Does Deinstitutionalization Increase Suicide?

Jiann-Ping Hsu College of Public Health, Georgia South University, Statesboro, GA 30460-8015, USA.
Health Services Research (Impact Factor: 2.78). 07/2009; 44(4):1385-405. DOI: 10.1111/j.1475-6773.2009.00986.x
Source: PubMed


(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.
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.
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.
Downsizing of public inpatient mental health services may increase suicide rates. Nevertheless, an increase in community mental health funding may be promising.

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    • "Since a shift from inpatient care toward community care has been accomplished, drastic closure of psychiatric beds and mental health policies’ pressure to abbreviate acute hospitalizations might create an unanswered demand for hospitalizations. Yoon and Bruckner46 assessed variation in suicide rates in relation to psychiatric beds and community health spending in the US for the years 1982–1998. They found that supply of psychiatric beds was negatively associated with suicide rates: a decrease in one bed per 100,000 persons was associated with an increase of 0.025 suicides per 100,000 persons annually. "
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    • "Levels of morbidity and rates of involuntary admission in the in-patient population may be higher now than in the past (Priebe et al. 2005 ; Keown et al. 2011) but the effect of service changes on the rate of inpatient suicide is uncertain. One ecological study from the USA suggested a reduction in public psychiatric beds between 1982 and 1998 was associated with increased suicide rates (Yoon & Bruckner, 2009). In recent years several initiatives have aimed to improve the quality of care of psychiatric in-patients and reduce suicide (CASP, 2004 ; Joint Commission Resources, 2007 ; NPSA, 2009 ; Hampton, 2010). "
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