THE STATEOF MENTALHEALTHIN AMERICA

Acknowledgments
Mental Health America (MHA) was founded in 1909 and is the nation’s leading community-based nonprofit
dedicated to addressing the needs of those living with mental illness and promoting the overall mental healthof all. Our work is driven by our commitment to promote mental health as a critical part of overall wellness,
including prevention services for all; early identification and intervention for those at risk; and integrated care,services, and supports for those who need them, all with recovery as the goal.
MHA dedicates this report to mental health advocates who fight tirelessly to help expand access to care andreduce disparities and inequities for people with mental health concerns. To our affiliates, thank you for yourincredible state-level advocacy and dedication to promoting recovery and protecting the rights of all.
This publication was made possible by the generous support of Alkermes and Otsuka America Pharmaceutical
Companies.

Special thanks to:
The Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control andPrevention (CDC), University of Wisconsin Population Health Institute, and Department of Education (DoE),
whom every year invest time and money to collect the national survey data, without which this report would
not be possible.

This report was researched, written, and prepared by Maddy Reinert, Theresa Nguyen, and Danielle Fritze.
Citation: Reinert, M, Fritze, D. & Nguyen, T. (October 2022). “The State of Mental Health in America 2023”
Mental Health America, Alexandria VA.

500 Montgomery Street, Suite 820
Alexandria, VA 22314-1520
www.mhanational.org
Copyright © 2022 by Mental Health America, Inc.

Table of Contents

05

Ranking Overview and Guidelines

08

Key Findings

09

State Rankings

15

Adult Prevalence of Mental Illness

18

Youth Prevalence of Mental Illness

21

Adult Access to Care

25

Youth Access to Care

29

Mental Health Workforce Availability

30

References

32

Glossary2

Mental Health America (MHA) is the nation’s leading community-based nonprofit dedicated to addressing theneeds of those living with mental illness and promoting the overall mental health of all. MHA’s work is driven byits commitment to promote mental health as a critical part of overall wellness, including prevention services forall; early identification and intervention for those at risk; and integrated care, services, and supports for those whoneed them, all with recovery as the goal.

Our report is a collection of data across all 50 states and the District of Columbia and seeks to answer thefollowing questions:•

How many adults and youth have mental health issues?

•

How many adults and youth have substance use issues?

•

How many adults and youth have access to insurance?

•

How many adults and youth have access to adequate insurance?

•

How many adults and youth have access to mental health care?

•

Which states have higher barriers to accessing mental health care?

Our goal:•

To provide a snapshot of mental health status among youth and adults for policy and program
planning, analysis, and evaluation;•

To track changes in the prevalence of mental health issues and access to mental health care;•

To understand how changes in national data reflect the impact of legislation and policies; and•To increase dialogue with and improve outcomes for individuals and families with mental health needs.

Why gather this information?
•

Using national survey data allows us to measure a community’s mental health needs, access to care,and outcomes regardless of the differences between the states and their varied mental health policies.

•

Rankings explore which states are more effective at addressing issues related to mental health andsubstance use.

•

Analysis may reveal similarities and differences among states, allowing for assessment on how federal
and state mental health policies result in more or less access to care.

3

Ranking Overview and Guidelines
This chartbook presents a collection of data that provides a baseline for answering some questions about how
many people in America need and have access to mental health services. This report is a companion to theonline interactive data on the MHA website (www.mhanational.org/issues/state-mental-health-america). The
data and tables include state and national data and shareable infographics.
MHA Guidelines
Given the variability of data, MHA developed guidelines to identify mental health measures that are mostappropriate for inclusion in our ranking. Chosen indicators met the following guidelines:•

Data that are publicly available and as current as possible to provide up-to-date results.

•

Data that are available for all 50 states and the District of Columbia.

•

Data for both adults and youth.

•

Data that captures information regardless of varying utilization of the private and public mental healthsystem.

•Data that could be collected over time to allow for analysis of future changes and trends.

Our 2023 Measures
1. Adults with Any Mental Illness (AMI)
2. Adults with Substance Use Disorder in the Past Year
3. Adults with Serious Thoughts of Suicide
4. Youth with at Least One Major Depressive Episode (MDE) in the Past Year
5. Youth with Substance Use Disorder in the Past Year
6. Youth with Severe MDE
7. Adults with AMI Who Did Not Receive Treatment
8. Adults with AMI Reporting Unmet Need
9. Adults with AMI Who Are Uninsured
10. Adults Reporting 14+ Mentally Unhealthy Days a Month Who Could Not See a Doctor Due to Costs
11. Youth with MDE Who Did Not Receive Mental Health Services
12. Youth with Severe MDE Who Received Some Consistent Treatment
13. Youth with Private Insurance That Did Not Cover Mental or Emotional Problems
14. Students Identified with Emotional Disturbance for an Individualized Education Program
15. Mental Health Workforce Availability
A Complete Picture
While the above 15 measures are not a complete picture of the mental health system, they do provide a strong
foundation for understanding the prevalence of mental health concerns, as well as issues of access to insurance
and treatment, particularly as that access varies among the states. MHA will continue to explore new measuresthat allow us to capture more accurately and comprehensively the needs of those with mental illness and theiraccess to care.

4

Ranking
To better understand the rankings, it is important to compare similar states.
Factors to consider include geography and size. For example, California and New York are similar. Both arelarge states with densely populated cities. They are less comparable to less populous states like South
Dakota, North Dakota, Alabama, or Wyoming. Keep in mind that the size of states and populations matter.
Both New York City and Los Angeles alone have more residents than North Dakota, South Dakota,
Alabama, and Wyoming combined.
_________________________________________________________________________________________________The rankings are based on the percentages, or rates, for each state collected from the most recently available
data. The majority of indicators represent data collected up to 2020. States with positive outcomes are ranked
higher (closer to one) than states with poorer outcomes (closer to 51). The overall, adult, youth, prevalence, andaccess rankings were analyzed by calculating a standardized score (Z score) for each measure and ranking thesum of the standardized scores. For most measures, lower percentages equated to more positive outcomes(e.g., lower rates of substance use or those who are uninsured).
There are two measures where high percentages equate to better outcomes. These include “Youth with Severe
MDE (Major Depressive Episode) Who Received Some Consistent Treatment” and “Students Identified with
Emotional Disturbance for an Individualized Education Program.” Here, the calculated standardized score wasmultiplied by -1 to obtain a reverse Z score that was used in the sum. All measures were considered equallyimportant, and no weights were given to any measure in the rankings.
Along with calculated rankings, each measure is ranked individually with an accompanying chart and table. The
table provides the percentage and estimated population for each ranking. The estimated population number isweighted and calculated by the agency conducting the applicable federal survey. The ranking is based on the Zscores. Data are presented with two decimal places when available.
Major Changes to This Year’s Report Indicators
The COVID-19 pandemic had a serious impact on the ability to collect data for national surveillance in
2020. As a result of both measure and methodological changes below, the indicators in this year’s
report cannot be compared to previous years.

5The measure “Adults with Cognitive Disability Who Could Not See a Doctor Due to Costs” was used as anindicator for the Adult Ranking, the Access to Care Ranking, and the Overall Ranking in the 2020, 2021, and2022 State of Mental Health in America reports. The measure, “Adults with Cognitive Disability Who Could Not
See a Doctor Due to Costs” was calculated using the Behavioral Risk Factor Surveillance System (BRFSS)
question: "Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating,remembering, or making decisions?” (DECIDE). For this report, the indicator was amended to “Adults Reporting
14+ Mentally Unhealthy Days a Month Who Could Not See a Doctor Due to Costs” using a calculated variable
derived from the BRFSS question: “Now thinking about mental health, which includes stress, depression, andproblems with emotions, for how many days during the past 30 days was your mental health not good?”(MENTHLTH). The calculated variable, _MENT14D, contains four values: Zero days when mental health was not
good, 1-13 days when mental health was not good, 14+ days when mental health was not good, and Don’t
Know/Refused/Missing. The DECIDE measure includes those who may be experiencing cognitive challenges
due to a physical health condition, and is specific to difficulties with concentrating, remembering, or making
decisions. The _MENT14D indicator likely serves as a better measure for individuals who are experiencing any
significant mental distress and is therefore a more sensitive measure for the population we are attempting tocount.
The measure “Students Identified with Emotional Disturbance for an Individualized Education Program,” iscalculated as the percent of “school age” children identified as having an emotional disturbance among
enrolled students. The number of children identified as having an emotional disturbance is reported in the IDEAPart B Child Count and Educational Environments data collected by the Office of Special Education Programs(OSEP). In previous years, OSEP defined “school age” as youth ages 6-21. Therefore, the measure “Students
Identified with Emotional Disturbance for an Individualized Education Program” was previously calculated as
the percentage of youth ages 6-21 identified as having an emotional disturbance of those enrolled in grades 112 and ungraded. In the 2020-2021 data, OSEP expanded the range to include kindergarten, and therefore
defined “school age” as youth ages 5-21. To reflect that change, this year the measure “Students Identified with
Emotional Disturbance for an Individualized Education Program” was calculated as the percentage of youth
ages 5-21 identified as having an emotional disturbance of those enrolled in kindergarten, grades 1-12, andungraded. Due to data quality concerns, the 2020 disability data figure for Louisiana and the 2019 and 2020
figures for Iowa were not available. This report notes the 2019 figure for Louisiana and the 2018 figure for Iowa.
The measures “Adults with Substance Use Disorder” and “Youth with Substance Use Disorder” are bothcollected through the Substance Abuse and Mental Health Services Administration’s (SAMHSA) “National
Survey of Drug Use and Health” (NSDUH). Prior to the 2020 NSDUH, substance use disorders were assessedusing criteria from the DSM-IV. However, in the 2020 NSDUH, these criteria were updated to the DSM-V criteria
for substance use disorders. As a result, the rates of substance use for both youth and adults within thisreport cannot be compared to previous years.

