Citation

Zimmerman SC, Matthay EC, Rudolph KE, Goin DE, Farkas K, Rowe CL, Ahern J. Am. J. Epidemiol. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Oxford University Press)

DOI

10.1093/aje/kwab123

PMID

unavailable

Abstract

California's Mental Health Services Act (MHSA) substantially expanded funding of County mental health services through a state tax, and led to broad prevention efforts and intensive services for individuals experiencing serious mental disorders. We estimated the associations between MHSA and mortality due to suicide, homicide, and acute effects of alcohol. Using annual cause-specific mortality data for each US state and the District of Columbia from 1976-2015, we used a generalization of the quasi-experimental synthetic control method to predict California's mortality rate for each outcome in the absence of MHSA using a weighted combination of comparison states. We calculated the association between MHSA and each outcome as the absolute difference and percentage difference between California's observed and predicted average annual rates over the post-intervention years (2007-2015). MHSA was associated with modest decreases in average annual rates of homicide (-0.81/100,000, corresponding to a 13% reduction) and acute alcohol effects mortality (-0.35/100,000 corresponding to a 12% reduction). Placebo test inference suggested the associations were unlikely due to chance. MHSA was not associated with suicide. Protective associations with mortality due to homicide and acute effects of alcohol provide evidence for modest health benefits of MHSA at the population level.

Language: en

Keywords

Homicide; Suicide; Alcohol; California; Mental Health; Mental Health Services Act; Synthetic Control