THE ECONOMY AND SUICIDES: MEDICAID'S IMPACT ON THE MENTAL HEALTH INDUSTRY

Purpose: In 2009, suicide was the tenth leading cause of death in the US.  Economic downturns might be associated with increased levels of job insecurity, reduced access to health insurance and higher psychological distress that could trigger suicides. Low to medium income individuals may receive treatment for mental health disorders through Medicaid. This study sought to evaluate the effect of unemployment on Medicaid provisions (i.e. beneficiaries and expenditures) and suicides; to assess the impact of Medicaid provisions on the supply of mental health facilities and occupations; and to examine the effect of the composition of the mental health workforce on suicides.

Methods: Data were collected for nine northeastern states from 1999-2009. Unemployment data derived from the Bureau of Labor Statistics. Suicide data derived from Center for Disease Control’s Vital Statistics program. Medicaid data derived from the Centers for Medicare & Medicaid Services. State fixed-effects regression models were used to examine the associations between unemployment, Medicaid provisions and mental health occupations, and suicides. Models include controls for gender, age and race/ethnicity, and population size. All statistical tests were based on a two-sided α significance level of p<.05. Statistical analyses were performed with STATA.

Results: This study found that unemployment was associated with higher suicides, more Medicaid beneficiaries and lower Medicaid mental health spending, with a statistically significant effect for males and females and for White non-Hispanics in particular. Medicaid had a positive effect on the supply of mental health clinics (p<.001) and increased employment among psychiatrists (p<.001), physician assistants (p<.05) and mental health counselors (p<.001). A one percentage point increase in the employment of psychologists could reduce suicides among white non-Hispanics by 0.02 percent and among the overall population and males by 0.03 percent. Likewise, a one percentage point increase in the employment of psychiatrists could reduce female suicides by .04 percent. However, an increase in the employment of physician assistants and mental health counselors would negatively impact the number of suicides among males and females (p<.01) and White non-Hispanics (p<.001).

Conclusion: As unemployment increases so does Medicaid beneficiaries and suicides. Medicaid provisions, the mental health industry and associated professionals also impact suicide deaths. Budget cuts on Medicaid mental health services and reduced access to mental health care facilities and professionals could adversely affect suicides.