2024 State of Mental Health in America Report

The State of Mental Health in America 2024
Item Type Report
Authors Reinert, Maddy; Fritze, Danielle; Nguyen, Theresa
Publication Date 2024-07-01
Keywords EAP; Employee assistance programs; Substance-Related

Disorders; Mental Health
Citation Reinert, M., Fritze, D., & Nguyen, T. (July 2024). The State
of Mental Health in America 2024. Mental Health America,
Alexandra, VA.
Publisher Mental Health America
Download date 05/11/2024 05:24:12
Link to Item http://hdl.handle.net/10713/22688

Acknowledgments
Mental Health America (MHA) was founded in 1909 and is the leading national nonprofit dedicated to the
promotion of mental health, well-being, and illness prevention. Our work is informed, designed, and led by the
lived experience of those most affected. Operating nationally and in communities across the country, Mental
Health America advocates for closing the mental health equity gap, while increasing nationwide awareness
and understanding through public education, direct services, tools, and research, making MHA a national
standard bearer in public mental health advocacy and community-based solutions.
MHA dedicates this report to mental health advocates who fight tirelessly to help expand access to care and
reduce disparities and inequities for people with mental health concerns. To our affiliates, thank you for your
incredible state-level advocacy and dedication to promoting recovery and protecting the rights of all.
Special thanks to:
The Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control
and Prevention (CDC), the University of Wisconsin Population Health Institute, the U.S. Department of Health
and Human Services Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau
(MCHB), and the Department of Education (DoE), who 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, Danielle Fritze and Theresa Nguyen.
Citation: Reinert, M, Fritze, D & Nguyen, T (July 2024). “The State of Mental Health in America 2024.” Mental
Health America, Alexandria VA.
500 Montgomery Street, Suite 820

Alexandria, VA 22314-1520
www.mhanational.org
Copyright © 2024 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
22 Adult Access to Care
26 Youth Access to Care
29 Mental Health Workforce Availability
30 Youth with MDE Who Reported Treatment or
Counseling Helped Them
31 Creating Supportive Communities: A Spotlight on Prevention
32 Keeping People in Communities: A Spotlight on Housing
36 References
42 Glossary
3
Mental Health America (MHA) is the nation’s leading national nonprofit dedicated to the promotion of
mental health, well-being, and illness prevention. Our work is informed, designed, and led by the lived
experience of those most affected. Mental Health America advances the mental health and well-being of
all people living in the U.S. through public education, research, advocacy and public policy, and direct
service. We envision a world in which all people and communities have equitable opportunity for mental
well-being and are enabled to flourish and live with purpose and meaning.
Our report is a collection of data across all 50 states and the District of Columbia and seeks to answer the
following 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 and
substance use.
• Analysis may reveal similarities and differences among states, allowing for assessment of how federal
and state mental health policies result in more or less access to care.
4
Ranking Overview and Guidelines
This report 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 the
online interactive data on the MHA website (www.mhanational.org/issues/state-mental-health-america). The
data and tables include state and national data.
MHA Guidelines
Given the variability of data, MHA developed guidelines to identify mental health measures that are most
appropriate 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 health
system.
• Data that could be collected annually over time to allow for analysis of future changes and trends.
Our 2024 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 Serious Thoughts of Suicide
7. Youth Flourishing
8. Adults with SUD Who Needed but Did Not Receive Treatment
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. Adults with AMI with Private Insurance That Did Not Cover Mental or Emotional Problems
12. Youth with MDE Who Did Not Receive Mental Health Services
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
Data is also presented for Youth with MDE Who Reported Treatment or Counseling Helped Them, but this
indicator was not included in the rankings because data for South Carolina and South Dakota was suppressed
in 2021-2022.
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 measures that allow us to capture more accurately and comprehensively the needs of those with mental
illness and their access to care.
5
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 are
large 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 for each state collected from the most recently available data. The
majority of indicators represent data collected up to 2022. States with positive outcomes are ranked higher
(closer to one) than states with poorer outcomes (closer to 51). The overall, adult, youth, prevalence, and
access rankings were analyzed by calculating a standardized score (Z score) for each measure and ranking
the sum 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 three measures where high percentages equate to better outcomes. These include “Youth
Flourishing,” “Students Identified with Emotional Disturbance for an Individualized Education Program,” and
“Youth with MDE Who Reported Treatment or Counseling Helped Them.” Here, the calculated standardized
score was multiplied by -1 to obtain a reverse Z score that was used in the sum. All measures were considered
equally important, 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 is weighted and calculated by the agency conducting the applicable federal survey. The ranking is
based on the Z scores. 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 national surveillance data in 2020.
During this time, federal agencies updated the measures they collect and how they are collected. As a result,
the indicators in this year’s State of Mental Health in America report cannot be compared to previous years.
The following summarizes how this year’s report has been updated from previous reports.
The measures “Youth with Severe MDE,” “Youth with Severe MDE Who Received Some Consistent Treatment,”
“Adults with AMI Who Did Not Receive Treatment,” and “Adults with AMI Reporting Unmet Need” were removed
from this year’s report.
Each of these measures were calculated using data from the Substance Abuse and Mental Health Services
Administration’s (SAMHSA’s) National Survey on Drug Use and Health (NSDUH). The indicator “Youth with
Severe MDE” was removed because it did not differ significantly from the measure “Youth with at Least One
Major Depressive Episode (MDE) in the Past Year.” In 2022, SAMHSA made changes to the mental health and
substance use treatment questions. This report relies on state-level data, which is only available in a two-year
pair. The changes to the 2022 mental health treatment measures meant that the dataset was not comparable
to the 2021 measures and could not be combined into a two-year pair. These measures may return to the
indicator list in next year’s report once the 2022-2023 NSDUH data are available.
6
The measures “Youth with Serious Thoughts of Suicide,” “Youth Flourishing,” “Adults with SUD Who Needed
but Did Not Receive Treatment,” and “Adults with AMI with Private Insurance That Did Not Cover Mental or
Emotional Problems” were added to the indicator list in this year’s report.
The measure “Youth with Serious Thoughts of Suicide” was added because SAMHSA began gathering data on
youth suicidality for the first time in 2020, and this is the first report published since that data has been made
available. “Youth Flourishing” captures data on flourishing among children and adolescents ages 6-17, and
was added as an upstream, protective measure for youth as part of the Prevalence ranking. “Adults with SUD
Who Needed but Did Not Receive Treatment” and “Adults with AMI with Private Insurance That Did Not Cover
Mental or Emotional Problems” were added to capture more nuanced information about access to behavioral
health care in the U.S.
For the measure “Students Identified with Emotional Disturbance for an Individualized Education Program,”
data for Iowa on the number of students with Emotional Disturbance was not available. Iowa does not collect
disability category data and therefore was excluded from the ranking for that indicator.
Survey Limitations
Eleven 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, in
2020 data collection shifted to both in-person interviews and online questionnaires due to the COVID-19
pandemic. Since 2020, SAMHSA discovered that these changes to data collection created a mode effect such
that estimates from the web and in-person interviews cannot be compared to estimates from in-person
interviews alone. As a result, SAMHSA has determined that 2021 will represent a trend break from previous
years, meaning the results of the NSDUH moving forward will not be comparable to data collected before
2021. This means that the rankings presented throughout this year’s State of Mental Health in America
report cannot be reliably compared to the rankings 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 Behavioral Risk Factor Surveillance System (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 are representative of the general population. An example limitation
of particular importance to the mental health community 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, these data 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 to treatment 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 2022. This means that they are the most current data
reported by the states and available to the public.
7
OF ADULTS EXPERIENCED A MENTAL ILLNESS IN THE PAST YEAR.
EQUIVALENT TO NEARLY 60 MILLION AMERICANS.
2022 HAD THE HIGHEST NUMBER OF

DEATHS BY SUICIDE EVER RECORDED
IN THE U.S.
REPORTED EXPERIENCING SERIOUS

THOUGHTS OF SUICIDE.
OF THOSE WHO
DID RECEIVE
YOUTH HAD AT (NEARLY 3 TREATMENT, ONLY
LEAST ONE MAJOR MILLION YOUTH)
DEPRESSIVE DID NOT RECEIVE
EPISODE (MDE) IN TREATMENT. SAID IT HELPED
THE PAST YEAR. THEM.
OF ADULTS IN THE U.S.

HAD A SUBSTANCE USE
DISORDER IN THE PAST
ADULTS WITH FREQUENT MENTAL
YEAR.
DISTRESS COULD NOT SEE A DOCTOR
DUE TO COST, A 2% INCREASE OVER
OF THEM DID NOT RECEIVE
THE LAST REPORT.
TREATMENT.
THERE ARE 340 PEOPLE FOR EVERY 1

MENTAL HEALTH PROVIDER IN THE U.S.
STILL HAVE PRIVATE INSURANCE THAT

DOES NOT COVER MENTAL HEALTH.
Overall Ranking
State Rank
Massachusetts 1
An overall ranking of 1-13 indicates lower prevalence of mental illness and Connecticut 2
higher rates of access to care. An overall ranking of 39-51 indicates higher Maine 3
New York 4
prevalence of mental illness and lower rates of access to care. The
New Jersey 5
combined scores of all 15 measures make up the overall ranking. The
District of Columbia 6
overall ranking includes both adult and youth measures, as well as Vermont 7
prevalence and access to care measures. New Hampshire 8
Hawaii 9
Pennsylvania 10
The 15 measures that make up the overall ranking include: Michigan 11
Virginia 12
1. Adults with Any Mental Illness (AMI) Wisconsin 13
2. Adults with Substance Use Disorder in the Past Year Maryland 14
3. Adults with Serious Thoughts of Suicide Illinois 15
Rhode Island 16
4. Youth with at Least One Major Depressive Episode (MDE) in
California 17
the Past Year
Delaware 18
5. Youth with Substance Use Disorder in the Past Year Kentucky 19
6. Youth with Serious Thoughts of Suicide Ohio 20
7. Youth (Ages 6-17) Flourishing Florida 21
8. Adults with SUD Who Needed But Did Not Receive Kansas 22
Minnesota 23
Treatment
Indiana 24
9. Adults with AMI Who Are Uninsured Iowa 25
10. Adults Reporting 14+ Mentally Unhealthy Days a Month Georgia 26
Who Could Not See a Doctor Due to Costs Utah 27
11. Adults with AMI with Private Insurance That Did Not Cover South Dakota 28
North Carolina 29
Mental or Emotional Problems
South Carolina 30
12. Youth with MDE Who Did Not Receive Mental Health Arkansas 31
Services Nebraska 32
13. Youth with Private Insurance That Did Not Cover Mental or Louisiana 33
Emotional Problems Mississippi 34
14. Students (K+) Identified with Emotional Disturbance for an New Mexico 35
Texas 36
Individualized Education Program
West Virginia 37
15. Mental Health Workforce Availability Oklahoma 38
Alabama 39
Wyoming 40
The chart is a visual representation of the Washington 41
sum of the scores for each state. It provides Tennessee 42
an opportunity to see the difference between North Dakota 43
ranked states. For example, Massachusetts Missouri 44
Idaho 45
(ranked one) has a score that is lower (better
Colorado 46
than the average) than Virginia (ranked 12). Oregon 47
Ohio (ranked 20) has a score that is closest Alaska 48
to zero (the average). Montana 49
Arizona 50
Nevada 51
15.00 10.00 5.00 0.00 -5.00 -10.00
9
OVERALL MONTANA
(RANKED 49):
MASSACHUSETTS
(RANKED 1):
MAINE
(RANKED 3):
RANKING The indicators that

