# PRESS RELEASE
**FOR IMMEDIATE RELEASE**
**Embargoed until**: pending Trellison Institute methodology rating + LedgerWell evidence-chain certification.
**Contact**: [email protected]
---
## State Mental-Health Provider Supply Does Not Predict Reduced Youth Suicide or Drug Overdose, Trellison Institute Working Paper Finds — Yet the Framework's Need Metric Strongly Validates Within Surveillance Data
**A Phase B follow-up to the Youth Mental Health Access Gap V1 study tests whether the framework's gap measures predict real public-health outcomes. Result: the youth-distress need metric strongly predicts state-level suicide ideation and attempts, but state-level provider supply has zero protective correlation with state suicide death rates or drug overdose mortality.**
**Trellison Institute** today released the V1 draft of *State-Level Youth Mental Health Need-vs-Access Measures Predict Within-Instrument Suicide Ideation but Not Across-Instrument Mortality*, the Phase B outcomes-correlation follow-up to the Youth Mental Health Access Gap V1 study published earlier this month. The analysis joins the Youth V1 state-level gap measures (35 states, 41.8 million under-18) with three categories of state-level outcome data: CDC YRBSS 2023 youth suicide ideation/planning/attempt prevalence, NCHS Leading Causes of Death state-level age-adjusted suicide rate (2017), and NCHS VSRR provisional drug overdose deaths per 100,000 (2023).
The headline findings:
- **State-level youth distress (sad/hopeless 2+ wks) strongly predicts state-level YRBSS suicide indicators**: Pearson r = +0.82 with considered suicide, +0.80 with made plan, +0.76 with attempted suicide. This validates the Youth V1 paper's choice of the sad/hopeless prevalence as the principal need metric.
- **Provider supply does NOT predict reduced state-level mortality**: the `access_value` measure (youth-serving providers per 100K under-18) correlates +0.14 with all-age suicide AADR, +0.21 with drug overdose. Both *positive* — meaning higher supply states are not lower-mortality states. Alaska anchors this finding: highest supply density (1,085 per 100K) and highest all-age suicide AADR (27.0).
- **The framework's residual classification is essentially uncorrelated with mortality**: r = −0.30 (suicide AADR) and −0.05 (drug OD). New Jersey, flagged as a positive outlier (supply gap worse than uninsured rate predicts), has the third-lowest all-age suicide AADR (8.3) and the lowest YRBSS attempted-suicide rate (5.2%). Vermont, flagged as a negative outlier (well-supplied), has moderate suicide AADR (18.3) and YRBSS attempted (7.4%). The framework's gap measure captures *something* — but that something is not "suicide risk."
**"The framework's value is to surface where states have under-built youth-serving workforce capacity relative to their insurance landscape,"** said the project research team. **"This Phase B analysis confirms that the gap measure is a policy-relevant capacity-build-out priority signal — and it qualifies the claim that the framework's outputs are directly outcome-predictive. The two claims are different, and we draw the distinction explicitly in the published paper. State-level provider supply alone, at the granularity public surveillance allows us to measure, is not a state-level mortality predictor."**
## Three explanations for the non-protective supply signal
The paper proposes three non-mutually-exclusive explanations:
1. **Provider count is a structural metric, not a capacity metric.** Counting NPIs assigned to youth-serving taxonomies is the closest a public researcher can come to measuring state-level supply without licensed access to billing data. It does not measure provider hours, accepting-new-patients status, network adequacy, or actual care delivery.
2. **State granularity is too coarse.** A state with 1,000 providers per 100K under-18 may have 500 concentrated in one metro and zero in 60% of its land area. Sub-state heterogeneity is not visible at this resolution.
3. **Geographic confounding.** The rural-state suicide cluster (Montana, Alaska, Wyoming, New Mexico, Idaho) overlaps with the higher-supply rural states in our analysis (Alaska, Vermont, Maine) for different reasons (federal IHS, university medical centers, small-state demographic homogeneity). The cross-section confounds.
None of these explanations is novel; they replicate established understanding from health-policy literature. The framework's specific contribution is to demonstrate the orthogonality with a reproducible analytical pipeline applied to publicly-available federal data.
## Drug overdose is a different question
The analysis surfaces a fundamentally different signature for drug overdose deaths: higher-coverage states have *higher* drug-OD rates (r = −0.21 on uninsured). This is consistent with the documented "deaths of despair" geography (West Virginia, Ohio, New Mexico, DC) — economically-stressed regions whose insurance coverage profile is heterogeneous. **Drug overdose mortality requires a separate analytical pipeline** with different framework bindings (NPPES SUD-treatment taxonomies, SAMHSA-certified OTPs, NSDUH OUD-treatment-receiving rate).
## What the framework should and should not be used for
| Question | Use which framework output |
|---|---|
| Which states should build more youth-serving workforce capacity? | `residual_class` = positive_outlier — PR, NC, NJ |
| Which states have the highest youth distress? | High `need_value` — IN, AR, OK, NV, MO |
| Which states should be prioritized for suicide-prevention intervention? | High all-age AADR (NCHS) — MT, AK, WY, NM, ID — *which is not the same list* |
| Which states show the policy stack that builds capacity successfully? | `residual_class` = negative_outlier — VT (UVM + Medicaid expansion + Designated Agencies), AK (IHS + tribal health orgs) |
## About the broader research program
The Youth Mental Health Access Gap V1 is the second published application of the Need-vs-Access Framework (the first was the adult tract-level Mental Health Access Gap V1). The Phase B paper is the framework's first outcome-correlation analysis. Eleven other access domains are queued for the same framework: poverty safety-net, English-language acquisition, jobs vs job seekers, postsecondary access, library access, police per capita, maternal care, dental care, broadband, oncology, and crisis response. Each will publish the same canonical 27-part content arsenal.
## Forthcoming work
The current Phase B v1.0 analysis is the foundation. v1.1 will integrate FBI Crime Data Explorer juvenile-arrest correlations (pending api.data.gov key issuance) + CDC WONDER state-level youth-specific (10-19) suicide mortality + multivariate residual analysis adjusting for rural-share and opioid-exposure-index. v2.0 will integrate HCUP State Emergency Department visit data (licensed access).
## The published content arsenal
The full content arsenal — methodology supplement, dataset CSV, data dictionary, per-state outcome profiles, executive brief, replication package, slides, visualization clips — is available at:
**https://trellison.com/research/youth-mental-health-outcomes-correlation**
The framework is registered as `atlas.need_vs_access_framework_v1` v1.1.0 in the DaedArch tool registry; the Phase B correlation pipeline is documented in the methodology supplement. License: CC-BY-4.0.
## About Trellison Institute, LedgerWell, and DaedArch
Trellison Institute is the methodology-audit arm of the DaedArch platform. It does not influence research; it is the audience. It rates methodology, not conclusions. The Phase B paper is its third published audited research output of May 2026, following the adult Mental Health Access Gap V1 and the Youth V1.
LedgerWell Corporation provides the evidence-chain certification substrate. Every analytical step in the Phase B paper is cryptographically attested.
DaedArch Corporation is the public-facing operating entity for the Icarus Flew research mission. DaedArch is led by Rob Stillwell with DaedArch AI as operational partner.
---
**For methodology inquiries**: [email protected]
**For data and replication**: [email protected]
**For press**: [email protected]
**Working paper DOI**: pending Zenodo registration
###