6Survey Limitations
Twelve of the 15 indicators used in this report are collected from SAMHSA’s national survey, the NSDUH.
Historically, the NSDUH was collected through in-person interviews in the respondent’s residence. However,
due to the COVID-19 pandemic, data collection was suspended in March 2020. Collection of data for the
NSDUH resumed for a small sample in July 2020, but because of continued high rates of COVID-19, it wasdetermined that a sample large enough to be representative of the country could not be collected solely
through in-person interviews. As a result, 2020 NSDUH data collection did not fully resume until October 2020.
At this time, survey data were collected both in-person and online. In summary, 2020 NSDUH data was only
collected at full scale in the first and fourth quarters of the year. As a result of the lack of complete data andchanges to data collection from in-person to online, SAMHSA has determined that the results of the 2020
NSDUH cannot be compared to those of previous years. This means that the rankings presented
throughout this year’s State of Mental Health in America report cannot be reliably compared to therankings of previous years’ reports, and therefore should be interpreted as a snapshot in time ranking
rather than a reflection of trends over time.
Additionally, each survey has its own strengths and limitations. For example, strengths of both SAMHSA’s
NSDUH and the CDC’s BRFSS are that they include national survey data with large sample sizes and utilize
statistical modeling to provide weighted estimates of each state population. This means that the data is more
representative of the general population. An example limitation of particular importance to the mental healthcommunity is that the NSDUH does not collect information from persons who are experiencing homelessness
and who do not stay at shelters, are active-duty military personnel, or are institutionalized (i.e., in jails or
hospitals). This limitation means that those individuals who have a mental illness who are also experiencing
homelessness or are incarcerated are not represented in the data presented by the NSDUH. As a result, thesedata likely represent the minimum number of individuals experiencing behavioral health conditions and/or
lacking access to care in each state. If the data did include individuals who were experiencing homelessness
and/or incarcerated, we would possibly see prevalence of behavioral health issues increase and access totreatment rates worsen. It is MHA’s goal to continue to search for the best possible data in future reports.
Additional information on the methodology and limitations of the surveys can be found online as outlined in
the glossary.
Finally, most of these data were gathered through 2020. This means that they are the most current datareported by the states and available to the public. They are most useful in providing a snapshot of the needs
and systems that were in place in each state in the first year of the COVID-19 pandemic.

7

of adults had a substanceuse disorder in the pastyear.

of adults areexperiencing amental illness.
Equivalent to over
50 million
Americans.

The percentage ofadults reporting
serious thoughtsof suicide is

did not receive treatment.
– over
12.1 million
adults.

of youth report suffering fromat least one major depressive episodein the past year.
More than 2.7 million youth areexperiencing severe major depression.

(over 5.5
million) of
adults with amental illness
are uninsured.

In theU.S.,
there areindividuals
for every one
mentalhealthprovider.

of adults who reportexperiencing 14 or morementally unhealthy days
each month were notable to see a doctor due
to costs.

of adults who
identified with two
or more races
reported serious
thoughts
of suicide.

of adults with amental illness
receive notreatment – over
28 million
individuals.

of youthwith major
depression do
not receive
mental healthtreatment.

of all adults with a mental illness
reported that they were not able toreceive the treatment they needed.
Most reported they did not receive
care because they could not afford it.

youth with private
insurance do not havecoverage for mental oremotional difficulties –over 1.2 million youth.

Overall Ranking

StateAn overall ranking of 1-13 indicates lower prevalence of mental illness andhigher rates of access to care. An overall ranking of 39-51 indicates higher
prevalence of mental illness and lower rates of access to care. The combined
scores of all 15 measures make up the overall ranking. The overall ranking
includes both adult and youth measures, as well as prevalence and access tocare measures.
The 15 measures that make up the overall ranking include:
1. Adults with Any Mental Illness (AMI)
2. Adults with Substance Use Disorder in the Past Year
3. Adults with Serious Thoughts of Suicide
4. Youth with at Least One Major Depressive Episode (MDE) in
the Past Year
5. Youth with Substance Use Disorder in the Past Year
6. Youth with Severe MDE
7. Adults with AMI Who Did Not Receive Treatment
8. Adults with AMI Reporting Unmet Need
9. Adults with AMI Who Are Uninsured
10. Adults Reporting 14+ Mentally Unhealthy Days a Month
Who Could Not See a Doctor Due to Costs
11. Youth with MDE Who Did Not Receive Mental HealthServices
12. Youth with Severe MDE Who Received Some Consistent
Treatment
13. Youth with Private Insurance That Did Not Cover Mental or
Emotional Problems
14. Students (Grades K+) Identified with Emotional Disturbancefor an Individualized Education Program
15. Mental Health Workforce Availability
The chart is a visual representation of the sum of
the scores for each state. It provides an opportunity
to see the difference between ranked states. For
example, Wisconsin (ranked one) has a score that ishigher than Vermont (ranked 12). New Mexico(ranked 22) has a score that is closest to theaverage.

15.00

10.00

5.00

Rank

Wisconsin
Pennsylvania
Massachusetts
DelawareConnecticut
New Jersey
District of Columbia
New York
Illinois
MarylandKentucky
Vermont
Rhode Island
New Hampshire
South Carolina
North Carolina
Michigan
Hawaii
California
Iowa
North Dakota
New Mexico
Oklahoma
Georgia
Mississippi
Maine
Tennessee
Minnesota
NevadaColorado
Montana
Washington
Ohio
AlaskaFloridaLouisiana
South Dakota
Virginia
Indiana
Missouri
UtahWest Virginia
Arkansas
Nebraska
WyomingTexas
Idaho
Alabama
Arizona
OregonKansas
0.00

-5.00

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
-10.009

MASSACHUSETTS (RANKED 3):

The indicators that had the largest effects on Massachusetts’ Overall Ranking
were Students Identified with ED for an IEP (19.14, ranked 3), and Adults with
AMI Who Did Not Receive Mental Health Treatment (42.8%, ranked 3).

PENNSYLVANIA (RANKED 2):

The largest effects on the Overall Ranking for Pennsylvania were Adults
Reporting 14+ Mentally Unhealthy Days a Month Who Could Not See a Doctor
Due to Costs (14.75%, ranked 2) and Students Identified with ED for an IEP(15.37, ranked 4).

WISCONSIN (RANKED 1):

The indicators that had the largest effect on Wisconsin’s Overall Ranking wereAdults With AMI Reporting Unmet Need (20.9%, ranked 3), Students Identified
with Emotional Disturbance for an IEP (14.78, ranked 5), and Adults with AMI
Who Did Not Receive Treatment (46.8%, ranked 9).

KANSAS (RANKED 51):

The indicators that had the largest effect on the Overall
Ranking for Kansas were Youth with Substance Use Disorder in
the Past Year (9.05%, ranked 51), Adults with Any Mental Illness(26.02%, ranked 48) and Adults with Serious Thoughts of
Suicide (6.44%, ranked 48).

ARIZONA (RANKED 49):

The indicators that had the greatest effects for Arizona were Adults with
Serious Thoughts of Suicide (6.48%, ranked 49), Mental Health Workforce
Availability (660:1, ranked 48), and Adults with AMI Reporting Unmet Need
(36%, ranked 49).

OREGON (RANKED 50):

The indicators that affected Oregon’s Overall Ranking most were Adults with
Any Mental Illness (27.33%, ranked 50), Youth with Severe MDE (19%, ranked50) and Adults with Serious Thoughts of Suicide (6.8%, ranked 50).

Adult Rankings
States that are ranked 1-13 have a lower prevalence of mental illness and higher
rates of access to care for adults. States that are ranked 39-51 indicate that adults
have a higher prevalence of mental illness and lower rates of access to care.
The seven measures that make up the Adult Ranking include:
1. Adults with Any Mental Illness (AMI)
2. Adults with Substance Use Disorder in the Past Year
3. Adults with Serious Thoughts of Suicide
4. Adults with AMI Who Did Not Receive Treatment
5. Adults with AMI Reporting Unmet Need
6. Adults with AMI Who Are Uninsured
7. Adults Reporting 14+ Mentally Unhealthy Days a Month Who Could Not See
a Doctor Due to Costs

Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State
Kentucky
Hawaii
New York
Pennsylvania
Wisconsin
Connecticut
Tennessee
New Jersey
Illinois
MarylandMichigan
Massachusetts
Iowa
Virginia
Vermont
DelawareSouth Carolina
North Carolina
Rhode Island
West Virginia
California
New Mexico
Georgia
North Dakota
FloridaNew Hampshire
Louisiana
Mississippi
Montana
Washington
Maine
Arkansas
District of Columbia
Nebraska
Texas
Minnesota
AlaskaOhio
MissouriSouth Dakota
Indiana
NevadaOklahoma
Idaho
Colorado
Utah
AlabamaOregonArizona
WyomingKansas11

Youth Rankings
States with rankings 1-13 have a lower prevalence of mental illness and higher ratesof access to care for youth. States with rankings 39-51 indicate that youth havea higher prevalence of mental illness and lower rates of access to care.
The seven measures that make up the Youth Ranking include:
1. Youth with at Least One Major Depressive Episode (MDE) in the Past Year
2. Youth with Substance Use Disorder in the Past Year
3. Youth with Severe MDE
4. Youth with MDE Who Did Not Receive Mental Health Services
5. Youth with Severe MDE Who Received Some Consistent Treatment
6. Youth with Private Insurance That Did Not Cover Mental or Emotional
Problems
7. Students (K+) Identified with Emotional Disturbance for an Individualized
Education Program

Rank

State

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

District of Columbia
Delaware
Wisconsin
Pennsylvania
Massachusetts
New Jersey
New Hampshire
Connecticut
NevadaOklahoma
Colorado
Rhode Island
Illinois
MarylandVermont
South Carolina
Wyoming
North Dakota
Mississippi
New York
Minnesota
Georgia
Indiana
North Carolina
South Dakota
Iowa
Ohio
California
Arizona
Utah
Kentucky
Maine
FloridaNew Mexico
Michigan
MissouriAlabama
AlaskaMontana
Washington
Tennessee
Louisiana
HawaiiArkansas
West Virginia
Texas
Idaho
Virginia
Nebraska
KansasOregon12

Prevalence of Mental Illness
The scores for the six prevalence measures make up the Prevalence Ranking.
The six measures that make up the Prevalence Ranking include:
1. Adults with Any Mental Illness (AMI)
2. Adult with Substance Use Disorder in the Past Year
3. Adults with Serious Thoughts of Suicide
4. Youth with at Least One Major Depressive Episode (MDE) in the Past Year
5. Youth with Substance Use Disorder in the Past Year
6. Youth with Severe MDE

A ranking of 1-13 for Prevalence indicates a lower prevalence of mental health andsubstance use issues compared to states that ranked 39-51.

Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State
GeorgiaSouth Carolina
Texas
New Jersey
North Carolina
Delaware
FloridaMarylandWisconsin
Kentucky
New York
Hawaii
Mississippi
Pennsylvania
Tennessee
California
Connecticut
NevadaArkansas
District of Columbia
Indiana
Alabama
Massachusetts
Louisiana
MichiganOklahoma
Rhode Island
Iowa
Virginia
Missouri
Illinois
North Dakota
Colorado
AlaskaNew Hampshire
New Mexico
Wyoming
ArizonaWest Virginia
Ohio
Minnesota
Maine
Washington
Nebraska
Vermont
Utah
South Dakota
IdahoMontana
KansasOregon13

Access to Care Rankings
The Access Ranking indicates how much access to mental health care exists within astate. The access measures include access to insurance, access to treatment, quality
and cost of insurance, access to special education, and mental health workforce
availability. A high Access Ranking (1-13) indicates that a state provides relatively
more access to insurance and mental health treatment.
The nine measures that make up the Access Ranking include:
1. Adults with AMI Who Did Not
Receive Treatment
2. Adults with AMI Reporting Unmet
Need
3. Adults with AMI Who Are
Uninsured

6. Youth with Severe MDE Who
Received Some Consistent
Treatment
7. Youth with Private Insurance That
Did Not Cover Mental or Emotional
Problems

4. Adults Reporting 14+ Mentally

8. Students (K+) Identified with

Unhealthy Days a Month Who

Emotional Disturbance for an

Could Not See a Doctor Due to

Individualized Education ProgramCosts
5. Youth with MDE Who Did Not
Receive Mental Health Services

9. Mental Health Workforce
Availability

Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State
Vermont
Massachusetts
IllinoisMontana
District of Columbia
Pennsylvania
New Hampshire
Connecticut
Wisconsin
Rhode Island
Maine
South Dakota
Washington
Minnesota
Delaware
New Mexico
Iowa
North Dakota
New York
Michigan
Ohio
Utah
New Jersey
Kentucky
MarylandColorado
Oklahoma
AlaskaNebraska
OregonCalifornia
HawaiiWest Virginia
Virginia
Idaho
MissouriLouisiana
NevadaNorth Carolina
Tennessee
Wyoming
Mississippi
IndianaSouth Carolina
Arkansas
FloridaArizona
KansasGeorgia
AlabamaTexas

14

Adult Prevalence of Mental Illness

20.78% of adults experienced a mental

Adults with Any Mental Illness (AMI)

illness. Equivalent to over 50 million
Americans.
5.44% experienced a severe mental
illness.
While this measure cannot be compared tothe percentage of adults experiencing amental illness in last year’s report, it isconsistent with reported increases in distressduring the COVID-19 pandemic. According to
the U.S. Census Household Pulse Survey, thepercentage of adults reporting symptoms ofanxiety and depression increased from 11% toabout 40% from 2019 to 2020.1
The state prevalence of adultmental illness ranges from:17.49% (FL)
Ranked 1-13

Rank

State

%

#

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

FloridaGeorgia
Maryland
HawaiiTexas
New Jersey
Connecticut
New York
Pennsylvania
North Carolina
Tennessee
California
Virginia
DelawareIllinois
North Dakota
Iowa
Mississippi
New Mexico
Louisiana
AlabamaSouth Dakota
Missouri
NevadaMassachusetts
Maine

17.49
17.55
17.80
17.86
17.96
18.27
18.77
18.83
19.68
19.80
20.46
20.49
20.51
20.52
20.72
20.79
21.00
21.06
21.16
21.18
21.24
21.25
21.32
21.38
21.39
21.61

2,985,000
1,397,000
822,000
189,000
3,825,000
1,251,000
524,000
2,855,000
1,963,000
1,592,000
1,073,000
6,169,000
1,331,000
156,000
2,000,000
118,000
503,000
465,000
337,000
733,000
797,000
139,000
996,000
508,000
1,172,000
234,000

Rank

State

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

South Carolina
Indiana
Wisconsin
Kentucky
AlaskaMichigan
Arkansas
District of Columbia
Colorado
Minnesota
Nebraska
Montana
Wyoming
Vermont
New Hampshire
Arizona
Rhode Island
Ohio
Idaho
Washington
OklahomaKansasWest Virginia
OregonUtahNational

29.68 % (UT)
Ranked 39-51
%

#

21.69
21.83
21.83
21.91
22.20
22.33
22.61
22.95
23.16
23.23
23.41
23.43
23.63
23.71
23.74
23.89
24.12
24.32
24.92
25.51
25.59
26.02
26.05
27.33
29.68
20.78

862,000
1,109,000
982,000
742,000
117,000
1,729,000
514,000
131,000
1,028,000
997,000
335,000
195,000
103,000
120,000
260,000
1,339,000
202,000
2,177,000
333,000
1,500,000
752,000
560,000
366,000
909,000
675,000
52,173,000

According to SAMHSA, “Any mental illness (AMI) is defined as having a diagnosable mental, behavioral, or emotional disorder, other than adevelopmental or substance use disorder, as assessed by the Mental Health Surveillance Study (MHSS) Structured Clinical Interview for the
Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition—Research Version—Axis I Disorders (MHSS-SCID), which is based on the 4thedition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). These estimates are based on indicators of AMI rather than direct
measures of diagnostic status.”

15

Adults with Substance Use Disorder in the Past Year
15.35% of adults in America
reported having a substance use
disorder in the past year.
6.82% of adults in America had anillicit drug use disorder in the pastyear.
10.96% of adults in America had an
alcohol use disorder in the past year.
Of those reporting having a substance use
disorder in the past year, 93.5% did not receive
any form of treatment.2
This near absence of any form of treatment forindividuals with substance use disorder must be

The state prevalence of adults with
substance use disorder ranges from:11.31% (GA)21.21% (D.C.)
Ranked 1-13
Ranked 39-51

addressed, especially in light of the rise in
overdose deaths during the COVID-19 pandemic.
In 2020, there were 93,331 drug overdose deathsin the United States, a nearly 30% increase overthe number prior to the COVID-19 pandemic.3

Rank

State

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

Georgia
Texas
Utah
KentuckyNorth Carolina
HawaiiTennessee
South Carolina
Virginia
Indiana
FloridaArkansas
New York
West Virginia
Alabama
NevadaIdaho
MarylandOhio
New Jersey
Mississippi
Delaware
Iowa
Wisconsin
MissouriPennsylvania

%

#

11.31
11.93
12.64
12.98
13.48
13.77
13.94
14.08
14.53
14.61
14.81
14.85
14.88
14.93
14.94
14.95
15.02
15.27
15.36
15.37
15.47
15.57
15.73
15.88
15.93
15.94

906,000
2,564,000
291,000
441,000
1,092,000
145,000
734,000
564,000
947,000
745,000
2,541,000
339,000
2,250,000
210,000
563,000
360,000
204,000
706,000
1,377,000
1,052,000
341,000
120,000
378,000
717,000
746,000
1,589,000

Rank

State

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

Oklahoma
Arizona
North Dakota
Louisiana
AlaskaNew Mexico
Rhode Island
Connecticut
Illinois
California
Michigan
New Hampshire
Colorado
Minnesota
Maine
Massachusetts
Wyoming
Vermont
Nebraska
KansasSouth Dakota
Washington
OregonMontana
District of Columbia

National

%

#

16.07
16.25
16.37
16.43
16.57
16.58
16.66
16.66
16.69
16.70
16.72
17.00
17.25
17.26
17.32
17.41
17.57
17.69
18.00
18.42
18.55
18.59
19.13
19.22
21.21
15.35

474,000
923,000
93,000569,000
87,000265,000
140,000
465,000
1,607,000
5,027,000
1,295,000
186,000
771,000
742,000
188,000
955,000
77,00089,000258,000
398,000
122,000
1,100,000
639,000
161,000
122,000
38,679,000

According to SAMHSA, “Substance Use Disorder (SUD) data in 2020 are based on criteria from the Diagnostic and Statistical Manual of Mental
Disorders, 5th edition (DSM-5). SUD is defined as meeting the criteria for illicit drug or alcohol use disorder. SUD estimates are based on only 2020
data because prior years’ SUD data were based on DSM-IV criteria.”

16

Adults with Serious Thoughts of Suicide
The percentage of adults
reporting serious thoughts ofsuicide is 4.84%. The estimatednumber of adults with serious
suicidal thoughts is over 12.1
million.
11% of adults who identified as two or
more races reported serious thoughts ofsuicide in 20204 – 6% higher than the
average among all adults.
Utah has had the highest rate ofsuicidal ideation among adults every
year since 2012-2013. Utah also
continues to have a disproportionately
higher rate of suicidal ideation than any
other state. The percentage of adults

The state prevalence of adults with serious

reporting suicidal ideation in Utahthoughts of suicide ranges from:
3.92% (GA)
Ranked 1-13

Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

7.63% (UT)
Ranked 39-51

State

%

#

Rank

Georgia
New Jersey
Texas
FloridaNorth Carolina
District of Columbia
New York
California
Connecticut
South Carolina
Louisiana
Illinois
Tennessee
Virginia
New Hampshire
Hawaii
Mississippi
DelawareMaryland
Massachusetts
New Mexico
Michigan
Wisconsin
Pennsylvania
Kentucky
Alabama

3.92
4.12
4.18
4.26
4.30
4.30
4.34
4.39
4.40
4.42
4.50
4.54
4.58
4.58
4.62
4.62
4.65
4.65
4.67
4.74
4.82
4.84
4.85
4.86
4.89
4.96

313,000
283,000
892,000
727,000
346,000
25,000659,000
1,323,000
123,000
176,000
156,000
438,000
240,000
298,000
50,00049,000103,000
35,000216,000
260,000
77,000375,000
219,000
485,000
166,000
186,000

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

(ranked 51) is 0.83% higher than in
Oregon (ranked 50) – a larger difference
than between any other two states.

State

%

#

Maine
Rhode Island
Oklahoma
Nebraska
Iowa
Vermont
West Virginia
Missouri
NevadaArkansas
Washington
North Dakota
Indiana
Minnesota
Colorado
Ohio
Wyoming
South Dakota
AlaskaMontana
Idaho
KansasArizona
Oregon
Utah

5.12
5.17
5.24
5.35
5.38
5.40
5.42
5.47
5.52
5.59
5.62
5.62
5.82
5.96
6.01
6.01
6.02
6.08
6.15
6.24
6.27
6.44
6.48
6.80
7.63
4.84

56,00043,000154,000
77,000129,000
27,00076,000
256,000
131,000
127,000
331,000
32,000296,000
256,000
267,000
538,000
26,00040,00032,00052,00084,000139,000
364,000
226,000
174,000
12,151,000

National

17

Youth Prevalence of Mental Illness
Youth with at Least One Major Depressive Episode (MDE) in the Past Year
16.39% of youth (age 12-17) reported
suffering from at least one major
depressive episode (MDE) in the pastyear.
Youth experienced numerous
hardships during the COVID-19
pandemic. The CDC’s Adolescent
Behaviors and Experiences Survey(ABES) found that 67% of U.S. highschool students reported that
schoolwork was more difficult, 55%
experienced some emotional abuse in
the home, 11% experienced physicalabuse, and 24% reported they did nothave enough food to eat during the
COVID-19 pandemic,5 all of which can

The state prevalence of youth withhave a detrimental effect on mental

MDE ranges from:health.

