Youth Ranking 2020

States with rankings 1-13 have lower prevalence of mental illness and higher rates of access to care for youth. States with rankings 39-51 indicate that youth have higher prevalence of mental illness and lower rates of access to care.

The 7 measures that make up the Youth Ranking include:

Youth with At Least One Major Depressive Episode (MDE) in the Past Year
Youth with Substance Use of Disorder in the Past Year
Youth with Severe MDE
Youth with MDE who Did Not Receive Mental Health Services
Youth with Severe MDE who Received Some Consistent Treatment
Children with Private Insurance that Did Not Cover Mental or Emotional Problems
Students Identified with Emotional Disturbance for an Individualized Education Program.

Rank	State
01	Vermont
02	Pennsylvania
03	District of Columbia
04	Maryland
05	Massachusetts
06	New Jersey
07	Rhode Island
08	Delaware
09	Maine
10	Minnesota
11	Ohio
12	New York
13	South Dakota
14	New Hampshire
15	Wisconsin
16	Louisiana
17	Connecticut
18	Mississippi
19	Kentucky
20	Virginia
21	Nebraska
22	Iowa
23	Hawaii
24	Alabama
25	North Dakota
26	Kansas
27	Michigan
28	Indiana
29	Georgia
30	Texas
31	Missouri
32	Utah
33	California
34	Tennessee
35	Washington
36	Illinois
37	Montana
38	Florida
39	West Virginia
40	Alaska
41	Oregon
42	Colorado
43	Wyoming
44	South Carolina
45	North Carolina
46	Oklahoma
47	Arkansas
48	Idaho
49	Arizona
50	New Mexico
51	Nevada

Youth with At Least One Major Depressive Episode (MDE) in the Past Year 2020

13.01% of youth (age 12-17) report suffering from at least one major depressive episode (MDE) in the past year.
Childhood depression is more likely to persist into adulthood if gone untreated.
The number of youth experiencing MDE increased by 99,000 from last years' dataset.
The state prevalence of youth with MDE ranges from the District of Columbia at 10.49% to Oregon at 16.34%.

Rank	State	Percentage	Number Sort descending
26	Rhode Island	13.30	10,000
34	Michigan	13.87	107,000
40	Montana	14.07	11,000
10	Hawaii	11.97	11,000
14	Pennsylvania	12.23	113,000
44	Ohio	14.35	129,000
36	New Hampshire	13.91	13,000
48	Maine	15.07	14,000
38	Illinois	14.00	141,000
05	New York	11.46	161,000
39	West Virginia	14.05	18,000
22	Florida	13.09	185,000
20	Nebraska	13.01	20,000
50	Idaho	16.22	24,000
46	New Mexico	14.88	25,000
06	Mississippi	11.56	28,000
13	Texas	12.19	296,000
01	District of Columbia	10.49	3,000
27	Arkansas	13.36	32,000
32	Kansas	13.84	33,000
41	Iowa	14.10	34,000
47	Nevada	14.97	34,000
23	Connecticut	13.16	36,000
02	Louisiana	10.76	39,000
25	California	13.23	401,000
09	Kentucky	11.94	41,000
33	Oklahoma	13.86	44,000
08	Alabama	11.90	45,000
15	South Carolina	12.31	46,000
49	Utah	15.48	47,000
51	Oregon	16.34	48,000
18	Vermont	12.83	5,000
28	Minnesota	13.56	58,000
19	Maryland	12.91	59,000
35	Colorado	13.89	59,000
42	Wyoming	14.20	6,000
12	North Dakota	12.13	6,000
30	Wisconsin	13.66	61,000
17	Tennessee	12.79	65,000
29	Massachusetts	13.60	66,000
45	Missouri	14.57	68,000
21	Arizona	13.06	72,000
31	Indiana	13.77	74,000
37	Washington	13.98	75,000
03	New Jersey	11.17	77,000
07	Delaware	11.58	8,000
43	Alaska	14.27	8,000
16	South Dakota	12.56	8,000
24	Virginia	13.22	83,000
11	North Carolina	12.03	95,000
04	Georgia	11.44	99,000

Youth with Severe Major Depressive Episode 2020

9.2% of youth (over 2.2 million youth) cope with severe major depression. Depression in youth often co-occurs with other disorders like substance use, anxiety and disorderly behavior.
The number of youth experiencing Severe MDE increased by 121,000 from last year’s dataset
The state prevalence of youth with Severe MDE ranges from 6.0% in Mississippi to 13.2% in Nevada.

