New article on psychiatric care by state

[hamstergang]

I just got my April 2022 edition of the ridiculously sized Psychiatric Times journal, and the headline article cites this following article from Healthcare insider: Best and Worst States for Mental Healthcare - HealthCareInsider.com

It ranks states on measures of cost, access, and the quality of mental health care. You can all certainly comment on that if you want. However, my reason for posting this is that the author, Stephanie Horan, claims that my state of NJ has the highest suicide rate in the country. I don't see what numbers she's using or where the data is coming from, but I have to believe she's wrong.

You can look up suicide rates by state here: Stats of the State - Suicide Mortality

NJ has had the lowest suicide rate in the country in 2016, 2018, 2019, and 2020, it was second lowest in 2015 and 2017, and it was third lowest in 2014 (data going back further likely shows more of the same). Even if we accept that there can be some word play involved (the CDC data above is for "age-adjusted" rates, for example), I can't imagine anyway to spin NJ as the highest suicide rate in the US.

Anyone have an explanation, or know how to contact the author and get a response?

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[erg923]

I just got my April 2022 edition of the ridiculously sized Psychiatric Times journal, and the headline article cites this following article from Healthcare insider: Best and Worst States for Mental Healthcare - HealthCareInsider.com

It ranks states on measures of cost, access, and the quality of mental health care. You can all certainly comment on that if you want. However, my reason for posting this is that the author, Stephanie Horan, claims that my state of NJ has the highest suicide rate in the country. I don't see what numbers she's using or where the data is coming from, but I have to believe she's wrong.

You can look up suicide rates by state here: Stats of the State - Suicide Mortality

NJ has had the lowest suicide rate in the country in 2016, 2018, 2019, and 2020, it was second lowest in 2015 and 2017, and it was third lowest in 2014 (data going back further likely shows more of the same). Even if we accept that there can be some word play involved (the CDC data above is for "age-adjusted" rates, for example), I can't imagine anyway to spin NJ as the highest suicide rate in the US.

Anyone have an explanation, or know how to contact the author and get a response?

Snooki

 

[deleted1100659]

interesting, the two states im licensed in aren't last, just very close to last, lol.

 

[littlefred]

interesting, the two states im licensed in aren't last, just very close to last, lol.

They took into consideration that you are a psychiatrist in those states.


Just kidding

 

[birchswing]

I think states are not necessarily the best way to divvy that up as they are as geographically large as some countries. Metro areas clustered on one side of a state will have very different care from rural areas on another that may have more in common with a bordering state that's geographically closer. Things like Medicaid expansion would make a difference at a state level, but not availability of practitioners or the quality of them.

 

[smalltownpsych]

According to the article, Hawaii is the lowest rate and NJ the highest. Maybe the metric was, if I had to live in Jersey instead of a Hawaii, I’d want to die too.
Seriously though, the state I’m currently working is ranked very low and California where I used to live and work is ranked higher. Doesn’t match up with my own experience of the situation. Could be that the data was selected more to make a political point than to be accurate or useful.

 

[ObsequiousAplomb]

Interesting. Connecticut had the highest out-of-pocket costs but the lowest rates of people not getting mental health treatment due to cost.

 

[comp1]

I think states are a great way to divvy this info up. So much of this is based on how parity laws are interpreted as well as funding and even how involuntary hospitalizations work.

 

[Merovinge]

I think states are a great way to divvy this info up. So much of this is based on how parity laws are interpreted as well as funding and even how involuntary hospitalizations work.

Yes and no, the baseline differences in the states SES/literacy/etc are pretty dramatic and those have a huge impact on mental health.

 

[whopper]

I've lived in several of these states, practiced in them and I agree with what I see.

Ohio was the best I've seen. Why? Their entire southern half of the state's long-term facility was as nice as a great college dorm. The courts actively sought guidance from some of the best forensic psychiatrists in the country such as Phil Resnick or Doug Mossman. Inmates in jails got forensic evaluation in days if not the same day as being suspecting of having a severe psych problem by anyone involved in the system-the police office, judge, lawyer, jail doctor, correctional officer, etc.

I'm currently in Missouri and psych services here are a piece of c____. Jail inmates suffering from schizophrenia aren't seen for about 10 months, left to fester in their cell and the jail doctor can't send them to a long-term psych center or medicate them against their will. You can't even send the patient to a long-term facility unless the patient is charged with a crime. So their number 40 doesn't surprise me at all.

Kentucky? That place was a joke. Hospitals in KY kept trying to transfer to my hospital in Cincinnati and I'd always block them. They must've fixed themselves up some to be a 27 since I last saw them.

Me: Are they involuntarily committed?
Them: Yes
Me: You can't transfer them end of story. Their commitment is only good in Kentucky. The second they cross state lines you are now holding them against their will. Your facility has a psych unit so it's a Cobra violation to try to transfer them here.
Them: Doc, our psychiatrist is a quack. We need to send them to a real place. (Seriously stuff like this has been said).
Me: Then I'd recommend you tell your employers your psychiatrists aren't doing their jobs but as of now you can't transfer them over here.

