Suicide Prevention Programs across U.S. Mental Health Care Facilities: Differences By Organizational Practices

Background and Purpose: Suicide has continuously been ranked as a leading cause of death among adolescents ages 10 to 14 in the United States. Yet, access to suicide prevention services remains challenging for this population. Importantly, socioeconomic disadvantage is often associated with barriers to mental health treatment and higher rates of suicide attempts. To address this problem, the National Strategy for Suicide Prevention promoted initiatives for increasing prevention services in 2021. Identifying practices that support providing suicide prevention services in mental health settings can play an important role in preventing adolescent suicide.

Methods: This cross-sectional study used the 2023 National Substance Use and Mental Health Services Survey to investigate the availability of suicide prevention services for adolescents and how those provisions are associated with organizational practices. This survey includes data on facility characteristics (practices, services offered, payment options) from nearly all US mental health facilities. A socio-technical approach was used to categorize organization practices shown to support the implementation of services like suicide prevention. We used logistic regression models to examine whether facility practices, such as providing innovative services, were associated with the availability of suicide prevention services for adolescents.

Results: In total, 6,750 mental health facilities served adolescents in the U.S. Overall, 71% offered suicide prevention services, 91% took Medicaid, 60% offered a sliding fee scale, and 46% offered pay assistance. Facilities offering innovative services to adolescents, like mobile crisis services, were twice as likely to offer suicide prevention services (OR=2.05, p<.001, 95% CI: 1.99-2.62). Facilities offering psychiatric emergency services had four times the odds of offering suicide prevention services (OR=4.10, p<.001, 95% CI: 3.18-4.72). However, client outcome follow-up after discharge was not significantly associated with providing suicide prevention services for adolescents (OR= 1.02, p=0.64).

Conclusion and Implications: Facility practices contributed to significant provisions of suicide prevention services for adolescents. Facilities offering innovative services like psychiatric emergency services and mobile crisis services were more likely to offer suicide prevention services. Identifying practices that can increase service availability to adolescent populations is essential to improving access to suicide prevention.