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

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

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

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

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

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

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

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

2020 Mental Health in America - Youth Data