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Publication Briefs

Study Suggests Mental Health Staffing Affects the Probability of Suicide-Related Events among Veterans

In the United States, suicide rates have been increasing for two decades, alongside a national shortage of mental health professionals. More than 75% of US counties have a mental health provider shortage. Thus far, there is mixed evidence on the effects of mental health staffing on suicide-related outcomes. Further, estimating the direct relationship between mental health staffing and suicide rests largely on the ability to separate causal influences from confounding factors. This study sought to measure the effect of staffing on suicide-related events. Using VA data, investigators identified 109,367 Veterans who separated from active duty between 2010 and 2017 and who received care at any of 125 VA medical centers from July 2014 to June 2018. The main outcome was whether a Veteran experienced a suicide-related event (SRE) in each two-week pay period between 2014 and 2017. SREs included suicidal self-directed violence, suicide attempts, suicide, and self-directed violence with undetermined intent. The key independent variable was the facility-level mental health provider staffing level over a given pay period. Investigators also examined patient demographics, branch of service, year of separation, number of dependents, and mental health use during active service, as well as VA facility characteristics and market-level characteristics.


  • Mental health (MH) staffing had a large causal effect on the probability of a suicide-related event. From 2014 to 2018, the per-pay period probability of an SRE among this study cohort was 0.05%. A 1% increase in mental health staffing led to a 1.6 percentage point reduction in SREs.
  • This effect was concentrated in the most capacity-constrained facilities, suggesting that staffing increases would have the largest effect in those facilities.
  • There was substantial geographic variation in MH staffing levels across the facilities in this study. For example, in 2018, average mental health provider staffing ranged from 5 standardized clinic days per pay period per 10,000 enrollees to 21 standardized clinic days. There was a similar variation in Veterans’ engagement with VA services. In 2018, the average engagement ranged from virtually no engagement (0%) to 46% by facility-pay period.


  • Retaining and increasing mental health staffing would have substantial benefits for Veterans, especially in the most capacity constrained facilities.


  • This study cohort is limited to those separating from service between 2014 and 2018.
  • Findings did not account for non-VA service use or non-VA documented outcomes.

This study was partly funded by HSR&D’s Quality Enhancement Research Initiative (QUERI). Messrs. Feyman and Figueroa, Mss. Yuan and Kabdiyeva, and Drs. Shafer, Pizer, and Strombotne are part of QUERI’s Partnered-Evidence-based Policy Resource Center.

Feyman Y, Figueroa S, Yuan Y, Price M, Kabdiyeva A, Nebeker J, Ward M, Shafer P, Pizer S, and Strombotne K. Effect of Mental Health Staffing Inputs on Suicide-Related Events. Health Services Research. September 11, 2022; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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