Rank	State	Percentage	Number Sort descending
09	New York	7.5	102,000
11	Nebraska	7.7	12,000
50	Maine	13.1	12,000
32	Florida	10	137,000
01	Mississippi	6	14,000
47	West Virginia	11.3	14,000
05	Iowa	6.9	17,000
42	New Mexico	10.5	17,000
48	Idaho	11.7	17,000
12	Kansas	7.8	18,000
18	Arkansas	8.4	19,000
13	District of Columbia	7.9	2,000
03	Kentucky	6.3	21,000
25	Texas	9	211,000
21	California	8.8	258,000
19	Oklahoma	8.4	26,000
36	Connecticut	10.2	27,000
08	Louisiana	7.5	27,000
51	Nevada	13.2	28,000
14	Alabama	8.1	29,000
02	North Dakota	6	3,000
15	Vermont	8.2	3,000
43	Utah	10.7	31,000
23	South Carolina	8.9	32,000
16	Colorado	8.3	35,000
49	Oregon	12.7	36,000
35	Wyoming	10.1	4,000
04	Delaware	6.6	4,000
33	Maryland	10	43,000
41	Minnesota	10.5	44,000
22	Arizona	8.9	47,000
06	New Jersey	7	47,000
45	Wisconsin	10.8	47,000
29	Alaska	9.3	5,000
07	South Dakota	7.3	5,000
40	Massachusetts	10.5	50,000
46	Missouri	11.3	51,000
39	Tennessee	10.4	52,000
38	Indiana	10.4	54,000
27	Virginia	9.1	55,000
44	Washington	10.7	56,000
10	Georgia	7.7	65,000
26	Michigan	9.1	68,000
28	Montana	9.2	7,000
37	Rhode Island	10.2	7,000
30	North Carolina	9.8	75,000
20	Pennsylvania	8.6	77,000
24	Hawaii	9	8,000
17	New Hampshire	8.3	8,000
31	Ohio	9.9	87,000
34	Illinois	10.1	98,000

Youth with Substance Use Disorder in the Past Year 2020

4.13% of youth in America reported having a substance use disorder in the past year.
1.87% had an alcohol use disorder in the past year, while 3.07 percent had an illicit drug use disorder.
The state prevalence of youth with substance use disorder in the past year ranges from 3.18% in Georgia to 6.54% in Alaska.

Rank	State	Percentage	Number Sort descending
22	Kansas	4.088204261	10,000
23	Arkansas	4.103869488	10,000
24	Iowa	4.177114319	10,000
49	New Mexico	6.014429216	10,000
08	Kentucky	3.620369457	12,000
43	Nevada	5.195238999	12,000
12	Utah	3.839603996	12,000
35	Connecticut	4.639595161	13,000
30	Oklahoma	4.359725042	14,000
15	Louisiana	3.886166165	14,000
34	California	4.625460574	140,000
17	Alabama	3.961135797	15,000
21	South Carolina	4.086818098	15,000
05	Maryland	3.449672251	16,000
44	Oregon	5.304943479	16,000
11	Missouri	3.719937618	17,000
28	Minnesota	4.274638216	18,000
03	Indiana	3.291448092	18,000
25	Wisconsin	4.231806383	19,000
31	North Dakota	4.385811586	2,000
41	District of Columbia	5.143210752	2,000
45	Wyoming	5.400402884	2,000
46	Vermont	5.465448491	2,000
13	Tennessee	3.855519348	20,000
27	Massachusetts	4.260760958	21,000
04	New Jersey	3.342732377	23,000
10	Virginia	3.645123485	23,000
48	Colorado	5.597954012	24,000
40	Arizona	4.769366312	26,000
01	Georgia	3.182475035	27,000
42	Washington	5.180724175	28,000
02	Pennsylvania	3.185802626	29,000
09	North Carolina	3.627702805	29,000
29	Delaware	4.321874967	3,000
38	Rhode Island	4.689070325	3,000
14	Michigan	3.869633218	30,000
18	Ohio	3.991856442	36,000
26	New Hampshire	4.254965351	4,000
39	Maine	4.746754906	4,000
47	South Dakota	5.586386863	4,000
16	Hawaii	3.925247869	4,000
51	Alaska	6.539439208	4,000
37	Illinois	4.666726976	47,000
50	Montana	6.295415565	5,000
19	New York	4.038806972	57,000
32	West Virginia	4.419896883	6,000
20	Nebraska	4.048445012	6,000
33	Florida	4.535326733	64,000
36	Idaho	4.646841263	7,000
07	Texas	3.614661795	88,000
06	Mississippi	3.493247299	9,000

Youth with MDE who Did Not Receive Mental Health Services 2020

59% 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, almost 50% of youth are still not receiving the mental health services they need.
The state prevalence of untreated youth with depression ranges from 39.5% in Rhode Island to 74.3% in North Carolina.