affected Montana’s
Overall Ranking the
most were Adults with
The indicators that
had the largest effects
on Massachusetts’
Overall Ranking were
The indicators that
Maine performed best
on were Youth with
MDE Who Did Not
Any Mental Illness Students Identified Receive Mental Health
(27.12%, ranked 46), with Emotional Services (34.6%,
Adults with Serious Disturbance for an ranked 2), Youth with
Thoughts of Suicide Individualized Private Insurance That
(6.02%, ranked 48), Education Program Did Not Cover Mental
and Youth with Serious (19.03, ranked 2), and or Emotional Problems
Thoughts of Suicide Adults Reporting 14+ (2.7%, ranked 2), and
(14.64%, ranked 48). Mentally Unhealthy Adults with SUD Who
Days a Month Who Needed but Did Not
Could Not See a Receive Treatment
Doctor Due to Costs (70.55%, ranked 5).
(15.84%, ranked 4).
NEVADA
(RANKED 51): ARIZONA
The indicators that (RANKED 50):
had the largest effects The indicators that CONNECTICUT
on Nevada’s Overall affected Arizona’s (RANKED 2):
Ranking were Youth Overall Ranking the The indicators that
with Substance Use most were Youth with affected Connecticut’s
Disorder in the Past at Least One Major Overall Ranking the
Year (14.09%, ranked Depressive Episode most were Youth with
50), Youth with at (MDE) in the Past Year Serious Thoughts of
Least One Major (23.96%, ranked 50), Suicide (11%, ranked 2),
Depressive Episode Youth with Private Youth with Private
(MDE) in the Past Year Insurance That Did Not Insurance That Did Not
(23.51%, ranked 49), Cover Mental or Cover Mental or
and Youth with Private Emotional Problems Emotional Problems
Insurance That Did Not (14.8%, ranked 48), and (2.3%, ranked 1), and
Cover Mental or Mental Health Adults with Serious
Emotional Problems Workforce Availability Thoughts of Suicide
(14.80%, ranked 49). (590:1, ranked 47). (4.16%, ranked 1).
Adult Rankings Rank State
1 New York
2 New Jersey
States that are ranked 1-13 have a lower prevalence of mental illness and higher 3 Massachusetts
rates of access to care for adults. States that are ranked 39-51 indicate that adults 4 Hawaii
5 Maine
have a higher prevalence of mental illness and lower rates of access to care. 6 Maryland
7 Pennsylvania
The seven measures that make up the Adult Ranking include: 8 Connecticut
9 Virginia
1. Adults with Any Mental Illness (AMI) 10 New Hampshire
2. Adults with Substance Use Disorder in the Past Year 11 Delaware
3. Adults with Serious Thoughts of Suicide 12 Kentucky
13 Rhode Island
4. Adults with SUD Who Needed but Did Not Receive Treatment
14 Wisconsin
5. Adults with AMI Who Are Uninsured 15 Michigan
6. Adults Reporting 14+ Mentally Unhealthy Days a Month Who Could Not See 16 Indiana
a Doctor Due to Costs 17 Ohio
18 Florida
7. Adults with AMI with Private Insurance That Did Not Cover Mental or
19 Vermont
Emotional Problems 20 Arkansas
21 Iowa
22 California
23 Tennessee
24 Kansas
25 South Carolina
26 South Dakota
27 District of Columbia
28 Minnesota
29 Illinois
30 New Mexico
31 Washington
32 North Carolina
33 West Virginia
34 Arizona
35 Oregon
36 Alabama
37 Louisiana
38 Missouri
39 Georgia
40 Colorado
41 Nebraska
42 Idaho
43 Alaska
44 Texas
45 Mississippi
46 Utah
47 Oklahoma
48 Nevada
49 North Dakota
Ranked 1-13 Ranked 39-51
50 Montana
51 Wyoming
11
Rank State
Youth Rankings 1 District of Columbia
2 Connecticut
3 Massachusetts
States with rankings 1-13 have a lower prevalence of mental illness and higher rates
4 Illinois
of access to care for youth. States with rankings 39-51 indicate that youth have 5 Georgia
a higher prevalence of mental illness and lower rates of access to care. 6 Vermont
7 Maine
8 Utah
The seven measures that make up the Youth Ranking include:
9 Michigan
10 New Jersey
11 New York
2. Youth with Substance Use Disorder in the Past Year
12 Wisconsin
3. Youth with Serious Thoughts of Suicide 13 Pennsylvania
4. Youth (Ages 6-17) Flourishing 14 New Hampshire
5. Youth with MDE Who Did Not Receive Mental Health Services 15 Texas
6. Youth with Private Insurance That Did Not Cover Mental or Emotional 16 Kansas
17 Virginia
Problems
18 Mississippi
7. Students (K+) Identified with Emotional Disturbance for an Individualized 19 Minnesota
Education Program 20 California
21 Hawaii
22 Florida
23 Rhode Island
24 Iowa
25 South Dakota
26 North Carolina
27 Indiana
28 Wyoming
29 Ohio
30 Nebraska
31 Maryland
32 Alabama
33 North Dakota
34 Delaware
35 South Carolina
36 Kentucky
37 West Virginia
38 Louisiana
39 Oklahoma
40 Idaho
41 Missouri
42 Montana
43 Arkansas
44 Colorado
45 New Mexico
46 Tennessee
47 Alaska
48 Washington
49 Oregon
50 Arizona
51 Nevada
12
Rank State
Prevalence of Mental Illness 1 Connecticut
2 New Jersey
3 Georgia
A ranking of 1-13 for Prevalence indicates a lower prevalence of mental health and
4 South Carolina
substance use issues compared to states that ranked 39-51. 5 Texas
6 Mississippi
The seven measures that make up the Prevalence Ranking include: 7 Hawaii
8 New York
1. Adults with Any Mental Illness (AMI) 9 Massachusetts
2. Adults with Substance Use Disorder in the Past Year 10 North Carolina
3. Adults with Serious Thoughts of Suicide 11 Florida
12 Michigan
13 California
5. Youth with Substance Use Disorder in the Past Year 14 Illinois
6. Youth with Serious Thoughts of Suicide 15 Maryland
7. Youth (Ages 6-17) Flourishing 16 Virginia
17 Delaware
18 Pennsylvania
19 Kansas
20 New Hampshire
21 Alabama
22 District of Columbia
23 Wisconsin
24 Arkansas
25 South Dakota
26 Kentucky
27 Maine
28 Utah
29 Tennessee
30 Ohio
31 Indiana
32 Nebraska
33 West Virginia
34 Minnesota
35 Arizona
36 Rhode Island
37 Iowa
38 Oklahoma
39 Louisiana
40 North Dakota
41 Vermont
42 Wyoming
43 Missouri
44 New Mexico
45 Nevada
46 Alaska
47 Idaho
48 Montana
49 Washington
Ranked 1-13 Ranked 39-51 50 Colorado
51 Oregon
13
Access to Care Rankings Rank State
1 Vermont
2 Maine
The Access Ranking indicates how much access to mental health care exists within 3 Massachusetts
a state. The access measures include access to insurance, access to treatment, 4 District of Columbia
5 Rhode Island
quality and cost of insurance, access to special education, and mental health
6 Oregon
workforce availability. A high Access Ranking (1-13) indicates that a state provides 7 New York
relatively more access to insurance and mental health care than those ranked 39- 8 New Hampshire
51. 9 Connecticut
10 Pennsylvania
11 Wisconsin
The eight measures that make up the Access Ranking include:
12 Ohio
13 Iowa
1. Adults with SUD Who Needed 5. Youth with MDE Who Did Not 14 Minnesota
but Did Not Receive Treatment Receive Mental Health Services 15 Washington
2. Adults with AMI Who Are 6. Youth with Private Insurance That 16 New Mexico
Uninsured Did Not Cover Mental or Emotional 17 Colorado
18 Indiana
3. Adults Reporting 14+ Mentally Problems
19 Virginia
Unhealthy Days a Month Who 7. Students (K+) Identified with 20 Kentucky
Could Not See a Doctor Due to Emotional Disturbance for an 21 New Jersey
Costs Individualized Education Program 22 Michigan
4. Adults with AMI with Private 8. Mental Health Workforce 23 Idaho
24 Maryland
Insurance That Did Not Cover Availability
25 Illinois
Mental or Emotional Problems 26 Utah
27 Hawaii
28 Delaware
29 Louisiana
30 Montana
31 Alaska
32 Missouri
33 Wyoming
34 California
35 Kansas
36 South Dakota
37 Nebraska
38 North Dakota
39 Oklahoma
40 Florida
41 Arkansas
42 West Virginia
43 Tennessee
44 North Carolina
45 Nevada
46 Alabama
47 Georgia
48 Arizona
49 South Carolina
50 Mississippi
51 Texas
14
Adult Prevalence of Mental Illness 23.08% of adults experienced a mental
Adults with Any Mental Illness (AMI) illness in the past year, equivalent to
nearly 60 million Americans.
5.86% experienced a severe mental

illness.
In 2022, completely rural counties had

the highest percentage of adults
reporting AMI (25.7%). Large metro
counties had the lowest percentage of
adults with AMI (22.1%).1 While rural
communities are resilient and can
provide residents with more
connection, they often face increased
risk factors for poor mental health and
barriers to accessing care. In many
states, families in rural communities
The state prevalence of adult are more likely to experience poverty,2
mental illness ranges from: face food insecurity,3 and have less
29.19% (UT) access to preventative services and
19.38% (NJ)
Ranked 1-13 Ranked 39-51 providers than those in non-rural
areas.4
Rank State % # Rank State % #

1 New Jersey 19.38 1,389,000 27 Kansas 24.41 532,000
2 Florida 20.45 3,563,000 28 Indiana 24.44 1,260,000
3 Delaware 20.93 165,000 29 Ohio 24.52 2,214,000
4 Connecticut 21.05 599,000 30 Nevada 24.65 600,000
5 New York 21.11 3,273,000 31 Rhode Island 24.67 216,000
6 Hawaii 21.47 234,000 32 Minnesota 24.74 1,077,000
7 Texas 21.94 4,797,000 33 South Dakota 24.89 166,000
8 Illinois 22.01 2,136,000 34 Alaska 24.96 132,000
9 Mississippi 22.16 487,000 35 Tennessee 25.47 1,370,000
10 California 22.19 6,665,000 36 New Mexico 25.67 414,000
11 North Carolina 22.19 1,804,000 37 Nebraska 25.71 376,000
12 Virginia 22.28 1,470,000 38 Oklahoma 25.88 768,000
13 South Carolina 22.35 902,000 39 North Dakota 25.95 150,000
14 Maryland 22.37 1,056,000 40 West Virginia 26.28 367,000
15 Georgia 22.52 1,836,000 41 Colorado 26.30 1,186,000
16 Michigan 22.89 1,789,000 42 Missouri 26.50 1,248,000
17 New Hampshire 23.06 259,000 43 District of Columbia 26.63 143,000
18 Massachusetts 23.18 1,292,000 44 Iowa 26.71 649,000
19 Pennsylvania 23.18 2,352,000 45 Vermont 26.80 141,000
20 Arizona 23.26 1,308,000 46 Montana 27.12 234,000
21 Wisconsin 23.66 1,082,000 47 Washington 27.14 1,629,000
22 Kentucky 23.77 813,000 48 Wyoming 27.44 121,000
23 Arkansas 23.86 546,000 49 Oregon 27.48 922,000
24 Maine 24.07 268,000 50 Idaho 28.02 402,000
25 Alabama 24.09 931,000 51 Utah 29.19 700,000
26 Louisiana 24.34 838,000 National 23.08 58,867,000
According to SAMHSA, “Any Mental Illness (AMI) aligns with Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria and is
defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder. 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
17.82% of adults in the U.S.

had a substance use disorder
in the past year, totaling over
45 million people.
11.28% of adults had an alcohol

use disorder in the past year.
9.41% of adults in the U.S. had

a drug use disorder in the past
year. In 2022, marijuana was
the most common substance
identified for those with a drug
use disorder. 6.9% of adults
with a drug use disorder had a
The state prevalence of adults with marijuana use disorder in
substance use disorder ranges from: 2022.5
14.15% (UT) 24.30% (AK)

1 Utah 14.15 340,000 27 Michigan 18.42 1,440,000
2 Alabama 15.19 587,000 28 Wisconsin 18.44 844,000
3 Florida 15.30 2,665,000 29 West Virginia 18.68 261,000
4 South Carolina 15.42 622,000 30 Maine 18.80 209,000
5 Texas 15.45 3,380,000 31 Delaware 18.81 148,000
6 North Carolina 15.71 1,277,000 32 Missouri 18.89 889,000
7 Arkansas 15.76 361,000 33 Indiana 19.08 983,000
8 New Jersey 16.34 1,171,000 34 Massachusetts 19.16 1,068,000
9 Hawaii 16.35 178,000 35 Ohio 19.19 1,733,000
10 Tennessee 16.49 887,000 36 Iowa 19.32 469,000
11 Mississippi 16.82 370,000 37 Oklahoma 19.66 584,000
12 Georgia 16.99 1,385,000 38 Wyoming 20.21 89,000
13 New Hampshire 17.37 195,000 39 Washington 20.23 1,214,000
14 Kentucky 17.41 596,000 40 Minnesota 20.43 890,000
15 Nebraska 17.58 257,000 41 Louisiana 20.62 710,000
16 Kansas 17.69 386,000 42 North Dakota 20.80 120,000
17 Maryland 17.73 837,000 43 Montana 21.00 181,000
18 Virginia 17.79 1,173,000 44 Nevada 21.60 525,000
19 New York 17.81 2,762,000 45 Rhode Island 22.61 198,000
20 Illinois 17.86 1,733,000 46 Oregon 22.71 762,000
21 Arizona 17.97 1,011,000 47 Vermont 22.79 120,000
22 Pennsylvania 18.01 1,827,000 48 Colorado 23.08 1,040,000
23 California 18.04 5,418,000 49 New Mexico 23.55 380,000
24 Idaho 18.17 260,000 50 District of Columbia 24.22 130,000
25 South Dakota 18.24 121,000 51 Alaska 24.30 128,000
26 Connecticut 18.39 523,000 National 17.82 45,438,000
According to SAMHSA, “Substance Use Disorder (SUD) estimates are based on Diagnostic and Statistical Manual of Mental Disorders, 5th edition
criteria. SUD is defined as meeting the criteria for drug or alcohol use disorder. Beginning with the 2021 National Survey on Drug Use and Health,
questions on prescription drug use disorder were asked of all past year users of prescription drugs, regardless of whether they misused prescription
drugs.”
16
Adults with Serious Thoughts of Suicide
5.04% of adults reported
experiencing serious thoughts of
suicide. The estimated number
of adults with serious suicidal
thoughts in the U.S. is over 12.8
million.
After slight decreases in suicide deaths in

2019 and 2020, the number of individuals
who died by suicide in 2022 was the highest
number ever recorded in the U.S.6
Only 15% of adults experiencing suicidal

ideation reported that it was because of the
COVID-19 pandemic in 2022. However, these
rates were significantly higher among Black
and Hispanic adults, who experienced some
of the highest rates of death and greatest
socioeconomic impacts of the pandemic.
The state prevalence of adults with serious 27% of Black adults and 16% of Hispanic
thoughts of suicide ranges from: adults reported their suicidal ideation was
because of COVID-19 in 2022, compared to
4.16% (CT) 7.12% (UT)
11% of white adults.7

1 Connecticut 4.16 118,000 27 Illinois 5.26 511,000
2 New York 4.29 665,000 28 Kansas 5.31 116,000
3 Massachusetts 4.36 243,000 29 Vermont 5.35 28,000
4 New Jersey 4.37 313,000 30 Kentucky 5.41 185,000
5 Maryland 4.41 208,000 31 Michigan 5.42 424,000
6 Maine 4.56 51,000 32 Alabama 5.44 210,000
7 Hawaii 4.64 50,000 33 Oklahoma 5.47 162,000
8 South Carolina 4.67 188,000 34 Alaska 5.47 29,000
9 North Carolina 4.70 382,000 35 Louisiana 5.51 190,000
10 Rhode Island 4.74 41,000 36 Iowa 5.51 134,000
11 Pennsylvania 4.74 481,000 37 Washington 5.51 331,000
12 Delaware 4.75 37,000 38 New Mexico 5.55 90,000
13 Virginia 4.76 314,000 39 Indiana 5.56 287,000
14 Florida 4.80 836,000 40 South Dakota 5.59 37,000
15 New Hampshire 4.87 55,000 41 Missouri 5.61 264,000
16 Mississippi 4.94 109,000 42 Oregon 5.61 188,000
17 California 4.97 1,491,000 43 North Dakota 5.68 33,000
18 Texas 4.98 1,090,000 44 West Virginia 5.71 80,000
19 Georgia 5.02 410,000 45 Nevada 5.75 140,000
20 Minnesota 5.07 221,000 46 Wyoming 5.84 26,000
21 Tennessee 5.11 275,000 47 Colorado 5.91 266,000
22 Arizona 5.15 290,000 48 Montana 6.02 52,000
23 Wisconsin 5.16 236,000 49 Nebraska 6.15 90,000
24 Ohio 5.21 470,000 50 Idaho 6.68 96,000
25 Arkansas 5.23 120,000 51 Utah 7.12 171,000
26 District of Columbia 5.25 28,000 National 5.04 12,860,000
17
Youth Prevalence of Mental Illness
Youth with at Least One Major Depressive Episode (MDE) in the Past Year
20.17% of youth (ages 12-17) reported

suffering from at least one major
depressive episode (MDE) in the past
year.
15% of youth in the U.S. experienced an

MDE with severe impairment, meaning it
severely impacted their functioning at
work, school, or home.
While this indicator measures the

percentage of youth who met the criteria
for depression under the DSM-V, other
datasets suggest that distress among
youth is much more prevalent.
According to the 2021 Youth Risk
Behavior Survey (YRBS), 42% of high
The state prevalence of youth with school students reported persistent
MDE ranges from: feelings of sadness or hopelessness.8
16.02% (DC) 24.96% (OR)


