Does deinstitutionalization increase suicide?
OBJECTIVE
(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.


RESULTS
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.
Yoon
Jangho
J
Jiann-Ping Hsu College of Public Health, Georgia South University, Statesboro, GA 30460-8015, USA. yoonjangho@gmail.com
Bruckner
Tim A
TA
D000328:Adult; D017677:Age Distribution; D015984:Causality; D003688:Deinstitutionalization / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006742:Hospital Bed Capacity / Q000191:economics / Q000706:statistics & numerical data; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult