The relative risk of death for public mental health clients is higher in all eight states during all years than for state general populations, as shown by the SMRs (Table 1). The actual numbers of deaths among public mental health clients ranged from 4.9 to 1.2 times higher than the expected number of deaths. Oklahoma and Texas had the highest SMRs, about three to five times higher actual numbers of deaths than expected deaths during several years. Arizona, Missouri, and Utah had actual numbers of deaths that were twice as high as expected deaths. In Virginia and Rhode Island, the actual number of deaths ranged from 1.8 to 1.2 times higher than expected deaths. The SMR for Vermont was 3.2.