1 District of Columbia 16.02 5,000 27 Kansas 20.34 50,000
2 Hawaii 17.15 17,000 28 Indiana 20.44 114,000
3 Georgia 17.39 159,000 29 Tennessee 20.50 111,000
4 South Carolina 17.88 72,000 30 Pennsylvania 20.50 193,000
5 Utah 18.33 62,000 31 Delaware 20.55 15,000
6 Texas 18.40 483,000 32 Ohio 20.79 190,000
7 Michigan 18.65 142,000 33 Iowa 20.88 54,000
8 Mississippi 18.73 47,000 34 Nebraska 21.12 35,000
9 Oklahoma 18.76 63,000 35 Florida 21.43 325,000
10 Arkansas 18.97 47,000 36 Idaho 21.50 37,000
11 Massachusetts 19.18 93,000 37 North Dakota 21.56 13,000
12 South Dakota 19.21 14,000 38 Missouri 21.59 105,000
13 Vermont 19.25 8,000 39 New Hampshire 21.63 20,000
14 Alabama 19.41 76,000 40 Wyoming 21.70 10,000
15 Wisconsin 19.41 89,000 41 Alaska 21.72 13,000
16 North Carolina 19.46 160,000 42 Montana 21.89 18,000
17 Kentucky 19.50 69,000 43 Minnesota 22.07 102,000
18 New York 19.58 272,000 44 Rhode Island 22.15 16,000
19 New Jersey 19.70 141,000 45 Maryland 22.17 105,000
20 Connecticut 19.83 54,000 46 New Mexico 23.23 40,000
21 West Virginia 19.85 25,000 47 Colorado 23.32 103,000
22 Louisiana 19.91 74,000 48 Washington 23.39 135,000
23 Maine 19.93 18,000 49 Nevada 23.51 58,000
24 California 20.01 616,000 50 Arizona 23.96 139,000
25 Illinois 20.21 202,000 51 Oregon 24.96 76,000
26 Virginia 20.22 133,000 National 20.17 5,217,000
18
Youth with Substance Use Disorder in the Past Year
8.95% of youth in the U.S. had a
substance use disorder in the past
year.
3.32% had an alcohol use disorder in

the past year, while 7.17% had a
drug use disorder.
According to a survey of youth ages 13-18

being assessed for substance use disorder
treatment from 2014-2022, the most common
reasons youth reported using substances
were to feel mellow, calm or relaxed (73%), to
have fun or experiment (50%), to sleep better
or to fall asleep (44%), and to stop worrying
about a problem or to forget bad memories
(44%). Forty percent reported they used
substances to help with depression or
The state prevalence of youth with a anxiety.9 Upstream substance use prevention
substance use disorder ranges from: strategies could focus on these motivations
by better addressing underlying stressors
5.43% (UT) 16.01% (NM)
faced by youth, helping families improve
sleep habits or hygiene, and promoting
mental wellness or healthy coping skills.

1 Utah 5.43 18,000 27 Georgia 9.29 85,000
2 New Hampshire 7.13 7,000 28 Illinois 9.33 93,000
3 New Jersey 7.25 52,000 29 Ohio 9.41 86,000
4 North Carolina 7.42 61,000 30 Wyoming 9.43 5,000
5 South Carolina 7.44 30,000 31 Hawaii 9.44 9,000
6 Connecticut 7.66 21,000 32 Tennessee 9.47 51,000
7 Mississippi 7.69 19,000 33 New York 9.53 132,000
8 Virginia 7.69 50,000 34 Idaho 9.86 17,000
9 Texas 7.79 204,000 35 Vermont 10.10 4,000
10 Alabama 7.82 31,000 36 Wisconsin 10.28 47,000
11 Michigan 8.12 62,000 37 Minnesota 10.30 47,000
12 Massachusetts 8.14 39,000 38 District of Columbia 10.34 4,000
13 Florida 8.19 124,000 39 Arizona 10.68 62,000
14 California 8.21 253,000 40 Montana 10.93 9,000
15 South Dakota 8.23 6,000 41 Iowa 10.95 28,000
16 Maryland 8.31 39,000 42 Washington 10.96 63,000
17 Kentucky 8.40 30,000 43 Rhode Island 11.03 8,000
18 Pennsylvania 8.55 80,000 44 Missouri 11.15 54,000
19 Maine 8.66 8,000 45 Colorado 11.27 50,000
20 Arkansas 8.77 22,000 46 Oklahoma 11.49 38,000
21 Indiana 8.78 49,000 47 Alaska 11.51 7,000
22 Kansas 8.81 22,000 48 Oregon 12.52 38,000
24 West Virginia 8.96 11,000 50 Nevada 14.09 35,000
25 North Dakota 8.97 5,000 51 New Mexico 16.01 27,000
26 Delaware 9.09 7,000 National 8.95 2,316,000
According to SAMHSA, “Substance Use Disorder (SUD) estimates are based on Diagnostic and Statistical Manual of Mental Disorders, 5th edition
criteria. SUD is defined as meeting the criteria for drug or alcohol use disorder. Beginning with the 2021 National Survey on Drug Use and Health,
questions on prescription drug use disorder were asked of all past year users of prescription drugs, regardless of whether they misused prescription
drugs.”
19
Youth with Serious Thoughts of Suicide
13.16% of youth (over 3.4 million
youth) are experiencing serious
thoughts of suicide.
There are significant racial disparities for

youth suicidality. In 2021-2022, the
percentage of youth reporting suicidal
ideation was highest among youth who
identified as Native Hawaiian or Other
Pacific Islander (25%) and as more than
one race (20%). Suicide rates are highest
for American Indian and Alaska Native
youth and young adults ages 10-24 (36.3
per 100,000). From 2018-2021, the suicide
rate among Black youth and young adults
increased 37%, the highest increase
across race/ethnicity.10
There are also disparities among LGBQ+

The state prevalence of youth with serious students in the U.S. According to the 2021
thoughts of suicide ranges from: YRBS, 45% of LGBQ+ high school students
reported seriously considering attempting
10.68% (DC) 15.00% (OR)
suicide, compared to 15% of heterosexual
students.11

1 District of Columbia 10.68 4,000 27 Florida 13.40 203,000
2 Connecticut 11.00 30,000 28 Pennsylvania 13.46 127,000
3 Michigan 11.85 90,000 29 New Hampshire 13.58 13,000
4 Texas 12.05 316,000 30 Arizona 13.61 79,000
5 Massachusetts 12.24 59,000 31 North Dakota 13.63 8,000
6 New York 12.25 170,000 32 Wisconsin 13.69 63,000
7 Georgia 12.34 113,000 33 Oklahoma 13.71 46,000
8 Mississippi 12.37 31,000 34 Nevada 13.80 34,000
9 South Carolina 12.55 50,000 35 Iowa 13.80 36,000
10 New Jersey 12.71 91,000 36 West Virginia 13.90 18,000
11 North Carolina 12.79 105,000 37 Minnesota 13.94 64,000
12 Kentucky 12.94 46,000 38 Arkansas 14.03 35,000
13 New Mexico 12.95 22,000 39 Hawaii 14.04 14,000
14 Rhode Island 12.98 10,000 40 Tennessee 14.16 77,000
15 Utah 13.04 44,000 41 Nebraska 14.18 24,000
16 Delaware 13.06 10,000 42 Ohio 14.25 130,000
17 Vermont 13.07 6,000 43 Colorado 14.26 63,000
18 Kansas 13.09 32,000 44 South Dakota 14.33 11,000
19 Louisiana 13.20 49,000 45 Wyoming 14.34 7,000
20 Illinois 13.21 132,000 46 Missouri 14.43 70,000
21 Alabama 13.23 52,000 47 Alaska 14.52 9,000
22 Maryland 13.32 63,000 48 Montana 14.64 12,000
23 Maine 13.34 12,000 49 Washington 14.79 85,000
24 Indiana 13.34 74,000 50 Idaho 14.89 25,000
25 California 13.34 411,000 51 Oregon 15.00 46,000
26 Virginia 13.37 88,000 National 13.16 3,406,000
20
Youth (Ages 6-17) Flourishing
Only 60.5% of youth ages 6-17 across
the U.S. meet all three criteria for
flourishing.
Flourishing is determined as a positive indicator

of mental health and wellbeing by the Health
Resources and Services Administration’s (HRSA)
Maternal and Child Health Bureau.12 The criteria
for flourishing were designed to assess children
and adolescents’ learning, resilience, and self-
regulation. Youth who were flourishing were those
who always or usually showed interest and
curiosity in learning new things, work to finish
tasks they started, and stayed calm and in control
when faced with a challenge. Rates of flourishing
are associated with school engagement and other
positive outcomes for youth.13
A 2019 study found that the prevalence of

flourishing was associated with increases in
family resilience and connection, even across
The state prevalence of youth flourishing ranges youth who had experienced higher levels of
from: adversity such as multiple adverse childhood
experiences (ACEs) or lower household
67.30% (GA) 54.30% (KY)
14
Ranked 1-13 Ranked 39-51 incomes. This suggests that state investment in
early interventions and supports for parents and
families can result in greater flourishing.

1 Georgia 67.30 1,140,135 27 Arizona 59.50 659,292
2 Illinois 65.10 1,227,071 28 New Hampshire 59.50 105,697
3 Hawaii 64.80 128,879 29 District of Columbia 59.40 44,019
4 New Mexico 64.00 209,545 30 Rhode Island 59.10 82,001
5 Kansas 63.00 300,226 31 Virginia 59.00 739,666
6 Mississippi 63.00 297,462 32 Delaware 58.60 81,622
8 California 62.70 3,729,267 34 North Dakota 58.00 68,132
9 Connecticut 62.70 314,841 35 North Carolina 57.90 911,184
10 Massachusetts 62.30 573,969 36 Tennessee 57.60 590,681
11 Maryland 62.10 558,711 37 Oklahoma 57.30 367,068
12 South Dakota 62.10 90,027 38 Utah 57.30 367,698
13 Minnesota 61.80 544,795 39 Alaska 57.20 67,381
14 New Jersey 61.80 816,222 40 Indiana 57.00 604,001
15 Iowa 61.60 300,447 41 Missouri 57.00 529,779
16 Florida 61.20 1,759,625 42 Idaho 56.90 178,277
17 Wisconsin 61.20 529,575 43 Alabama 56.70 420,313
18 New York 60.80 1,612,253 44 Colorado 56.70 484,277
19 Ohio 60.70 1,059,324 45 Montana 56.50 90,594
20 Michigan 60.60 873,500 46 Arkansas 56.00 267,516
21 Texas 60.60 3,058,797 47 Vermont 55.20 44,448
22 Pennsylvania 60.40 1,086,892 48 Washington 54.80 611,376
23 Wyoming 60.30 55,957 49 Maine 54.40 91,980
24 South Carolina 59.90 461,746 50 Oregon 54.40 319,747
25 West Virginia 59.70 147,572 51 Kentucky 54.30 364,150
26 Nevada 59.60 278,526 National 60.50 29,863,306
21
Adult Access to Care
Rank State % #
Adults with SUD Who Needed But Did Not Receive 1 West Virginia 67.24 224,000
2 Kentucky 69.57 500,000
Treatment 3 Wyoming 70.11 71,000
4 Arkansas 70.51 324,000
5 Maine 70.55 165,000
6 Tennessee 71.39 765,000
7 Indiana 71.49 688,000
8 Kansas 71.54 299,000
9 Mississippi 71.62 299,000
10 Alabama 72.15 510,000
11 New York 72.59 2,331,000
12 South Dakota 72.88 100,000
13 Pennsylvania 72.90 1,505,000
14 Montana 73.01 149,000
15 Missouri 73.11 766,000
16 Iowa 73.30 356,000
17 Utah 73.67 300,000
18 Idaho 73.74 225,000
The state prevalence of adults with SUD with unmet 19 Massachusetts 73.87 873,000
20 New Mexico 74.15 278,000
treatment needs ranges from:
21 Oklahoma 74.44 479,000
67.24% (WV) 83.99% (IL) 22 Ohio 74.57 1,542,000
Ranked 1-13 Ranked 39-51 23 New Jersey 74.91 1,008,000
24 Michigan 74.98 1,251,000
25 District of Columbia 75.02 124,000
Over three-quarters (76.9%) of all adults with a substance use disorder did 26 Nebraska 75.19 213,000
not receive the treatment they needed. 27 South Carolina 75.64 585,000
28 Vermont 75.70 92,000
Most adults with SUD who sought or thought about receiving treatment 29 Florida 75.97 2,329,000
reported they didn’t because they thought they should have been able to 30 New Hampshire 76.54 175,000
handle their drug or alcohol use on their own (75.4%). 31 Louisiana 77.15 615,000
32 Virginia 77.45 1,006,000
This was followed by: 33 North Dakota 77.62 94,000
34 Wisconsin 77.65 723,000
• Not ready to start treatment (58.6%)
35 Colorado 78.36 907,000
• Not ready to stop or cut back using alcohol or drugs (48.4%)
36 Minnesota 78.40 757,000
• Thought it would cost too much (47.7%)
37 Hawaii 78.52 151,000
• Did not know how or where to get treatment (47.3%). 38 Texas 78.54 3,099,000
39 Connecticut 79.14 478,000
A potential limitation of this measure is that SAMHSA’s definition of treatment
40 Rhode Island 79.32 190,000
does not include receiving harm reduction services. Harm reduction is a 41 Delaware 79.32 129,000
critical part of the continuum of prevention and treatment for substance use 42 Nevada 79.33 470,000
disorders and can fill the gap between when individuals want help but are not 43 Washington 79.53 1,116,000
ready to receive treatment or stop using substances.15 Harm reduction 44 North Carolina 79.56 1,217,000
strategies are proven to be effective in supporting individuals who are 45 Arizona 79.59 894,000
currently using drugs or alcohol by preventing overdose and infectious 46 Oregon 79.91 691,000
disease transmission, connecting individuals to peers, reducing stigma 47 Maryland 80.01 691,000
associated with substance use, and connecting individuals to education and 48 Georgia 80.36 1,245,000
healthcare or social services they may not otherwise have access to.16 These 49 Alaska 81.51 109,000
50 California 82.77 4,963,000
programs can be even more effective when done in collaboration with other
51 Illinois 83.99 1,624,000
agencies to meet whole family’s needs.17 However, states vary significantly in
National 76.90 39,692,000
their laws regarding harm reduction services, 18 limiting access for many
throughout the U.S.
22
Adults with AMI Who Are Uninsured
Rank State Rate #
2 Vermont 3.40 5,000
3 Oregon 4.40 43,000
4 Maine 4.50 12,000
5 Rhode Island 4.50 11,000
6 Hawaii 4.60 12,000
7 Wisconsin 4.70 48,000
8 Maryland 4.90 55,000
9 New Hampshire 4.90 13,000
10 New York 5.00 162,000
11 New Mexico 5.20 22,000
12 Massachusetts 5.30 68,000
13 Virginia 5.40 80,000
14 Kentucky 5.60 44,000
15 Pennsylvania 5.80 133,000
16 Iowa 6.40 45,000
17 New Jersey 6.40 84,000
18 Idaho 6.50 27,000
The state prevalence of uninsured
19 Michigan 6.50 115,000
adults with mental illness ranges from:
20 Indiana 6.60 84,000
2.60% (DC) 22.90% (TX)
21 Delaware 7.10 11,000
22 Colorado 7.20 88,000
23 Connecticut 7.50 42,000
24 Louisiana 7.50 64,000
10.1% of adults (over 5.9 million people) with a mental illness are uninsured,
25 Ohio 7.50 164,000
compared to 9.3% of adults without a mental illness.
26 Arkansas 7.80 40,000
In 2022, 64% of adults who were uninsured said that they did not have health 27 California 7.80 522,000
insurance because they could not afford it.19 Without health insurance, individuals 28 Alaska 7.90 10,000
29 Washington 7.90 137,000
often delay or forgo mental health care. In 2019, 62% of uninsured adults with
30 Nevada 8.70 55,000
anxiety or depression did not receive treatment, compared to 37% of those with
31 Utah 8.70 64,000
private insurance and 35% of those with Medicaid.20 When individuals forgo care,
32 Minnesota 9.10 100,000
their conditions often worsen,21 causing them to reach a crisis point in which they
33 Illinois 9.30 197,000
need to receive care. This is not only costly to the individual but also to medical
34 Nebraska 9.40 33,000
providers, states, and the federal government, who are responsible for most
35 Missouri 9.50 127,000
uncompensated care costs.
36 West Virginia 10.50 41,000
37 Arizona 10.60 132,000
States can improve health coverage rates for individuals with mental health
38 Montana 11.80 27,000
conditions and reduce uncompensated care costs through Medicaid expansion.
39 South Dakota 12.40 19,000
From 2013-2022, the uninsured rate among low-income adults decreased from
40 Tennessee 12.80 182,000
35% to 15% in states that expanded Medicaid, while the rate only decreased from
41 North Dakota 12.90 18,000
44% to 30% in non-expansion states.22 From 2018-2019, uncompensated care
42 Kansas 13.50 70,000
costs increased 6% across all states, but decreased 14% in Virginia and Maine, the
43 South Carolina 13.60 111,000
two states that expanded Medicaid that year.23
44 Alabama 14.40 132,000
45 Florida 14.90 516,000
Nine of the 10 states that have not expanded Medicaid are ranked 39-51. Among
46 North Carolina 15.50 271,000
these non-expansion states, 13-24% of the remaining uninsured population fall
47 Oklahoma 16.10 121,000
within the Medicaid coverage gap.24 Wisconsin (ranked 7th) is the only non-
48 Georgia 18.70 351,000
expansion state that does not have a Medicaid coverage gap, as state policy
49 Wyoming 19.70 24,000
ensures that all low-income residents are either covered by Medicaid or given
50 Mississippi 22.80 111,000
subsidies to purchase private insurance.25 Other states, like Tennessee, have
51 Texas 22.90 1,068,000
created safety net programs to fill gaps in access to behavioral health care for
National 10.10 5,916,000
uninsured residents. While the impacts of these programs are not reflected in this
indicator, they are reflected in the other access to care indicators in this report.
23
Adults Reporting 14+ Mentally Unhealthy Days a Month Who Could Not See a Doctor Due
to Costs
24.58% of adults who reported experiencing 14 or

