Access to Care Ranking 2022 The Access Ranking indicates how much access to mental health care exists within a state. The access measures include access to insurance, access to treatment, quality and cost of insurance, access to special education, and workforce availability. A high Access Ranking (1-13) indicates that a state provides relatively more access to insurance and mental health treatment. The 9 measures that make up the Access Ranking include: 1. Adults with AMI who Did Not Receive Treatment 2. Adults with AMI Reporting Unmet Need 3. Adults with AMI who are Uninsured 4. Adults with Cognitive Disability who Could Not See a Doctor Due to Costs 5. Youth with MDE who Did Not Receive Mental Health Services 6. Youth with Severe MDE who Received Some Consistent Treatment 7. Children with Private Insurance that Did Not Cover Mental or Emotional Problems 8. Students Identified with Emotional Disturbance for an Individualized Education Program 9. Mental Health Workforce Availability Rank 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State Vermont Massachusetts Maine Wisconsin Minnesota New Hampshire Rhode Island Pennsylvania Connecticut District of Columbia Washington Montana Illinois Maryland New York Kentucky Delaware Iowa Oregon New Mexico Colorado Ohio South Dakota New Jersey Michigan Utah North Dakota Oklahoma West Virginia California Hawaii Indiana Nebraska Alaska Louisiana Wyoming Virginia North Carolina Nevada Arkansas Missouri Idaho South Carolina Kansas Tennessee Arizona Mississippi Georgia Florida Alabama Texas Adults with Ami Who Are Uninsured 2022 11.1% (over 5.5 million) of adults with a mental illness remain uninsured. The rankings for this indicator used data from the 2017-2018 NSDUH. In December 2017, Congress passed the Tax Cuts and Jobs Act, which eliminated the individual mandate penalty from the ACA. There was a 0.5% increase from last year's dataset, the first time this indicator has increased since the passage of the ACA. The increase in this indicator is consistent with data from the U.S. Census Bureau, which found that in 2018, the rate of uninsured Americans rose for the first time since the ACA took effect. Only twenty states saw a reduction in Adults with AMI who are uninsured in this year's dataset. The largest reductions were seen in Louisiana (5.0%), South Dakota (3.3%), Kentucky (2.4%) and Kansas (2.2%). The largest increases were seen in Iowa (5.1%), Mississippi (3.9%), Arkansas (3.7%) and Missouri (3.2%). The state prevalence of uninsured adults with mental illness ranges from 3.8% in Massachusetts to 21.5% in Texas. Rank 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 State Massachusetts Kentucky Rhode Island District of Columbia Hawaii Vermont New York Connecticut Maryland Pennsylvania Wisconsin Michigan Ohio Illinois Delaware California Minnesota New Mexico New Hampshire Alaska North Dakota South Dakota Montana West Virginia New Jersey Colorado Arkansas Iowa Utah Nevada Arizona Nebraska Washington Oregon Louisiana Virginia Maine Indiana Idaho Kansas Georgia Tennessee North Carolina South Carolina Oklahoma Florida Wyoming Mississippi Alabama Missouri Texas National Percentage 3.80% 4.20% 4.40% 4.70% 4.70% 5.10% 5.20% 5.40% 5.60% 5.90% 6.30% 6.90% 6.90% 7.10% 7.30% 7.40% 8.00% 8.10% 8.80% 9.70% 9.80% 9.80% 10.00% 10.10% 10.60% 10.80% 11.30% 11.30% 11.30% 11.50% 11.60% 11.60% 11.60% 11.80% 12.40% 12.40% 12.60% 13.40% 14.00% 14.00% 15.20% 15.30% 15.40% 15.60% 17.60% 17.80% 18.00% 18.20% 19.30% 19.30% 21.50% 11.1 Number 45,000 33,000 9,000 6,000 9,000 6,000 151,000 28,000 43,000 115,000 56,000 108,000 150,000 130,000 12,000 434,000 69,000 28,000 22,000 11,000 11,000 10,000 17,000 37,000 116,000 113,000 52,000 46,000 70,000 61,000 127,000 32,000 165,000 95,000 95,000 147,000 31,000 153,000 42,000 63,000 