A new study published in Health Services Research looked at the effect of mental health staffing on suicide-related events.
“We wanted to answer a seemingly simple question: does increasing mental health staffing at Veterans Health Administration (VHA) facilities reduce suicide-related events?” study author Yevgeniy Feyman told us. “While this seems straightforward on its face, the existing evidence is mixed. Some work has found that staffing reduces suicide related events, while others have found no effect.”
The research team’s expectation was that increased staffing would reduce suicide-related events.
“We had some reasons for thinking this,” Feyman told us. “First, the mechanism is pretty obvious: more staffing means that more Veterans are able to get care, possibly get diagnosed sooner, and get treated quicker. Second, demand for mental health services is particularly high among Veterans, who are overrepresented among all suicide deaths in the U.S.”
That being said, Feyman explained, there are complications to the straightforward mechanism. It’s likely that facilities treating Veterans with more mental health needs are already better staffed. This so-called “reverse causality” could lead to findings showing the opposite effect (that mental health staffing increases suicide-related events). To deal with this, the research team took a more rigorous statistical approach with improved measures of staffing that we hoped would help deal with possible limitations of prior work.
“Simply put, mental health is important,” Feyman told us. “Diagnosing and treating mental health conditions is a priority for health systems around the country, and the VA in particular has substantially increased mental health staff over the past decade.”
Researchers collected data on 109,000 Veterans who recently left service. They were able to identify various demographics (like age and gender), as well as whether Veterans experienced a suicide-related event in a given two-week time period. They then collected data from the 125 facilities that these Veterans used for health care that included measures of staffing. Using the rich data from the VHA, researchers could see the number of clinical hours that providers provided at each facility, which provides a more accurate measure of how much mental health staffing there really is versus just measuring the number of providers.
With this data, the research team applied a so-called “quasi-experimental” statistical strategy. They measured changes in staffing that were caused only by the time that providers take off for federal holidays, paid time off, or because they’re sick. This helped to deal with the reverse causality that makes this kind of research challenging.
“Our results were more or less consistent with what we expected, suicide related events fell in response to increased staffing,” Feyman told us. “But the magnitude was quite a bit larger than we had expected. A one per cent increase in staffing led to a 1.6 per cent reduction in suicide related events. That’s huge! It means that increasing staffing disproportionately reduces suicide related events.”
The research team found that this effect is even larger at less-staffed facilities: there, a one per cent increase in staffing led to a 2.5 per cent reduction in suicide related events.
“Our findings have clear implications for the VHA: increasing staffing in less-staffed facilities can help reduce suicide related events among Veterans,” Feyman told us. “But we think that there are implications for the private sector too.”
The VHA is generally well-staffed when it comes to mental health. But in the private sector, it’s much more challenging to find mental health providers.
“Our approach can be used by large healthcare systems in the private sector to measure staffing and identify where additional staff should be allocated to have the best bang for the buck.”