more mentally unhealthy days each month were not
able to see a doctor due to costs. This was a 2%
increase over last year’s report.
High costs of mental health care are a critical barrier

to access. In 2022, 58.9% of adults with a mental
illness in the past year who sought or thought they
should receive mental health care said the reason they
did not receive it was because they thought it would
cost too much.26
The largest increases in adults experiencing frequent

mental distress* who could not see a doctor due to
cost were in Nevada (10.46% increase), Kentucky
The prevalence of adults with 14+ mentally
(8.89%), and Tennessee (7.61%). However, decreasing
unhealthy days who could not see a doctor
health care affordability was not unique to these
due to cost ranges from:
states – nationally between 2017 and 2021, prices for
healthcare services increased 14%, with the greatest 12.88% (HI) 34.95% (GA)
increases for inpatient services.27 Ranked 1-13 Ranked 39-51

1 Hawaii 12.88 16,793 27 Ohio 22.76 375,207
2 Rhode Island 13.90 18,748 28 South Dakota 22.90 19,731
3 Vermont 15.04 12,752 29 Montana 23.00 32,700
4 Massachusetts 15.84 127,266 30 Nebraska 23.52 42,413
5 Oregon 17.44 103,696 31 Illinois 24.54 327,839
6 Connecticut 18.34 75,156 32 Alaska 25.15 20,818
7 Delaware 18.37 20,855 33 Kentucky 25.28 141,765
8 New Mexico 18.49 48,170 34 Idaho 26.02 56,813
9 Pennsylvania 18.66 283,014 35 Louisiana 26.14 181,572
10 Wisconsin 18.84 138,097 36 Arizona 26.25 245,891
11 Maine 18.85 33,832 37 Utah 27.74 110,845
12 Iowa 19.10 63,036 38 Kansas 27.83 97,880
13 New Hampshire 19.41 36,583 39 Florida 27.91 733,717
14 Michigan 19.45 253,407 40 Tennessee 28.19 309,054
15 Maryland 19.48 134,072 41 Missouri 29.17 236,191
16 Minnesota 19.55 125,782 42 South Carolina 29.22 186,625
17 New York 20.25 480,099 43 Oklahoma 29.71 159,026
18 California 20.26 855,786 44 Arkansas 30.37 142,055
19 New Jersey 20.75 204,236 45 North Carolina 30.71 387,402
20 District of Columbia 20.87 15,247 46 Mississippi 31.15 108,393
21 West Virginia 21.17 62,187 47 Nevada 32.26 115,706
22 Virginia 21.25 232,815 48 Wyoming 32.97 21,562
23 Washington 21.35 213,394 49 Alabama 33.24 233,201
24 Indiana 21.90 190,222 50 Texas 34.38 1,223,117
25 Colorado 22.16 161,822 51 Georgia 34.95 462,803
26 North Dakota 22.27 18,476 National 24.58 9,897,868
*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 health not good?”
Having 14 or more mentally unhealthy days each month is defined as experiencing frequent mental distress. 28
24
Adults with AMI with Private Insurance That Did Not Cover Mental or Emotional
Problems
10.2% of adults who experienced a mental illness in the past year had
private health insurance that did not cover mental or emotional
problems.
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 for
mental health are included in the plan). It does not require private
insurers to cover mental health services.
Even when people have some insurance coverage for their mental
health, it does not guarantee they will be able to receive mental health
care that is covered by insurance. Individuals are often forced to pay to
see out-of-network providers because of a lack of mental health
providers working in network. A 2024 study found that patients went
out-of-network 3.5 times more often to see a behavioral health clinician,
10.6 times more often to see a psychologist, 8.9 times more often to
see a psychiatrist, and 19.9 times more often for sub-acute behavioral The prevalence of adults with AMI whose
health inpatient care than to see a medical/surgical clinician.29 Many private insurance did not cover mental or
behavioral health providers practice out-of-network because they are emotional problems ranges from:
reimbursed significantly less than medical/surgical clinicians. 30 3.60% (VT) 24.70% (MS)
Under the revised parity rules proposed in 2023, plans would be
required to collect and analyze data on practices including
reimbursement rates and network composition, and if such practices
created unequal access to individuals with mental health conditions,
plans would have to take action to correct them.31

1 Vermont 3.60 3,000 27 Nevada 10.30 30,000
2 Washington 3.70 30,000 28 Connecticut 10.80 35,000
3 Rhode Island 3.80 5,000 29 New Mexico 11.00 20,000
4 Ohio 5.80 65,000 30 Hawaii 11.10 13,000
5 Maryland 6.10 35,000 31 Tennessee 11.10 69,000
6 New York 6.10 100,000 32 Minnesota 11.30 66,000
7 District of Columbia 6.60 6,000 33 Missouri 11.30 73,000
8 Virginia 6.60 54,000 34 Pennsylvania 11.40 135,000
9 Massachusetts 6.70 47,000 35 Florida 11.80 194,000
10 Oregon 6.90 36,000 36 Idaho 11.80 28,000
11 Iowa 7.00 25,000 37 Louisiana 12.00 33,000
12 Alaska 7.20 4,000 38 Utah 12.70 62,000
13 Maine 7.40 9,000 39 Arkansas 12.90 27,000
14 Indiana 8.00 51,000 40 Wyoming 13.10 7,000
15 Wisconsin 8.00 49,000 41 Oklahoma 13.20 41,000
16 Colorado 8.10 57,000 42 North Carolina 13.40 109,000
17 Delaware 8.80 7,000 43 Arizona 13.80 76,000
18 New Hampshire 8.80 14,000 44 Alabama 15.80 66,000
19 Georgia 8.90 75,000 45 North Dakota 15.90 13,000
20 Illinois 9.30 98,000 46 Texas 16.50 350,000
21 Kansas 9.40 26,000 47 Montana 16.70 14,000
22 Michigan 9.40 80,000 48 South Carolina 16.80 58,000
23 Kentucky 9.50 31,000 49 Nebraska 17.60 39,000
24 New Jersey 9.50 78,000 50 West Virginia 20.00 23,000
25 South Dakota 9.60 8,000 51 Mississippi 24.70 42,000
26 California 10.30 316,000 National 10.20 2,929,000
25
Youth Access to Care
Youth with MDE Who Did Not Receive Mental Health Services
56.1% of youth with major depression did

not receive any mental health treatment.
This was defined as receiving treatment or
counseling from a medical doctor or other
professional or receiving medication for
MDE.
In 2022, youth with MDE were asked whether

they felt they had an unmet need for
treatment and the main reasons why they
did not receive it. 48.3% of youth with MDE
reported an unmet need for treatment,
totaling 987,000 youth in the U.S.32 The
main reason youth reported not receiving
care was they felt they should have been
able to handle their mental health on their
own (86.9%). That was followed by being
worried what people would think or say if
The state prevalence of untreated
they got treatment (59.8%), being worried
youth with depression ranges from:
that the information they shared would not
31.50% (DC) 82.10% (SD) be kept private (57.8%), and not knowing
Ranked 1-13 Ranked 39-51 how or where to get treatment (55.5%).33

