Dataset Information

California's Mental Health Services Act and Mortality Due to Suicide, Homicide, and Acute Effects of Alcohol: A Synthetic Control Application.

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 postintervention years (2007-2015). MHSA was associated with modest decreases in average annual rates of homicide (-0.81/100,000 persons, corresponding to a 13% reduction) and mortality from acute alcohol effects (-0.35/100,000 persons, corresponding to a 12% reduction). Placebo test inference suggested that the associations were unlikely to be due to chance. MHSA was not associated with suicide. Protective associations with mortality due to homicide and acute alcohol effects provide evidence for modest health benefits of MHSA at the population level.

SUBMITTER: Zimmerman SC

PROVIDER: S-EPMC8576368 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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California's Mental Health Services Act and Mortality Due to Suicide, Homicide, and Acute Effects of Alcohol: A Synthetic Control Application.

Zimmerman Scott C SC Matthay Ellicott C EC Rudolph Kara E KE Goin Dana E DE Farkas Kriszta K Rowe Christopher L CL Ahern Jennifer J

American journal of epidemiology 20211001 10

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 qua ...[more]

PMID: 33884408

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Project description:ImportanceDespite growing national concern about high and increasing rates of pregnancy-associated mortality due to homicide, suicide, and drug overdose, state-level incidence has previously not been available.ObjectiveTo identify cases of pregnancy-associated homicide, suicide, drug overdose, and deaths involving firearms in the US from calendar year 2018 to 2022 and estimate 5-year proportionate mortality and mortality ratios per 100 000 live births by state and cause of death.Design, setting, and participantsThis cross-sectional study is a population-based analysis of the 2018-2022 restricted-use mortality files provided by the National Center for Health Statistics. These data include all deaths occurring in the US, with geographic identifiers for state of residence. All records in which the decedent was female aged 10 to 44 years and pregnant at the time of death or up to 1 year earlier were included in the analysis. Data were analyzed from July 1 to December 1, 2024.Main outcomes and measuresInternational Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for underlying cause of death were used to identify cases of homicide, suicide, drug overdose, and deaths involving firearms occurring in each state from 2018 to 2022. Proportionate mortality was estimated as the count of cases divided by the total count of deaths of pregnant and postpartum women in each state. Cause-specific mortality ratios were estimated as the count of cases divided by the total count of live births in each state from 2018 to 2022.ResultsNationally, there were 10 715 deaths of people who were pregnant or within 1 year post partum from 2018 to 2022, including 837 homicides, 579 suicides, 2083 drug overdoses, and 851 that involved firearms. Proportionate mortality and mortality ratios for homicide, suicide, and drug overdose varied across the US. Of states with more than 9 cases, pregnancy-associated homicide mortality was highest in Mississippi (12.86 per 100 000 live births), pregnancy-associated suicide mortality was highest in Montana (21.55 deaths per 100 000 live births), and pregnancy-associated drug overdose was highest in Delaware (36.03 deaths per 100 000 live births). Firearms accounted for as many as 15.56% of pregnancy-associated deaths in Colorado, and pregnancy-associated firearm mortality was highest in Mississippi (13.42 deaths per 100 000 live births).Conclusions and relevanceThe information in this study may provide relevant guidance for state and local intervention strategies to advance the health, safety, and well-being of women during pregnancy and beyond.

Project description:In 2011, a historic Supreme Court decision mandated that the state of California substantially reduce its prison population to alleviate overcrowding, which was deemed so severe as to preclude the provision of adequate healthcare. To comply, California passed the Public Safety Realignment Act (Assembly Bill [AB] 109), representing the largest ever court-ordered reduction of a prison population in U.S. history. AB109 was successful in reducing the state prison population; however, although the policy was precipitated by inadequate healthcare in state prisons, no studies have examined its effects on prisoner health. As other states grapple with overcrowded prisons and look to California's experience with this landmark policy, understanding how it may have impacted prisoner health is critical. We sought to evaluate the effects of AB109 on prison mortality and assess the extent to which policy-induced changes in the age distribution of prisoners may have contributed to these effects. To do so, we used prison mortality data from the Bureau of Justice Statistics and the California Deaths in Custody reporting program and prison population data from the National Corrections Reporting Program to examine changes in overall prison mortality, the age distribution of prisoners, and age-adjusted prison mortality in California relative to other states before and after the implementation of AB109. Following AB109, California prisons experienced an increase in overall mortality relative to other states that attenuated within three years. Over the same period, California experienced a greater upward shift in the age distribution of its prisoners relative to other states, suggesting that the state's increase in overall mortality may have been driven by this change in age distribution. Indeed, when accounting for this differential change in age distribution, mortality among California prisoners exhibited a greater reduction relative to other states in the third year after implementation. As other states seek to reduce their prison populations to address overcrowding, assessments of California's experience with AB109 should consider this potential improvement in age-adjusted mortality.

Dataset Information

California's Mental Health Services Act and Mortality Due to Suicide, Homicide, and Acute Effects of Alcohol: A Synthetic Control Application.

Publications

California's Mental Health Services Act and Mortality Due to Suicide, Homicide, and Acute Effects of Alcohol: A Synthetic Control Application.

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