FAQs

Q: What methods were used to rank states? 
A: MHA used data that was: publicly available and as current as possible to provide up-to-date results; available for all 50 states and the District of Columbia; available for both adults and youth; and able to capture information regardless of varying utilization of the private and public mental health system.

The rankings are based on the percentages, or rates, for each state collected from the most recently available data, mostly up through 2022 (see below for more specifics on time period). States with positive outcomes are ranked higher (closer to one) than states with poorer outcomes (closer to 51). The overall, adult, youth, prevalence, and access rankings were analyzed by calculating a standardized score (Z score) for each measure and ranking the sum of the standardized scores. For most measures, lower percentages equated to more positive outcomes (e.g., lower rates of substance use or those who are uninsured).

There are three measures where high percentages equate to better outcomes. These include “Youth Flourishing,” “Students Identified with Emotional Disturbance for an Individualized Education Program,” and “Youth with MDE Who Reported Treatment or Counseling Helped Them.” Here, the calculated standardized score was multiplied by -1 to obtain a reverse Z score that was used in the sum. All measures were considered equally important, and no weights were given to any measure in the rankings. 

Q: What are the 15 measures used? 
A: The measures we use are:

1. Adults with Any Mental Illness (AMI)
2. Adults with Substance Use Disorder in the Past Year
3. Adults with Serious Thoughts of Suicide 
4. Youth with at Least One Major Depressive Episode (MDE) in the Past Year
5. Youth with Substance Use Disorder in the Past Year
6. Youth with Serious Thoughts of Suicide
7. Youth (Ages 6-17) Flourishing
8. Adults with SUD Who Needed But Did Not Receive Treatment
9. Adults with AMI Who Are Uninsured
10. Adults Reporting 14+ Mentally Unhealthy Days a Month Who Could Not See a Doctor Due to Costs
11. Adults with AMI with Private Insurance That Did Not Cover Mental or Emotional Problems
12. Youth with MDE Who Did Not Receive Mental Health Services
13. Youth with Private Insurance That Did Not Cover Mental or Emotional Problems 
14. Students (K+) Identified with Emotional Disturbance for an Individualized Education Program
15. Mental Health Workforce Availability

While the measures are not a complete picture of the mental health system, they do provide a foundation for understanding the prevalence of mental health concerns and issues of access to insurance and treatment, particularly as that access varies among the states.

Q: How was the data weighted to calculate the Overall, Adult, Youth, Need/Prevalence, and Access Rankings? 
A: All measures included in each of these rankings were considered equally important in calculating the aggregate rankings, and no weights were given to any measure. However, there are more measures of Access (8) than Prevalence of Mental Illness (7), so the Overall Ranking is slightly more representative of access than prevalence.

Q: Why can’t this year’s results be compared to previous years? 
A: The COVID-19 pandemic had a serious impact on the ability to collect national surveillance data in 2020. During this time, federal agencies updated the measures they collect and how they are collected. As a result, the indicators in this year’s State of Mental Health in America report cannot be compared to previous years.

Eleven of the 15 indicators used in this report are collected from SAMHSA’s national survey, the NSDUH. Historically, the NSDUH was collected through in-person interviews in the respondent’s residence. However, in 2020 data collection shifted to both in-person interviews and online questionnaires due to the COVID-19 pandemic. Since 2020, SAMHSA discovered that these changes to data collection created a mode effect such that estimates from the web and in-person interviews cannot be compared to estimates from in-person interviews alone. As a result, SAMHSA has determined that 2021 will represent a trend break from previous years, meaning the results of the NSDUH moving forward will not be comparable to data collected before 2021.

This means that the rankings presented throughout this year’s State of Mental Health in America report cannot be reliably compared to the rankings of previous years’ reports, and therefore should be interpreted as a snapshot in time ranking rather than a reflection of trends over time.

You can, however, compare states within this year’s rankings (2024) to each other.