207,000 148,000 240,000 119,000 117,000 512,000 19,000 81,000 154,000 209,000 759,000 5,514,000 Adults with Ami Who Did Not Receive Treatment 2022 Over half (56%) of adults with a mental illness receive no treatment. Over 27 million individuals experiencing a mental illness are going untreated. The state prevalence of untreated adults with mental illness ranges from 42.6% in Vermont to 67.1% in Hawaii. Rank 01 02 03 04 05 06 07 08 09 10 State Vermont Iowa Massachusetts Wisconsin Minnesota Maine Nebraska Arkansas Utah North Dakota Percentage 42.60% 44.20% 44.70% 44.80% 46.10% 47.70% 48.80% 49.60% 49.70% 50.10% Number 49,000 181,000 526,000 400,000 401,000 117,000 134,000 228,000 307,000 56,000 Rank 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 State Ohio Rhode Island Montana Kansas North Carolina West Virginia Pennsylvania New Hampshire South Dakota Illinois Missouri Idaho Kentucky Tennessee Colorado Connecticut Delaware New Mexico Washington Oregon Virginia District of Columbia Michigan South Carolina Oklahoma Indiana Arizona New Jersey Alabama Maryland Nevada New York Alaska Mississippi Louisiana Texas Wyoming California Florida Georgia Hawaii National Percentage 50.30% 51.00% 51.10% 51.20% 51.60% 51.70% 51.90% 52.30% 52.30% 52.60% 53.30% 53.40% 53.50% 53.50% 53.60% 54.00% 54.20% 54.20% 54.30% 54.50% 54.70% 55.20% 55.40% 56.10% 56.60% 56.70% 57.00% 57.10% 57.30% 58.00% 58.00% 58.30% 58.70% 59.30% 59.60% 60.70% 61.70% 61.80% 63.50% 63.50% 67.10% 55.90% Number 1,088,000 99,000 89,000 229,000 801,000 191,000 1,012,000 131,000 56,000 958,000 575,000 161,000 420,000 514,000 558,000 276,000 86,000 185,000 778,000 439,000 645,000 74,000 866,000 427,000 376,000 643,000 619,000 627,000 454,000 452,000 305,000 1,690,000 66,000 265,000 453,000 2,148,000 64,000 3,617,000 1,823,000 860,000 127,000 27,646,000 Adults with Ami Reporting Unmet Need 2022 Almost a quarter (24.7%) of all adults with a mental illness reported that they were not able to receive the treatment they needed. This number has not declined since 2011. Individuals seeking treatment but still not receiving needed services face the same barriers that contribute to the number of individuals not receiving treatment: 1. No insurance or limited coverage of services. 2. Shortfall in psychiatrists, and an overall undersized mental health workforce. 3. Lack of available treatment types (inpatient treatment, individual therapy, intensive community services). 4. Disconnect between primary care systems and behavioral health systems. 5. Insufficient finances to cover costs ñ including copays, uncovered treatment types, or when providers do not take insurance. The state prevalence of adults with AMI reporting unmet treatment needs ranges from 14.9% in Hawaii to 37.1% in the District of Columbia. Rank 01 02 03 04 State Hawaii Louisiana South Carolina Montana Percentage 14.90% 18.40% 19.70% 21.50% Number 28,000 139,000 150,000 37,000 Rank State Percentage 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 Minnesota New Jersey Massachusetts New York West Virginia Florida New Hampshire New Mexico Kentucky Oklahoma Wisconsin Illinois California Connecticut Texas Washington Georgia Alaska Wyoming Arkansas Ohio Vermont Mississippi South Dakota Rhode Island North Dakota Pennsylvania Tennessee Maine Alabama Indiana Michigan North Carolina Nebraska Virginia Utah Delaware Arizona Oregon Idaho Nevada Missouri Maryland Colorado Kansas Iowa District of Columbia 21.60% 21.60% 21.70% 21.70% 22.20% 22.40% 22.40% 22.70% 22.90% 22.90% 22.90% 23.20% 23.50% 23.50% 24.00% 24.00% 24.10% 24.40% 24.50% 24.70% 24.80% 25.20% 25.30% 25.30% 25.40% 25.60% 25.70% 25.70% 25.90% 26.70% 26.80% 26.80% 27.20% 27.60% 27.70% 27.90% 28.10% 28.40% 28.80% 29.10% 29.30% 30.10% 30.20% 31.80% 32.60% 32.90% 37.10% 52 National 24.70% Number 