A few minutes later, the nurse tells me, "Doctor, that place is still trying to transfer that patient over here. They know you'll say no so now they're trying a different area in our hospital." We call that other area. Tell them what's going on. They reject the patient too. Then it's like a few hours later and another psychiatrist in another hospital calls me up. "Hey James, did some piece of crap hospital in Kentucky with a quack psychiatrist try to send you a patient over at UC?" Me-"yes" and I fill them in.

This Kentucky situation would happen about once every 1-3 months.

 

[R. Matey]

I think the article might be reporting the crude suicide rate over the population (maybe the 2010 census?) where the CDC is reporting the age-adjusted suicide rate. It's not mere semantics either: if you follow the link to their explanation of age-adjusted rates, they show how the reporting the crude death rate can be misleading.

 

[hamstergang]

I think the article might be reporting the crude suicide rate over the population (maybe the 2010 census?) where the CDC is reporting the age-adjusted suicide rate. It's not mere semantics either: if you follow the link to their explanation of age-adjusted rates, they show how the reporting the crude death rate can be misleading.

That link is very interesting, thanks. I hadn't before known or understood what age-adjusted death rates were all about.

Unfortunately, I doubt this is the explanation for the article in my first post. The only pre-printed data I could find quickly was this from 2019: https://suicidology.org/wp-content/uploads/2021/03/2019States_crude_ageadj_rates_TABLE.pdf
It shows the crude and age-adjusted suicide rates by state, and NJ has the least in both.

I then played with: CDC WONDER
and 2020 has the same trend, so for 2021 to completely flip that would surprise me.

 

[R. Matey]

That link is very interesting, thanks. I hadn't before known or understood what age-adjusted death rates were all about.

Unfortunately, I doubt this is the explanation for the article in my first post. The only pre-printed data I could find quickly was this from 2019: https://suicidology.org/wp-content/uploads/2021/03/2019States_crude_ageadj_rates_TABLE.pdf
It shows the crude and age-adjusted suicide rates by state, and NJ has the least in both.

I then played with: CDC WONDER
and 2020 has the same trend, so for 2021 to completely flip that would surprise me.

Ah, ok. Well, so much for an easy explanation then. We're probably in the same boat that I would need to see what figures the person used in order to know what happened there since its not readily apparent. Can't rule out a misprint either.

 

[VA Hopeful Dr]

At this point I think we should just go ahead and change the state motto of South Carolina to "thank God for Mississippi"

 

[ObsequiousAplomb]

At this point I think we should just go ahead and change the state motto of South Carolina to "thank God for Mississippi"

But then what would Alabama's motto be?

 

[J ROD]

50/51....sounds about right. I did resident in 23/51 and the difference is huge. No resources where I am.

 

[hamstergang]

Well, I succeeded in getting the Psychiatric Times article text changed. Instead of incorrectly stating that NJ has the highest suicide rate, it states:

Psychiatric Care in the US: Are We Facing a Crisis?

What US state has the best mental health care?

www.psychiatrictimes.com

"Hawaii has the lowest rate of suicidal thoughts, and New Jersey has the highest."
The graphic is still wrong, but whatever.

The editor responded to me, citing data from mhanational.org that NJ is highest is "Adults with Serious Thoughts of Suicide." The document provided to me does show NJ as #1 in that category ... meaning that NJ has the lowest rate (3.41% compared to the national average of 4.19%). And Hawaii is nowhere near either end.

So back to the emails. And let this be a lesson to everyone to always see the data yourself before accepting what an article says to be true.

 

[Stagg737]

Idk, I think it's a crap article and rankings are somewhat arbitrary. Mississippi is ranked 51 and Texas is 45 and they are ranked 2 and 3 respectively in terms of quality of care. Meanwhile Vermont is ranked 4 overall and has the worst quality of care. The quality measurements also confuse me, as a lot of them seem more representative of the state population's baseline demographics rather than actual quality of care...

The weighting doesn't really make sense either, the cost and access variables both looked at 6 measures and quality looked at 8 measures but the 3 variables carry the same weight. So seems like it's trying to give less weight to the quality variable, which is made even more obvious by measures within cost and access which are basically duplicated. Cost has "uninsured rate" while access has "adults with MH that are uninsured". Cost also has "Adults not receiving MH care d/t cost" and access has "Adults with SMI who didn't receive treatment". Sure, they're not exactly the same but I'd be shocked to find out those variables aren't capturing a significant amount of data with very high congruency, essentially inflating the cost and access weighting further.

That's not even mentioning the obvious political bias that is openly stated in the article, which makes it difficult for me to take any of it at face value with what I stated above. I'd be more interested to see the full rankings for each individual variable, as I think the article and rankings as they stand are essentially worthless and likely have little validity in their actual measures (as evidenced by Hamstergang's posts). I'm disappointed that this was featured in a professional news source.

