Mental Health Workforce Shortages Tied to Increase in Youth Suicides

Workforce shortages among mental health professionals in the U.S. were linked to increased rates of youth suicide at the county level, a cross-sectional study showed.

After adjusting for socioeconomic and demographic characteristics, mental health workforce shortage designation was associated with an increased youth suicide rate compared with no or partial designation (adjusted incidence rate ratio [aIRR] 1.16, 95% CI 1.07-1.26), and an increased rate of youth firearm suicide (aIRR 1.27, 95% CI 1.13-1.42), reported Jennifer Hoffmann, MD, MS, of the Ann & Robert H. Lurie Children’s Hospital of Chicago, and colleagues.

For counties with an assigned numeric workforce shortage score, the adjusted youth suicide rate increased 4% for every 1-point increase (aIRR 1.04, 95% CI 1.02-1.06), they noted in JAMA Pediatrics.

“Our results underscore the critical need to expand the mental health professional workforce in counties across the country,” said Hoffmann in a press release.

The authors also noted that implementing policies that reduce firearm access to young people “may be considered as a suicide prevention strategy.”

Suicide is the second most common cause of death among adolescents in the U.S., with rates increasing over the last decade.

In an accompanying editorial, Aaron Carroll, MD, MS, of the Indiana University School of Medicine, and Denise Hayes, PhD, of the Indiana University School of Public Health, both in Bloomington, argued that the U.S. has never invested in mental health.

“We have never valued mental health the way we do physical health,” they wrote. Of the $3 trillion spent on healthcare annually, “a pittance” is directed to behavioral and psychiatric issues.

They called for more innovation in mental health care, including leveraging telehealth to expand access and relaxing regulations that restrict practitioners from practicing across state lines.

Hoffmann and colleagues also noted that “mental health capacity can be increased through integration of mental health care into primary care settings and schools and through expansion of telehealth services.”

However, Carroll and Hayes recommended adopting community-based, rather than school-based, approaches, including the use of community centers, libraries, and places of worship, suggesting that these sites “may create a more holistic and affirming strategy.”

They also stressed the need for more diversity among healthcare professionals to “create more engagement with diverse youth.”

For this retrospective study, Hoffmann and colleagues used data from all U.S. counties and all youth suicides (ages 5 to 19) from January 2015 through December 2016 obtained from death certificates through the CDC’s Compressed Mortality File, for which 2016 was the most recently released dataset. They also used publicly available health professional shortage area data from the Health Resources and Services Administration.

During this period, 5,034 youth suicides occurred (72.8% male, 68.2% white), with an annual suicide rate of 3.99 per 100,000 youth. Of all U.S. counties, 67.6% were designated as mental health workforce shortage areas.

Counties designated as mental health workforce shortage areas had lower rates of insurance, lower educational attainment, greater unemployment rates, higher poverty, and a larger share of white residents. These counties also tended to be more rural in comparison to counties with either partial or no such designation.

“Prospective studies are needed to determine whether improvements in mental health professional workforce shortages at the county level will reduce youth suicides,” the authors concluded.

One limitation to the study was the use of the Compressed Mortality File, which leaves open the potential for misclassification of demographics and causes of death.

Hoffmann and team also noted that the available datasets did not make it possible to assess “actual use of mental health services,” nor were they able to track household firearm ownership.