187,000 238,000 255,000 628,000 82,000 643,000 56,000 78,000 181,000 152,000 204,000 422,000 1,379,000 120,000 845,000 341,000 326,000 28,000 25,000 114,000 540,000 29,000 113,000 27,000 50,000 29,000 499,000 249,000 63,000 212,000 306,000 419,000 423,000 76,000 326,000 172,000 45,000 306,000 231,000 88,000 154,000 325,000 236,000 331,000 145,000 134,000 50,000 12,236,000 Adults with Disability Who Could Not See a Doctor Due to Costs 2022 29.67% of adults with a cognitive disability were not able to see a doctor due to costs. According to the Centers for Disease Control (CDC), 12% of people in the U.S. had a cognitive disability, even when adjusted for age. The percentage of people with cognitive disability ranged from 8.9% in some states to 19.6%. The prevalence of adults with cognitive disability who couldnít see a MD due to cost ranges from 18.48% in Rhode Island to 40.65% in Texas. Rank 01 02 03 04 05 06 07 08 09 10 11 12 State Rhode Island Vermont Connecticut Iowa Massachusetts North Dakota Wisconsin Hawaii Kentucky West Virginia Washington Montana Percentage 18.48 20.33 20.59 21.22 21.68 22.25 22.28 22.90 23.34 23.35 23.45 23.68 Number 18,204 9,346 52,774 47,967 122,701 12,879 94,587 24,832 132,541 63,123 129,850 24,375 Rank 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 State Pennsylvania Maryland Nevada New York District of Columbia New Jersey California South Dakota New Mexico Minnesota Ohio Maine Michigan Delaware Louisiana Idaho Colorado Nebraska Alaska Tennessee New Hampshire Arkansas Indiana Oregon Virginia Missouri Arizona Oklahoma South Carolina Illinois North Carolina Wyoming Utah Mississippi Florida Alabama Kansas Georgia Texas National Percentage 23.77 23.87 24.31 24.53 24.59 25.19 25.54 26.14 26.15 26.19 26.99 27.34 27.50 27.59 27.79 28.05 28.69 29.48 29.49 29.93 30.40 30.53 30.53 30.67 30.71 30.88 31.35 31.52 31.70 32.25 32.94 32.94 33.31 33.37 34.90 38.35 38.74 39.18 40.65 29.67 Number 269,121 102,734 72,956 351,676 13,849 * 798,630 17,659 54,176 102,491 290,259 39,967 281,553 21,424 155,929 43,386 111,500 37,445 17,492 224,845 35,528 117,147 191,026 118,469 198,169 192,461 203,838 138,679 161,528 306,123 356,776 14,280 81,119 121,330 733,738 233,440 97,643 370,081 954,935 8,496,389 Youth with MDE Who Did Not Receive Mental Health Services 2022 60.3% of youth with major depression do not receive any mental health treatment. Youth experiencing MDE continue to go untreated. Even among the states with greatest access for youth, 1 in 3 youth are still not receiving the mental health services they need. The state prevalence of untreated youth with depression ranges from 30.0% in Maine to 73.1% in Texas. Rank 01 02 03 04 05 06 07 08 09 10 11 12 State Maine Colorado District of Columbia Vermont Maryland Wyoming Utah New Hampshire Iowa Oregon Washington Indiana Percentage 30.00% 39.30% 41.00% 42.60% 44.70% 44.90% 45.40% 46.60% 49.30% 49.70% 49.80% 51.50% Number 4,000 20,000 1,000 3,000 32,000 4,000 25,000 7,000 21,000 29,000 50,000 50,000 Rank 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 State North Carolina Delaware Nebraska Montana Kansas North Dakota Wisconsin Illinois Pennsylvania Virginia New Mexico Oklahoma Massachusetts Missouri Minnesota Arkansas New Jersey Kentucky South Dakota Michigan New York Louisiana Ohio Alaska West Virginia California Rhode Island Nevada Connecticut Tennessee Alabama Idaho Florida South Carolina Georgia Arizona Hawaii Mississippi Texas National Percentage 51.90% 52.30% 52.60% 53.50% 54.50% 54.60% 55.10% 55.20% 55.20% 55.20% 55.90% 56.00% 56.80% 57.30% 58.30% 58.90% 58.90% 59.30% 59.60% 59.70% 60.90% 62.50% 63.30% 63.40% 63.90% 64.50% 64.90% 65.20% 65.60% 66.50% 66.80% 67.10% 67.30% 67.60% 67.80% 70.10% 71.00% 71.70% 73.10% 60.30% Number 74,000 6,000 12,000 6,000 21,000 4,000 36,000 