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Deinstitutionalization Leads to Rise in Suicide

A new study finds that reducing the number of beds available in public psychiatric hospitals is associated with increased suicide rates — that for every bed lost for 100,000 people in the population, 45 additional suicides would occur per year.

Furthermore, community-based mental health care is often not funded at a level sufficient to help.

“The expansion of the community mental health system has not been able to successfully integrate persons with severe mental disorders and thereby couldn’t replace public bed reductions,” said study author Jangho Yoon, Ph.D., at the University of California School of Public Health, in Berkeley.
The study appears online in the journal Health Services Research.

Ronald Manderscheid, Ph.D., is the director of Mental Health and Substance Use Programs at SRA International, a research and consulting organization He says the study “covers the essential bases” to examine this relationship.

Manderscheid, who is not affiliated with this research, said it does not undermine the idea that mentally ill people can be safely served in the community.

“There’s no particular reason why most people with a mental health problem need a bed. They need good care. The idea of deinstitutionalization was wonderful, but its implementation was absolutely terrible,” he said, adding that cutting state hospital funding “became a vehicle to save money, not to improve care.”

Yoon’s research also found that if spending on community-based services goes above a certain level, reducing state hospital beds would not increase suicide. However, only Pennsylvania and Vermont fund community-based services above that level, which is $107 per capita in 2008 dollars.

The study also gives support to advocates of equal insurance coverage for mental and physical disorders. State laws mandating “parity” were linked with lower suicide rates. However, increased numbers of private psychiatric hospital beds did not make up for losses in state beds.

“In the psychiatric care market, there is evidence that for-profits disproportionately serve profitable patients with less severe symptoms,” Yoon said. Consequently, increased numbers of such beds do not help the most debilitated mentally ill people, who often are poor and do not have insurance.

Manderscheid said that the recession is having a drastic effect on mental health services overall, increasing the risks faced by the mentally ill.

“The whole structure is eroding,” he said, “Not just ambulatory outpatient programs, but also hospitals, local not-for-profits and local community-based organizations. Private hospitals are also in trouble in many communities.”

Source: Health Behavior News Service

Deinstitutionalization Leads to Rise in Suicide

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2018). Deinstitutionalization Leads to Rise in Suicide. Psych Central. Retrieved on March 20, 2019, from
Scientifically Reviewed
Last updated: 8 Aug 2018
Last reviewed: By a member of our scientific advisory board on 8 Aug 2018
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