 

[smalltownpsych]

Well, I succeeded in getting the Psychiatric Times article text changed. Instead of incorrectly stating that NJ has the highest suicide rate, it states:

Psychiatric Care in the US: Are We Facing a Crisis?

What US state has the best mental health care?

www.psychiatrictimes.com

"Hawaii has the lowest rate of suicidal thoughts, and New Jersey has the highest."
The graphic is still wrong, but whatever.

The editor responded to me, citing data from mhanational.org that NJ is highest is "Adults with Serious Thoughts of Suicide." The document provided to me does show NJ as #1 in that category ... meaning that NJ has the lowest rate (3.41% compared to the national average of 4.19%). And Hawaii is nowhere near either end.

So back to the emails. And let this be a lesson to everyone to always see the data yourself before accepting what an article says to be true.

Would it be inappropriate for me to make a joke about the Jersey Shore relating to this "finding" of people in Jersey thinking about killing themselves a lot?

 

[hamstergang]

Would it be inappropriate for me to make a joke about the Jersey Shore relating to this "finding" of people in Jersey thinking about killing themselves a lot?

It would be inappropriate, but only because NJ has the nation's lowest rate of adults with suicidal thoughts and the lowest rate of actual suicides. The article in the Psychiatric Times has be fully fixed finally (editor was very friendly and open to feedback). I feel accomplished.

Any jokes about the Jersey Shore are welcome and likely true.

 

[FlowRate]

Quality:

• Adults Reporting Any Mental Illness in the Past Year: (?Stigma, ?Homeless pop, ?what counts as mental illness, ?how does presence/history of mental illness relate to quality)
• Average Number of Poor Mental Health Days per Month: (Self report?, Stoic/Farmer culture?, may actually be a decent measure)
• Alcohol Use Disorder in the Past Year:
• Substance Use Disorder in the Past Year:
• Suicide Rate
• Drug Overdose Death Rate:
• 180-day State Hospital Readmission Rates:
• State Psychiatric Hospital Beds per Capita:

Measuring quality of healthcare is notoriously difficult. Most of these things strike me as being more about the state population ("substrate") rather than the quality of care delivered. Or, in other words, it's a good measure of the self-reported "quality" of mental health of people living in the state, not of people who are trying to access care or who have accessed care, and not adjusted for differences in baseline population mental health or other confounding factors.

I've worked in two of the top 15. Both are rated as having the same "quality" and both are rated as having lower quality than most of the other top 15 states. But I can say the quality of care especially in the higher ranked state is very good. The higher ranked state probably has worse access then the lower ranked one but is rated as having better access than the latter. The cost of care delivered in terms of % of state GDP in the higher ranked state is probably MUCH higher than in the latter but has a better state insurance system. But the "cost" measures are mostly about out of pocket costs/insurance coverage.

One of the access measures:

• Mental Health Offices as a Percentage of All Businesses:

In other words, states where there are likely more solo practitioners and less academic/big group docs.

Just a lot of methodological issues making these rankings not super useful.

 

[samac]

I've lived in several of these states, practiced in them and I agree with what I see.

Ohio was the best I've seen. Why? Their entire southern half of the state's long-term facility was as nice as a great college dorm. The courts actively sought guidance from some of the best forensic psychiatrists in the country such as Phil Resnick or Doug Mossman. Inmates in jails got forensic evaluation in days if not the same day as being suspecting of having a severe psych problem by anyone involved in the system-the police office, judge, lawyer, jail doctor, correctional officer, etc.

I'm currently in Missouri and psych services here are a piece of c____. Jail inmates suffering from schizophrenia aren't seen for about 10 months, left to fester in their cell and the jail doctor can't send them to a long-term psych center or medicate them against their will. You can't even send the patient to a long-term facility unless the patient is charged with a crime. So their number 40 doesn't surprise me at all.

Kentucky? That place was a joke. Hospitals in KY kept trying to transfer to my hospital in Cincinnati and I'd always block them. They must've fixed themselves up some to be a 27 since I last saw them.

Me: Are they involuntarily committed?
Them: Yes
Me: You can't transfer them end of story. Their commitment is only good in Kentucky. The second they cross state lines you are now holding them against their will. Your facility has a psych unit so it's a Cobra violation to try to transfer them here.
Them: Doc, our psychiatrist is a quack. We need to send them to a real place. (Seriously stuff like this has been said).
Me: Then I'd recommend you tell your employers your psychiatrists aren't doing their jobs but as of now you can't transfer them over here.

A few minutes later, the nurse tells me, "Doctor, that place is still trying to transfer that patient over here. They know you'll say no so now they're trying a different area in our hospital." We call that other area. Tell them what's going on. They reject the patient too. Then it's like a few hours later and another psychiatrist in another hospital calls me up. "Hey James, did some piece of crap hospital in Kentucky with a quack psychiatrist try to send you a patient over at UC?" Me-"yes" and I fill them in.

This Kentucky situation would happen about once every 1-3 months.

I’m cackling start the KY situation. Was it SUN? That’s close enough to the state line I could see that happening.