Citation

Feyman Y, Figueroa SM, Yuan Y, Price M, Kabdiyeva A, Nebeker J, Ward M, Shafer P, Pizer SD, Strombotne KL. Health Serv. Res. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, John Wiley and Sons)

DOI

10.1111/1475-6773.14064

PMID

36089760

Abstract

OBJECTIVE: To estimate the effects of changes in Veterans Health Administration (VHA) mental health services staffing levels on suicide-related events among a cohort of Veterans. DATA SOURCES: Data were obtained from the VHA Corporate Data Warehouse, the Department of Defense and VA Infrastructure for Clinical Intelligence, the VHA survey of enrollees, and from customized VHA databases tracking suicide related events. Geographic variables were obtained from the Area Health Resources Files and from the Centers for Medicare and Medicaid Services. STUDY DESIGN: We used an instrumental variables (IV) design with a Heckman correction for non-random partial observability of use of mental health services. The principal predictor was a measure of provider staffing per 10,000 enrollees. The outcome was the probability of a suicide-related event. DATA COLLECTION/EXTRACTION METHODS: Data were obtained for a cohort of Veterans who recently separated from active service. PRINCIPAL FINDINGS: From 2014-2018, the per-pay period probability of a suicide-related event among our cohort was 0.05 percent. We found that a one percent increase in mental health staffing led to a 1.6 percentage point reduction on suicide-related events. This was driven by the first tertile of staffing, suggesting diminishing returns to scale for mental health staffing.

CONCLUSIONS: VHA facilities appear to be staffing-constrained when providing mental health care. Targeted increases in mental health staffing would be likely to reduce suicidality.

Language: en

Keywords

Suicide; Veterans; Access to Care; Mental Health Services; Resource Allocation; Workforce