Records of mental health clients were electronically linked and matched with death records from state vital statistics agencies by the public mental health agencies in six states: Arizona, Missouri, Oklahoma, Rhode Island, Texas, and Utah. The states used computer software developed by the Oklahoma State Mental Health Authority and statistical analysis software such as SPSS (SPSS Inc, Chicago, Ill) or SAS (SAS Institute Inc, Cary, NC) to match death records with records of clients receiving services during the year of their deaths. Virginia used deaths reported for clients in state psychiatric hospitals. Individual records were used for each deceased client by the seven states. Vermont AADRs and SMRs were based on mental health clients represented in the Vermont death records. Probabilistic population estimation (10) was used to establish an unduplicated client count and estimate the number of Vermont clients who died during the period or the overlap between clients served and death files. Vermont AADRs and SMRs were based on mental health clients represented in the Vermont death records. Vermont rates were calculated for a combination of 3 years to minimize the effects of annual fluctuations.