1 District of Columbia 31.50 2,000 27 Virginia 54.50 75,000
2 Maine 34.60 6,000 28 Michigan 55.70 71,000
3 Louisiana 38.90 31,000 29 New Jersey 56.40 71,000
4 Illinois 39.30 79,000 30 Mississippi 56.60 26,000
5 Idaho 42.60 14,000 31 Oklahoma 56.60 28,000
6 Rhode Island 43.20 8,000 32 Delaware 56.80 9,000
7 Oregon 44.70 37,000 33 West Virginia 57.10 14,000
8 Maryland 46.00 49,000 34 New York 57.20 149,000
9 Massachusetts 46.10 35,000 35 Arkansas 58.30 24,000
10 Montana 46.60 9,000 36 Alabama 58.70 42,000
11 Wisconsin 47.00 37,000 37 North Dakota 61.30 9,000
12 North Carolina 47.20 71,000 38 California 62.40 346,000
13 Wyoming 47.20 4,000 39 Tennessee 62.40 69,000
14 Utah 47.90 24,000 40 Minnesota 63.50 70,000
15 Florida 49.70 155,000 41 Nebraska 65.10 24,000
16 Iowa 51.20 28,000 42 Indiana 66.40 65,000
17 Ohio 52.00 97,000 43 Alaska 66.70 9,000
18 Colorado 52.90 64,000 44 Kansas 66.70 34,000
19 Connecticut 53.00 24,000 45 Arizona 67.20 101,000
20 New Hampshire 53.00 11,000 46 Texas 67.60 284,000
21 Vermont 53.00 3,000 47 South Carolina 67.70 39,000
22 Missouri 53.30 65,000 48 New Mexico 69.60 31,000
23 Georgia 53.70 75,000 49 Hawaii 69.90 8,000
24 Pennsylvania 53.70 104,000 50 Nevada 73.70 47,000
25 Washington 54.00 79,000 51 South Dakota 82.10 8,000
26 Kentucky 54.10 32,000 National 56.10 2,793,000
26
Youth with Private Insurance That
Rank State Rate #
Did Not Cover Mental or Emotional Problems 1 Connecticut 2.30 4,000
2 Maine 2.70 1,000
3 Kansas 3.90 5,000
4 South Dakota 4.90 2,000
7 New York 5.60 36,000
8 Minnesota 6.00 18,000
9 Vermont 6.00 1,000
10 Illinois 6.10 35,000
11 Wyoming 6.10 2,000
12 Indiana 6.20 20,000
13 Iowa 6.30 9,000
14 New Mexico 6.30 3,000
15 New Jersey 6.50 24,000
16 Virginia 6.50 23,000
17 Colorado 6.70 16,000
18 California 6.80 95,000
19 Utah 6.80 15,000
20 Washington 6.80 22,000
21 Idaho 6.90 6,000
The state prevalence of youth lacking mental health 22 Alaska 7.20 1,000
coverage ranges from: 23 Rhode Island 7.20 2,000
24 Oregon 7.40 11,000
2.30% (CT) 17.00% (MS)
25 Alabama 7.50 11,000
26 North Dakota 7.60 2,000
27 Florida 7.70 48,000
28 Wisconsin 7.70 20,000
29 Ohio 8.00 39,000
Nationally, 8.5% of youth who are covered under private insurance do
not have coverage for mental or emotional difficulties – totaling over 1
31 Hawaii 8.30 4,000
million youth.
32 Nebraska 8.30 8,000
33 Oklahoma 9.00 9,000
While the Affordable Care Act (ACA), enacted in 2010, requires
34 Missouri 9.10 20,000
individual plans and small group coverage to include coverage for
35 Montana 9.20 4,000
mental health services, it does not require large group plans for 36 Massachusetts 9.40 28,000
employers with more than 50 employees to cover mental health 37 Louisiana 9.60 10,000
services as essential health benefits. Many state laws require these 38 Georgia 10.40 42,000
large group plans to cover mental health services, but there are still 39 Michigan 10.40 40,000
several states that do not have health insurance coverage mandates. 40 Kentucky 10.70 15,000
41 Texas 10.90 112,000
Even in states that do require health insurance coverage for large group 42 West Virginia 11.20 6,000
plans to cover mental health services, these laws don’t apply to large 43 Delaware 12.00 5,000
group plans that are self-insured (meaning the employer pays the costs 44 Maryland 13.60 36,000
of its health benefits rather than purchasing a health insurance policy). 45 Tennessee 14.00 29,000
In 2023, the Employer Health Benefits Survey from Kaiser Family 46 Arkansas 14.10 12,000
Foundation found that 65% of covered workers were in a self-funded 47 North Carolina 14.20 55,000
48 Arizona 14.80 30,000
plan.34 As a result of MHPAEA not requiring mental health coverage and
49 Nevada 14.80 18,000
the ACA not requiring large group plans to cover mental health services,
50 South Carolina 15.90 26,000
there are still many individuals who have private insurance plans that
may not cover mental health services, significantly limiting their ability 8.50 1,039,000
National
to access or afford care.
27
Students (K+) Identified with Emotional Disturbance Rank State Rate #
1 Vermont 28.01 2,122
for an Individualized Education Program 2 Massachusetts 19.03 16,978
3 Minnesota 19.00 16,074
5 Maine 13.97 2,342
6 Wisconsin 13.09 10,111
7 Indiana 11.15 11,294
8 North Dakota 10.98 1,269
11 Rhode Island 9.95 1,337
12 South Dakota 9.39 1,301
13 Nebraska 9.17 2,840
14 Illinois 8.78 15,585
15 Oregon 8.62 4,762
16 Delaware 8.03 1,117
17 Ohio 7.79 12,742
The state rate of students identified as having an emotional 18 Texas 7.60 39,911
disturbance (ED) for an individual education program (IEP) 19 Missouri 7.47 6,401
20 Michigan 7.38 10,245
ranges from:
21 Virginia 7.08 8,676
28.01 (VT) 1.55 (AL)
Ranked 39-51 22 New York 6.73 16,536
Ranked 1-13
23 Wyoming 6.49 595
24 District of Columbia 6.46 511
Only .667 percent** of students are identified as having an emotional disturbance
26 Kentucky 6.17 3,910
(ED) for an Individualized Education Program (IEP). While there was an increase in
27 Arizona 6.09 6,781
mental distress among students from 2019-2021,35 the percentage of students
28 New Mexico 5.81 1,771
identified with emotional disturbance for an IEP decreased in all states except for
29 Alaska 5.73 731
Wyoming, Texas, and South Dakota.
30 Colorado 5.62 4,710
IEPs are critical for ensuring that youth with disabilities can receive the 31 Maryland 5.49 4,717
individualized services, supports, and accommodations to succeed in a school 32 Oklahoma 5.43 3,603
setting. However, without sufficient funding, staffing, and guidance, identification of 33 Montana 5.27 789
students with emotional disturbance may contribute to disparities for underserved 34 Georgia 5.17 8,792
youth. The federal eligibility criteria for ED have shown poor reliability among school 35 Kansas 4.94 2,290
psychologists,36 allowing for students to be classified differently depending on where 36 New Jersey 4.75 6,226
they attend school. Nationally, multiracial and Black students continue to be 37 Washington 4.62 4,939
overrepresented among students identified with emotional disturbance. In 2022, 38 Hawaii 4.55 768
6.23% of all multiracial youth with a disability and 5.68% of Black youth with a 39 Idaho 4.08 1,280
disability were identified with emotional disturbance, compared to 4.52% of all 40 Florida 4.01 11,263
students identified with a disability.37 Students identified with ED may also be limited 41 Nevada 3.86 1,823
to learning in more restrictive environments, increasing stigma and leading to poorer 42 California 3.69 21,573
educational outcomes. Nationally, students with ED were 1.31% more likely to spend 43 Tennessee 3.31 3,224
less than 40% of their day inside a regular classroom than the average among all 44 West Virginia 3.22 761
students with a disability in 2022 – in some states they were more than 10% more 45 North Carolina 2.93 4,439
likely to spend most of their time outside of a regular classroom.38 46 South Carolina 2.47 1,886
47 Louisiana 2.45 1,700
To keep students in the least restrictive settings while meeting their educational and 48 Utah 2.38 1,610
mental health needs, schools must receive additional funding and staff. In 2022, 45% 49 Arkansas 2.04 970
of schools reported vacancies in special education roles and 78% reported difficulty in 50 Alabama 1.55 1,127
hiring special education staff.39 While funding has increased for schools through 51 Iowa * *
emergency school funds in recent years, a 2021-2022 survey of school principals by National 6.67 320,828
the National Center for Education Statistics found 39% of schools said inadequate *Data from Iowa was suppressed because Iowa does
funding and inadequate access to mental health professionals still significantly not use special education categories.
limited their school’s ability to provide student mental health support. 40 **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.
28
Mental Health Workforce Availability Rank State #
1 Massachusetts 140:1
2 Alaska 150:1
3 District of Columbia 160:1
4 Oregon 160:1
5 Maine 190:1
6 Vermont 190:1
7 Connecticut 220:1
8 Rhode Island 220:1
9 Washington 220:1
10 Colorado 230:1
11 New Mexico 230:1
12 California 240:1
13 Oklahoma 240:1
14 Utah 270:1
15 Wyoming 270:1
16 Montana 280:1
17 New Hampshire 280:1
18 New York 300:1
19 Louisiana 310:1
The state rate of mental health 20 Maryland 310:1
workforce ranges from: 21 Delaware 320:1
22 Michigan 320:1
140:1 (MA) 800:1 (AL)
23 Minnesota 320:1
Ranked 1-13 Ranked 39-51 24 Nebraska 330:1
25 Ohio 330:1
26 Illinois 340:1
In the U.S., there are 340 individuals for every one mental health provider.* As of March 27 North Carolina 340:1
2024, over 122 million people lived in a mental health workforce shortage area, and only 28 Hawaii 350:1
27% of the mental health need in shortage areas was being met by mental health 29 Kentucky 370:1
providers.41 Over the next 15 years, the National Center for Health Workforce Analysis has 30 New Jersey 370:1
projected increasing shortages for several behavioral health providers, including 31 Arkansas 390:1
psychologists, psychiatrists, and mental health and addiction counselors.42 32 Pennsylvania 400:1
33 Idaho 420:1
One of the ways to increase access to mental health providers is to expand the use of 34 Nevada 420:1
peer support specialists. SAMHSA recognizes peer support as an effective, evidence- 35 Wisconsin 420:1
based practice and peer support specialists as critical parts of treatment teams.43 To 36 Missouri 430:1
further expand the use of peer support specialists there must be an increase in the 37 Kansas 450:1
settings in which they can practice, the services they can provide, and reimbursement for 38 Virginia 450:1
those services. First, the organizations that can provide Medicare-covered peer support 39 South Dakota 460:1
services should be expanded to include rural health clinics, federally qualified health 40 North Dakota 470:1
centers (FQHCs), and other community health centers through the passage of the PEERS 41 South Carolina 490:1
in Medicare Act.44 These community health centers are often providing care to 42 Mississippi 500:1
underserved communities with limited access to other services, and peer support 43 Florida 510:1
specialists can help to bolster their workforces. 44 Indiana 530:1
45 Iowa 530:1
States can also expand the use of peer support specialists in mental health promotion 46 Tennessee 560:1
and early intervention services through the rehabilitative option in their Medicaid plans. In 47 Arizona 590:1
many states, individuals must have a mental health diagnosis to qualify for peer services, 48 Georgia 600:1
which limits the ability of peers to provide support before mental health concerns reach a 49 West Virginia 620:1
point of crisis. The rehab option allows states to use peers for preventive non-clinical 50 Texas 690:1
services in community settings, as has been done in Georgia.45 To work toward prevention 51 Alabama 800:1
and early intervention, states can also expand their Medicaid plans to reimburse for parent National 340:1
and family peer support services (currently reimbursed in 27 states) and youth peer
support services (currently reimbursed in 18 states). 46 *The term “mental health provider” includes
psychiatrists, psychologists, licensed clinical
social workers, counselors, marriage and
Finally, many peer specialists do not make a living wage and are forced to leave the family therapists, and advanced practice
workforce, further limiting access to mental health services. In 2022, 45% of state mental nurses specializing in mental health care.
health agencies reported that Medicaid reimbursement for peers is too low. 47 To ensure
that peers can remain in the workforce, states should raise their reimbursement rates, as
was recently done in Virginia48 and North Carolina.49
29
Youth with MDE Who Reported Treatment or Rank State Rate #
Counseling Helped Them** 2 Montana 84.50 8,000
4 Arkansas 81.40 14,000
6 Maine 78.40 8,000
7 Colorado 77.60 42,000
8 Wisconsin 77.50 28,000
9 New York 77.20 77,000
10 Wyoming 77.00 4,000
11 Alabama 75.60 21,000
12 Vermont 75.60 2,000
13 Minnesota 75.30 30,000
14 Indiana 73.30 20,000
15 Washington 72.70 48,000
16 New Mexico 71.70 9,000
17 New Jersey 70.60 35,000
18 North Carolina 70.20 52,000
19 Florida 70.10 103,000
20 Tennessee 68.10 26,000
21 Idaho 67.70 9,000
The state rate of youth with MDE reporting 22 California 66.80 134,000
treatment helped them ranges from: 23 Illinois 66.80 78,000
24 Georgia 66.30 38,000
84.60% (DC) 32.50% (IA) 25 North Dakota 64.80 3,000
Ranked 1-13 Ranked 39-51 26 Pennsylvania 64.50 57,000
27 Texas 64.30 79,000
28 Oklahoma 63.80 13,000
Nationally, 65.0% of youth with MDE who received mental health treatment or 29 West Virginia 62.70 6,000
counseling reported that it helped them at least “some.” Only a little over a 30 Maryland 61.90 34,000
31 Michigan 61.60 33,000
third (36%) reported it helped them “a lot” or “extremely.” Quality of care for
32 Louisiana 61.30 28,000
youth with MDE varied significantly from the highest ranked to lowest ranked 33 Virginia 59.20 33,000
states – there was a 52% difference in the percentage of youth reporting 34 Utah 58.70 13,000
treatment or counseling helped them between the District of Columbia 35 Delaware 58.50 4,000
36 Kansas 58.20 8,000
(ranked 1) and Iowa (ranked 49).
37 Ohio 57.10 47,000
38 Kentucky 56.60 14,000
While increasing access to mental health care is critical, ensuring people are
39 Alaska 55.10 2,000
receiving quality care is equally important. Ensuring access to care means 40 Oregon 54.60 22,000
little if individuals do not want to access it, do not want to continue utilizing 41 Rhode Island 54.10 3,000
care because they don’t feel like it is helping them, or at worst, are 42 Massachusetts 53.90 22,000
43 Nevada 51.70 8,000
experiencing harms as a result of their treatment.
44 Nebraska 48.10 6,000
45 Arizona 44.30 21,000
There are few standardized, publicly available quality measures for mental
health care. According to a 2021 environmental scan of quality measures by 47 Hawaii 38.60 1,000
the National Committee for Quality Assurance (NCQA), most federal programs 48 Missouri 36.50 16,000
rely on process or non-standardized quality measures. The most frequently 49 Iowa 32.50 8,000
50 South Carolina * *
used quality measures across programs were screening for depression and
51 South Dakota * *
follow-up, follow-up after hospitalization for mental illness, and initiation and National 65.00 1,301,000
engagement of alcohol and other drug abuse treatment.50 These are all
*Data for South Carolina and South Dakota were
process measures, and do not include whether the individual felt that they suppressed due to limited sample sizes.
received quality care or that it helped them. Quality measures should be
**This includes youth with MDE who received
codesigned with individuals with lived experience of mental health conditions treatment or counseling in the past year and
to adequately capture what is meaningful to people receiving care. State answered the question, “During the past 12
months, how much has treatment or counseling
mental health agencies should also include measures of patient experience helped you?” with “some,” “a lot,” or “extremely.”
data, including both inpatient and outpatient treatment experiences, as part of
their quality measurement and reporting, and should use this data to increase
the accountability of plans and providers licensed to operate in the state.
30
Creating Supportive Communities: A Spotlight on State Percentage of parents
reporting their child lives in a
Prevention supportive neighborhood,
2021-2022
To reduce the negative impact of the mental health crisis, states Utah 69.50
must take an upstream public health approach focused on South Dakota 66.00
Idaho 65.80
prevention of mental distress and promotion of well-being. In 2023,
Vermont 65.60
Mental Health America, along with the Association for State and Minnesota 65.50
Territorial Health Officials (ASTHO), the Centers for Disease Control North Dakota 65.30
and Prevention (CDC), and the Center for Law and Social Policy Iowa 65.00
(CLASP) released a framework for the role of public health in Wyoming 64.40
Nebraska 64.10
mental health promotion and suicide prevention.51 The goal of this
Maine 64.00
framework was to outline strategies to prevent illness and promote Kansas 63.90
well-being by improving the conditions in which individuals live, Wisconsin 63.50
learn, work, and play. Missouri 63.10
Ohio 62.10
Two of the core strategies identified through this framework were Kentucky 61.70
to improve the essential conditions for health and well-being and to Michigan 61.00
Indiana 60.80
promote protective environments and social connections. Social
Massachusetts 60.70
and community support are integral to overall health, where low Alabama 60.50
levels of social support are associated with poor health outcomes West Virginia 60.50
and high levels have been found to improve both physical and Pennsylvania 60.40
mental health.52 These strategies are reflected in federal initiatives New Hampshire 60.30
New Jersey 60.20
like the National Strategy for Suicide Prevention and the objectives
Illinois 60.00
of Healthy People 2030, but little progress has been made in recent Tennessee 59.60
years. Of the nine objectives to increase social and community Montana 58.80
support in Healthy People 2030, five have gotten worse and one has Virginia 58.30
shown little or no change over time.53 According to data from the Rhode Island 57.90
2022 Behavioral Risk Factor Surveillance Survey, the most Colorado 57.80
Mississippi 57.70
commonly reported adverse social determinants of health were
Connecticut 57.40
social isolation or loneliness and a lack of social and emotional Alaska 57.30
support, both identified as proxies for a lack of social connection.54 South Carolina 57.30
In 2021-2022, only 56% of families in the U.S. reported that their Georgia 56.40
children lived in supportive neighborhoods. A supportive Arkansas 56.00
Delaware 55.60
neighborhood was defined as one in which people in the
North Carolina 55.50
neighborhood helped each other, people in the neighborhood Maryland 55.30
watched out for each other’s children, and people knew where to go Oklahoma 55.20
for help in their community when they encountered difficulties. Louisiana 55.10
Lacking community support is a risk factor for poor mental health Washington 55.10
Hawaii 53.20
outcomes.55,56 Nevada, ranked last overall in this year’s State of
Florida 53.00
Mental Health in America report, had the lowest percentage of Oregon 52.60
families reporting their children lived in supportive neighborhoods, New York 50.90
at only 44%.57 Texas 50.10
Arizona 48.90
California 48.70
New Mexico 46.80
District of Columbia 45.60
Nevada 44.20
National 56.00
31
To build social connection and promote mental well-being, states and localities must create communities in
which people are able to thrive. Some prevention strategies, such as early childhood programs and family
economic supports, have been found to have wide-reaching impact on both increased social support in
communities58 and reduction of poor mental health outcomes and adverse childhood experiences (ACEs).59
Several of these evidence-based interventions are under the jurisdiction of state or local governments.60 For
example, states should continue to invest in early childhood home visiting programs and group-based
parenting programs. Both of these interventions have been found to improve early childhood development,
increase economic well-being, strengthen family and community connection,61 and reduce the risk of ACEs.62
States should also invest in economic supports for families, such as expansions of state earned income tax
credit (EITC) laws and state child care subsidies. Research has found that both strategies can improve
maternal and child health and well-being, increase economic and employment stability, and contribute to
positive community-level outcomes such as increased school engagement and reductions in violence.63,64
According to the National Academy of Sciences, economic supports like the EITC that help to stabilize families
before they are experiencing financial crises can also reduce parental stress and lead to improvements in child
health outcomes.65 As of April 2024, there were still 15 states without any state EITC, including Nevada, North
Dakota, Wyoming, Idaho, and Tennessee, all of which are ranked 39-51 overall in this year’s State of Mental
Health in America report.66 To achieve long-term population-level improvements in mental health, states must
invest in these upstream approaches to create more stable, thriving, and connected communities.
Keeping People in Communities: A Spotlight on Housing
A thriving and connected community has access to affordable and stable housing which helps to draw in new
residents and reduces the impact of families facing homelessness during a financial crisis. Furthermore,
residential stability has been associated with several measures of well-being and community cohesion,
including greater life satisfaction, improved educational outcomes, better physical and mental health, and
increased civic and social engagement within communities.67 Once individuals and families face
homelessness, the cascading impact is profound. Housing insecurity and homelessness are associated with
higher risk of ACEs,68 violence and victimization, depression, and suicidal ideation.69
The U.S. is currently facing a worsening housing crisis. In 2022, the number of renter households that spent
more than 30% of their income on rent and utilities reached a record high of 22.4 million.70 Additionally, the U.S.
Department of Housing and Urban Development (HUD) reported that the number of families in 2021 with an
unmet need for affordable rental housing, referred to as worst-case housing needs, was the highest ever
recorded. The percentage of very low-income renters experiencing worst-case housing needs was also the
highest ever recorded at 44.1%,71 leaving many low-income individuals and families at risk of experiencing
homelessness. In 2023, HUD reported 650,000 people were experiencing homelessness on a single night in
January 2023, a 12% increase from 2022.72
This crisis has generated bipartisan support for increasing the availability of mental health services and finding
solutions for homelessness. However, the solutions currently being proposed in many states to combat
homelessness and housing insecurity are moving away from community-based care toward punitive or
coercive approaches designed to remove individuals from their communities. In June 2024, the Supreme Court
ruled that cities could ban people from sleeping and camping in public places, even if there are no available
alternatives. This ruling criminalizes homelessness by allowing localities to charge fines or incarcerate
individuals sleeping in public places. For people who cannot afford housing and for whom there are no
alternative shelters, fines and incarceration will only exacerbate hardship. These policies will remove
individuals from community and family connections, destabilize those who may already be receiving mental
32
health treatment or other services, and leave people with debts or criminal records that can further hamper
their ability to find housing and employment opportunities.
Other states and localities have proposed the use of involuntary hospitalization or conservatorships as
solutions to homelessness. In 2023, New York City Mayor Eric Adams announced a directive allowing for
involuntary hospitalization of individuals showing signs of mental distress who seem unable to meet their own
basic needs, which could include experiencing homelessness.73 In California, the Lanterman-Petris-Short Act
provides for involuntary commitment and treatment for individuals determined to be a danger to themselves or
others or gravely disabled. In 2024, a law went into effect that expanded the definition of “gravely disabled.”
Someone can now be considered “gravely disabled” if they are unable to provide for their basic personal needs
for food, clothing, shelter, personal safety, or necessary medical care as a result of a mental health disorder,
chronic alcoholism, or a severe substance use disorder.74 While these policies may be created in an effort to
provide care to people who need it, often this policy approach, which targets unhoused people with mental
illness, can cause more harm than help by starting cycles of hospitalization and creating unnecessary police
interactions.75
Involuntary hospitalization does not resolve unmet needs like a lack of affordable housing or mental health
services, and resources would be better spent addressing upstream causes to avoid rehospitalization and
keep individuals in their communities. The rise of policies using involuntary hospitalization may also deter
people from seeking mental health care when they need it. In 2022, 23.4% of adults with any mental illness
(AMI)76 and nearly half (45%) of youth who had experienced a major depressive episode (MDE)77 in the past
year reported that one of the reasons they did not receive mental health treatment was because they were
afraid of being committed to a hospital or forced into treatment against their will.
Reason for Not Receiving Mental Health Treatment Among Youth Ages 12-17 With a Percentage*
Past-Year Major Depressive Episode, 2022
Thought they should have been able to handle their mental health, emotions, or 86.90
behavior on their own
Worried about what people would think or say if they got treatment 59.80
Worried that information would not be kept private 57.80
Did not know how or where to get treatment 55.50
Thought no one would care if they got better 53.90
Did not think treatment would help them 51.50
Thought their family, friends, or religious group would not like it if they got treatment 48.20
Afraid of being committed to hospital or forced into treatment against their will 45.00
Not ready to start treatment 44.50
Thought they would be told they needed to take medication 39.40
Did not have enough time for treatment 34.80
Thought it would cost too much 33.30
Could not find treatment program or healthcare professional they wanted to go to 30.20
Had problems with things like transportation, childcare, or getting appointments at 24.20
times that worked for them
Did not have health insurance coverage for mental health treatment 13.30
Thought that if people knew they were in treatment, bad things would happen, like 13.30
losing their job, home, or children
No openings in treatment program or with healthcare professional they wanted to go to 11.70
Health insurance would not pay enough of costs for treatment 8.80
*Respondents were asked to choose all that apply.
33
Increasing Connection Through Enhanced Care, Peer Support, and Other Community-Based
Services
In a supportive neighborhood, people are offered the services they need for stability and know where to go to
find them. When recovering from disability, social connections allow people to receive support within their
communities. Enhanced treatments or specialty care that provide connection, like supportive housing and peer
support services, decrease the likelihood of hospitalizations and incarceration and increase long-term positive
outcomes.78,79,80
When individuals have a stable place to live, they are more likely to engage in treatment services that allow
them to stay in their communities. Research shows that individuals with chronic illnesses engaged in
supportive housing and Housing First programs are more likely to stay housed than those who receive usual
care. These programs provide individuals with immediate access to stable and affordable housing while they
receive supportive services, including mental health or substance use services. Initial studies of Housing First
also found that those in the program spent significantly less time hospitalized and less time homeless than
those who received usual care.81 In 2023, the U.S. Department of Veterans Affairs credited their Housing First
programs with decreasing veteran homelessness by over 52% since 2010.82 These programs are person-
centered and recovery-oriented, and often include opportunities for social engagement, allowing for more
socially-connected communities.83 An analysis of Pathways Housing First in New York City found that
chronically homeless individuals assigned to Housing First had greater social integration into their
neighborhoods than those in shelters and other temporary living situations.84 Rather than spending resources
on punitive policies aimed at those experiencing homelessness, states can invest in supportive housing
programs and other services to prevent homelessness and housing instability, including rental assistance
programs, emergency housing funds, and tenant outreach and education about available community
supports.85
Peer support specialists and community health workers can also help engage people experiencing housing
instability and/or mental health challenges by providing social connection, emotional support, and linkages to
resources to meet their needs within their communities. States and localities should work to implement
successful peer support and outreach programs like the Intensive and Sustained Engagement Team (INSET)
program in New York and the Richmond City Health District in Virginia. In 2017, the Mental Health Association
of Westchester created the INSET program to connect with individuals who were ordered or were at risk of
being court-ordered to receive Assisted Outpatient Treatment (AOT). Participants in the program are treated as
partners with the INSET team and are empowered to determine their own goals in recovery, get the support
they desire, and engage in shared decision-making. One of the primary goals of the INSET program is to create
and maintain social connections, so that individuals can receive community support when needed, reducing
the probability of future hospital stays, homelessness, or incarceration.86 In Virginia, the Richmond City Health
District partners with the housing authority to embed health resource centers in public housing developments
in the city. These centers are run by community health workers with lived experience in public housing who
work to connect residents with mental health, employment, and other supportive services in their community. 87
Finally, community connections can be built through power-sharing with community members. Residents of
communities often know best what the root causes of disconnection are within their communities and which
investments can have the greatest impact. Cities and states should implement power-sharing practices like
community participatory budgeting, in which residents can decide how to allocate portions of the state or local
budget to various projects. The Department of Housing and Urban Development (HUD) has advised that these
community participatory budgeting practices can be used by cities through HUD housing and community
development funds to promote affordable housing and provide services to individuals in need within their
34
communities.88 States can also engage in policy and programmatic co-design with individuals, including youth,
with lived experience. Co-designing solutions with community members with lived experience can ensure
solutions are more effective at addressing the root causes of problems within communities as well as increase
engagement with those solutions.89 These strategies of power-sharing and community co-design inherently
build connection by bringing residents together to collaborate on solutions to improve their communities.90
35
References
1. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality,
National Survey on Drug Use and Health (2022). Table 6.3B. Retrieved from
https://www.samhsa.gov/data/sites/default/files/reports/rpt42728/NSDUHDetailedTabs2022/NSDUHDetailedTab
s2022/NSDUHDetTabsSect6pe2022.htm#tab6.72a
2. Save the Children. (2024). Rural Child and Family Well-being Data Dashboards. Retrieved from https://www.rural-
child-family-data.org/
3. Ibid.
4. Mental Health America (2024). Rural Mental Health Resources. Retrieved 6/21/2024 from
https://mhanational.org/rural
6. Curtin, S.C., Garnett, M.F., & Ahmad, F.B. (2023). Provision Estimates of Suicide by Demographic Characteristics:
United States, 2022. Vital Statistics Rapid Release; no.34. DOI: https://doi.org/10.15620/cdc:133702
8. The Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention
(2023). Youth Risk Behavior Survey Data Summary and Trends Report 2011-2021.
https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf
9. Connolly, S., Govoni, T.D., Jiang, X. et al. (2024). Characteristics of Alcohol, Marijuana, and Other Drug Use Among
Persons Aged 13-18 Years Being Assessed for Substance Use Disorder Treatment – United States, 2014-2022.
MMWR Morbidity and Mortality Weekly Report 2024; 73:93-98. DOI: http://dx.doi.org/10.15585/mmwr.mm7305a1
10. Stone, D.M., Mack, K.A., Qualters, J. (2023). Notes from the Field: Recent Changes in Suicide Rates, by Race and
Ethnicity and Age Group – United States, 2021. MMWR Morbidity and Mortality Weekly Report 2023; 72:160-162.
DOI: http://dx.doi.org/10.15585/mmwr.mm7206a4
12. Health Resources and Services Administration Maternal and Child Health Bureau (2020). Mental and Behavioral
Health NSCH Data Brief, October 2020. https://mchb.hrsa.gov/sites/default/files/mchb/data-research/nsch-data-
brief-2019-mental-bh.pdf
13. Bethell, C.D., Gombojav, N., & Whitaker, R.C. (2019). Family Resilience and Connection Promote Flourishing Among
US Children, Even Amid Adversity. Health Affairs, 38(5). DOI: https://doi.org/10.1377/hlthaff.2018.05425
14. Ibid.
15. Substance Abuse and Mental Health Services Administration (2023). Harm Reduction. Retrieved 6/20/2024 from
https://www.samhsa.gov/find-help/harm-reduction
16. National Institute on Drug Abuse (2022). Harm Reduction. Retrieved 6/20/2024 from https://nida.nih.gov/research-
topics/harm-reduction
17. National Center on Substance Abuse and Child Welfare (2024). Harm Reduction in the Context of Child Well-Being:
Key Considerations for Policymakers. https://ncsacw.acf.hhs.gov/files/harm-reduction-part2.pdf
18. The Network for Public Health Law (2020). Harm Reduction and Overdose Prevention 50-State Survey.
https://www.networkforphl.org/wp-content/uploads/2020/12/50-State-Survey-Harm-Reduction-Laws-in-the-United-
States-final.pdf
19. Tolbert, J., Drake, P., & Damico, A. (2023). Key Facts about the Uninsured Population. Kaiser Family Foundation.
https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
36
20. Panchal, N., Rae, M., Saunders, H., Cox, C., & Rudowitz, R. (2022). How Does Use of Mental Health Care Vary by
Demographics and Health Insurance Coverage? Kaiser Family Foundation. https://www.kff.org/mental-
health/issue-brief/how-does-use-of-mental-health-care-vary-by-demographics-and-health-insurance-coverage/
21. Collins, S.R., Roy, S., & Masitha, R. (2023). Paying for It: How Health Care Costs and Medical Debt Are Making
Americans Sicker and Poorer. The Commonwealth Fund.
https://www.commonwealthfund.org/publications/surveys/2023/oct/paying-for-it-costs-debt-americans-sicker-
poorer-2023-affordability-survey
22. Rubin, I., Cross-Call, J., & Lukens, G. (2021). Medicaid Expansion: Frequently Asked Questions. The Center for
Budget and Policy Priorities. https://www.cbpp.org/research/health/medicaid-expansion-frequently-asked-
questions-0
23. Lukens, G. (2022). Uncompensated Care Costs Fell in States That Recently Expanded Medicaid. The Center for
Budget and Policy Priorities. https://www.cbpp.org/blog/uncompensated-care-costs-fell-in-states-that-recently-
expanded-medicaid
24. Kaiser Family Foundation (2022). Distribution of Eligibility for ACA Health Coverage Among the Remaining
Uninsured. https://www.kff.org/affordable-care-act/state-indicator/distribution-of-eligibility-for-aca-coverage-
among-the-remaining-
uninsured/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
25. Healthinsurance.org. Medicaid Eligibility and Enrollment in Wisconsin. Retrieved 6/25/2024 from
https://www.healthinsurance.org/medicaid/wisconsin/
27. The Health Care Cost Institute (2023). 2021 Health Care Cost and Utilization Report.
https://healthcostinstitute.org/images/pdfs/HCCI_2021_Health_Care_Cost_and_Utilization_Report.pdf
28. 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
29. Mark, T.L. & Parish, W. (2024). Behavioral Health Parity – Pervasive Disparities in Access to In-Network Care
Continue. RTI International. https://dpjh8al9zd3a4.cloudfront.net/publication/behavioral-health-parity-pervasive-
disparities-access-network-care-continue/fulltext.pdf
30. Ibid.
31. Inseparable, American Foundation for Suicide Prevention, American Psychological Association, Eating Disorders
Coalition, Mental Health America, National Alliance on Mental Illness (NAMI) & The Kennedy Forum (2024).
Proposed Mental Health Parity Rules Will Increase Behavioral Health Tech Investments, Spur Innovation.
https://www.linkedin.com/pulse/proposed-mental-health-parity-rules-increase-behavioral-
xpjae/?trackingId=epu9l1LMRYi%2FP%2BekQfSEuw%3D%3D
National Survey on Drug Use and Health (2022). Table A.37AB. Retrieved from
https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-annual-national-web-
110923/2022-nsduh-nnr.htm#taba.38b
National Survey on Drug Use and Health (2022). Table A.38B. Retrieved from
34. The Kaiser Family Foundation (2023). 2023 Employer Health Benefits Survey, Section 10: Plan Funding.
https://www.kff.org/report-section/ehbs-2023-section-10-plan-
funding/#:~:text=Sixty%2Dfive%20percent%20of%20covered,coverage%20to%20limit%20their%20liabilities.
37
36. Scardamalia, K., Bentley-Edwards, K.L. & Grasty, K. (2019). Consistently inconsistent: An examination of the
variability in the identification of emotional disturbance. Psychology in the Schools, 56(4): 569-581. Retrieved from
https://onlinelibrary.wiley.com/doi/pdf/10.1002/pits.22213
37. Department of Education Office of Special Education Programs (OSEP). IDEA Data Center, 2022 IDEA Section 618,
State Level Data Files, Child Count and Educational Environments. Retrieved 6/25/2024 from
https://data.ed.gov/dataset/idea-section-618-state-part-b-child-count-and-educational-environments/resources
38. Ibid.
39. Whittaker, M. (2023). High Standards & Innovative Solutions: How Some States are Addressing the Special
Educator Shortage Crisis. U.S. Department of Education Office of Special Education and Rehabilitative Services
Blog. https://sites.ed.gov/osers/2023/05/high-standards-innovative-solutions-how-some-states-are-addressing-
the-special-educator-shortage-crisis/
40. Tamez-Robledo, N. (2024). Why Schools Still Struggle to Provide Enough Mental Health Resources for Students.
EdSurge. https://www.edsurge.com/news/2024-02-19-why-schools-still-struggle-to-provide-enough-mental-
health-resources-for-students
41. Health Resources and Services Administration (HRSA) Bureau of Health Workforce (March 2024). Second Quarter
of Fiscal Year 2024 Designated HPSA Quarterly Summary. Retrieved from https://data.hrsa.gov/topics/health-
workforce/health-workforce-shortage-areas
42. Health Resources and Services Administration (HRSA) National Center for Health Workforce Analysis (2024).
Health Workforce Projections. Retrieved 6/26/2024 from https://bhw.hrsa.gov/data-research/projecting-health-
workforce-supply-demand
43. The Substance Abuse and Mental Health Services Administration (2024). Bringing Recovery Supports to Scale
Technical Assistance Center Strategy, Supervision of Peer Workers. Retrieved 6/26/2024 from
https://www.samhsa.gov/sites/default/files/brss-tacs-peer-worker-supervision.pdf
44. Promoting Effective and Empowering Recovery Services (PEERS) in Medicare Act of 2023. H.R. 6748, S. 3498,
118th Congress (2023-2024). https://www.congress.gov/bill/118th-congress/house-bill/6748/text
45. The Georgia Department of Behavioral Health and Developmental Disabilities. Certified Peer Specialists. Retrieved
6/27/2024 from https://dbhdd.georgia.gov/recovery-transformation/cps
46. NRI (2022). State Mental Health Agency Peer Specialist Workforce, NRI’s 2022 State Profiles. https://www.nri-
inc.org/media/4dzhgyv1/peer-specialists_final.pdf
47. Ibid.
48. Medicaid Peer and Family Support Rate Increase, Budget Amendments. SB30 Item 304 #2s, 2022 Session.
https://budget.lis.virginia.gov/amendment/2022/1/SB30/Introduced/MR/304/2s/
49. North Carolina Department of Health and Human Services (2023). Behavioral Health Reimbursement Rates
Increased for the First Time in a Decade. https://www.ncdhhs.gov/news/press-releases/2023/11/15/behavioral-
health-reimbursement-rates-increased-first-time-decade
50. Niles, L. & Olin, S. (2021). Behavioral Health Quality Framework: A Roadmap for Using Measurement to Promote
Joint Accountability and Whole-Person Care, A White Paper. The National Committee for Quality Assurance
(NCQA). https://www.ncqa.org/wp-
content/uploads/2021/07/20210701_Behavioral_Health_Quality_Framework_NCQA_White_Paper.pdf
51. https://mhanational.org/sites/default/files/reports/Final-Mental-Health-Promotion-Suicide-Prevention-
Framework.pdf
52. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy
People 2030: Social Cohesion. Retrieved 6/28/2024 from https://health.gov/healthypeople/priority-areas/social-
determinants-health/literature-summaries/social-cohesion
53. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy
People 2030: Social and Community Context. Retrieved 6/28/2024 from
https://health.gov/healthypeople/objectives-and-data/browse-objectives/social-and-community-context
54. Town, M., Eke, P., Zhao, G., et al. (2024). Racial and Ethnic Differences in Social Determinants of Health and
Health-Related Social Needs Among Adults – Behavioral Risk Factor Surveillance System, United States, 2022.
MMWR Morbidity and Mortality Weekly Report 2024; 73:204-208. DOI:
http://dx.doi.org/10.15585/mmwr.mm7309a3
38
55. The Centers for Disease Control and Prevention (2024). Risk and Protective Factors for Suicide. Retrieved
7/10/2024 from https://www.cdc.gov/suicide/risk-factors/
56. Wickramaratne, PJ, Yangchen, T, Lepow, L, Patra, BG, Glicksburg, B, Talati, A, Adekkanattu, P, Ryu, E, Biernacka,
JM, Charney, A, Mann, JJ, Pathak, J, Olfson, M, & Weissman, MM (2022). Social Connectedness As a Determinant
of Mental Health: A Scoping Review. PLoS One, 17(10): e0275004. DOI:
https://doi.org/10.1371/journal.pone.0275004
57. Child and Adolescent Health Measurement Initiative. 2021-2022 National Survey of Children’s Health (NSCH) data
query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and
Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau
(MCHB). Retrieved 07/01/2024 from https://www.childhealthdata.org/browse/survey/allstates?q=10652
58. County Health Rankings & Roadmaps (2018). What Works? Social and Economic Opportunities to Improve Health
for All. The University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation.
https://www.countyhealthrankings.org/reports/what-works-social-and-economic-opportunities-to-improve-health-
for-all
59. The Association of State and Territorial Health Officials (2021). Adverse Childhood Experiences: The Case for
Funding Primary Prevention. ASTHOBrief. https://www.astho.org/globalassets/brief/adverse-childhood-
experiences-the-case-for-funding-primary-prevention.pdf /
60. County Health Rankings & Roadmaps (2018). What Works? Social and Economic Opportunities to Improve Health
for All. Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
https://www.countyhealthrankings.org/reports/what-works-social-and-economic-opportunities-to-improve-health-
for-all
61. Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (2024). Maternal, Infant,
and Early Childhood Home Visiting (MIECHV) Program. Retrieved 7/10/2024 from
https://mchb.hrsa.gov/programs-impact/programs/home-visiting/maternal-infant-early-childhood-home-visiting-
miechv-program
62. The Association of State and Territorial Health Officials (2021). Adverse Childhood Experiences: The Case for
Funding Primary Prevention. ASTHOBrief. https://www.astho.org/globalassets/brief/adverse-childhood-
experiences-the-case-for-funding-primary-prevention.pdf /
63. County Health Rankings & Roadmaps (2022). Earned Income Tax Credit (EITC). The University of Wisconsin
Population Health Institute and Robert Wood Johnson Foundation. Retrieved 7/10/2024 from
https://www.countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/earned-
income-tax-credit-eitc
64. County Health Rankings & Roadmaps (2022). Child Care Subsidies. The University of Wisconsin Population Health
Institute and Robert Wood Johnson Foundation. Retrieved 7/10/2024 from
https://www.countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/child-care-
subsidies
65. Waxman, S., Sherman, A. & Cox, K. (2021). Income Support Associated with Improved Health Outcomes for
Children, Many Studies Show. Center on Budget and Policy Priorities. https://www.cbpp.org/research/federal-
tax/income-support-associated-with-improved-health-outcomes-for-children-many
66. National Conference of State Legislatures (2024). Earned Income Tax Credit Overview. Retrieved 7/10/2024 from
https://www.ncsl.org/human-services/earned-income-tax-credit-overview
67. Habitat for Humanity (2023). How does homeownership contribute to social and civil engagement?
https://www.habitat.org/sites/default/files/documents/22-85504_USRM_EvidenceBrief-CivilSocialEng_FASH-
hires%20%285%29.pdf
68. National Health Care for the Homeless Council and the National Network to End Family Homelessness (2019).
Homelessness & Adverse Childhood Experiences, The Health and Behavioral Health Consequences of Childhood
Trauma. https://nhchc.org/wp-content/uploads/2019/08/aces-fact-sheet.pdf
69. Padgett, D. K. (2020). Homelessness, Housing Instability and Mental Health: Making the Connections. BJPsych
Bulletin 2020; 44(5): 197-201. DOI: https://doi.org/10.1192%2Fbjb.2020.49
70. Joint Center for Housing Studies of Harvard University (2024). America’s Rental Housing 2024.
https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_Americas_Rental_Housing_2024.p
df
39
71. U.S. Department of Housing and Urban Development, Office of Policy Development and Research (2023). Worst
Case Housing Needs 2023 Report to Congress.
https://www.huduser.gov/portal//portal/sites/default/files/pdf/Worst-Case-Housing-Needs-2023.pdf
72. U.S. Department of Housing and Urban Development (2023). 2023 Annual Homelessness Assessment Report: By
the Numbers. https://www.hud.gov/sites/dfiles/PA/documents/2023_PIT_Count_By_the_Numbers.pdf
73. City of New York (2022). Mayor Adams Announces Plan to Provide Care for Individuals Suffering From Untreated
Severe Mental Illness Across NYC. https://www.nyc.gov/office-of-the-mayor/news/870-22/mayor-adams-plan-
provide-care-individuals-suffering-untreated-severe-mental#/0
74. Baass, M. (2024). California Department of Health Care Services, Senate Bill (SB) 43, Changes to “Gravely
Disabled” Behavioral Health Information Notice: 24-011, Frequently Asked Questions.
https://www.dhcs.ca.gov/provgovpart/Documents/SB-43-FAQs.pdf
75. Davis, K. & Plotnick, D. (2023). Involuntary hospitalization proves systemic failures. Mental Health America.
https://mhanational.org/blog/involuntary-hospitalization-proves-systemic-failures
78. National Low Income Housing Coalition (2023). The Evidence is Clear: Housing First Works. Retrieved
07/19/2024 from https://nlihc.org/sites/default/files/Housing-First-Evidence.pdf
79. Aidala, A., McAllister, W., Yomogida, M., Alatas, H. & Torsiglieri, A. (2023). FUSE 10-Year Follow-Up Report Initial
Findings. CSH and the Columbia University Mailman School of Public Health. https://www.csh.org/wp-
content/uploads/2023/10/FUSE-10-Year-Report-Initial-Findings.pdf
80. Mental Health America (2019). Evidence for Peer Support.
https://www.mhanational.org/sites/default/files/Evidence%20for%20Peer%20Support%20May%202019.pdf
81. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population
Health and Public Health Practice; Policy and Global Affairs; Science and Technology for Sustainability Program;
Committee on an Evaluation of Permanent Supportive Housing Programs for Homeless Individuals. Washington
(DC): National Academies Press (US); 2018. https://www.ncbi.nlm.nih.gov/books/NBK519591/
82. Liu, S. (2023). VA’s Implementation of Housing First Over the Years. The U.S. Department of Veterans Affairs.
https://www.va.gov/HOMELESS/featuredarticles/VAs-Implementation-of-Housing-First.asp
83. Wilkerson, R. et al. (2021). Socially Connected Communities, Solutions for Social Isolation. Healthy Places by
Design. https://healthyplacesbydesign.org/wp-content/uploads/2021/03/Socially-Connected-
Communities_Solutions-for-Social-Isolation.pdf
84. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population
Health and Public Health Practice; Policy and Global Affairs; Science and Technology for Sustainability Program;
Committee on an Evaluation of Permanent Supportive Housing Programs for Homeless Individuals. Washington
(DC): National Academies Press (US); 2018. https://www.ncbi.nlm.nih.gov/books/NBK519591/
85. The Network for Public Health Law (2021). Law and Policy Pathways to Preventing Housing Instability.
https://www.networkforphl.org/wp-content/uploads/2021/04/Law-and-Policy-Pathways-Preventing-Housing-
Instability-2.pdf
86. The Mental Health Association of Westchester (2018). MHA Launches INSET.
https://www.mhawestchester.org/news/mha-launches-inset
40
88. The U.S. Department of Housing and Urban Development, HUD Exchange. Participatory Budgeting. Retrieved
7/2/2024 from
https://www.hudexchange.info/programs/participatorybudgeting/#:~:text=Participatory%20Budgeting%20(PB)%
20is%20a,and%20prioritizing%20public%20spending%20projects.
89. 100 Million Healthier Lives and the Institute for Healthcare Improvement. Co-Design, Engaging People with Lived
Experience. Retrieved 7/2/2024 from https://www.communitycommons.org/collections/5-Co-Design-Engaging-
People-with-Lived-Experience
41
Glossary
Indicator Description of Measure Source

