Access to mental health care and suicide rates
Publication id: shakya-2026-mental-health-suicide-jpam
Status: verified
Citation: Shakya, S. and RoyChoudhury, A. (2026). Access to mental health care services and suicide rates in the United States. Journal of Policy Analysis and Management. Download PDF
Related popular writing: Archbridge Institute op-ed.
Facts¶
Policy hook¶
States implementing prescriptive authority for psychologists to expand the supply of mental health providers.
Main finding¶
A 10% improvement in access to mental health providers reduces suicide rates by 3% (1.6 fewer suicides per 100,000 population). This equals approximately 3 additional mental health providers per mile in a county.
Data and setting¶
County-level panel data from 2016-2019 tracking the universe of psychiatric and psychological practice locations across all US counties using National Provider Enumeration System data. Suicide rates from CDC Wonder database.
Research design (plain language)¶
Instrumental variable approach using state implementation of psychologist prescriptive authority (RxP) laws as an exogenous instrument to address endogeneity between provider location and suicidality. Two-stage least squares regression with arcsinh-arcsinh specification on 12,556 county-year observations.
One caveat¶
Results show complementarity between psychologists and psychiatrists. When isolating only psychologist supply, effects become statistically insignificant. Treatment effects represent local average treatment effects (LATE) for those affected by RxP laws, limiting generalizability beyond states with similar regulatory variation.
PDF or DOI¶
Why it matters¶
Mental health provider shortages are widespread in the US. This study provides causal evidence that expanding access through scope-of-practice deregulation can reduce suicide mortality. Unlike previous correlational studies, using RxP laws as a natural experiment shows policymakers can meaningfully improve mental health outcomes through regulatory changes that broaden the provider workforce.