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County and State Data Map: Defining Mental Health Across Communities

THE MHA MAPPING PROJECT

Mental Health America (MHA) has seen a significant increase in the number of people experiencing mental health concerns during the COVID-19 pandemic.

Since 2014, MHA has provided online mental health screenings to more than one million people. In 2020, that number grew to 2.6 million users that year alone. In 2021, 5 million users came to MHA Screening to take a mental health screen and learn more about their mental health.

In 2021, MHA published four reports and research studies using this timely, granular, and actionable data from the MHA Screening Program. Until now, the data has not been released at a county level. The lack of county-level data means that county board members, municipal health officials, and school administrators are unable to identify the specific problems facing their localities and how to invest in mental health services effectively.

To empower communities across the country with this information, MHA anticipates creating a publicly accessible dashboard where individuals can find detailed data about suicide ideation, depression, psychosis, and trauma across their state and county.

As part of the release of MHA Screening data in a mapping dashboard, MHA plans to release guides and resources for stakeholders on how to make meaningful and systemic changes.
 

SUICIDE DATA

In May 2021, MHA published Suicide and COVID-19: Communities in Need Across the U.S., evaluating data from individuals reporting frequent thoughts of suicide or self-harm on the depression screen (PHQ-9). MHA analyzed the data collected from over 2.6 million users who accessed its real-time online mental health screening in 2020. Information from these users represents the largest dataset ever collected from a help-seeking population experiencing mental health conditions during COVID-19.

Suicide Key Findings

State-Level: 

  • The three states with the highest number of people reporting frequent suicidal ideation in 2020 were California, Texas, and Florida.
  • Hawaii had the highest percentage of individuals reporting suicidal ideation of those who took a depression screen, followed by Montana, West Virginia, Nevada, and New Mexico.
  • Alaska had the highest proportion of individuals reporting frequent thoughts of suicide or self-harm in comparison to the overall state population, followed by Alabama, Wyoming, Indiana, and Hawaii. 

County-Level:

  • The three counties in the U.S. with the highest number of individuals reporting thoughts of suicide or self-harm on more than half or nearly every day of the previous two weeks were Los Angeles County, CA, Maricopa County, AZ, and Cook County, IL.
  • Large County Analysis: Of the most populous counties, Bexar County, TX had the highest proportion of the population report frequent thoughts of suicide or self-harm, followed by Clark County, NV, Riverside County, CA, Maricopa County, AZ, and San Bernardino County, CA.
  • Small and Mid-Size County Analysis: Carroll County, KY had the highest proportion of the population report frequent thoughts of suicide or self-harm, followed by Switzerland County, IN, Whitley County, KY, Greensville County, VA and Ripley County, IN. It is also notable that many of the top 20 counties in this part of the analysis are in rural areas with little access to mental health care supports. 

SEVERE DEPRESSION DATA

In August 2021, MHA published Severe Depression and COVID-19: Communities in Need Across the U.S., analyzing data collected from 725,949 individuals who took a depression screen (PHQ-9) as part of the MHA Screening Program in 2020. The analysis finds that 62 percent of people scored with symptoms of severe or moderately severe depression. Of those who scored with symptoms of severe depression, 70 percent had never been diagnosed with a mental health condition and 67 percent had never received any kind of mental health treatment or support. 

Severe Depression Key Findings

State-Level:

  • Alaska had the highest percentage of individuals at-risk for severe depression, compared to the overall state population. Indiana, Alabama, Wyoming and Arizona followed.

County-Level:

  • Large County Analysis: Among large counties, Bexar County, TX, had the highest percentage of individuals at-risk for severe depression. Clark County, NV; Maricopa County, AZ; San Bernardino County, CA; and Riverside County, CA followed. 
  • Small and Mid-Size County Analysis: Among small and mid-sized counties, Carol County, KY, scored highest. Baraga County, MI; Unicoi County, TN; Dearborn County, IN; and Richland County, MT followed.

Demographics: Respondents who identified as non-binary were most likely in the Gender category to score with symptoms of severe depression. Native Americans were the Race/Ethnicity category with the highest risk. Individuals ages 11-17 were the Age category scoring highest, and households reporting less than $20K annual income screened most at-risk.

TRAUMA AND PTSD DATA

In October 2021, MHA released Trauma and COVID-19: Communities in Need Across the U.S., analyzing data collected from individuals who took a Post-Traumatic Stress Disorder (PTSD) screen and individuals seeking mental health supports who self-identified as trauma survivors through the MHA Online Screening Program in 2020 and early 2021.

Trauma Key Findings

Trauma is different for everyone—what seems normal to one person might be traumatic for another. Each of the 10 MHA mental health screening tools, including the one for PTSD, allows respondents to self-identify as a member of a select population. One of these populations is “trauma survivor.” MHA’s new analysis includes insights into the population self-identifying as trauma survivors.

State-Level:

  • Alaska (0.0205%) had the highest number of trauma survivors in comparison to the overall state population, followed by Oregon (0.110%) and Maine (0.109%).

County-Level:

  • Among large counties: Salt Lake County, Utah (0.085%), had the highest percentage of the population identifying as trauma survivors, followed by Franklin County, Ohio (0.085%) and Travis County, Texas (0.078%).
  • Among small and mid-size counties: Rowan County, Kentucky (0.15%), had the highest percentage of the population identifying as trauma survivors, followed by Winchester City, Virginia (0.14%) and Asotin County, Washington (0.14%).