Adults with Any Mental Illness (AMI) aligns with Diagnostic and Statistical Manual of SAMHSA, Center for
Any Mental Mental Disorders, 4th edition criteria and is defined as having a Behavioral Health
Illness (AMI) diagnosable mental, behavioral, or emotional disorder, other than a Statistics and Quality,
developmental or substance use disorder. These estimates are based on National Survey on Drug
indicators of AMI rather than direct measures of diagnostic status. For Use and Health,
details, see Section B of 2021-2022 National Survey on Drug Use and https://www.samhsa.g
Health: Guide to State Tables and Summary of Small Area Estimation ov/data/release/2022-
Methodology at https://www.samhsa.gov/data/report/2021-2022-nsduh- national-survey-drug-
guide-state-tables-and-summary-sae-methodology. use-and-health-nsduh-
Data survey years: 2021-2022.
releases
Adults with Substance use disorder (SUD) estimates are based on DSM-5 criteria. SUD SAMHSA, Center for
SUD Needing is defined as meeting the criteria for drug or alcohol use disorder. Behavioral Health
But Not Beginning with the 2021 NSDUH, questions on prescription drug use Statistics and Quality,
Receiving disorder were asked of all past year users of prescription drugs, regardless National Survey on Drug
Treatment of whether they misused prescription drugs. The estimates in this table Use and Health,
include prescription drug use disorder data from all past year users of https://www.samhsa.g
prescription drugs. ov/data/release/2022-
Respondents were classified as needing substance use treatment if they national-survey-drug-
met Diagnostic and Statistical Manual of Mental Disorders, 5th edition use-and-health-nsduh-
(DSM-5) criteria for a drug or alcohol use disorder or received treatment for
releases
drug or alcohol use through inpatient treatment/counseling, outpatient
treatment/counseling, medication-assisted treatment, telehealth treatment,
or treatment received in a prison, jail, or juvenile detention center.
Substance use treatment questions are asked of respondents who used
drugs or alcohol in their lifetime.
Not receiving substance use treatment among those needing treatment (%)
= 100 * [X1 ÷ (X1 + X2)], where X1 is the number of people not receiving
treatment who needed treatment, X2 is the number people receiving
treatment who needed treatment, and (X1+ X2) denotes the number of
people who needed treatment.
Data survey year: 2022.
Adults with For IRINSUR4, a respondent is classified as having any health insurance SAMHSA, Center for
AMI Who Are (IRINSUR4=1) if they satisfied ANY of the following conditions: Behavioral Health
Uninsured 1. Covered by Medicare (IRMEDICR=1); 2. Covered by Medicaid/CHIP Statistics and Quality,
(IRMCDCHP=1); 3. Covered by Tricare, Champus, ChampVA, VA, or Military National Survey on Drug
(IRCHMPUS=1); 4. Covered by private insurance (IRPRVHLT=1); 5. Covered Use and Health,
by other health insurance (IROTHHLT=1). https://www.samhsa.g
A respondent is classified as NOT having any health insurance ov/data/release/2022-
(IRINSUR4=2) if they meet EVERY one of the following conditions: national-survey-drug-
1. Not covered by Medicare (IRMEDICR=2); 2. Not covered by use-and-health-nsduh-
Medicaid/CHIP (IRMCDCHP=2); 3. Not covered by Tricare, Champus,
releases
ChampVA, VA, or Military (IRCHMPUS=2); 4. Not covered by private
insurance (IRPRVHLT=2); 5. Not covered by other health insurance
(IROTHHLT=2).
42
Adults with Substance Use Disorder (SUD) estimates are based on Diagnostic and SAMHSA, Center for
Substance Statistical Manual of Mental Disorders, 5th edition criteria. SUD is defined Behavioral Health
Use Disorder as meeting the criteria for drug or alcohol use disorder. Beginning with the Statistics and Quality,
in the Past 2021 National Survey on Drug Use and Health, questions on prescription National Survey on Drug
Year drug use disorder were asked of all past year users of prescription drugs, Use and Health,
regardless of whether they misused prescription drugs. Drug use includes https://www.samhsa.g
the use of marijuana (including vaping), cocaine (including crack), heroin, ov/data/release/2022-
hallucinogens, inhalants, or methamphetamine in the past year or any use national-survey-drug-
(i.e., not necessarily misuse) of prescription pain relievers, tranquilizers, use-and-health-nsduh-
stimulants, or sedatives in the past year.
releases
Adults This indicator is derived from the Centers for Disease Control and Centers for Disease
Reporting 14+ Prevention Behavioral Risk Factor Surveillance System (BRFSS) core Control and Prevention
Mentally questionnaire. Mentally unhealthy days were determined using the Behavioral Risk Factor
Unhealthy calculated variable _MENT14D. _MENT14D is calculated from the following Surveillance System
Days a Month BRFSS question: “Now thinking about mental health, which includes stress, Survey Data 2022,
Who Could depression, and problems with emotions, for how many days during the https://www.cdc.gov/br
Not See a past 30 days was your mental health not good?” (MENTHLTH). The fss/annual_data/annual
Doctor Due to calculated variable, _MENT14D, contains four values: Zero days when _2022.html
Costs 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 Downloaded and
know/refused/missing. calculated on 5/8/2024.
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 when
mental health was not good” to _MENT14D.