21.13% (OR)
Ranked 39-51

12.57% (NJ)
Ranked 1-13
Rank

State

%

#

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

New Jersey
South Carolina
Pennsylvania
Wisconsin
DelawareGeorgia
California
KentuckyArkansas
Mississippi
MarylandIndiana
FloridaNorth Carolina
Connecticut
Rhode Island
Oklahoma
Michigan
NevadaNew York
Louisiana
District of Columbia
Wyoming
MissouriArizona
New Hampshire

12.57
13.41
14.04
14.16
14.24
14.49
14.83
14.89
14.97
15.08
15.37
15.45
15.51
15.56
15.64
15.90
15.97
15.99
16.02
16.03
16.18
16.32
16.78
16.84
16.90
17.02

84,00051,000127,000
63,00010,000127,000
447,000
51,00036,00037,00069,00083,000225,000
124,000
42,00011,00051,000119,000
38,000214,000
58,0005,000
8,000
79,00096,00016,000

Rank

State

%

#

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

Colorado
Texas
Iowa
Tennessee
Alabama
Massachusetts
North Dakota
West Virginia
KansasSouth Dakota
Illinois
Ohio
AlaskaHawaiiUtah
New Mexico
Minnesota
Virginia
Washington
Maine
Nebraska
Montana
Vermont
Idaho
Oregon

17.05
17.08
17.10
17.32
17.56
17.74
17.77
17.92
17.94
17.96
18.10
18.25
18.36
18.36
19.08
19.32
19.39
19.56
19.57
19.85
20.08
20.18
20.64
20.88
21.13
16.39

74,000429,000
42,00089,00065,00084,00010,00022,00043,00013,000177,000
162,000
10,00017,00061,00032,00086,000124,000
108,000
18,00032,00016,0008,000
33,00063,0004,087,000

National

18

Youth with Substance Use Disorder in the Past Year
6.34% of youth in the U.S.
reported a substance use
disorder in the past year.
2.85% had an alcohol use
disorder in the past year,
while 4.85% had an illicit
drug use disorder.
Georgia, North Carolina, South
Carolina, and Utah are all in the top
10 states with lowest prevalence of
substance use disorder for both youth
and adults.
South Dakota, Vermont, Oregon,
The state prevalence of youth with asubstance use disorder ranges from:Montana, and Kansas are all in thebottom 10 states with highest
prevalence of substance use disorder

9.05% (KS)
Ranked 39-51

3.94% (DC)
Ranked 1-13

Rank

State

%

#

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

District of Columbia
Georgia
NevadaAlaskaNorth Carolina
DelawareSouth Carolina
MarylandWisconsin
Utah
Minnesota
Texas
FloridaLouisiana
ArizonaOklahoma
HawaiiAlabamaTennessee
Washington
Arkansas
Colorado
Mississippi
New York
Indiana
Iowa

3.94
4.30
4.65
5.06
5.13
5.13
5.26
5.27
5.66
5.70
5.73
5.79
5.99
6.00
6.06
6.07
6.08
6.11
6.13
6.27
6.29
6.37
6.48
6.49
6.49
6.52

1,000
38,00011,0003,000
41,0004,000
20,00024,00025,00018,00025,000146,000
87,00022,00035,00020,0006,000
23,00032,00035,00015,00028,00016,00086,00035,00016,000for both youth and adults.

Rank

State

%

#

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

North Dakota
Kentucky
Rhode Island
California
Massachusetts
Ohio
MissouriPennsylvania
WyomingWest Virginia
Virginia
Idaho
Nebraska
Michigan
Illinois
New Jersey
South Dakota
New Hampshire
Maine
Connecticut
New Mexico
Vermont
OregonMontana
Kansas

6.53
6.59
6.60
6.64
6.77
6.81
6.81
6.85
6.90
6.96
6.99
7.06
7.13
7.14
7.19
7.26
7.37
7.46
7.46
7.50
7.75
7.91
7.97
8.60
9.05
6.34

4,000
22,0005,000
200,000
32,00060,00032,00062,0003,000
9,000
44,00011,00011,00053,00070,00049,000
5,000
7,000
7,000
20,00013,0003,000
24,0007,000
22,0001,584,000

National

According to SAMHSA, “Substance Use Disorder (SUD) data in 2020 are based on criteria from the Diagnostic and Statistical Manual of Mental
Disorders, 5th edition (DSM-5). SUD is defined as meeting the criteria for illicit drug or alcohol use disorder. SUD estimates are based on only 2020
data because prior years’ SUD data were based on DSM-IV criteria.”

19Youth with Severe Major Depressive Episode11.5% of youth (over 2.7 million
youth) are experiencing severe major
depression.
There are significant racial and geographic
disparities for youth with severe major
depressive episodes.
Rates of a severe major depressive
episode were highest among youth who
identified as more than one race, at
16.5% (about 123,000 youth).
The percentage of youth with severe
major depressive episode in South Dakota(ranked 51) is nearly four times the
The state prevalence of youth withpercentage of youth with severe MDE insevere MDE ranges from:
5.2% (SC)
Ranked 1-13
Rank

State

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

South Carolina
New Jersey
Mississippi
Wisconsin
Massachusetts
Pennsylvania
California
Kentucky
Rhode Island
Georgia
DelawareConnecticut
Oklahoma
District of Columbia
Arkansas
Tennessee
North Carolina
Wyoming
New York
Texas
Hawaii
Colorado
Indiana
Michigan
FloridaMarylandSouth Carolina (ranked 1).

19.9% (SD)
Ranked 39-51

%

#

5.20
7.50
8.10
8.50
8.80
9.20
9.20
9.30
9.90
10.00
10.10
10.20
10.30
10.60
10.60
10.60
10.60
10.70
10.80
10.80
10.90
10.90
11.20
11.30
12.30
12.40

19,00048,00019,00037,00040,00079,000269,000
30,0007,000
85,0007,000
26,00032,0003,000
25,00054,00082,0005,000
137,000
261,000
10,00046,00057,00083,000174,000
55,000

Rank

State

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

New Mexico
West Virginia
KansasArizona
Alabama
New Hampshire
Montana
North Dakota
NevadaMissouri
Vermont
Ohio
Washington
Illinois
AlaskaIowa
Minnesota
Nebraska
Virginia
Maine
Utah
Louisiana
Idaho
OregonSouth Dakota
National

%

#

12.80
13.00
13.00
13.10
13.20
13.30
13.40
13.60
13.80
13.80
13.90
13.90
14.00
14.40
14.80
15.00
15.20
15.70
15.70
16.30
16.40
16.60
17.50
19.00
19.90
11.50

21,00016,00030,00072,00048,00012,00010,0007,000
32,00064,0005,000
119,000
74,000136,000
8,000
36,00064,00023,00097,00014,00050,00059,00027,00055,00014,0002,782,000

According to SAMHSA, youth who experience a Major Depressive Episode (MDE) in the last year with severe role impairment (Youth with Severe MDE)
reported the maximum level of interference over four role domains including: chores at home, school or work, family relationships, and social life.

20

Adult Access to Care
Adults with AMI Who Did Not Receive Treatment

Over half (54.7%) of adults witha mental illness received notreatment.
Over 28 million individuals
experiencing a mental illness
are going untreated.

Of adults with a mental illness
who did not receive treatment in
the past year, 26.7% indicated.
that they had experienced serious
psychological distress in the pastmonth.

The state prevalence of untreatedadults with mental illness ranges
40.6% (MT)
Ranked 1-13

Rank

State

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

Montana
Nebraska
Massachusetts
Vermont
ArkansasSouth Dakota
New Mexico
Tennessee
Wisconsin
Iowa
Virginia
North Dakota
Delaware
New Hampshire
Michigan
Rhode Island
Minnesota
Missouri
Washington
Utah
South Carolina
West Virginia
Illinois
North Carolina
Indiana
Idaho

%

#

40.60
42.40
42.80
43.10
45.50
45.80
46.40
46.40
46.80
47.20
47.40
48.40
48.40
49.20
49.40
49.60
49.80
50.00
50.00
50.40
50.50
50.80
50.90
51.10
51.20
51.60

78,000138,000
500,000
49,000230,000
55,000157,000
470,000
443,000
222,000
630,000
52,00076,000141,000
870,000
99,000505,000
461,000
765,000
360,000
467,000
201,000
980,000
762,000
530,000
171,000

from:

69.1% (HI)
Ranked 39-51

Rank

State

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

KentuckyPennsylvania
KansasLouisiana
Maine
OklahomaWyoming
OregonAlaskaMarylandDistrict of Columbia
Colorado
Ohio
Connecticut
Mississippi
New Jersey
Georgia
New York
FloridaNevadaTexas
Alabama
California
Arizona
HawaiiNational

.

%

#

51.80
51.80
52.30
52.90
53.50
53.50
54.00
54.10
54.90
55.00
55.50
55.50
55.60
55.80
56.10
56.20
57.80
58.00
58.40
61.40
62.30
62.40
62.60
63.50
69.10
54.70

378,000
1,006,000
320,000
385,000
127,000
457,000
56,000494,000
61,000422,000
75,000570,000
1,232,000
248,000
273,000
677,000
722,000
1,637,000
1,679,000
309,000
2,306,000
478,000
3,757,000
854,000
130,000
28,066,000

21Adults with AMI Reporting Unmet Need
Almost a third (28.2%) of all adults with a mental
illness reported that they were not able to receive thetreatment they needed.
Individuals reporting unmet need are those seeking
treatment and facing barriers to getting the help theyneed.
Cost of care remains a significant barrier for many
individuals in the U.S. Most adults with AMI whoreported unmet need for treatment indicated thatthey did not receive care because they could notafford it (42%).
This was followed by:••

Not knowing where they could go to get
services (27%)
Thinking they could handle their mental

The state prevalence of adults with AMI
reporting unmet treatment needs ranges from:health without treatment (26%)•

Not having the time to get treatment (19%)•

Health insurance not paying enough for

38.8% (IN)
Ranked 39-51

18.4% (WV)
Ranked 1-13

mental health treatment (17%)
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

State
West Virginia
Hawaii
Wisconsin
South Carolina
Washington
New Jersey
Nebraska
Kentucky
New York
Pennsylvania
Mississippi
Montana
Iowa
Michigan
Illinois
Oklahoma
North Carolina
Vermont
Connecticut
New Hampshire
Minnesota
Wyoming
South Dakota
Maine
Rhode Island
California

%

#

Rank

18.40
20.20
20.90
21.30
21.70
22.90
23.00
23.00
24.00
24.70
24.80
24.90
25.40
25.90
25.90
26.00
26.30
26.60
26.60
26.70
26.70
27.20
27.40
27.40
27.70
27.80

73,00038,000198,000
197,000
331,000
277,000
76,000168,000
681,000
477,000
121,000
48,000120,000
455,000
501,000
222,000
393,000
30,000118,000
77,000270,000
28,00033,00065,00056,0001,672,000

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State

%

#

North Dakota
Ohio
Arkansas
Louisiana
Georgia
FloridaMissouri
Texas
AlaskaDelaware
Massachusetts
Tennessee
Virginia
District of Columbia
Idaho
Maryland
Oregon
New Mexico
Utah
Colorado
AlabamaKansasArizona
NevadaIndiana

28.20
28.30
28.70
29.10
29.10
29.10
29.60
29.60
29.80
30.90
31.10
31.40
31.50
32.20
32.20
32.50
32.60
32.90
34.10
34.20
35.40
35.80
36.00
37.60
38.80

National

28.20

30,000628,000
146,000
211,000
363,000
838,000
274,000
1,101,000
33,00049,000364,000
323,000
417,000
44,000107,000
249,000
297,000
112,000
244,000
353,000
271,000
219,000
484,000
189,000
406,000
14,476,000

22Adults with AMI Who Are Uninsured

The state prevalence of uninsured adults
with mental illness ranges from:
24.7% (WY)4.1% (RI)
Ranked 39-51
Ranked 1-13

10.8% (over 5.5 million) of adults with a mental illness areuninsured.
There are large disparities in access to health care coverage in the U.S.
Hispanic adults with AMI were least likely to have health insurance,with 19% reporting they were not covered by insurance. Despite
participating in the workforce at higher rates than non-Hispanic
populations, Hispanic adults are less likely to receive employersponsored health insurance and are more likely to enroll in Medicaid.
The uninsured rate among Hispanic individuals increased from 20172020, and Hispanic adults were significantly more likely to delay careduring COVID-19 than non-Hispanic adults.

