The SMRs can be used to show the relative risk of death between mental health clients and state populations. SMRs were calculated for public mental health clients, who received at least one public mental health service in the year of their death, in each state and year for which data were submitted. The SMR is the ratio of the actual number of deaths in a population to the number of expected deaths based on an overall population, controlling for age and sex, which are major determinants of mortality. In this indirect method of standardization, yearly age-specific death rates for men and women in the general population of each state are applied to the public mental health population by age and sex of the state public mental health system to estimate the expected number of deaths for the service population during that year. The number of male clients and the number of female clients are determined in each of the 11 age categories mentioned previously for AADRs. The number of clients in each sex–age category is multiplied by the sex–age-specific death