Adults with Adults ages 18 or older were asked: “At any time in the past 12 months, did SAMHSA, Center for
Serious you seriously think about trying to kill yourself?” If they answered “Yes,” Behavioral Health
Thoughts of they were categorized as having serious thoughts of suicide in the past Statistics and Quality,
Suicide year. National Survey on Drug
Use and Health,
Data survey years: 2021-2022. https://www.samhsa.g
ov/data/release/2022-
national-survey-drug-
use-and-health-nsduh-
releases
Youth with Youth with private insurance that did not cover mental or emotional SAMHSA, Center for
Private problems is defined as any individual ages 12-17 responding “No” to Behavioral Health
Insurance HLTINMNT. HLTINMNT is defined as: “Does [SAMPLE MEMBER POSS] Statistics and Quality,
That Did Not private health insurance include coverage for treatment for mental or National Survey on Drug
Cover Mental emotional problems?” Use and Health,
or Emotional https://www.samhsa.g
Problems Data survey years: 2021-2022. ov/data/release/2022-
releases
43
Mental Health Mental health workforce availability is the ratio of the county population to County Health Rankings
Workforce the number of mental health providers, including psychiatrists, and
Availability psychologists, licensed clinical social workers, counselors, marriage and Roadmaps. http://www.co
family therapists, and advanced practice nurses specializing in mental untyhealthrankings.org/
health care. In 2015, marriage and family therapists and mental health
providers that treat alcohol and other drug abuse were added to this
measure.
These data come from the National Provider Identification data file, which
has some limitations. Providers who transmit electronic health records are
required to obtain an identification number, but very small providers may
not obtain a number. While providers have the option of deactivating their
identification number, some mental health professionals 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 that mental health providers may be registered
with an address in one county while practicing in another county.

