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Articles   |    
Changes in Suicide Rates and in Mental Health Staffing in the Veterans Health Administration, 2005–2009
Ira R. Katz, M.D., Ph.D.; Janet E. Kemp, R.N., Ph.D.; Frederic C. Blow, Ph.D.; John F. McCarthy, Ph.D.; Robert M. Bossarte, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200253
View Author and Article Information

Dr. Katz is affiliated with the Office of Mental Health Operations, U.S. Department of Veterans Affairs (VA), and the Department of Psychiatry, University of Pennsylvania, Philadelphia. Send correspondence to him at the Philadelphia VA Medical Center, University and Woodland Avenues, Philadelphia, PA 19104 (e-mail: ira.katz2@va.gov). Dr. Kemp is with the Office of Suicide Prevention, Office of Mental Health Services, VA Central Office, Washington,D.C. Dr. Blow and Dr. McCarthy are with the Serious Mental Illness Treatment Resource and Evaluation Center, VA Medical Center, Ann Arbor, Michigan, and the Department of Psychiatry, University of Michigan, Ann Arbor. Dr. Bossarte is with the Center for Excellence, VA Medical Center, Canandaigua, New York, and the Department of Psychiatry, University of Rochester, Rochester, New York.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Between 2005 and 2009, the Veterans Health Administration (VHA) enhanced its mental health programs and increased outpatient mental health staffing by 52.8%. However, suicide rates among VHA patients remained the same. This study evaluated this finding by examining variability in staffing increases between VHA’s 21 regional networks (Veterans Integrated Service Networks) (VISNs) and associations with suicide rates.

Methods  Suicide rates among VHA patients were derived from the National Death Index and VHA clinical and administrative records for 2005 and 2009. Comparisons across VISNs used measures of proportional change in mental health staffing (overall and in inpatient, residential, intensive case management, and outpatient programs) and comparable measures of mental health staffing per 1,000 mental health patients.

Results  Significant correlations were found between proportional changes from 2005 to 2009 in suicide rates and outpatient mental health staffing (r=–.453, p=.039) and outpatient mental health staffing per 1,000 patients (r=–.533, p=.013). The ten VISNs above the median in proportional changes in mental health staffing had average decreases in suicide rates of 12.6% while those below had increases of 11.6% (p=.005). For proportional changes in mental health staffing per 1,000 patients, those above the median had decreases of 11.2% and those below had increases of 13.8% (p=.014). For the average VISN, it would have required a 27.5%–36.8% increase in outpatient staff over 2005 levels to decrease suicide rates by 10%.

Conclusions  Mental health enhancements in VHA were associated with decreases in suicide rates in VISNs where the increases in mental health outpatient staffing were greatest.

Abstract Teaser
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Figure 1 Proportional changes (2009/2005) in suicide rates and in mental health outpatient staffing for the 21 Veterans Integrated Service Networksa

aR2 linear=.205

Figure 2 Proportional changes (2009/2005) in suicide rates and in mental health outpatient staffing per 1,000 mental health patients for the 21 Veterans Integrated Service Networksa

aR2 linear=.284

Anchor for Jump
Table 1Mean suicide rates, mental health staffing, and patients served in 2005 and 2009 across the 21 Veterans Integrated Service Networks
Anchor for Jump
Table 2Correlations between proportional changes in suicide rates and in mental health staffing between 2005 and 2009 in 21 Veterans Integrated Service Networks
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References

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