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America’s mental health disparities

By Bethany Bray December 11, 2014

When it comes to mental health care, how does your home state rank?

The advocacy organization Mental Health America (MHA) recently compiled a state-by-state ranking of mental health indicators nationwide.

The 50-page report exposes disparities across the United States, not only in the availability of mental health services but also in the number of uninsured individuals, the overall prevalence of mental illness, the frequency of drug or alcohol addiction, the number of suicide attempts and other factors.

MHA weighed a state’s prevalence of mental illness against its availability of mental health care to Rank Map_w_wordscompile an overall ranking. The states that rose to the top of this list are in New England: Massachusetts, Vermont and Maine. Conversely, the worst-ranked states are Nevada, Mississippi and Arizona.

For the report, MHA compiled mental health information about residents of all 50 states and the District of Columbia, culling data from numerous surveys, including the Substance Abuse and Mental Health Services Administration’s National Survey of Drug Use and Health and the National Survey of Children’s Health.

Some highlights of MHA’s findings:

  • The top five states based on the lowest prevalence of mental illness and the highest rates of access to care are Massachusetts, Vermont, Maine, North Dakota and Delaware.
  • States with the highest prevalence of mental illness and lowest rates of access to care are Arizona, Mississippi, Nevada, Washington and Louisiana.
  • Across the United States, the average rate of adults who are mentally ill and also uninsured is 3.5 percent. The best-ranked states in this category are Massachusetts (0.9 percent prevalence), Connecticut (1.4 percent), Hawaii and Vermont (both 1.5 percent), the District of Columbia (1.6 percent) and Delaware (1.7 percent). The states with the highest percentage of mentally ill adults without insurance are Alabama (6.3 percent), Mississippi (5.6 percent), Utah (5.5 percent) and Idaho (5.4 percent). Arizona, Nevada and West Virginia were next on the list, all with 5 percent prevalence.
  • States with the highest rates of access to mental health care are, in order, Vermont, Massachusetts, Maine, Delaware and Iowa.
  • States with the lowest rates of access to mental health care are, in order, Nevada, Mississippi, Alabama, Louisiana and Texas.
  • The highest rates of emotional, behavioral and developmental issues among youth occur along states just to the west of the Appalachian Mountains. This area also has some of the highest rates of poverty and social inequality. However, this area also shows some of the lowest rates of substance use among youth.
  • The average rate of adults with dependence on alcohol or illegal drugs across the United States is 8.46 percent. Compared with this average, the District of Columbia, Rhode Island and Montana are the three worst-ranked states, with 13.78 percent, 10.91 percent and 10.38 percent prevalence, respectively. The top-ranked states are Alabama (6.58 percent) and Utah (6.79 percent).
  • The states with the highest rates of youth with emotional, behavioral or development issues are Kentucky, the District of Columbia, Arkansas and Maine; the states with the lowest rates are Alabama, South Dakota, Colorado and Utah. Across the United States, the average percentage of youth with emotional, behavioral or development issues is 8.5 percent. Kentucky’s percentage (13.95) is more than double that of Alabama (6.87 percent).
  • New Mexico, Washington, Oregon and Utah had the highest prevalence rates of “youth with at least one major depressive episode,” while the District of Columbia, North Dakota, New York and New Jersey had the lowest rates.


MHA’s report, titled Parity or Disparity: The State of Mental Health in America 2015, was released earlier this month and is available at

“This report paints a picture across the entire nation of both our mental health and how well we are caring for the people who need assistance,” said Paul Gionfriddo, MHA CEO, in a press release. “Sadly, disparity – more than parity – is the rule.”

Founded in 1909, MHA is a nonprofit based in Alexandria, Virginia, with 240 community affiliates across the nation.





Bethany Bray is a staff writer for Counseling Today. Contact her at


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  1. Mary

    Hi Bethany. Thanks to all and to you for making this important report available! As a Washingtonian, I was not happy to see my state rank at the bottom, sigh. Anyway, I have a couple of questions. I looked through the report, but I couldn’t find any reference as to how and where the data was collected. I’d be interested to know if state rankings are based on government programs only, a combination of government and private programs, or what. Also, what’s included in the report’s definition of “mental illness” For example, does it lean towards severe and chronic mental illness disorders, such as bi-polar disorder, schizophrenia, etc. or is it all inclusive (e.g., adjustment disorders, a single episode mood disorder, etc.). Thanks much, Mary

    1. Counseling Today

      Hello Mary,
      Thanks — you raise some good questions.

      MHA did include a glossary at the end of the report. This is from page 51:
      “Adults with AMI (Any Mental Illness)
      Any Mental Illness (AMI) is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder, assessed by the Mental Health Surveillance Study (MHSS) Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition—Research Version—Axis I Disorders (MHSSSCID) which is based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Three categories of mental illness severity are defined based on the level of functional impairment: mild mental illness, moderate mental illness, and serious mental illness. Any mental illness includes persons in any of the three categories. These mental illness estimates are based on a predictive model and are not direct measures of diagnostic status.”

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