did not affect suicide rates.
Deinstitutionalization and the concomitant drop in public psychiatric hospital beds may jeopardize care for poor, severely mentally ill patients who need treatment but lack the resources to pay for it, note the researchers. They believe that deinstitutionalization has been implemented without sufficient evaluation of possible health risks. Their findings were based on State-level data from various sources for the years 1982-1998 for 50 U.S. States and the District of Columbia. These sources included the National Center for Health Statistics Compressed Mortality File and the American Hospital Association Annual Survey of Hospitals. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00086).
See "Does deinstitutionalization increase suicide?" by Drs. Yoon and Bruckner in the August 2009 HSR: Health Services Research, 44(4), pp. 1385-1405.