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.

Full-text preview

Available from:
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental disorders was more of a social stigmatizing act than a therapeutic act. After the birth of the mental health disciplines, psychiatric hospitalization was legitimized and has proven to be indispensable, preventing suicides and helping individuals in need. However, despite more than a century passing since this legitimization occurred, psychiatric hospitalization remains a controversial issue. There is the question of possible negative outcomes after a psychiatric admission ceases to take its protective effect, and even of whether the psychiatric admission itself is related to a negative setback after discharge. This review aims to summarize some of the most important negative outcomes after discharge from a psychiatric institution. These experiences were organized into two groups: those after a brief psychiatric hospitalization, and those after a long-stay admission. The author further suggests possible ways to minimize these adversities, emphasizing the need of awareness related to this important issue.
    Full-text · Article · Apr 2014 · Psychology Research and Behavior Management
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Psychiatric in-patients are at high risk of suicide. Recent reductions in bed numbers in many countries may have affected this risk but few studies have specifically investigated temporal trends. We aimed to explore trends in psychiatric in-patient suicide over time.MethodA prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997-2008). Suicide rates were determined using National Confidential Inquiry and Hospital Episode Statistics (HES) data. RESULTS: Over the study period there were 1942 psychiatric in-patient suicides. Between the first 2 years of the study (1997, 1998) and the last 2 years (2007, 2008) the rate of in-patient suicide fell by nearly one-third from 2.45 to 1.68 per 100 000 bed days. This fall in rate was observed for males and females, across ethnicities and diagnoses. It was most marked for patients aged 15-44 years. Rates also fell for the most common suicide methods, particularly suicide by hanging on the ward (a 59% reduction). Although the number of post-discharge suicides fell, the rate of post-discharge suicide may have increased by 19%. The number of suicide deaths in those under the care of crisis resolution/home treatment teams has increased in recent years to approximately 160 annually. CONCLUSIONS: The rate of suicide among psychiatric in-patients in England has fallen considerably. Possible explanations include falling general population rates, changes in the at-risk population or improved in-patient safety. However, a transfer of risk to the period after discharge or other clinical settings such as crisis resolution teams cannot be ruled out.
    Full-text · Article · May 2012 · Psychological Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Summary form only given. In a toroidal experimental device bounded whistlers are launched to produce the RF plasma. These waves are toroidal counterparts of helicon waves in thin cylindrical tubes, where poloidal mode coupling plays a significant role. In the steady state average electron density of ≈1012 per cc and average electron temperature of ≈20 eV are obtained at 10-3 mbar of the argon filling pressure and less than 600 G of ambient toroidal magnetic field. In these experiments input power level in the EMHD regime (ωth≪ω≪ωcc) is kept below 1.5 kW. In this paper we shall present their radio frequency breakdown and discharge sustaining capabilities. After breakdown stage, discharge is sustained by toroidal bounded whistlers as confirmed by wave vector measurements. In these pulsed experiments time evolution behaviour of the discharge is studied in four distinct phases of RF breakdown, steady state attainment, decay and afterglow. Experimental results based on toroidal mode structure, background effects, time evolution of distribution function and other plasma parameters of interest will be presented and their implication in understanding the breakdown
    No preview · Article · Jan 2000 · IEEE International Conference on Plasma Science
Show more