How to slow Michigan’s skyrocketing suicide rate

Justin Haskins

Since 1949, the health care community has celebrated Mental Health Awareness Month in May. One of the issues doctors and other medical professionals will attempt to tackle this year is reducing the United States’ growing suicide rate.

The Centers for Disease Control and Prevention reports greater than 42,000 Americans took their own lives in 2014, a 45.7 percent increase since 2000. There are, on average, 117 suicides each day, according to the American Foundation for Suicide Prevention.

The suicide rate in Michigan is slightly higher than the national average; in 2014, there were 13.23 suicides per 100,000 people in Michigan and 12.93 suicides per 100,000 nationally. Michigan is 32nd among the states, but its suicide rate has risen by startling numbers since 2000.

In 2014, there were 1,354 suicides reported in Michigan, nearly 400 more than in 2000, an increase of 39 percent.

Numerous considerations must be taken into account when analyzing the causes behind suicide rate increases, but available data indicate certificate of need (CON) laws — regulations of the health care industry imposed at the state level — may be one of the most important policies linked to rising suicide rates.

CON regulations mandate health care providers receive approval from a state government agency before increasing access to care. Whenever a provider adds services, purchases new medical equipment, or expands a facility or builds a new one, obtaining a certificate of need is required.

In many cases, CON agencies choose to block the expansion of services or the building of new facilities, because CON advocates believe government officials, rather than doctors and medical professionals, should decide when and where new health care services are offered.

CON regulations vary from state to state, but the goal is always the same: limit the number of services available. Thomas Stratmann and Jacob Russ at the Mercatus Center at George Mason University found states with CON regulations have on average “99 fewer hospital beds per 100,000 people” than states without the regulations.

Michigan is one of 36 states that have CON laws, and one of only 26 states with CON regulations aimed at managing psychiatric care.

Research shows when quality mental health services are less available, suicide rates tend to be higher, which explains why rates in rural communities are often greater than in many urban regions. By restricting access to mental health care, CON laws inadvertently cause mental health problems to go undertreated, including suicide.

In April, debate raged in the Michigan Legislature over Gov. Rick Snyder’s plan to reform Michigan’s $2.4 billion Medicaid behavioral health budget. Snyder proposed in his fiscal year 2017 budget allowing 14 Medicaid health maintenance organizations, many of which operate for profit, to compete for contracts to manage the state’s budget for behavioral health services, replacing 10 government-run prepaid inpatient health plans.

In April, the Legislature rejected Snyder’s plan, at least temporarily. A permanent resolution is still being considered by lawmakers in Lansing.

Adjusting the state’s mental health system is an important part of creating a sustainable future for publicly funded mental health care programs, but an easy and cost-effective way of improving access to care without raising taxes or cutting spending in other programs is to reform or eliminate certificate of need laws.

Justin Haskins is executive editor

of the Heartland Institute.