77,000 57,000 58,000 18,000 30,000 44,000 37,000 42,000 23,000 42,000 27,000 6,000 74,000 103,000 32,000 76,000 6,000 13,000 278,000 6,000 28,000 24,000 40,000 34,000 19,000 117,000 34,000 75,000 67,000 7,000 20,000 255,000 2,173,000 Youth with Severe MDE Who Received Some Consistent Treatment 2022 Nationally, only 27.2% of youth with severe depression receive some consistent treatment (7-25+ visits in a year). Even when simply measuring the number of visits, fewer than 1 in 3 youth with severe depression meet this determination of consistent care. The state prevalence of youth with severe depression who received some outpatient treatment ranges from 65.6% in Maine to 12.2% in Tennessee. High percentages are associated with positive outcomes and low percentages are associated with poorer outcomes. Rank State Percentage Number 01 02 03 04 Maine Vermont New Hampshire Wyoming 65.60% 49.70% 47.60% 45.60% 7,000 3,000 4,000 3,000 05 Colorado 43.10% 16,000 Rank 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 State Massachusetts Pennsylvania Illinois Oregon Wisconsin Delaware Minnesota District of Columbia Washington Montana Maryland Oklahoma North Dakota Indiana Alabama Michigan Iowa South Dakota Kentucky New Jersey New York Nebraska Idaho Utah California Ohio Virginia North Carolina South Carolina Connecticut Arkansas Kansas New Mexico Louisiana West Virginia Rhode Island Alaska Georgia Texas Nevada Florida Arizona Mississippi Hawaii Missouri Tennessee National Percentage 42.20% 39.90% 38.30% 36.60% 36.40% 36.30% 35.90% 35.80% 35.70% 35.50% 34.50% 33.60% 33.00% 32.90% 31.30% 30.40% 29.50% 29.30% 28.60% 28.40% 28.30% 27.80% 27.70% 27.30% 26.10% 25.10% 25.00% 24.90% 24.20% 23.60% 22.70% 22.70% 22.50% 21.10% 20.90% 20.40% 20.20% 20.10% 19.20% 18.70% 17.00% 16.10% 13.50% 13.30% 12.60% 12.20% 27.20% Number 19,000 28,000 38,000 14,000 19,000 3,000 17,000 1,000 24,000 3,000 18,000 12,000 2,000 23,000 8,000 26,000 9,000 2,000 9,000 14,000 29,000 5,000 6,000 11,000 72,000 19,000 19,000 27,000 8,000 5,000 7,000 6,000 5,000 7,000 3,000 1,000 1,000 14,000 44,000 5,000 20,000 10,000 2,000 1,000 5,000 6,000 661,000 Children with Private Insurance that Did Not Cover Mental or Emotional Problems 2022 The Mental Health Parity and Addiction Equity law (MHPAE) was enacted in 2008 and promised the equal coverage of mental health and substance use services. However, the rate of children with private insurance that does not cover mental or emotional problems increased 0.3 percent from last year's dataset, and there are still 950,000 youth without coverage for their behavioral health. The state prevalence of children lacking mental health coverage ranges from 1.9% in Massachusetts to 17.7% in Arkansas. Rank 01 02 03 04 05 06 07 08 09 10 11 12 State Massachusetts Vermont Connecticut Rhode Island Missouri New Hampshire Oklahoma District of Columbia West Virginia Wisconsin South Dakota Utah Percentage 1.90% 2.10% 3.50% 3.80% 4.20% 4.30% 4.40% 4.50% 4.50% 4.50% 4.70% 4.70% Number 5,000 0 5,000 1,000 9,000 2,000 6,000 1,000 2,000 12,000 2,000 10,000 Rank 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 State New Jersey Washington Maine Michigan Virginia Maryland Illinois Oregon Pennsylvania Delaware Georgia Nevada Indiana Iowa Ohio Alaska New York New Mexico Kansas Minnesota California Mississippi Hawaii Tennessee Louisiana Kentucky Montana Colorado North Carolina Arizona Florida Idaho South Carolina Alabama Wyoming Texas Nebraska North Dakota Arkansas National Percentage 5.00% 5.20% 5.40% 6.10% 6.40% 6.50% 6.60% 6.60% 6.80% 7.00% 7.00% 7.10% 7.40% 7.40% 7.40% 7.50% 7.70% 7.80% 7.90% 8.00% 8.20% 8.20% 8.30% 8.80% 9.00% 9.30% 9.50% 9.60% 10.00% 10.20% 11.70% 12.20% 12.40% 12.50% 12.70% 13.80% 15.40% 15.60% 17.70% 8.10% Number 18,000 15,000 3,000 27,000 22,000 15,000 