The Impact of Provider Productivity on Suicide-Related Events Among Veterans.

Abstract

Objective: To examine the relationship between mental health provider productivity, staffing levels, and suicide-related events (SREs) among U.S. Veterans receiving care within the Veterans Health Administration (VHA), focusing on therapy and medication management providers.

Data sources/setting: We analyzed administrative data from the Department of Defense and VHA (2014-2018), encompassing 109,376 Veterans who separated from active duty between 2010 and 2017.

Design: A longitudinal design estimated the effects of facility-level provider work rate and staffing on SREs, adjusting for patient and facility characteristics. An instrumental variables (IV) approach addressed potential endogeneity.

Data collection/extraction methods: Data were obtained from the VHA Corporate Data Warehouse and the VHA Survey of Enrollees.

Principal findings: A 1% increase in therapy provider work rate led to a 12.1% increase in SRE probability, regardless of staffing levels. Conversely, a 1% increase in staffing levels led to a 1.6% reduction in SREs, with the largest effect in low-staffed facilities. For medication management providers, work rate had no overall impact on SREs, except in medium-staffed facilities. A 1% increase in staffing levels for medication management providers led to a 1.7% reduction in SREs.

Conclusions: Increased work rates, particularly in low-staffed VHA facilities, may elevate suicide-related risks. In contrast, staffing increases simultaneously improve access and reduce adverse outcomes. Where possible, policymakers should prioritize staffing growth over productivity gains to improve access to mental health clinics and ensure Veteran safety and care quality.