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By Jennifer Cheang, MHA Digital Marketing Manager

The 2018 State of Mental Health in America rankings are in, and mental health is not looking great for us Americans.

Over half of American adults with mental illness do not receive any type of care.

Even among the top-ranking states in the report, less than half of American adults with mental health conditions received any type of treatment. That means that mental health care and access is only marginally better in these states compared to the lower-ranked states.

So, who came out on top for mental health? And where do we need improvement?


1. Massachusetts

For every 200 people living in Massachusetts, there is at least 1 mental health provider. Massachusetts ranked first for mental health workforce availability, but even in the “best” state, we are still not addressing behavioral health on the same level as physical health when it comes to access to care.

Massachusetts has the lowest prevalence of mental illness and highest rates of access to care for adults among 50 states and DC. Massachusetts also has the lowest percentage of uninsured adults with mental illness. Unfortunately, having insurance coverage does not mean access to needed treatment.

Most children in Massachusetts who had private insurance had mental health care covered as part of their plans.

2. South Dakota

For every 660 people living in South Dakota, there is at least 1 mental health provider.

South Dakota ranked first for youth mental health. South Dakota also has the lowest prevalence of mental health or substance use issues among both youth and adults overall.

South Dakota has the lowest rate of youth with severe major depression.

3. Minnesota

For every 510 people living in Minnesota, there is at least 1 mental health provider.

40% of Minnesotan youth with severe depression receive some outpatient treatment. That’s more than three times the rate of the lowest ranked state for youth with severe depression.

Minnesota (ranked 2nd after District of Columbia) had the lowest percentage of Severely Depressed mental health screeners (24.51%).


Bottom 3

49. Arizona

For every 850 people living in Arizona, there is at least 1 mental health provider.

After Colorado, Arizona had the highest prevalence of youth with alcohol or substance use problems.

Arizona has the second highest prevalence of youth with mental illness and second lowest access to care.

50. Mississippi

For every 820 people living in Mississippi, there is at least 1 mental health provider.

Mississippi has the highest prevalence of youth AND adult alcohol and substance use of all 50 states and DC.

Mississippi also has the worst access to care. 1 In 3 adults with disability in Mississippi couldn’t see a doctor due to costs.

Only 11.3% of youth with severe depression in Mississippi received some treatment, compared to nearly 40% of all Minnesotan youth with severe depression (the highest ranked).

51. Nevada

For every 580 people living in Nevada, there is at least 1 mental health provider.

Nevada has the highest prevalence of mental illness and lowest access to care among Youth.

2 out of 3 Nevadan adults with a mental illness received no treatment.

According to, Nevada had the highest percentage of people who scored in the severe level for depression (33.72%). Nevada also had the highest rate of thoughts of self-harm and suicide reported among mental health screeners.

Click here for the full list of states and DC.

The good news is that healthcare reform does help.

The rates of uninsured adults with mental illness have decreased by 5% as a result of the ACA and states that increased Medicaid expansion saw greater improvement in youth coverage and fewer uninsured adults with mental illness.

In fact, 8 out of 10 of the states that ranked in the Top 10 expanded Medicaid in 2017.

For example, states with the greatest decrease in youth whose private insurance didn’t cover mental illness implemented Medicaid expansion and increased CHIP enrollment (Montana, Hawaii, New Jersey, Ohio, and Alaska).

So, what does this mean for the 43 million Americans living with mental illness?

  • Investment in preventive services and recovery services (e.g. peer-operated and supportive employment services), would provide support and opportunity for individuals with mental health conditions in mental health provider shortage areas.
  • Online resources and Screenings should be made more accessible. Many screeners at, regardless of sex, age, race, or income reported that they would “Find additional information online” and/or take regular screenings. Ensuring that screening tools, along with accurate information, are available allows for these individuals to remain informed and monitor their mental health.
  • Medicaid expansion helps increase access to care. Medicaid is the largest payer for mental health services. By expanding Medicaid, mental health coverage increases the number of individuals that are diagnosed and, if necessary, treated before they encounter extreme consequences (self-harm, substance abuse, incarceration, etc.).
  • Providers must negotiate higher reimbursement rates for services, incentivizing more mental health professionals to take private and/or public insurance.
  • Early intervention and identification will be key in addressing the mental health needs of youth. A timely response to the mental health needs of youth, can prevent them from entering adulthood in crisis.
  • Outreach and awareness is critical among members of special populations. Mental health services or resources that are tailored to the specific needs of populations like members of the LGBT+ community, students, caregivers, new/expecting mothers, and veterans are necessary given the continuing demand.

While we’ve made great strides in mental health over the decades, the US is still lagging far behind in many aspects of mental health care quality and access.

With increasing calls for mental health reform, Mental Health America will continue to work at the local, state, and federal levels to ensure that leaders across the country make mental health a priority so individuals with mental health conditions can receive support before a crisis – Before Stage 4.

JACKIE PALMER (not verified)

Tue, 01/16/2018 - 16:45

A group missing from "special populations" on The Best and Worst States for Mental Health are the kids living with the effects of early childhood trauma. This group of children have life long challenges that affect not only themselves, but society as well. There are a plethora of foster and adoptive families in desperate need of help with very limited resources.