Best and Worst States for Mental Healthcare

The number of Americans experiencing a mental illness is the highest it’s ever been. Mental Health America reports that in 2019, just prior to the COVID-19 pandemic, almost 20% of adults experienced a mental illness. 

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Recently estimated figures are even higher. According to the Census Bureau’s Household Pulse Survey, at the end of 2021, 47% of adults reported experiencing symptoms of anxiety and 39% reported symptoms of depression. 

To determine the best states for mental healthcare, HealthCareInsider looked at key measures such as adults reporting any mental illness in the past year, average out-of-pocket spending for adults with a mental illness and mental health providers per capita. 

We compared all 50 states and Washington, D.C., to determine how they rank across cost, access, and quality.

“More liberal states are doing a better job with mental healthcare than conservative states,” says Assistant Professor of Clinical Psychology at Columbia Ainsley Burke. “Mental health is more openly discussed in openminded communities with less judgment. Conservative laws and mandates, for example banning discussion of certain topics like sexual identity in schools, discourages people from talking about issues and seeking treatment.”

With one in five suffering from mental illness, proper treatment is more imperative than ever as the COVID-19 pandemic continues. 

“When searching for mental health specialists, it’s critical to find out whether you’re covered,” says Jeff Smedsrud, co-founder at HealthCare.com.

“Some accept insurance while others may only conduct their practice through self-pay. To reduce costs, check with your health insurance company for a list of in-network mental health providers and ask if your provider offers a sliding scale.”

Please read below for our findings and methodology.

State	Rank	Score	Cost	Access	Quality
Maryland	1	69.96	24.75	23.88	21.34
Virginia	2	65.52	19.08	21.91	24.53
Massachusetts	3	64.89	24.86	25.73	14.31
Vermont	4	61.98	23.11	30.20	8.67
Pennsylvania	5	61.65	23.88	19.62	18.15
Minnesota	6	60.70	18.75	28.13	13.82
California	7	60.61	22.79	18.21	19.62
Wisconsin	8	60.18	19.84	22.02	18.32
Hawaii	9	60.07	19.41	18.10	22.57
Rhode Island	10	57.92	21.04	20.60	16.27
Colorado	11	56.36	19.84	26.38	10.14
Connecticut	12	55.87	20.28	17.44	18.15
Oregon	13	55.44	20.93	21.26	13.25
Maine	14	55.22	19.30	23.98	11.94
New York	15	55.11	18.97	14.72	21.42
New Jersey	16	54.76	17.12	16.79	20.85
Montana	17	54.05	12.65	25.29	16.11
Nebraska	18	54.02	9.59	23.00	21.42
Michigan	19	53.77	22.24	20.17	11.37
Ohio	20	53.39	19.08	22.79	11.53
Utah	21	53.09	12.97	24.42	15.70
Iowa	22	52.82	19.51	13.85	19.46
North Carolina	23	52.74	11.12	20.28	21.34
Indiana	24	52.08	16.46	15.92	19.71
Delaware	25	51.70	14.94	17.88	18.89
District of Columbia	26	51.05	21.91	16.46	12.67
Kentucky	27	50.37	17.55	18.42	14.39
Arizona	28	49.74	16.35	22.35	11.04
New Hampshire	29	48.81	22.35	15.26	11.20
North Dakota	30	48.81	11.77	17.66	19.38
South Dakota	31	48.70	8.29	23.00	17.42
Louisiana	32	48.65	16.13	15.92	16.60
Washington	33	48.43	18.86	17.55	12.02
Kansas	34	46.50	14.39	18.53	13.57
Illinois	35	46.17	12.76	14.28	19.13
Nevada	36	46.06	14.28	15.92	15.86
Georgia	37	45.38	11.56	11.34	22.49
Arkansas	38	45.03	7.41	19.95	17.66
Wyoming	39	44.21	8.72	21.26	14.23
Missouri	40	43.66	15.48	14.28	13.90
Tennessee	41	43.01	12.86	14.61	15.54
West Virginia	42	42.87	10.36	21.80	10.71
New Mexico	43	41.95	18.21	13.85	9.89
Alaska	44	41.81	10.47	16.79	14.55
Texas	45	41.65	10.03	8.39	23.22
Florida	46	40.69	10.68	9.48	20.52
Oklahoma	47	38.27	8.29	15.59	14.39
Idaho	48	37.64	7.41	13.30	16.93
Alabama	49	37.26	11.34	9.48	16.43
South Carolina	50	36.30	12.32	4.03	19.95
Mississippi	51	36.09	6.65	5.56	23.88

Best and Worst States for Mental Healthcare: Countdown

Methodology

To determine the best and worst states for mental healthcare, HealthCareInsider compared the 50 states and Washington, D.C. across three key categories: 1) Cost, 2) Access, and 3) Quality.

