Involuntary Psychiatric Commitment and the Incidence of Suicide: An Economic Analysis
- Presenter:
Chair: David Cutler; Discussant: Alison Cuellar Mon June 5, 2006 10:45-12:15 Room 313
State laws permitting involuntary psychiatric commitment of those who constitute a risk to themselves, such as suicide attempters, are presumably intended to decrease suicide rates. Whether such laws have this intended effect has, however, not been previously investigated. Hence, this paper examines the relationship of involuntary commitment laws to state-level suicide rates drawn from the CDC’s Injury Mortality Reports data for 1999-2002. The empirical analysis is grounded in a discrete-choice expected-utility-maximization model in which an individual chooses whether or not to attempt suicide, given that the ‘success’ of an attempt is uncertain and that unsuccessful attempts are associated with involuntary psychiatric commitment. Within this model, the comparative-static impact of an increase in the term of involuntary commitment comprises two opposing effects. One effect is a standard deterrent effect: a longer commitment term reduces utility for those who attempt and fail, thus discouraging attempts and reducing the probability of a ‘successful’ suicide. The other, opposing effect entails escalation in the intensity of attempt made: to reduce the chance of ‘failure’ (remaining alive), an individual faced with a longer commitment term will increase the lethality of his attempt, thereby increasing the probability of ‘success’. Consequently, the impact of an increase in the commitment term is ambiguous—the suicide rate will fall or rise, respectively, depending on whether the deterrent effect or the escalation effect dominates. To test whether longer commitment terms discourage or encourage suicides, I have compiled data on state commitment laws, focusing in particular on the statutory maximum commitment term allowed (for an initial term of commitment). This data is then merged with state-level gender- and age-specific suicide rates obtained from the CDC’s WISQARS database. Other covariates, in addition to the commitment term measure and standard demographics, include indices of binge drinking, mental distress, disability, religiosity, and gun control. Potential endogeneity of commitment term laws is partially addressed by including the state’s lagged suicide rate (for 1960) as a regressor. Preliminary analysis of the 2002 data for a variety of age-gender cells finds dominant deterrent effects for women aged 65-69 and men aged 55-64, but a dominant escalation effect for men aged 70-79. This sort of heterogeneity is predicted by the model, in that the deterrent effect is predicted to be relatively small for the oldest men (who have the highest reported probabilities of success). This analysis will be expanded for the entire period, 1999-2002, for which WISQARS permits age-adjusted suicide rates to be generated. Also, data on commitment rates will be collected in order to reflect the true expected penalty posed by commitment. Finally, the issue of legal endogeneity will be explored via instrumental variables and longitudinal analysis extending well beyond the period of the WISQARS data.
