Counseling Today, Online Exclusives

Maldistribution: Mental health care in America

By Bethany Bray October 14, 2019

Access to mental health care varies greatly depending on where one lives in the United States. This variance is so great that Mental Health America (MHA) referred to the situation as a “maldistribution” of behavioral health providers in a recent report.

In Massachusetts, there is a mental health provider for every 180 residents, which marks the best ratio in the nation. On the other end of the spectrum is Alabama, which has the nation’s worst ratio at 1,100 residents for every one mental health provider. Texas, West Virginia, Georgia, Arizona, Tennessee, Mississippi and Iowa are the others states that have ratios of 700:1 or worse.

MHA, a Virginia-based nonprofit advocacy organization, compiles a report of mental health indicators each year from nationwide survey data, including information from the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention. In tabulating its ratios, MHA included counselors, psychiatrists, psychologists, licensed clinical social workers, marriage and family therapists, and nurses specializing in mental health care in its definition of mental health provider.

MHA’s report, The State of Mental Health in America, was released in September.

When weighing access to mental health care and insurance against prevalence of mental illness, substance abuse, suicidal ideation and other factors, MHA ranked Pennsylvania, New York, Vermont, Rhode Island and Maryland as the top five states (in that order) for mental health in its most recent report. Nevada was ranked last in MHA’s list, preceded by Oregon, Idaho, Utah and Wyoming.

The organization also recognized Rhode Island as rising from 27th to fourth in its overall rankings over the past six years. In contrast, Alaska has gone from 17th to 46th, Kansas from 18th to 42nd, and North Carolina from 16th to 35th during that same time period.

MHA tracks a number of other mental health indicators in its annual report, including statistics on youth and adults with substance use disorders, depression and suicide, as well as insurance coverage and rates of treatment and other data. MHA notes that rates of overall mental illness (defined as “having a diagnosable mental, behavioral or emotional disorder, other than a developmental or substance use disorder”) among American adults have remained relatively stagnant, increasing from 18.19% to 18.57% between 2012 and 2017. However, suicidal ideation among adults rose from 3.77% to 4.19% over those six years.

Of note is a more than 4% increase in prevalence of past-year major depressive episodes in youth ages 12 to 17 (an increase of 8.66% to 13.01% from 2012 to 2017).

“While ensuring that youth with mental health conditions have greater access to care is vitally important, the only way to address the rising prevalence of mental health conditions in youth is to address the upstream causes on a population level,” wrote MHA. “States must invest time and resources into researching and understanding the causes for this drastic worsening of mental health in youth ages 12-17 and generating meaningful and effective policies and programs to address mental health concerns before they reach the point of becoming a diagnosable mental health condition.”




Mental Health America’s The State of Mental Health in America 2020

When it comes to mental health, how does your state stack up?

View the full report and state rankings at

State-by-state ranking of adult mental health factors (page 16 of MHA’s report;




CT Online’s recap of MHA’s 2019 report: “America’s mental health disparities





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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.


1 Comment

  1. Gerard FitzGerald

    Based upon the numbers in the report when we equate potential clients, significance of diagnosis – prognosis, and other factors, we have a TRILLION DOLLAR. PROBLEM and also realize the huge shortage of clinicians and other mental health professionals.
    We know what the effect is but what is the cause (Thorndike, reverse cognitive processing), 2 million youth with disabling depression, 10 million people with suicide ideation and the numbers dealing with mental illness continue (numbers used are directly from article, there is a link above), the numbers are poised to grow at an exponential rate even with an additional 100000 licensed clinicians, masters level or above.


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