Demographics:

  • High-Risk Populations: According to the screening data, more than eight in 10 people who identified as trauma survivors screened with moderate-to-severe symptoms of a mental health condition -- and the percentage of young people who identified as trauma survivors is significant: six in 10 people who identified as trauma survivors are under age 25, and three in 10 are under age 18.

PTSD Key Findings

PTSD is a mental health condition characterized by ongoing distress that can occur as a response to experiencing or witnessing a traumatic event. Across the US in 2020 and 2021, 93% scored at-risk when taking a PTSD screen. At-risk rates for any mental health condition on MHA Screening are historically high since the sample consists of a help-seeking population. Our 2020 and 2021 data reflected a significant increase in the rate of those scoring at-risk for PTSD compared to 2019 (84%). The increased at-risk rates are a reflection of the enormous stress our country faced during 2020 and 2021.

State-Level:

  • West Virginia had the highest percentage of individuals scoring at-risk for PTSD (95%), followed by Arkansas (95%) and Nevada (94%).

County-Level:

  • Among large counties: St. Louis County, Missouri (0.029%), had the highest percentage of the population scoring at-risk for PTSD, followed by Franklin County, Ohio (0.026%)  and Salt Lake County, Utah (0.026%).
  • Among small and mid-size counties: Benton County, Indiana (0.092%), had the highest percentage of the population scoring at-risk, followed by Cass County, Iowa (0.072%) and Asotin County, Washington (0.066%).

Demographics: 

  • High-Risk Populations: The same four populations that were more likely to experience frequent suicidal ideation and screen at-risk for severe depression also screened at-risk for PTSD in MHA screens in 2020 and early 2021. Individuals who selected “another gender” (rather than identifying as female or male) scored 96% at-risk for PTSD; Native American or American Indian scored 95% at-risk for PTSD; ages 11-17 scored 93% at-risk for PTSD; and/or from low-income households generating less than $20K scored 94% at-risk for PTSD.

PSYCHOSIS DATA

In December 2021, MHA released our fourth and final brief, Psychosis and COVID-19: Communities in Need Across the U.S., analyzing data collected from 175,795 individuals who took a Prodromal Questionnaire – Brief Version (PQ-B) screen from January 2020-October 2021 through the MHA Online Screening Program. The analysis found Franklin County, Ohio (Columbus area) had the highest percentage of the population screen at-risk for psychotic-like experiences on MHA Screening of all large counties in 2020 and 2021.

More broadly, 79% of those who took a PQ-B screen from January 2020-October 2021 scored at risk for psychotic-like experiences. The analysis also showed many more people were taking the PQ-B screen in 2021 versus 2020. The number of people self-selecting to complete a psychosis screen was 29% higher in 2021 than in 2020. Psychosis is a general term to describe a set of symptoms of mental illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions.

Psychosis Key Findings  

A psychotic-like experience is an event that affects an individual’s thoughts and perceptions and causes some loss of contact with reality. It can be a symptom of several mental health conditions, and in some cases may lead to schizophrenia or other psychotic disorders if left untreated. “Clinical high-risk” refers to the period in which an individual experiences changes in mental health – including changes in perceptions, cognition and mood prior to the onset of their first psychotic episode. Screening for “clinical high-risk” helps to identify individuals who are at heightened risk of developing psychosis. These data are critically important in the prevention and early intervention of psychotic disorders.

 State-Level:

  • Alaska had the highest percentage of individuals score at-risk for psychotic-like experiences in comparison to the overall state population, followed by Alabama, and Maine.  

County-Level:

  • Among large counties: Franklin County, Ohio, had the highest percentage of the population score at-risk for psychotic-like experiences on MHA Screening, followed by Bexar County, Texas, and Maricopa County, Arizona. 
  • Among small and mid-size counties: Bristol County, Virginia had the highest percentage of the population score at-risk for psychotic-like experiences, followed by Whitley County, Kentucky, and Humboldt County, Nevada.

Demographics: 

  • Age: While young adults ages 18-24 were the largest group of respondents, youth ages 11-17 were the most likely to score at risk of psychotic-like experiences on the PQ-B screen. 89% of 11-17-year-old screeners scored at risk on the psychosis screen.
  • Income: Individuals who reported lower household incomes were more likely to screen at risk for psychotic-like experiences than those who reported higher household incomes. Among individuals who reported a household income of less than $20,000, 82% screened at risk for psychotic-like experiences.

PROGRAM AND POLICY IMPLICATIONS

We envision an effective use of this critical data to design policies and legislation that channel federal, state, and local funds into mental health care that is high quality and responsive to the needs of all Americans. 

Both the mapping dashboard and MHA reports provide a real-time reflection of communities across the nation, which in turn can transform programs and resources at the most local level. We know that early intervention is a critical component of preventing and treating mental illness, including child development programs, childcare, school-based mental health services, mental health education, and workforce development funding. However, most of these areas have largely been under-resourced for far too long.

To shape these necessary investments, it is essential to examine the intersection of mental health and social determinants of health and how private and public sectors can address the unmet need.
 

COMING SOON


MHA and Lundbeck will host a 90-minute webinar on February 16, 2022. 

Schroeder Stribling, president and CEO of Mental Health America, and Deborah Dunsire, Lundbeck Global CEO will discuss the outcomes of this dynamic research followed by a mapping dashboard demonstration. 

Connect With Us

If you have questions about our research, the mapping dashboard, or ways to partner, email Rafael Rivas at rrivas@mhanational.org.