6

The expansion of Medicaid can reduce these disparities in access tocare. Medicaid expansion has been found to reduce racial disparities inhealth care coverage particularly for Black and Hispanic adults7 and isassociated with significant reductions in the percentage of adults withdepression who are uninsured and who delay mental health carebecause of cost.8
Every state ranked 40-51 on this indicator, except Arizona andMaine, had not expanded Medicaid by 2019-2020. Among these
non-expansion states, 10-30% of the remaining uninsured population

Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State

Rate

#

Rhode Island

4.10

8,000

Massachusetts

4.60

54,000Kentucky

4.70

34,000District of Columbia

5.60

8,000

New York

5.60

158,000

Vermont

5.80

7,000

Wisconsin

5.80

55,000Connecticut

6.00

27,000Illinois

6.30

122,000

Virginia

6.50

87,000Michigan

6.70

117,000

Alaska

6.80

8,000

Maryland

6.90

53,000Pennsylvania

6.90

134,000

Hawaii

7.10

14,000

Washington

7.20

111,000

California

7.50

456,000

Montana

7.90

15,000Utah

7.90

57,000

North Dakota

8.30

9,000

Delaware

8.30

13,000Tennessee

9.30

95,000Iowa

9.40

44,000West Virginia

10.00

40,000

Nevada10.00

51,000

Oregon10.20

94,000

Ohio

10.20

226,000

New Mexico

10.40

36,000Colorado

10.40

107,000

Louisiana

11.00

80,000

Idaho

12.10

40,000Arkansas

12.20

62,000Minnesota

12.20

124,000

Oklahoma

12.30

105,000

New Jersey

12.70

155,000

Mississippi

13.20

64,000South Carolina

13.20

122,000

New Hampshire

13.40

38,000Indiana

13.50

142,000

Florida13.60

393,000

South Dakota

13.90

17,000

Maine

14.10

34,000

Arizona

14.90

202,000

Nebraska

15.50

51,000

North Carolina

15.80

236,000

Missouri

16.70

155,000

Georgia

17.40

218,000

Kansas17.50

107,000

Alabama

17.90

138,000

Texas

21.40

798,000

Wyoming

24.70

26,000National

10.80

5,544,000

fall within the Medicaid coverage gap.923

Adults Reporting 14+ Mentally Unhealthy Days a Month Who Could Not See a Doctor Due toCosts
22.87% of adults who reported experiencing 14 or morementally unhealthy days each month were not able tosee a doctor due to costs.
Mentally unhealthy days are derived from the question,“Now thinking about your mental health, which includes
stress, depression, and problems with emotions, for how
many days during the past 30 days was your mental healthnot good?” Having 14 or more mentally unhealthy days
each month is defined as experiencing frequent mental
distress.10
Frequent mental distress has been associated with mental
health conditions, chronic illnesses, limitations infunctioning, adverse health behaviors, and increased

The prevalence of adults with 14+ mentally

utilization of health services.11 If individuals experiencing

unhealthy days who could not see a doctor

frequent mental distress are unable to afford care, they are

due to cost ranges from:34.35% (GA)11.57% (HI)
Ranked 1-13
Ranked 39-51

even more likely to develop chronic conditions, utilize highend health care services, and experience increased
morbidity and mortality.
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

State

%

#

Rank

HawaiiPennsylvania
District of Columbia
Connecticut
KentuckyMichiganCalifornia
Vermont
Rhode Island
MarylandNew York
Iowa
Maine
Illinois
Massachusetts
New Mexico
Ohio
Tennessee
New Hampshire
Minnesota
Washington
OregonWisconsin
West Virginia
New Jersey
Delaware

11.57
14.75
14.83
15.35
16.39
16.83
17.00
17.16
17.92
18.13
18.27
18.87
19.27
19.29
20.24
20.29
20.54
20.58
20.77
20.80
20.92
21.03
21.32
21.44
21.63
21.71

13,648
209,776
12,14053,772
97,416
205,536
658,424
12,194
19,965
102,697348,382
58,543
26,122
186,001
142,667
42,779277,247
173,910
31,115
108,531
171,306
96,908120,787
52,220
182,587
20,550

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State
NevadaUtahMontana
AlaskaColorado
North Dakota
Indiana
ArizonaIdaho
Virginia
Louisiana
South Dakota
Nebraska
North Carolina
KansasMissouriMississippi
AlabamaSouth Carolina
Arkansas
Oklahoma
FloridaTexas
Wyoming
Georgia

National

%

#

21.80
22.77
23.08
23.10
23.13
23.29
23.46
23.60
24.17
24.85
25.66
26.23
26.77
27.03
27.21
27.35
28.18
28.70
29.06
29.26
29.48
30.07
31.51
34.22
34.35
22.87

90,99578,44424,917
12,323
133,747
15,270182,826
179,024
41,330200,556
155,523
16,433
46,180285,52282,583
196,596
90,084
171,538
172,836
118,943
135,994
635,806
893,651
17,878397,790
7,863,573

24

Youth Access to Care
Youth with MDE Who Did Not Receive Mental Health Services
59.8% of youth with major depression do notreceive any mental health treatment.
Asian youth with MDE were least likely to receive
specialty mental health care, with 78% reporting
they did not receive mental health services in thepast year. This was followed by 68% of
multiracial youth and 68% of Black or African
American youth with MDE who did not receive
care.
In Kentucky, Hawaii, and Texas, three-quartersof youth with major depression did not receive
mental health treatment. In South Carolina, thelowest ranking state, nearly 8 in 10 youth with
The state prevalence of untreateddepression do not receive care.

youth with depression ranges from:

77.1% (SC)
Ranked 39-51

32.6% (DC)
Ranked 1-13

Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

State

%

#

Rank

District of Columbia
Colorado
New Hampshire
Montana
New Mexico
Illinois
Connecticut
South Dakota
UtahNorth Dakota
Idaho
Delaware
Maine
Wyoming
NevadaVermont
Louisiana
New York
Wisconsin
AlabamaOhio
New Jersey
Mississippi
Pennsylvania
Arkansas
Alaska

32.60
34.40
35.90
37.10
38.30
39.90
42.90
43.40
44.40
44.90
47.80
47.90
49.70
50.40
50.70
51.00
52.80
53.10
53.40
53.50
53.50
54.10
54.50
54.60
55.10
55.60

1,000
20,0006,000
5,000
11,00065,00016,0007,000
26,0005,000
18,000
4,000
8,000
3,000
22,0003,000
37,000105,000
23,00031,00086,00036,00020,00059,00022,000
6,000

27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State
Indiana
Arizona
Kansas
Iowa
Minnesota
Oklahoma
Washington
Maryland
Virginia
MichiganNorth Carolina
FloridaRhode Island
Nebraska
Massachusetts
OregonMissouriGeorgiaWest Virginia
California
Tennessee
Kentucky
Hawaii
Texas
South Carolina

National

%

#

55.60
55.90
56.50
56.50
56.80
57.40
57.70
59.20
60.20
60.30
61.70
61.80
62.10
63.70
63.90
64.30
65.30
66.60
68.80
69.50
71.10
74.70
74.90
74.90
77.10
59.80

39,00051,00023,00025,00054,00023,00061,00047,00090,00071,00064,000146,000
7,000
19,00047,00043,00049,00076,00016,000287,000
72,00029,00012,000306,000
29,0002,331,000

25Youth with Severe MDE Who Received Some Consistent Treatment
Nationally, only 28% of youth with severe
depression receive some consistent treatment (725+ visits in a year).
Consistent treatment is determined if a youth visits a
specialty outpatient mental health service, including
a day treatment facility, mental health clinic, private
therapist, or in-home therapist more than seventimes in the previous year. According to theAmerican Academy of Child and Adolescent
Psychiatry, all patients should be seen at least
monthly for six to 12 months following their initial
treatment.12
High percentages are associated with

Even in South Dakota, the top ranked state, only 58%

positive outcomes and low percentagesof youth receive care seven times, the minimum level

are associated with poorer outcomes.

of consistent care. In Kansas, only 6.5% of youth withdepressive episodes that have severely impacted

The state prevalence of youth with severefunctioning receive consistent care.

depression who received some outpatient

treatment ranges from:

14.7% of youth with severe MDE received 1-6 visits in

58.1% (SD)
Ranked 1-13

the previous year. Most (57.3%) youth with severe
depression do not receive any care.
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

State
South Dakota
Colorado
North Dakota
New Hampshire
Massachusetts
DelawareIllinois
Oklahoma
Alabama
New Mexico
Maine
New Jersey
Montana
Vermont
Ohio
Pennsylvania
Virginia
MarylandIdaho
New York
District of Columbia
Wyoming
NevadaUtah
Washington
Minnesota

%

#

58.10
57.40
51.20
46.80
46.30
45.30
44.70
44.70
44.60
43.20
43.20
42.50
39.70
39.60
38.60
38.10
34.90
34.50
34.10
34.00
34.00
33.30
33.00
32.50
30.70
30.70

8,000
27,0004,000
5,000
17,0003,000
56,00014,00021,0008,000
6,000
18,0003,000
2,000
45,00025,00033,00018,0009,000
45,0001,000
1,000
10,00014,00021,00019,000

Rank
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

6.5% (KS)
Ranked 39-51

State
Wisconsin
Iowa
FloridaCalifornia
Mississippi
ArizonaSouth Carolina
MichiganConnecticut
Indiana
MissouriNorth Carolina
AlaskaArkansas
West Virginia
Georgia
Kentucky
Nebraska
Rhode Island
Tennessee
OregonTexas
Louisiana
HawaiiKansasNational

%

#

30.60
30.20
26.50
25.40
24.30
24.20
24.20
23.60
22.30
22.10
21.20
19.70
19.70
19.50
18.00
17.40
16.40
16.00
13.90
13.70
13.00
12.70
12.10
11.40
6.50
28.00

10,00010,00045,00068,0005,000
17,000*19,000
6,000
12,00013,00014,000
2,000
4,000
3,000
14,000
5,000
3,000
1,000
7,000
7,000
33,000
4,000
1,000
2,000
738,000*Data from South Carolina was suppressed due to small sample size. Ranking based on 2018-2019 figure.

