Shifting Perspective – Can Behavioral Health Care Resources Reduce State Firearm Homicide Rates?

Introduction
Firearm homicide rates have risen steadily over the last decade. Two potential forms of intervention discussed by policy makers include firearm safety legislation and behavioral health resources. We sought to determine if a relationship exists between a state’s behavioral health resources and firearm related homicide rate.
Methods
We conducted a time-series cross-sectional analysis using the state and year as the unit of analysis. Data from 2010 to 2018 were obtained from multiple publicly available sources. Age adjusted firearm homicide rate served as the main outcome variable. The main explanatory variables were number of behavioral health care workers, number of mental health treatment facilities, and mental health care expenditure. Additional covariates included socioeconomic factors, demographic factors, and firearm factors. Fixed effects linear regression was used to analyze the association between firearm homicide rate and behavioral health workforce, number of treatment facilities, and spending per capita.
Results
Mean age adjusted homicide rate increased during the study period, with an overall increased by 27% in 2018 (4.43 per 100,000) compared to 2010 (3.49 per 100,000). During this period, the states with highest age-adjusted firearm homicide rate included the District of Columbia, Louisiana, and Mississippi. Mean behavioral health care workers per state increased by 9.4% (2010: 224 per 100,000; 2018: 245 per 100,000). Mental health care facilities initially increased from 2010 (4 per 100,000) to 2012 (5.8 per 100,000) but demonstrated a steady decline
thereafter.
Unadjusted fixed effects modelling showed no significant relationship between behavioral workforce, mental health facilities, or spending per capita and firearm related homicide. After adjusting for socioeconomic and demographic variables, this association remained nonsignificant.
Conclusion
Behavioral health resources in the form of workforce, facilities, and spending per capita is not associated with firearm homicide rates on a state level.