33,000 10,000 32,000 3,000 25,000 8,000 22,000 10,000 33,000 2,000 48,000 5,000 8,000 20,000 111,000 6,000 3,000 19,000 11,000 15,000 3,000 22,000 34,000 27,000 65,000 11,000 19,000 16,000 3,000 135,000 13,000 5,000 17,000 950,000 Students Identified with Emotional Disturbance for An Individualized Education Program 2022 Only .759% of students are identified as having an Emotional Disturbance (ED) for an Individualized Education Program (IEP). For purposes of an IEP, the term ìEmotional Disturbance is used to define youth with a mental illness that is affecting their ability to succeed in school. Early identification for IEPs is critical. IEPs provide the services, accommodations and support students with ED need to receive a quality education. The rate for this measure is shown as a rate per 1,000 students. The calculation was made this way for ease of reading. Unfortunately, doing so hides the fact that the percentages are significantly lower. If states were doing a better job of identifying whether youth had emotional difficulties that could be better supported through an IEP the rates would be closer to 8% instead of .8 percent. The state rate of students identified as having an emotional disturbance for an IEP ranges from 32.23 per 1,000 students in Vermont to 2.13 per 1,000 students in Alabama. Rank 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 State Vermont Minnesota Massachusetts Pennsylvania Wisconsin Maine Indiana Iowa New Hampshire Connecticut Rhode Island North Dakota District of Columbia Illinois Oregon South Dakota Ohio Nebraska Delaware New York Missouri Michigan Virginia Maryland Mississippi Texas Arizona Kentucky Colorado Wyoming Montana Oklahoma Alaska Georgia New Mexico New Jersey Hawaii Kansas Washington Florida Idaho Nevada California West Virginia Tennessee North Carolina Utah South Carolina Louisiana Arkansas Alabama National Percentage 32.23 21.20 20.22 16.33 16.18 15.32 13.36 13.31 13.24 12.43 12.34 11.99 11.54 10.59 10.30 10.04 10.03 9.98 9.47 9.10 8.87 8.52 8.47 7.61 7.53 7.41 7.39 7.39 6.98 6.80 6.68 6.66 6.48 6.35 6.15 5.84 5.80 5.60 5.49 5.43 4.95 4.64 4.51 4.45 3.84 3.65 3.12 3.05 2.74 2.54 2.13 7.59 Number 2,326 17,016 17,455 26,105 * 2,468 12,712 * 2,132 5,824 1,610 1,240 802 18,381 5,568 1,251 15,281 2,861 1,211 22,063 7,188 11,314 9,913 6,180 3,193 35,851 7,756 4,501 5,687 589 906 4,057 765 10,124 1,830 7,313 959 2,459 5,633 14,062 1,412 2,085 25,424 1,025 3,470 5,187 1,933 2,143 1,727 1,123 1,420 345,160 Mental Health Workforce Availability 2022 The term ìmental health providerî includes psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, and advanced practice nurses specializing in mental health care. The rate of mental health providers has improved in nearly every state since last yearís report. The state rate of mental health workforce ranges from 150:1 in Massachusetts to 920:1 in Alabama. Rank 01 02 03 04 05 06 07 08 09 10 11 12 State Massachusetts Oregon District of Columbia Alaska Maine Vermont Connecticut Oklahoma Rhode Island New Mexico Washington California Number 150:1 180:1 190:1 200:1 200:1 210:1 240:1 240:1 240:1 250:1 250:1 270:1 Rank 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State Colorado Utah Wyoming New Hampshire Montana Louisiana New York Delaware Maryland Michigan Nebraska Minnesota Hawaii Ohio North Carolina Illinois Arkansas Kentucky New Jersey Pennsylvania Idaho Nevada Wisconsin Kansas Missouri North Dakota South Dakota Virginia South Carolina Florida Indiana Mississippi Iowa Tennessee Georgia Arizona West Virginia Texas Alabama Number 270:1 290:1 290:1 310:1 320:1 330:1 330:1 350:1 360:1 360:1 360:1 370:1 380:1 380:1 390:1 410:1 420:1 420:1 420:1 450:1 460:1 460:1 470:1 490:1 490:1 510:1 530:1 530:1 550:1 590:1 590:1 590:1 610:1 630:1 690:1 710:1 730:1 830:1 920:1