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Mental Health in America - Access to Care Data
The Access to Care data tells us how many adults and youth have access to insurance and access to mental health treatment in America.
The 9 access measures include:
Adult Access to Care
Adults with AMI who Did Not Receive Treatment
57.2% of adults with a mental illness received no treatment in 2012-2013. Although it is a slight decrease in percentage (from 58.34% in 2010-2011) the percentage of those who are likely to need some support before problems worsen is high.
States with most utilization of treatment have 30% more adults receiving treatment compared to the states with least utilization. In Nevada, 70.7% of adults with mental illness did not receive any treatment.
From 2010-2011 to 2012-2013, six states had significant changes (more than 10 percentage points). Iowa (-15.50%), Minnesota (-12.80%), Louisiana (-10.90%), and Missouri (-10.60%) experienced over a 10% reduction in the number of untreated adults with mental illness. Colorado (+10.40%) and Washington (+10.60%) experienced over a 10% increase in the number of untreated adults with mental illness.
2012-2013 Adults with No MH Treatment Percentage and Estimated Number by Ranking.
Adults with AMI Reporting Unmet Need
1:5 - One out of five (20.1%) adults with a mental illness report they are not able to get the treatment they need.
States with the highest levels of unmet need (bottom 10) are 1.6 times more likely to have people report unmet need.
Unlike the number of people with mental illness who did not receive treatment, the individuals who are reporting unmet need are seeking treatment and facing barriers to getting the help they need.
Having insurance does not mean access to care. In areas like Massachusetts, DC, or Vermont, many people with mental illness report having an unmet need even though most are insured. This difference speaks to the importance of reviewing adequacy of insurance. For example, does the insurance cover sufficient types of treatment, include enough access to providers, or cover the cost of treatment?
2012-2013 Adults with Unmet Need Percentage and Estimated Number by Ranking.
Adults with AMI who are Uninsured
18.5% (over 8 million) of adults with a mental illness were uninsured in 2012-2013, a slight decrease in percentage as compared to 2010-2011 (19.10%).
Most states (30 out of 50) experienced a decrease in the number of uninsured adults with mental illness between 2010-2011 and 2012-2013.
Individuals in states at the bottom 10 are 3 times more likely to be uninsured compared to those at the top 10.
Those in Nevada (ranked 51) are 10 times more likely to be uninsured compared to individuals in Massachusetts (ranked 1)
Two states experienced a larger than 10% change in percentage points over time. In both states, more individuals became uninsured over time: Tennessee (+11% more uninsured) and South Carolina (+12.1% more uninsured).
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2012-2013 Adults with AMI Uninsured Percentage and Estimated Number by Ranking.
Adults with Disability Who Could Not See a Doctor Due to Costs
1:4 (25.5%, 1.2 million) adults with a disability were not able to see a doctor due to costs. The inability to pay for treatment, because treatment is costly and/or insurance does not adequately cover treatment remains a barrier for individuals despite being insured.
Overall, individuals in the South face the most difficulty in barriers related to costs, access to insurance, and access to treatment.
2013 Adults with Disability Cost Barrier Percentage and Estimated Number by Ranking.
Youth Access to Care
Youth with MDE who Did Not Receive Mental Health Services
64.1% of youth with major depression do not receive any mental health treatment. That means, that 6 out of 10 young people who have depression and who are most at risk of suicidal thoughts, difficulty in school, and in relationship with others do not get treatment needed to support them.
3:4 - In the worst states like Virginia, Tennessee, and Arkansas more than 75% of youth with depression are not getting any treatment at all.
Even in the best states, 4 out of 10 youth report that they are not getting treatment.
Hope - There was a 1.9% decline in the number of untreated youth with depression, down from 66.0% in 2010-2011. Hopefully this shows an increasing commitment to early intervention and preventing the negative impact of untreated mental illness among our most vulnerable population.
2012-2013 Youth with MDE with No Treatment Percentage and Estimated Number by Ranking.
Youth with Severe MDE who Received Some Consistent Treatment
Nationally, only 21.7% of youth with severe depression receive some consistent treatment (7-25+ visits in a year).
15.7% received only 1-6 visits of treatment in the year.
Even among youth with severe major depression, 62.6% did not receive any mental health treatment.
In Nevada (ranked 51), youth with severe depression are 4 times less likely to get some outpatient treatment compared to youth in South Dakota (ranked 1).
**Yellow/Brown maps are used where high percentages are associated with positive outcomes and low percentages are associated with poorer outcomes.
Youth with Severe MDE Visit Distribution
The map below represents the number of outpatient visits a youth with severe depression received in the last year.
Even among youth with severe major depression, 62.6% did not receive any mental health treatment.
