Recovery Michigan

Suicide is a leading cause of death in the United States. From 2000 to 2014, it was the third most common cause of death among 10 to 24 year olds, the second most common cause of death among 25 to 34 year olds, and the tenth most common cause of death for all ages. The medical and work-loss costs of completed suicide are estimated to be over $51 billion. Suicide can have a devastating effect on the family and friends of the deceased. Depending on their relationship to a person who has committed suicide, those left behind are at greater risk for mental illness, substance use, and suicide.

Self-inflicted injuries not resulting in death are also common and costly. There were nearly 500,000 visits to the emergency department in 2013 for injuries where the patient caused self-harm. Those encounters cost over $10 billion in medical cost and lost productivity.

To better understand the health care system use of individuals experiencing suicidal or self-harm behavior, we examined MarketScan commercial and Medicaid health care insurance claims data. We identified individuals who had an emergency department visit in calendar year 2014 that was due to suicide or self-inflicted injury. We then examined the services they received in the 90 days prior to the emergency department visit separately by whether the person had commercial or Medicaid insurance.

These statistics demonstrate that some individuals who engage in self-harm behavior have contact with the health care system and are receiving behavioral health treatment. Over 40 percent had an antidepressant or anxiolytic prescription drug filled; 19 percent of the patients with commercial insurance and 14 percent of the Medicaid patients saw a primary care physician for a behavioral health condition. Those individuals might benefit from the provision of more intense services from their providers to prevent a self-harm event requiring emergency department services from occurring. The people who saw a primary care physician for a reason other than behavioral health might particularly benefit from screening.

There are a number of barriers that could be keeping individuals from receiving services that would reduce their likelihood of engaging in self-harm behavior. The differences in the use of services by individuals with commercial and Medicaid insurance indicates that access to care is one of those barriers. The commercially insured were more likely to have a primary care visit, specialty care visit, and prescription drug filled for a behavioral health medication prior to an intent-to-harm-self emergency department encounter. People with Medicaid were more likely to have an emergency department encounter.