Students This measure was calculated from data provided by IDEA Part B Child IDEA Data Center, 2022
Identified with Count and Educational Environments, Common Core of Data. Under IDEA IDEA Section 618, State
Emotional regulation, emotional disturbance is identified as a condition exhibiting one Level Data Files, Child
Disturbance or more of the following characteristics over a long period of time and to a Count and Educational
for an marked degree, which adversely affects a child’s educational performance: Environments.
Individualized 1. an inability to learn, which cannot be explained by intellectual, sensory or https://data.ed.gov/dat
Education health factors; 2. an inability to build or maintain satisfactory interpersonal aset/idea-section-618-
Program relationships with peers and teachers; 3. inappropriate behavior or feelings state-part-b-child-count-
under normal circumstances; 4. a general pervasive mood of unhappiness and-educational-
or depression; or 5. a tendency to develop physical symptoms or fears
environments/resource
associated with personal or school problems. This term includes
schizophrenia. The term does not apply to children who are socially
s
maladjusted, unless it is determined they have an emotional disturbance.
Percent of Students Identified with Emotional Disturbance for an U.S. Department of
Individualized Education Program was calculated as the percent of children Education, National Center
identified as having an emotional disturbance among all enrolled students for Education Statistics,
of “school age,” which includes kindergarten, grades 1-12, and “ungraded.” Common Core of Data.
https://nces.ed.gov/ccd
Data survey years: 2022-2023. /files.asp
Downloaded and
calculated on 2/21/2024.
Youth with at Among youth ages 12-17, Major Depressive Episode (MDE) is based on the SAMHSA, Center for
Least One Diagnostic and Statistical Manual of Mental Disorders, 5th edition Behavioral Health
Past Year definition, which specifies a period of at least 2 weeks when an individual Statistics and Quality,
Major experienced a depressed mood or loss of interest or pleasure in daily National Survey on Drug
Depressive activities and had a majority of specified depression symptoms. For Use and Health,
Episode details, see Section B of 2021-2022 National Survey on Drug Use and https://www.samhsa.g
(MDE) Health: Guide to State Tables and Summary of Small Area Estimation ov/data/release/2022-
Methodology at https://www.samhsa.gov/data/report/2021-2022-nsduh- national-survey-drug-
guide-state-tables-and-summary-sae-methodology. use-and-health-nsduh-
releases
44
Youth with Among youth ages 12-17, substance use disorder (SUD) estimates are SAMHSA, Center for
Substance based on Diagnostic and Statistical Manual of Mental Disorders, 5th Behavioral Health
Abuse edition criteria. SUD is defined as meeting the criteria for drug or alcohol Statistics and Quality,
Disorder in use disorder. Beginning with the 2021 National Survey on Drug Use and National Survey on Drug
the Past Year Health, questions on prescription drug use disorder were asked of all past Use and Health,
year users of prescription drugs, regardless of whether they misused https://www.samhsa.g
prescription drugs. Drug Use includes the use of marijuana (including ov/data/release/2022-
vaping), cocaine (including crack), heroin, hallucinogens, inhalants, or national-survey-drug-
methamphetamine in the past year or any use (i.e., not necessarily misuse) use-and-health-nsduh-
of prescription pain relievers, tranquilizers, stimulants, or sedatives in the
releases
past year.

Youth with Youth with Past Year MDE Who Did Not Receive Treatment is defined as SAMHSA, Center for
MDE Who Did those who apply to having past year MDE as defined above (“Youth With At Behavioral Health
Not Receive Least One Past Year Major Depressive Episode,” YMDEYR) and respond Statistics and Quality,
Mental Health “No” to YMDETXRX. National Survey on Drug
Services YMDETXRX is a recoded variable from combining the data from the Use and Health,
variables YTXMDEYR and YRXMDEYR. YTXMDEYR is calculated from the https://www.samhsa.g
question, “At any time in the past 12 months, did you see or talk to a ov/data/release/2022-
medical doctor or other professional about your [FEELNOUN]?” YRXMDEYR national-survey-drug-
is calculated from the question. “During the past 12 months, did you take use-and-health-nsduh-
prescription medication that was prescribed for [NUMPROBS]?” A response
releases
of “No” to YMDETXRX includes all youth 12-17 who answered “No” to both
YTXMDEYR and YRXMDEYR.

Youth with Youth ages 12-17 were asked: “At any time in the past 12 months, did you SAMHSA, Center for
Serious seriously think about trying to kill yourself?” If they answered “Yes,” they Behavioral Health
Thoughts of were categorized as having serious thoughts of suicide in the past year. Statistics and Quality,
Suicide National Survey on Drug
Data survey years: 2021-2022. Use and Health,
https://www.samhsa.g
ov/data/release/2022-
releases
Youth For children ages 6-17 years, three questions were asked that aimed to Child and Adolescent
Flourishing capture curiosity and discovery about learning, resilience, and self- Health Measurement
regulation. The survey question asked, "How often does this child: show Initiative. 2021-2022
interest and curiosity in learning new things (K6Q71_R), work to finish National Survey of
tasks they start (K7Q84_R), and (3) stay calm and in control when faced Children’s Health (NSCH)
with a challenge?" (K7Q85_R). The "Always" or "Usually" responses to the data query.
question indicate the child meets the flourishing item criteria. Questions
were developed based on a review of positive health indicators by a Data Resource Center for
Technical Expert Panel (TEP). This TEP included a representative group of Child and Adolescent
experts in the field of survey methodology, children's health, community Health supported by the
organizations, and family leaders. Additionally, there was a public U.S. Department of Health
comment period which yielded more interest in this concept. and Human Services,
Youth were considered to be flourishing on this measure if they reached all Health Resources and
three flourishing items. Services Administration
(HRSA), Maternal and
Data survey years: 2021-2022. Child Health Bureau
(MCHB).
Retrieved 5/1/2024 from
www.childhealthdata.org
45
Adults with Adults with AMI with private insurance that did not cover mental or SAMHSA, Center for
AMI with emotional problems is defined as adults ages 18+ with AMI responding Behavioral Health
Private “No” to HLTINMNT. For more information on what classifies adults with Statistics and Quality,
Insurance AMI, see the indicator Adults with Any Mental Illness (AMI). National Survey on Drug
That Did Not HLTINMNT is defined as: “Does [SAMPLE MEMBER POSS] private health Use and Health,
Cover Mental insurance include coverage for treatment for mental or emotional https://www.samhsa.g
or Emotional problems?” ov/data/release/2022-
Problems national-survey-drug-
Data survey years: 2021-2022. use-and-health-nsduh-
releases
Youth with Youth who reported receiving treatment or counseling for their mental SAMHSA, Center for
MDE health in the past 12 months were asked the question, “During the past 12 Behavioral Health
Reporting months, how much has treatment or counseling helped you?” [YOTMTHLP]. Statistics and Quality,
Treatment or The options for this question were 1=Not at all, 2=A little, 3=Some, 4=A lot, National Survey on Drug
Counseling and 5=Extremely. Use and Health,
Helped Them Youth with MDE Reporting Treatment or Counseling Helped Them was https://www.samhsa.g
calculated from youth (ages 12-17) with at least one past year MDE and ov/data/release/2022-
answered 3=Some, 4=A lot, or 5=Extremely to YOTMTHLP. national-survey-drug-
For more information on what classifies youth with MDE, see the indicator use-and-health-nsduh-
Youth with at Least One Past Year Major Depressive Episode (MDE).
releases
46

2024 State of Mental Health in America Report

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2024 State of Mental Health in America Report

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The State of Mental Health in America 2024

Item Type Report

Authors Reinert, Maddy; Fritze, Danielle; Nguyen, Theresa

Publication Date 2024-07-01

Keywords EAP; Employee assistance programs; Substance-Related

Publisher Mental Health America

Download date 05/11/2024 05:24:12

Link to Item http://hdl.handle.net/10713/22688

Special thanks to:

500 Montgomery Street, Suite 820

05 Ranking Overview and Guidelines

15 Adult Prevalence of Mental Illness

18 Youth Prevalence of Mental Illness

22 Adult Access to Care

26 Youth Access to Care

29 Mental Health Workforce Availability

30 Youth with MDE Who Reported Treatment or

Counseling Helped Them

31 Creating Supportive Communities: A Spotlight on Prevention

32 Keeping People in Communities: A Spotlight on Housing

• How many adults and youth have mental health issues?

Why gather this information?

Our 2024 Measures

1. Adults with Any Mental Illness (AMI)

To better understand the rankings, it is important to compare similar states.

Major Changes to This Year’s Report Indicators

2022 HAD THE HIGHEST NUMBER OF

REPORTED EXPERIENCING SERIOUS

OF ADULTS IN THE U.S.

THERE ARE 340 PEOPLE FOR EVERY 1

STILL HAVE PRIVATE INSURANCE THAT

15.00 10.00 5.00 0.00 -5.00 -10.00

RANKING The indicators that

5.86% experienced a severe mental

In 2022, completely rural counties had

Rank State % # Rank State % #

17.82% of adults in the U.S.

11.28% of adults had an alcohol

9.41% of adults in the U.S. had

Rank State % # Rank State % #

After slight decreases in suicide deaths in

Only 15% of adults experiencing suicidal

Rank State % # Rank State % #

20.17% of youth (ages 12-17) reported

15% of youth in the U.S. experienced an

While this indicator measures the

16.02% (DC) 24.96% (OR)

Rank State % # Rank State % #

3.32% had an alcohol use disorder in

According to a survey of youth ages 13-18

Rank State % # Rank State % #

There are significant racial disparities for

There are also disparities among LGBQ+

Rank State % # Rank State % #

Flourishing is determined as a positive indicator

A 2019 study found that the prevalence of

Rank State % # Rank State % #

24.58% of adults who reported experiencing 14 or

High costs of mental health care are a critical barrier