Children (0-17) with Private Insurance that Did Not Cover Mental or Emotional Problems
Children and youth are more likely to have insurance coverage compared to adults.
7.9% of youth had private health insurance that did not cover mental or emotional problems. With the passage of the Affordable Care Act, and Mental Health Parity, fewer youth should lack coverage in the future.
However, like adults, having insurance coverage does not mean that youth are able to access needed treatment. Given the complexities, such as lack of child psychiatrists in the workforce, it is likely that youth will continue to face more barriers to getting needed care compared to adults.
Children in states at the bottom 10 are 3.5 times more likely to lack mental health coverage compared to those at the top 10.
Those in Hawaii (ranked 51) are 10 times more likely to be uninsured compared to individuals in Connecticut (ranked 1).
2012-2013 Children Private Insurance Not Covering MH Percentage and Estimated Number by Ranking.
Students Identified with Emotional Disturbance for an Individualized Education Program
.786% of students are identified as having a Emotional Disturbance (ED) for an Individualized Education Program (IEP).
States in the top 10 (mostly in the Northeast) are 5 times more likely to identify youth with ED as compared to states in the bottom 10.
The term “Emotional Disturbance” is used to define youth with a mental illness for purposes of an IEP. Often times, youth with emotional or mental health problems are identified as having other issues rather than an emotional or mental health problem. In such cases, it is unclear whether their mental health problems are taken into consideration in planning for appropriate educational modifications and accommodations in their IEP.
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.
For example, in Vermont (ranked 1), the rate is 25.51, but the actual percentage is 2.55%. That is, 2.55% of students in Vermont are identified as having an emotional disturbance compared to only .17% of students in Arkansas.
**Yellow/Brown maps are used where high percentages are associated with positive outcomes and low percentages are associated with poorer outcomes.
2013 Students Identified as ED for IEP Rate Per 1,000 Students and Number by Ranking.
Mental Health Workforce Availability
Nationally, there is only one mental health provider for every 566 individuals.
The term mental health provider includes: psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists and advanced practice nurses specializing in mental health care.
In 2014, County Health Rankings added marriage and family therapists and mental health providers that treat alcohol and other drug abuse to the measure.
250:1 vs 1,100:1 - In states with the greatest number of available mental health providers (Massachusetts, Maine, and Vermont), there are approximately 250 individuals for every one mental health provider.
In states with the lowest number of available mental health providers (West Virginia, Texas, and Alabama), there are approximately 1,100 individuals for every one provider - more than 4 times less access compared to the best states. Individuals in Alabama have 6 times less access to treatment providers than individuals in Massachusetts.
Peer support specialists, workforce development programs, and innovative models of integrated care like Collaborative Care are possible solutions to the significant mental health workforce gap in the states.
2014 Mental Health Workforce Rate by Ranking.
The Access Ranking indicates overall how much access to mental health care exists within a state. The Access Ranking is analyzed by calculating a standardized score (Z score) for each measure, and ranking the sum of the standardized scores for each of the access measures above.
In Georgia or Florida, despite having lower percentages of individuals who need mental health services, those who have problems are likely to face more difficulty obtaining treatment as compared to other states.
The opposite is true for states like Maine or Vermont, where there are more individuals with mental health and substance use issues and higher rates of access to care.
Among states that rank the poorest, like Arizona, Idaho and Montana, there are comparatively more individuals needing mental health and substance use care, yet lower rates of access to mental health care.
Access to Care Ranking Compared to Other Positive Outcomes
States that invest in care for individuals with mental illness are likely to provide better services overall. Due to their investment for those in need, the states in the top 10 in the Access to Care Ranking have comparatively stronger communities.
Top 10 states in the Access to Care Ranking also rank among the top 10 states in the following positive outcomes.
Access to Care Ranking Compared to Other Poor Outcomes
States that invest in care for individuals with mental illness are likely to provide better services overall. Due to their investment for those in need, the states in the bottom 10 in the Access to Care Ranking have communities that struggle more compared to those states that rank in the top 10.
Bottom 10 states in the Access to Care Ranking also rank among the bottom 10 states in the following poor outcomes.
Mental Health in America 2016 Links
The State of Mental Health in America - Home
Ranking the States -Results of Overall, Adult, Youth, Prevalence, and Access to Care Rankings
Adult Data - Adult Prevalence and Access Data
Youth Data - Youth Prevalence and Access Data
Prevalence Data - How many adults and youth have a mental health or substance use problem in America?
Access to Care Data - How many adults and youth have access to insurance and mental health treatment in America?
Prevention and Early Intervention in Mental Health - Issue Spotlight
Glossary and Citations - For Indicators & Positive and Poor Outcomes
Print Version of The State of Mental Health in America
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