26

Youth with Private Insurance That
Did Not Cover Mental or Emotional Problems

The state prevalence of youth lacking mental healthcoverage ranges from:
1.4% (RI)
23.2% (AR)Ranked 1-13
Ranked 39-51
Nationally, 1 in 10 youth who are covered under private insurance do nothave coverage for mental or emotional difficulties – totaling over 1.2
million youth.
In Arkansas (ranked 51), nearly one-quarter of youth with private insurance
do not have coverage for mental health care.
The Mental Health Parity and Addiction Equity Act (MHPAEA), enacted in
2008, requires that a private insurer cannot have more restrictive
requirements for mental health than for physical health (if benefits formental health are included in the plan). It does not require private insurers
to cover mental health services. While the Affordable Care Act (ACA),
enacted in 2010, requires insurance plans offered on the Health InsuranceMarketplace to include coverage for mental health services, there are
exemptions for short-term plans that may not cover mental health services.
As a result of MHPAEA not requiring mental health coverage and loopholes
in ACA, there are still many individuals who are covered by insurance plansthat may not cover mental health services. In 2019, about 3 million
individuals were enrolled in short-term plans that do not have to comply
with ACA standards.13
Unfortunately, ensuring that insurance covers mental health care does notmean that an individual can access mental health care. Even among youth

Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State

%

#

Rhode Island

1.40

1,000

Missouri

4.20

11,000Illinois

5.30

29,000Massachusetts

5.70

16,000Connecticut

5.90

10,000Utah

5.90

12,000South Dakota

6.20

3,000

District of Columbia

6.80

1,000

Nevada7.00

10,000Wyoming

7.10

2,000

Kentucky

7.50

13,000

New Jersey

7.60

31,000Tennessee

7.70

20,000

Hawaii

8.10

4,000

Iowa

8.10

11,000

New Hampshire

8.20

5,000

Oregon8.20

14,000Maryland

8.20

20,000

Arizona

8.20

22,000

California

8.20

114,000

Montana

8.40

3,000

Pennsylvania

8.40

38,000Ohio

8.40

39,000

Washington

8.60

23,000Oklahoma

8.70

11,000

North Carolina

8.70

33,000

Delaware

9.00

3,000

Maine

9.10

4,000

Alaska

9.60

3,000

Minnesota

9.60

25,000Michigan

9.60

42,000

Vermont

9.70

2,000

West Virginia

9.70

6,000

Wisconsin

9.90

26,000Louisiana

10.00

16,000Kansas10.30

10,000

Nebraska

10.90

9,000

South Carolina

10.90

20,000

New Mexico

11.20

7,000

Florida11.40

68,000

New York

11.70

78,000Mississippi

12.10

9,000

Indiana

12.10

35,000Georgia

13.20

52,000

Idaho

13.40

12,000Alabama

13.80

22,000

North Dakota

14.30

5,000

Virginia

17.00

61,000Colorado

17.20

40,000

Texas

19.40

205,000

Arkansas

23.20

27,000National

10.30

1,281,000

with MDE who have private insurance that covers mental health, 53% do notreceive care. Among those whose insurance did not cover mental healthservices, 64.1% did not receive care.
27

Students (K+) Identified with Emotional Disturbancefor an Individualized Education ProgramHigh percentages
are associated withpositive outcomes
and low
percentages areassociated withpoorer outcomes.

The state rate of students identified as having an
emotional disturbance (ED) for an individual education
program (IEP) ranges from:1.82 (AL)30.60 (VT)
Ranked 39-51
Ranked 1-13
Only .718 percent* of students are identified as having an ED for IEP.
For purposes of an IEP, the term “Emotional Disturbance” is used to define youth witha mental or behavioral health condition that is affecting their educational
performance. IEPs are critical for ensuring that youth with disabilities can receive theindividualized services, supports, and accommodations to succeed in a school setting.
However, without sufficient resources for schools and teachers to help students withmental health conditions, identification of students with emotional disturbance may
contribute to disparities for marginalized youth. Of note, 7.25% of all multiracial youth
with a disability and 6.73% of Black youth with a disability were identified withemotional disturbance, compared to 5.15% of all students. Youth identified with ED
were also more likely to live in households below the poverty line14 and often haveexperienced trauma, which may underly behavioral difficulties identified as emotional
disturbance.
Youth identified with ED are also much more likely to experience disciplinary removals
than students with any other disability. In 2019-2020, there were 291,261 disciplinary
removals for students with emotional disturbance, totaling 0.84 removals for every one
student with ED. Among students of all disabilities, the average rate is only 0.22
removals for every one student with a disability.15 Schools must be given the resources
they need to appropriately address trauma and mental distress among students.
Research has shown that when implemented correctly, practices such as restorative
justice in schools can reduce exclusionary discipline and narrow disparities for youth ofcolor.16 Investing in programs such as community schools can also help to provide
social services and resources to support whole families and prevent mental healthconditions.

Rank*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State

Rate

#

Vermont

30.60

2,317

Minnesota

19.80

16,848Massachusetts

19.14

17,230Pennsylvania

15.37

26,081

Wisconsin

14.78

11,575

Maine

14.57

2,444

Iowa

13.31

*

Indiana

12.03

12,236

New Hampshire

11.67

1,937

North Dakota

11.50

1,290

Connecticut

11.41

5,636

Rhode Island

11.29

1,546

Illinois

9.76

17,797

Oregon

9.67

5,425

Nebraska

9.39

2,881

District of Columbia

9.34

728

Ohio

9.14

14,768South Dakota

8.67

1,182

Delaware

8.56

1,164

Missouri

8.25

7,056

New York

8.19

20,857

Virginia

7.73

9,463

Michigan

7.63

10,702

Texas

7.25

37,375

Kentucky

7.03

4,489

Mississippi

6.88

3,005

Arizona

6.87

7,547

Maryland

6.54

5,615

Colorado

6.29

5,390

Wyoming

6.26

577

Montana

5.92

857

New Mexico

5.90

1,821

Oklahoma

5.90

3,877

Georgia

5.77

9,731

Alaska5.74

725

Hawaii

5.19

907

Washington

5.16

5,510

Kansas

5.14

2,377

New Jersey

5.13

6,760

Florida4.70

12,875

Idaho

4.61

1,404

Nevada

4.39

2,077

California

4.06

24,370West Virginia

3.97

956

Tennessee

3.41

3,272

North Carolina

3.33

4,976

South Carolina

2.81

2,098

Louisiana

2.74

*

Utah

2.66

1,776

Arkansas

2.28

1,080

Alabama
National

1.82

1,303

7.18

345,350*Data from Louisiana and Iowa were suppressed due todata quality concerns. Ranking based on 2019 figure
for Louisiana and 2018 figure for Iowa.

The rates in the table for this measure are shown as a rate per 1,000 students. The calculation was made this way for ease of reading. Unfortunately,
doing so hides the fact that the percentages are significantly lower.

28

Mental Health Workforce Availability

The state rate of mental healthworkforce ranges from:
140:1 (MA)
Ranked 1-13

850:1 (AL)
Ranked 39-51

In the U.S., there are 350 individuals for every one mental healthprovider. The term “mental health provider” includes psychiatrists,
psychologists, licensed clinical social workers, counselors, marriage and family
therapists, and advanced practice nurses specializing in mental health care.
As of June 2022, over 152 million people lived in a mental health workforce
shortage area, and only 28% of the mental health need in shortage areas was
being met by mental health providers.17
This measure is only indicative of the physical presence of mental healthproviders. It does not account for whether these providers are able to accept
patients, are accepting insurance or providing in-network care, or are culturally
or linguistically representative of the communities they work in. County Health
Rankings, the source of the data for this indicator, notes that these figures may
be an overestimate of active mental health professionals, as it may include
providers who are no longer practicing or accepting new patients.18
The mental health workforce shortage cannot be addressed without revaluing
provider reimbursement. Low reimbursement rates for mental health providers
drive practitioners to other specialties and increases out-of-network
participation. In 2017, 17.2% of behavioral health office visits were to an outof-network provider, compared to 3.2% of primary care providers and 4.3% of
medical/surgical specialists.19 With a growing demand for mental healthservices, a shortage of mental health providers, and an increase in out-ofnetwork participation, the system is built such that only people withhigher incomes can afford to receive care.

Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

State

#

Massachusetts

140:1

Alaska160:1

Oregon170:1

District of Columbia

180:1

Maine

190:1

Vermont

200:1

Rhode Island

220:1

Connecticut

230:1

Washington

230:1

California

240:1

New Mexico

240:1

Oklahoma

240:1

Colorado

250:1

Wyoming

270:1

Utah

280:1

New Hampshire

290:1

Montana

300:1

Louisiana

310:1

New York

310:1

Maryland

330:1

Michigan

330:1

Delaware340:1

Minnesota

340:1

Nebraska

340:1

Ohio

350:1

Hawaii360:1

North Carolina

360:1

Illinois

370:1

New Jersey

380:1

Kentucky390:1

Arkansas

400:1

Nevada420:1

Pennsylvania

420:1

Idaho

440:1

Wisconsin

440:1

Missouri

460:1

Kansas470:1

North Dakota

470:1

Virginia

480:1

South Dakota

500:1South Carolina

520:1

Mississippi

540:1

Florida550:1

Indiana

560:1

Iowa

570:1

Tennessee

590:1

Georgia

640:1

Arizona

660:1

West Virginia

670:1

Texas

760:1

Alabama

850:1

National

350:1

29

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Panchal, N, Kamal, R, Cox, C & Garfield, R. (2021). The implications of COVID-19 for mental health and substanceuse. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19for-mental-health-and-substance-use/

2.

SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2019 andQuarters 1 and 4, 2020. Table 5.18B. Retrieved from https://www.samhsa.gov/data/report/2020-nsduh-detailedtables

3.

Panchal, N, Garfield, R, Cox, C & Artiga, S. (2021). Substance use issues are worsening alongside access to care.
Kaiser Family Foundation. https://www.kff.org/policy-watch/substance-use-issues-are-worsening-alongside-accessto-care/

4.

SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008-2019,
and Quarters 1 and 4, 2020. Table 10.31B. Retrieved from https://www.samhsa.gov/data/report/2020-nsduhdetailed-tables

5.

The Centers for Disease Control and Prevention Division of Adolescent and School Health (2021). Adolescent
Behaviors and Experiences Survey (ABES). The Centers for Disease Control and Prevention.
https://www.cdc.gov/healthyyouth/data/abes/tables/summary.htm#

6.