We analyzed those categories using 20 relevant metrics, which are detailed below. Each metric was graded on a 100-point scale, with a score of 100 representing the best mental healthcare at the most affordable cost.

Lastly, we determined each state and the District’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.

Cost – Total Points: 33.33

• Uninsured Rate: Full Weight
• Average Out-of-Pocket Spending for Adults With a Mental Illness: Full Weight
• Average Annual Health Insurance Premium as a Percentage of Income: Full Weight
• Adults Reporting Not Receiving Mental Health Treatment Due to Cost: Full Weight
• State Mental Health Agency Expenditures per Capita: Full Weight
• Median Cost of a 60-minute Psychotherapy Session: Full Weight

Access – Total Points: 33.33

• Mental Health Providers per Capita: Full Weight
• Mental Health Offices as a Percentage of All Businesses: Full Weight
• Mental Health and Substance Abuse Facilities as a Percentage of All Businesses: Full Weight
• Adults With a Serious Mental Illness in the Past Year Who Did Not Receive Treatment: Full Weight
• Adults With Any Mental Health Illness Who Are Uninsured: Full Weight
• Mental Health Rehabilitation Covered by Medicaid: Full Weight

Quality – Total Points: 33.33

• Adults Reporting Any Mental Illness in the Past Year: Full Weight
• Average Number of Poor Mental Health Days per Month: Full Weight
• Alcohol Use Disorder in the Past Year: Full Weight
• Substance Use Disorder in the Past Year: Full Weight
• Suicide Rate: Full Weight
• Drug Overdose Death Rate: Full Weight
• 180-day State Hospital Readmission Rates: Full Weight
• State Psychiatric Hospital Beds per Capita: Full Weight

Sources: Data used to create this ranking were collected from the Kaiser Family Foundation, Mental Health America, Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC), Bureau of Labor Statistics (BLS), Census Bureau, SimplePractice and Treatment Advocacy Center.

Mental Health Resources

• Anxiety and Depression Association of America (ADAA) provides information on prevention, treatment and symptoms of anxiety, depression and related conditions (240-485-1001)       
• Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) provides information and referrals on ADHD, including local support groups (800-233-4050)
• Depression and Bipolar Support Alliance (DBSA) provides information on bipolar disorder and depression, offers in-person and online support groups and forums (800-826-3632)
• International OCD Foundation provides information on OCD and treatment referrals (617-973-5801)
• National Center of Excellence for Eating Disorders (NCEED) provides up-to-date, reliable and evidence-based information about eating disorders (800-931-2237)
• Schizophrenia and Related Disorders Alliance of America (SARDAA) offers Schizophrenia Anonymous self-help groups and toll-free teleconferences (240-423-9432)
• Sidran Institute helps people understand, manage and treat trauma and dissociation; maintains a helpline for information and referrals (410-825-8888)
• Treatment and Research Advancements for Borderline Personality Disorder (TARA) offers a referral center for information, support, education and treatment options for BPD (888-482-7227)

Finding Treatment

• Psychology Today offers a national directory of therapists, psychiatrists, therapy groups and treatment facility options
• SAMHSA Treatment Locator provides referrals to low-cost/sliding scale mental health care, substance abuse and dual diagnosis treatment (800-662-4357)

Suicide and Crisis

• The American Foundation for Suicide Prevention provides referrals to support groups and mental health professionals, resources on loss, and suicide prevention information (888-333-2377)
• The National Domestic Violence Hotline provides 24/7 crisis intervention, safety planning and information on domestic violence (800-799-7233)
• The Suicide Prevention Lifeline connects callers to trained crisis counselors (800-273-8255)