Study: Suicide rates in U.S. linked to shortages of mental health providers in counties

By Melissa Patrick

Kentucky Health News

Increased rates of youth suicide were linked to counties that have workforce shortages among mental health providers, according to a new study. 

The study, published in JAMA Pediatrics, found that after adjusting for demographic and socioeconomic characteristics, counties with a mental health workforce shortage designation were associated with an increased youth suicide rate and an increased youth firearm suicide rate when compared to counties with no or partial mental health shortage designations.

“Our results underscore the critical need to expand the mental health professional workforce in counties across the country,” lead author Dr. Jennifer Hoffmann, an emergency medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, said in a news release. “In addition, policies that restrict firearm access to young people may be considered as a suicide prevention strategy."  

Using youth suicide data from every U.S. county, the researchers found there were 5,034 suicides by youth between the ages of  5 and 19 from 2015 to 2016, with an annual suicide rate of 3.99 per 100,000 youth. The study found that among all the counties where a youth suicide occurred, more than two-thirds of them, or 67.6%, were designated as mental health workforce shortage areas. 

And for counties with an assigned numeric workforce shortage score, the adjusted youth suicide rate increased 4% for every 1-point increase in the score, says the report. 

Counties that are designated as a Mental Health Healthcare Professional Shortage Area by the U.S. Health Resources and Services Administration are further assigned a score that ranges between 0-25, with higher scores indicating greater shortages. 

The researchers also found that there were geographic disparities, with higher suicide rates in rural and high poverty areas, where mental health professionals are scarce. 

 "Counties with mental health HPSA designation had more uninsured children, lower educational attainment, higher unemployment, higher poverty, higher percentages of non-Hispanic White residents, and were more often rural, compared with counties with partial/no HPSA designation," they write. 

Hoffmann offered several ways to improve access to youth mental health care.

“Mental health workforce capacity can be increased through integration of mental health care into primary care settings and schools, and through expansion of telehealth services,” Hoffmann said in the release. “Improving reimbursement rates for mental health services may further aid in recruitment and retention of mental health professionals, and hopefully reduce suicide rates among young people.”

Dr. Aaron Carroll of the Indiana University School of Medicine and Denise Hayes of the university's School of Public Health, argued in an accompanying editorial that money directed at hiring more mental health care professionals alone will not solve this problem. 

"Even if the money was available, it would be nearly impossible to fix this problem through hiring alone," they write. "We have never valued mental health the way we do physical health. Of the more than $3 trillion we spend on health care each year, a pitiful amount is dedicated to behavior and psychiatric issues." 

The news release notes that mental health problems are among the most common precipitating factors for youth suicide. Further, it says that up to one in five children in the U.S. has a mental health condition, but only about half of children who need mental health care receive it.

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Suicide is the second leading cause of death among U.S. adolescents, with rates rising over the last decade. 

This is also true in Kentucky. And in 2022, every county in Kentucky is designated as a Mental Health Professional Shortage Area. 

"Countless youth need help," Carroll and Hayes write. "Unfortunately, help is often in short supply." 

According to the 2021 Youth Risk Behavior Survey, 19% of Kentucky's high school students seriously considered attempting suicide during the 12 months before the survey and 15% of them made a plan about how they would do it in that same time frame. And 9.5% of them said they had actually attempted suicide one or more times in the year prior to the survey. 

Further, firearm deaths among Kentucky children between the ages of 1 and 19 increased 83% between 2013-15 and 2018-20, from 3.6 to 6.6 deaths per 100,000, according to data published in the 2022 Kids Count County Data Book. 

Dr. Lindsay Ragsdale, chief medical officer for Kentucky Children’s Hospital, recently told Kelsey Souto with WKYT-TV that the hospital is seeing an influx of youth coming into the emergency department experiencing a mental health crisis, due to gaps in outpatient resources.

"I think we have to start talking to children in adolescence about what they’re going through,” said Ragsdale. “To make it okay, to say I’m not okay.”

SAMHSA photo

Kentucky's youth are asking for more mental health resources, according  to a Kentucky Youth Advocate survey that asked them what state leaders should prioritize. Some of their responses were included in the County Data Book. 

"Mental health should be a big priority. As someone that has anxiety and it affects me everyday not just mentally but also physically, it is the best feeling knowing that people really care about me and the way I feel," said 14-year-old Elizabeth from Daviess County.

Help is available for anyone who is thinking about suicide or knows someone who is considering it. To get help, dial 988, which is the new suicide and crisis lifeline. The three-digit mental health crisis hotline offers free, confidential support and is available 24 hours a day.