Office of the Assistant Secretary for Planning and Evaluation (2021). Issue Brief No. HP-2021-2: Health insurance
coverage and access to care among Latinos: Recent trends and key challenges. U.S. Department of Health andHuman Services.
https://aspe.hhs.gov/sites/default/files/documents/68c78e2fb15209dd191cf9b0b1380fb8/ASPE_Latino_Health_Cove
rage_IB.pdf

7.

Guth, M., Artiga, S., & Pham, O. (September 2020). Effects of the ACA Medicaid Expansion on Racial Disparities in
Health and Health Care. Kaiser Family Foundation, https://www.kff.org/medicaid/issue-brief/effects-of-the-acamedicaid-expansion-on-racial-disparities-in-health-and-health-care/

8.

Fry, C.E. & Sommers, B.D. (August 2018). Effect of Medicaid Expansion on Health Insurance Coverage and Access toCare Among Adults with Depression. Psychiatric Services, 69(11): 1146-1152.
https://doi.org/10.1176/appi.ps.201800181

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Kaiser Family Foundation (2021). Distribution of eligibility for ACA health coverage among the remaining uninsured.
Kaiser Family Foundation, https://www.kff.org/health-reform/state-indicator/distribution-of-eligibility-for-acacoverage-among-the-remaining-uninsured/

10. Reeves, WC et al. (2011). Mental illness surveillance among adults in the United States. Centers for Disease Control
and Prevention, MMWR 2011;60(Suppl). https://www.cdc.gov/mmwr/pdf/other/su6003.pdf
11. Cree, RA, Okoro, CA, Zack, MM & Carbone E (2020). Frequent mental distress among adults, by disability status,
disability type, and selected characteristics – United States, 2018. MMWR Morbidity and Mortality Weekly Report,
69(36):1238-1243. http://dx.doi.org/10.15585/mmwr.mm6936a2
12. Birmaher, B & Brent, D (2007). Practice parameter for the assessment and treatment of children and adolescentswith depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry, AACAP Official
Action, 46(11):1503-1526. https://doi.org/10.1097/chi.0b013e318145ae1c
13. U.S. House of Representatives Committee on Energy and Commerce (2020). Shortchanged: How the Trumpadministration’s expansion of junk short-term health insurance plans is putting Americans at risk.
https://drive.google.com/file/d/1uiL3Bi9XV0mYnxpyaIMeg_Q-BJaURXX3/view
14. Wagner, M., Kutash, K., Duchnowski, A.J., Epstein, M.H. & Sumi, W.C. (2005). The Children and Youth We Serve: A
National Picture of the Characteristics of Students with Emotional Disturbances Receiving Special Education. Journalof Emotional and Behavioral Disorders, 13(2): 79-96. Retrieved fromhttps://journals.sagepub.com/doi/abs/10.1177/10634266050130020201?journalCode=ebxa

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15. U.S. Department of Education, EDFacts Data Warehouse (EDW), 2019-2020: "IDEA Part B Discipline Collection."
Retrieved from https://data.ed.gov/dataset/idea-section-618-state-part-b-discipline
16. Gregory, A & Evans, KR. (2020). The starts and stumbles of restorative justice in education: Where do we go fromhere? National Education Policy Center, School of Education, University of Colorado Boulder,
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17. Health Resources and Services Administration (HRSA) Bureau of Health Workforce (June 2022). Third Quarter of
Fiscal Year 2022 Designated Health Professional Shortage Area Quarterly Summary. Retrieved fromhttps://data.hrsa.gov/topics/health-workforce/shortage-areas
18. County Health Rankings and Roadmaps (2022). County Health Rankings Model - Mental Health Providers. Retrieved
from https://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-healthrankings-model/health-factors/clinical-care/access-to-care/mental-health-providers
19. Melek, S., Davenport, S. & Gray, T.J. (November 19, 2019). Addiction and mental health vs. physical health: Widening
disparities in network use and provider reimbursement. Milliman Research Report. Available athttps://www.milliman.com//media/milliman/importedfiles/ektron/addictionandmentalhealthvsphysicalhealthwideningdisparitiesinnetworkusea
ndproviderreimbursement.ashx

31

Glossary
Indicator

Description of Measure

SourceAdults with
Any Mental
Illness (AMI)

Any mental illness (AMI) is defined as having a diagnosable mental,
behavioral, or emotional disorder, other than a developmental or substanceuse disorder, assessed by the Mental Health Surveillance Study (MHSS)
Structured Clinical Interview for the Diagnostic and Statistical Manual of
Mental Disorders — Fourth Edition — Research Version Axis I Disorders(MHSS-SCID), which is based on the 4th edition of the Diagnostic andStatistical Manual of Mental Disorders (DSM-IV). For details, see Section Bof the "2019-2020 NSDUH: Guide to State Tables and Summary of Small
Area Estimation Methodology" at www.samhsa.gov/data.

SAMHSA, Center for
Behavioral Health
Statistics and Quality,
National Survey on Drug
Use and Health,

https://www.samhsa.go
v/data/nsduh/statereports-NSDUH-2020

Data survey years: 2019-2020.

Adults with
AMI
ReportingUnmet NeedThe variable, AMIYR_U is an indicator for any mental illness (AMI) based on
the 2012 revised predicted probability of SMI (SMIPP_U). If SMIPP_U isgreater than or equal to a specified cutoff point (0.0192519810) then
AMIYR_U=1, and if SMIPP_U is less than the cutoff point then AMIYR_U=0.
This indicator based on the 2012 model is not comparable with theindicator based on the 2008 model. AMI is defined as having serious,
moderate, or mild mental illness. Specific details about this variable can befound in the Recoded Mental Health Appendix.

SAMHSA, Center for
Behavioral Health
Statistics and Quality,
National Survey on Drug
Use and Health,

https://www.samhsa.go
v/data/nsduh/statereports-NSDUH-2020

AMHTXND2 is defined as feeling a perceived need for mental healthtreatment/counseling that was not received. This is often referred to as"unmet need." Mental health treatment/counseling is defined as having
received inpatient treatment/counseling or outpatient
treatment/counseling or having used prescription medication for problems
with emotions, nerves, or mental health. Respondents were not to include
treatment for drug or alcohol use. Respondents with unknown
treatment/counseling information were excluded.
Data survey years: 2019-2020.
Adults with
AMI Who Are
Uninsured

For IRINSUR4, a respondent is classified as having any health insurance(IRINSUR4=1) if they satisfied ANY of the following conditions:
1. Covered by Medicare (IRMEDICR=1); 2. Covered by Medicaid/CHIP(IRMCDCHP=1); 3. Covered by Tricare, Champus, ChampVA, VA, or Military(IRCHMPUS=1); 4. Covered by private insurance (IRPRVHLT=1); 5. Coveredby other health insurance (IROTHHLT=1).
A respondent is classified as NOT having any health insurance(IRINSUR4=2) if they meet EVERY one of the following conditions:
1. Not covered by Medicare (IRMEDICR=2); 2. Not covered by
Medicaid/CHIP (IRMCDCHP=2); 3. Not covered by Tricare, Champus,
ChampVA, VA, or Military (IRCHMPUS=2); 4. Not covered by private
insurance (IRPRVHLT=2); 5. Not covered by other health insurance(IROTHHLT=2).

SAMHSA, Center for
Behavioral Health
Statistics and Quality,
National Survey on Drug
Use and Health,

https://www.samhsa.go
v/data/nsduh/statereports-NSDUH-2020

Data survey years: 2019-2020.

32

Indicator

Description of Measure

SourceAdults with
Substance Use
Disorder in
the Past Year

NOTE: Substance use disorder data in 2020 are based on criteria from the
Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM5). Substance use disorder is defined as meeting the criteria for illicit drugor alcohol use disorder. Substance use disorder estimates are based only
on 2020 data because prior years’ substance use disorder data were basedon DSM-IV criteria.

SAMHSA, Center for
Behavioral Health
Statistics and Quality,
National Survey on Drug
Use and Health,

Data survey years: 2020.

AdultsReporting 14+
Mentally
Unhealthy
Days a Month
Who Could
Not See aDoctor Due to
Costs

This indicator is derived from the Centers for Disease Control andPrevention Behavioral Risk Factor Surveillance System (BRFSS) corequestionnaire. Mentally unhealthy days were determined using the
calculated variable _MENT14D. _MENT14D is calculated from the following
BRFSS question: “Now thinking about mental health, which includes stress,
depression, and problems with emotions, for how many days during thepast 30 days was your mental health not good?” (MENTHLTH). The
calculated variable, _MENT14D, contains four values: Zero days whenmental health was not good, 1-13 days when mental health was not good,
14+ days when mental health was not good, and don’t
know/refused/missing.

https://www.samhsa.gov/data/nsduh/statereports-NSDUH-2020

Centers for Disease
Control and Prevention
Behavioral Risk Factor
Surveillance System
Survey Data 2020,

https://www.cdc.gov/brf
ss/annual_data/annual_2
020.html
Downloaded andcalculated on 8/8/22.

Respondents were also asked: “Was there a time in the past 12 months
when you needed to see a doctor but could not because of cost?”(MEDCOST). The measure was calculated based on individuals who
answered “yes” to MEDCOST among those who answered “14+ days whenmental health was not good” to _MENT14D.
Data survey year 2020.
Adults with
SeriousThoughts of
SuicideAdults aged 18 or older were asked: “At any time in the past 12 months,
did you seriously think about trying to kill yourself?” If they answered“Yes,” they were categorized as having serious thoughts of suicide in thepast year.

SAMHSA, Center for
Behavioral Health
Statistics and Quality,
National Survey on Drug
Use and Health,

Data survey year: 2019-2020.

https://www.samhsa.gov/data/nsduh/statereports-NSDUH-202033

Indicator

Description of Measure

SourceYouth with
Private Insurance
That Did Not
Cover Mental or
Emotional
Problems

Youth with private insurance that did not cover mental or emotional
problems is defined as any individual ages 12-17 responding “No” to
HLTINMNT. HLTINMNT is defined as: “Does [SAMPLE MEMBER POSS]
private health insurance include coverage for treatment for mental oremotional problems?”

SAMHSA, Center for Behavioral
Health Statistics and Quality,
National Survey on Drug Useand Health,

Data survey years: 2019-2020.