Q: What time period is reflected in this year’s report? 
A: Most of the indicators in this year’s report are calculated from 2021-2022 data, but it may vary by indicator based on methodological differences. The indicators Adults with Any Mental Illness (AMI), Adults with SUD Needing But Not Receiving Treatment, Adults with AMI Who Are Uninsured, Adults with Substance Use Disorder in the Past Year, Adults with Serious Thoughts of Suicide, Adults with AMI with Private Insurance That Did Not Cover Mental or Emotional Problems, Youth with At Least One Past Year Major Depressive Episode (MDE), Youth with Substance Use Disorder in the Past Year, Youth with MDE Who Did Not Receive Mental Health Services, Youth with Serious Thoughts of Suicide, Youth with MDE Reporting Treatment or Counseling Helped Them, and Youth with Private Insurance That Did Not Cover Mental or Emotional Problems were calculated using 2021-2022 data. Adults Reporting 14+ Mentally Unhealthy Days a Month Who Could Not See a Doctor Due to Costs is based on Behavioral Risk Factor Surveillance System (BRFSS) data from 2022. Students (K+) Identified with Emotional Disturbance for an Individualized Education Program is based on Department of Education data from 2022-2023. Workforce Availability is based on 2022 County Health Rankings data. Youth Flourishing is based on National Survey of Children’s Health data from 2021-2022. For more information on each of the indicators, visit the Indicator Glossary here.

Q: Which indicators changed in this year’s report? 

The measures “Youth with Severe MDE,” “Youth with Severe MDE Who Received Some Consistent Treatment,” “Adults with AMI Who Did Not Receive Treatment,” and “Adults with AMI Reporting Unmet Need” were removed from this year’s report. Each of these measures were calculated using data from the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Use and Health (NSDUH). The indicator “Youth with Severe MDE” was removed because it did not differ significantly from the measure “Youth with at Least One Major Depressive Episode (MDE) in the Past Year.” In 2022, SAMHSA made changes to the mental health and substance use treatment questions. This report relies on state-level data, which is only available in a two-year pair. The changes to the 2022 mental health treatment measures meant that the dataset was not comparable to the 2021 measures and could not be combined into a two-year pair. These measures may return to the indicator list in next year’s report once the 2022-2023 NSDUH data are available. 

The measures “Youth with Serious Thoughts of Suicide,” “Youth Flourishing,” “Adults with SUD Who Needed but Did Not Receive Treatment,” and “Adults with AMI with Private Insurance That Did Not Cover Mental or Emotional Problems” were added to the indicator list in this year’s report. The measure “Youth with Serious Thoughts of Suicide” was added because SAMHSA began gathering data on youth suicidality for the first time in 2020, and this is the first report published since that data has been made available. “Youth Flourishing” captures data on flourishing among children and adolescents ages 6-17, and was added as an upstream, protective measure for youth as part of the Prevalence ranking. “Adults with SUD Who Needed but Did Not Receive Treatment” and “Adults with AMI with Private Insurance That Did Not Cover Mental or Emotional Problems” were added to capture more nuanced information about access to behavioral health care in the U.S. 

For the measure “Students Identified with Emotional Disturbance for an Individualized Education Program,” data for Iowa on the number of students with Emotional Disturbance was not available. Iowa does not collect disability category data and therefore was excluded from the ranking for that indicator.

Q: How do I interpret ranking vs. rate? Why did my ranking change if the rate did not change?  
A: Rankings are determined from Z scores, which compare a state’s rate against other states. If the rates in other states drastically improve or worsen, this can cause a change in other states’ rankings, even if their rates did not change. The ranking provides context for how a state is performing on each indicator in the context of other states and the national average. However, it is important to look at the rate for each indicator to know whether your state is improving or worsening.

Q: What does it mean to “not receive mental health treatment”? 
A: The indicator “Youth with MDE Who Did Not Receive Mental Health Services” is calculated using a recoded variable that divides people into did and did not receive care in the past year. The SAMHSA National Survey on Drug Use and Health “NSDUH” asks youth what types of mental health services they received in the past year. Individuals who reported they did not receive any treatment or counseling from a medical doctor or other professional or medication for MDE were determined not to have received mental health treatment in the past year.

Q: Will we be able to compare future State of Mental Health in America reports to previous years? 
A: We use data from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) “National Survey of Drug Use and Health” (NSDUH) to calculate most indicators within the State of Mental Health in America report. Due to methodological changes during the COVID-19 pandemic, SAMHSA has determined that 2021 will represent a trend break from previous years, meaning the results of the NSDUH moving forward will not be comparable to data collected before 2021. However, next year’s NSDUH data release should be comparable to the data in this year’s report.