Rank	State	Percentage	Number Sort descending
08	District of Columbia	48.7	1,000
14	West Virginia	54.2	10,000
26	Florida	57.2	106,000
22	Idaho	55.7	13,000
49	Nebraska	71.3	14,000
02	Connecticut	43.9	16,000
37	New Mexico	61.4	16,000
41	Mississippi	63.7	16,000
11	Louisiana	52.7	18,000
43	Texas	65.4	180,000
35	Arkansas	61.3	19,000
38	Kentucky	62	19,000
05	North Dakota	46.7	2,000
32	Iowa	59.8	20,000
47	Kansas	70.8	22,000
36	Nevada	61.4	22,000
12	Utah	53.8	24,000
42	California	63.9	245,000
46	Alabama	67.5	26,000
21	Oregon	55.6	27,000
03	Wisconsin	44.3	27,000
06	Minnesota	47.5	27,000
45	Oklahoma	65.8	28,000
19	Vermont	55.3	3,000
20	Colorado	55.6	30,000
50	South Carolina	73.7	33,000
10	Maryland	52.5	33,000
25	Tennessee	57	37,000
15	Massachusetts	54.5	38,000
34	Arizona	60.2	38,000
23	South Dakota	55.7	4,000
27	Delaware	57.3	4,000
01	Rhode Island	39.5	4,000
39	Wyoming	62.5	4,000
17	Indiana	54.8	40,000
28	New Jersey	57.8	40,000
31	Washington	59.1	40,000
09	Virginia	51.3	44,000
30	Missouri	59	45,000
44	Alaska	65.6	5,000
13	Pennsylvania	53.9	59,000
29	Hawaii	57.9	6,000
40	Montana	63.2	6,000
07	Ohio	48.6	63,000
33	Michigan	59.8	64,000
48	Georgia	70.9	67,000
51	North Carolina	74.3	68,000
16	New Hampshire	54.7	7,000
04	Maine	45.3	7,000
24	Illinois	56.1	80,000
18	New York	55.1	83,000

Youth with Severe MDE who Received Some Consistent Treatment 2020

Nationally, only 28.2% of youth with severe depression receive some consistent treatment (7-25+ visits in a year).
Late recognition in primary care settings and limited coverage of mental health services often prevent youth from receiving timely and effective treatment.
The state prevalence of youth with severe depression who received some outpatient treatment ranges from 53.9% in Maryland to 13.5% in South Carolina.

Rank	State	Percentage	Number Sort descending
18	North Dakota	33	1000
26	South Dakota	29.2	1000
09	District of Columbia	37.3	1000
16	Kentucky	34.2	10000
31	Tennessee	27.3	12000
17	Minnesota	33.7	13000
32	Washington	26.7	13000
07	Oregon	37.9	14000
48	Georgia	19.2	15000
38	Arizona	24.7	15000
08	Massachusetts	37.7	15000
19	New Jersey	32.5	16000
33	Indiana	26.1	16000
34	Virginia	26.1	16000
50	Mississippi	14.9	2000
23	Alaska	29.9	2000
25	Montana	29.3	2000
29	Hawaii	28.3	2000
03	Vermont	45.4	2000
04	Delaware	41.5	2000
11	Wyoming	36.3	2000
02	Maryland	49.2	21000
44	North Carolina	21.9	21000
43	New York	21.9	22000
06	Wisconsin	40.4	23000
10	Pennsylvania	37.1	23000
47	Florida	19.7	24000
24	Michigan	29.8	24000
37	Illinois	25	26000
12	Ohio	36	28000
15	New Hampshire	34.9	3000
51	Nevada	11.2	3000
05	Rhode Island	41.2	3000
30	West Virginia	27.8	4000
01	Maine	50	5000
42	New Mexico	22.6	5000
13	Nebraska	35.9	5000
45	Connecticut	21.6	5000
36	Texas	25	54000
39	California	24.6	59000
14	Idaho	35.8	6000
35	Alabama	25.9	6000
52	National	27.3	614000
21	Kansas	31.1	7000
22	Arkansas	30	7000
27	Iowa	28.8	7000
46	Colorado	21.5	8000
40	Utah	24.5	8000
41	Oklahoma	23.5	8000
49	Missouri	19	9000
20	Louisiana	32	9000
28	South Carolina	28.3	9000

Children with Private Insurance that Did Not Cover Mental or Emotional Problems 2020

The Mental Health Parity and Addiction Equity law (MHPAE) was enacted a decade ago 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 continues to increase, and private insurance companies continue to place subtle restrictions on coverage for mental health treatments.

Earlier this year, a federal judge ruled that United Behavioral Health, the nation’s largest behavioral health insurer, had violated parity by using overly restrictive guidelines for coverage of mental health and substance use services. In his decision, Judge Spero wrote, “one of the most troubling aspects of UBH’s guidelines is their failure to address in any meaningful way the different standards that apply to children and adolescents with respect to the treatment of mental health and substance use disorders.” To improve the worsening mental health of children and adolescents in the U.S., insurance companies must achieve parity in coverage.