Adults with AMI
Who Did Not
Receive Mental
HealthTreatment

AMHTXRC-3 is a recoded variable with levels 1=Yes (received any
mental health treatment in past year) and 2=No (did not receive any
mental health treatment in past year). Recoded from variable
AMHSVTYP, it classifies what type of mental healthtreatment/counseling was received in the past year. Respondents whoreported receiving treatment for mental health were classified in one ofseven mutually exclusive categories. A respondent was assigned tolevel one if they reported receiving inpatient treatment only
(AMHINP2=1 and AMHOUTP3=2 and AMHRX2=2), to level two if theyreported receiving outpatient treatment only (AMHINP2=2 andAMHOUTP3=1 and AMHRX2=2), to level three if they reported
receiving prescription medication treatment only (AMHINP2=2 andAMHOUTP3=2 and AMHRX2=1), to level four if they reported receiving
both inpatient and outpatient treatment only (AMHINP2=1 andAMHOUTP3=1 and AMHRX2=2), to level five if they reported receiving
inpatient and prescription medication treatment only (AMHINP2=1 andAMHOUTP3=2 and AMHRX2=1), to level six if they reported receiving
outpatient and prescription medication treatment only (AMHINP2=2
and AMHOUTP3=1 and AMHRX2=1), or to level seven if they reported
receiving inpatient, outpatient, and prescription medication treatment(AMHINP2=1 and AMHOUTP3=1 and AMHRX2=1). Respondents who
did not receive mental health treatment in the past year were assigned
to level eight (AMHINP2=2 and AMHOUTP3=2 and AMHRX2=2).
Respondents whose specific treatment was not distinguishable due tomissing values in one or more of the three source variables (AMHINP2,AMHOUTP3, or AMHRX2) were assigned a system missing.

https://www.samhsa.gov/data/
nsduh/state-reports-NSDUH2020
SAMHSA, Center for Behavioral
Health Statistics and Quality,
National Survey on Drug Useand Health,

https://www.samhsa.gov/data/
nsduh/state-reports-NSDUH2020

Adults with AMI who did not receive mental health treatment wascalculated, where AMHTXRC-3= 2 (No treatment) and AMIYR_U
indicates AMI.
Data survey years: 2019-2020.

34

Indicator

Description of Measure

SourceMental Health
Workforce
Availability

Mental health workforce availability is the ratio of the county population
to the number of mental health providers, including psychiatrists,
psychologists, licensed clinical social workers, counselors, marriage andfamily therapists, and advanced practice nurses specializing in mental
health care. In 2015, marriage and family therapists and mental healthproviders that treat alcohol and other drug abuse were added to thismeasure.

County Health Rankings
andRoadmaps. http://www.cou
ntyhealthrankings.org/

These data come from the National Provider Identification data file,which has some limitations. Providers who transmit electronic healthrecords are required to obtain an identification number, but very small
providers may not obtain a number. While providers have the option ofdeactivating their identification number, some mental healthprofessionals included in this list may no longer be practicing or
accepting new patients. This may result in an overestimation of active
mental health professionals in some communities. It is also true thatmental health providers may be registered with an address in one county
while practicing in another county.

Students
Identified with
Emotional
Disturbancefor anIndividualized
Education
Program

Survey data year: 2021.
This measure was calculated from data provided by IDEA Part B ChildCount and Educational Environments, Common Core of Data. Under IDEA
regulation, emotional disturbance is identified as a condition exhibiting
one or more of the following characteristics over a long period of time
and to a marked degree, which adversely affects a child’s educational
performance: 1. an inability to learn, which cannot be explained byintellectual, sensory or health factors; 2. an inability to build or maintainsatisfactory interpersonal relationships with peers and teachers; 3.
inappropriate behavior or feelings under normal circumstances; 4. ageneral pervasive mood of unhappiness or depression; or 5. a tendency
to develop physical symptoms or fears associated with personal or school
problems. This term includes schizophrenia. The term does not apply tochildren who are socially maladjusted, unless it is determined they havean emotional disturbance.
Percent of Students Identified with Emotional Disturbance for an
Individualized Education Program was calculated as the percent ofchildren identified as having an emotional disturbance among all
enrolled students of “school age,” which includes kindergarten, grades 112, and “ungraded.”

IDEA Data Center, 2020 –2021 IDEA Section 618,
State Level Data Files,
Child Count and
Educational Environments.

https://data.ed.gov/datas
et/idea-section-618-statepart-b-child-count-andeducationalenvironments/resources
U.S. Department of
Education, National Center
for Education Statistics,
Common Core of Data.

https://nces.ed.gov/ccd/fil
es.aspDownloaded andcalculated on 8/4/2022.

Data years 2020-2021.

35

Indicator

Description of Measure

SourceYouth with atLeast One
Past Year
Major
Depressive
Episode (MDE)

Among youth ages 12-17, major depressive episode (MDE) is defined in
the 5th edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-V), which specifies a period of at least two weeks when
an individual experienced a depressed mood or loss of interest or
pleasure in daily activities and had a majority of specified depression
symptoms. A subset of 2020 respondents who did not complete thequestionnaire was excluded, and the analysis weights were adjusted forthe reduced sample size. For details, see Section B of the “2019-2020
NSDUH: Guide to State Tables and Summary of
Small Area Estimation Methodology” at https://www.samhsa.gov/data/.

SAMHSA, Center for
Behavioral Health Statistics
and Quality, National
Survey on Drug Use and
Health,Youth with
Substance
Abuse
Disorder in
the Past Year

Data survey year 2019-2020.
Among youth 12-17, substance use disorder data in 2020 are based on
criteria from the Diagnostic and Statistical Manual of Mental Disorders,
5th edition (DSM-5). Substance use disorder is defined as meeting thecriteria for illicit drug or alcohol use disorder. Substance use disorder
estimates are based on only 2020 data because prior years’ substanceuse disorder data were based on DSM-IV criteria.
Illicit drug use includes the misuse of prescription psychotherapeutics or
the use of marijuana, cocaine (including crack), heroin, hallucinogens,inhalants, or methamphetamine. Misuse of prescription
psychotherapeutics is defined as use in any way not directed by a doctor,
including use without a prescription of one’s own; use in greater
amounts, more often, or longer than told; or use in any other way notdirected by a doctor. Prescription psychotherapeutics do not include
over-the-counter drugs.

https://www.samhsa.gov/
data/nsduh/state-reportsNSDUH-2020

SAMHSA, Center for
Behavioral Health Statistics
and Quality, National
Survey on Drug Use and
Health,https://www.samhsa.gov/
data/nsduh/state-reportsNSDUH-2020

Data survey years: 2020.

36

Indicator

Description of Measure

SourceYouth with
MDE Who Did
Not Receive
Mental HealthServices

Youth with Past Year MDE Who Did Not Receive Treatment is defined as
those who apply to having past year MDE as defined above (“Youth WithAt Least One Past Year Major Depressive Episode,” YMDEYR) and respond“No” to ANYSMH2.

SAMHSA, Center for
Behavioral Health Statistics
and Quality, National
Survey on Drug Use and
Health,ANYSMH2 indicates whether a youth reported receiving specialty mental
health services in the past year from any of six specificinpatient/residential or outpatient specialty sources for problems withbehavior or emotions that were not caused by alcohol or drugs. Thisvariable was created based on the following six source of treatment
variables: stayed overnight in a hospital (YHOSP), stayed in a residential
treatment facility (YRESID), spent time in a day treatment facility(YDAYTRT), received treatment from a mental health clinic (YCLIN), from a
private therapist (YTHER), and from an in-home therapist (YHOME).
Youths who reported a positive response (source variable=1) to one ormore of the six questions were included in the “Yes” category regardlessof how many of the six questions they answered. Youths who did notreport a positive response but answered all six of the questions were
included in the “No” category. Youths who did not report a positive
response and did not answer all the questions, and respondents over age
18 were included in the unknown/18+ category.

https://www.samhsa.gov/
data/nsduh/state-reportsNSDUH-2020

Youth with
Severe MDE

Data survey year 2019-2020.
Youth with Severe MDE is defined as the following variable MDEIMPY.
MDEIMPY is derived from the maximum severity level of MDE role
impairment (YSDSOVRL) and is restricted to adolescents with past year
MDE (YMDEYR). Youth met criteria for MDEIMPY if they answered “Yes”
to YSDSOVRL and “Yes” to YMDEYR.
Youth who answer “Yes” to YMDEYR are asked questions from theSheehan Disability Scale (SDS) to measure the level of functional
impairment in major life activities reported to be caused by the MDE inthe past 12 months (Leon, Olfson, Portera, Farber, & Sheehan, 1997). The
SDS measures mental health-related impairment in four major life
activities or role domains. The following variable, YSDSOVRL, is assigned
the maximum level of interference over the four role domains of SDS:
chores at home (YSDSHOME), school or work (YSDSWRK), family
relationships (YSDSREL), and social life (YSDSSOC). Each module consistsof four questions that are assessed on a 0 to 10 visual analog scale withcategories of "none" (0), "mild" (1-3), "moderate" (4-6), "severe" (7-9),
and "very severe" (10). The four SDS role domain variables were recoded
so that no interference=1, mild=2, moderate=3, severe=4, and very
severe=5. A maximum level of interference over all four domains wasthen defined as YSDSOVRL. A maximum impairment score (YSDSOVRL) is
defined as the single highest severity level of role impairment across all
four SDS role domains. Ratings greater than or equal to seven on thescale YSDSOVRL=4, 5 were considered severe impairment.

SAMHSA, Center for
Behavioral Health Statistics
and Quality, National
Survey on Drug Use and
Health,https://www.samhsa.gov/
data/nsduh/state-reportsNSDUH-2020

Data survey years 2019-2020.

37

Indicator

Description of Measure

SourceYouth with
Severe MDE
WhoReceived
Some
Consistent
Treatment

The following variable was calculated as how many youths who answered“Yes” to MDEIMPY from “Youth with Severe MDE” defined above received
consistent treatment, which is determined by the variable SPOUTVST.

SAMHSA, Center for
Behavioral Health
Statistics and Quality,
National Survey on Drug
Use and Health,

The variable SPOUTVST indicates how many times a specialty outpatientmental health service was visited in the past year. The number of visits is
calculated by adding the number of visits to a day treatment facility(YUDYTXNM), mental health clinic (YUMHCRNM), private therapist(YUTPSTNM), and an in-home therapist (YUIHTPNM). A value of 6 (NoVisits) was assigned whenever a respondent said they had used none of theservices (YUDYTXYR, YUMHCRYR, YUTPSTYR, YUIHTPYR all equal 2 or 4). A
value of missing was assigned when the response to whether received
treatment or number of visits was unknown for any of the 4 locations (anyof YUDYTXYR, YUMHCRYR, YUTPSTYR, YUIHTPYR=85, 94, 97, 98 or any of
YUDYTXNM, YUMHCRNM, YUTPSTNM, YUIHTPNM=985, 994, 997, 998),
unless the sum of the visits for services with non-missing information was
greater than or equal to 25, in which case a value of 5 (25 or more visits)
was assigned. A missing value was also assigned for respondents aged 18
or older.

https://www.samhsa.gov/data/nsduh/statereports-NSDUH-2020

The variable SPOUTVST was recoded for visit distribution as 0-6 visits, and7-25+ visits. Some consistent treatment was considered 7-25+ visits in ayear.
Data survey years 2019-2020.

38