Structural and Regional Disparities In Suicide Prevention Service Availability across U.S. Mental Health Treatment Facilities

Background
Suicide prevention is a critical component of behavioral health care as it plays a significant role in reducing mortality. However, the suicide prevention services may not be evenly distributed across treatment settings nationwide. The objective of this study is to explore structural and regional disparities in suicide prevention service availability among U.S. mental health facilities.

Methods
Data were drawn from the 2024 National Substance Use and Mental Health Services Survey (N-SUMHSS; n= 14,217), which included the U.S. mental health treatment facilities. Multivariable logistic regression models were applied to examine associations between structural and regional disparities and suicide prevention service availability. The key predictors of structural and regional disparities included ownership, facility type, integrated mental health, substance use treatment crisis intervention capacity, payment acceptance, and U.S. Census region.

Results
Findings revealed that suicide prevention service availability varied significantly, associated with ownership, facility type, and region (LR χ²(25) = 3066.28, p < .001, R² = .21). The private nonprofit facilities had higher odds of offering suicide prevention services (OR = 1.52, 95% CI [1.38, 1.67], p < .001) compared with private for-profit facilities, . While state government facilities have more than three times the odds (OR = 3.22, 95% CI [2.47, 4.21], p < .001) of providing suicide prevention. Moreover, facility type differences (psychiatric hospitals vs. outpatient facilities) are associated with lower odds of providing services (OR = 0.37, 95% CI [0.28, 0.50], p < .001). In the meantime, facilities offering integrated mental health and substance use treatment had nearly twice the odds of providing suicide prevention services (OR = 1.99, 95% CI [1.83, 2.16], p < .001), and those with crisis intervention teams had more than 2.5 times the odds (OR = 2.58, 95% CI [2.36, 2.83], p < .001). In addition, facilities accepting Medicaid (OR = 1.28, 95% CI [1.14, 1.45], p < .001), private insurance (OR = 1.59, 95% CI [1.40, 1.80], p < .001), and state-financed insurance (OR = 1.25, 95% CI [1.14, 1.36], p < .001) were more likely to offer services. On the other hand, regional disparities show that facilities in the West demonstrate the highest likelihood of providing suicide prevention services (73%) compared with facilities in the Northeast (66%).

Conclusion and Implications
Suicide prevention capacity is unevenly distributed across the U.S. mental health system, with disparities driven by organizational structure, service capacity, financing, and geography. Strengthening integrated treatment models and expanding crisis intervention infrastructure in under-resourced settings may improve equitable access to suicide prevention services.