The state prevalence of children lacking mental health coverage ranges from 2.0% in New Hampshire to 18.1% in Mississippi.

Rank	State	Percentage	Number Sort descending
01	Vermont	0.6	0
03	New Hampshire	2.5	1000
07	District of Columbia	4.6	1000
46	Nebraska	12.6	10000
47	Idaho	12.7	10000
20	Oregon	6.7	10000
29	Iowa	7.5	10000
30	Louisiana	7.6	10000
26	California	7.5	100000
42	Texas	11.5	108000
33	Oklahoma	7.9	11000
45	Nevada	12.6	13000
50	Arkansas	14.4	13000
06	New Jersey	4	14000
15	Missouri	5.9	14000
32	Utah	7.8	16000
08	Washington	5.2	16000
13	Wisconsin	5.5	16000
36	Colorado	8.3	17000
41	Kentucky	11	17000
24	Maryland	7.2	18000
05	Maine	3.4	2000
40	Alaska	10.3	2000
09	Rhode Island	5.3	2000
10	Montana	5.4	2000
11	South Dakota	5.4	2000
27	Minnesota	7.5	20000
19	Virginia	6.6	21000
22	Indiana	7.1	22000
12	Michigan	5.5	23000
18	Georgia	6.5	23000
51	South Carolina	14.8	23000
14	Ohio	5.9	26000
49	Tennessee	13.5	27000
17	Pennsylvania	6.1	29000
37	Hawaii	9.2	3000
43	Wyoming	12	3000
21	Delaware	6.9	3000
44	Arizona	12.1	32000
39	North Carolina	10	33000
23	Illinois	7.2	34000
02	Massachusetts	1.2	4000
25	West Virginia	7.2	4000
31	New Mexico	7.8	4000
35	New York	8.3	49000
04	Connecticut	3.3	5000
48	North Dakota	13.5	5000
38	Florida	9.4	52000
28	Mississippi	7.5	6000
16	Alabama	5.9	7000
34	Kansas	7.9	9000
52	National	7.8	901000

Students Identified with Emotional Disturbance for an Individualized Education Program 2020

Only .73%* of students are identified as having an ED for IEP.

For purposes of an IEP, the term “Emotional 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. Inadequate education leads to poor outcomes such as low academic achievement, social isolation, unemployment, and involvement in the juvenile system. Further, the federal eligibility criteria to identify students as having an emotional disturbance for an IEP have indicated extremely poor reliability among school psychologists, and therefore must be revised to adequately identify students in need of more supports.

*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 7 percent instead of .7 percent.

The state rate of students identified as having an Emotional Disturbance (ED) for an IEP ranges from 27.72% per 1,000 students in Vermont to 2.02% per 1,000 students in Alabama.

High percentages are associated with positive outcomes and low percentages are associated with poorer outcomes

Rank	State	Percentage	Number Sort descending
21	Delaware	8.32	1037
30	Georgia	6.70	10653
13	North Dakota	10.86	1066
22	Michigan	8.26	11273
42	West Virginia	4.94	1180
16	South Dakota	9.76	1184
04	Wisconsin	16.18	12217
07	Indiana	13.42	12798
41	Idaho	4.95	1354
51	Alabama	2.02	1365
38	Florida	5.84	14933
15	Ohio	9.80	15208
02	Minnesota	19.76	15666
10	Rhode Island	12.49	1618
03	Massachusetts	18.81	16338
49	Louisiana	2.79	1773
14	Illinois	10.17	18373
33	New Mexico	6.20	1889
48	Utah	3.17	1889
43	Nevada	4.45	1931
11	New Hampshire	12.32	2039
01	Vermont	27.72	2071
47	South Carolina	3.20	2208
06	Maine	13.73	2243
19	New York	9.49	23429
39	Kansas	5.48	2409
05	Pennsylvania	15.50	24746
44	California	4.36	24818
18	Nebraska	9.50	2664
35	Texas	6.09	28884
46	Tennessee	3.72	3342
24	Mississippi	7.90	3487
29	Oklahoma	6.78	4073
26	Kentucky	7.35	4468
17	Oregon	9.54	5122
40	Washington	5.11	5142
45	North Carolina	3.81	5394
12	Connecticut	11.51	5526
28	Colorado	6.90	5578
31	Wyoming	6.63	570
08	Iowa	12.98	5741
25	Maryland	7.69	6085
23	Missouri	8.25	6738
36	Alaska	5.93	707
27	Arizona	7.31	7551
34	New Jersey	6.12	7690
09	District of Columbia	12.78	840
32	Montana	6.35	848
20	Virginia	8.39	9752
37	Hawaii	5.92	979
50	Arkansas	2.24	988

2020 Mental Health in America - Youth Data