Data & rankings

Adults with any mental illness (AMI)

In 2024, 23.40% of adults in the U.S. experienced any mental illness (AMI) in the past year, equivalent to over 60 million people.

In 2024, 5.60% of adults had a serious mental illness.

The national rates of mental illness and serious mental illness among adults in the U.S. did not change significantly from 2021 to 2024.

In 2022 and 2023, the most recently available state-level data, 36 states had a higher prevalence of AMI than the national average. In Oregon, Utah, and West Virginia, the three lowest ranked states, nearly 1 in 3 adults had AMI in 2022-2023.

Adults with substance use disorder (SUD) in the past year

In 2024, 17.70% of adults in the U.S. had a substance use disorder (SUD) in the past year, totaling over 46 million people.

In 2024, the number of overdose deaths in the U.S. decreased for the first time since 2018,¹ likely due to state and federal investments in naloxone access, treatment, and other strategies. However, the percentage of adults with SUD did not change significantly from 2021 to 2024, indicating a continued need for substance use prevention and early intervention services across the U.S.

Some states have been successful in reducing both rates of SUD and overdose. Indiana (ranked 2), for example, had the largest decrease in adults with SUD, from 19.08% in 2021-2022 combined data to 15.53% in 2022-2023. Indiana also had the second largest decrease in overdose deaths during that period, at 18.00%.²

Adults with serious thoughts of suicide

In 2024, 5.50% of adults reported experiencing serious thoughts of suicide (suicidal ideation). The estimated number of adults with suicidal ideation in the U.S. in 2024 was over 14 million.

The most recently available suicide death data was collected in 2023. In 2023, the suicide rate was 14 per 100,000 people. Both rates of suicidal ideation and deaths were the same in 2023 as in 2022.

There were, however, changes in state rates of suicidal ideation among adults during that period. Texas had a statistically significant 0.68% decrease in suicidal ideation among adults from 2021 to 2023. Massachusetts had the largest increase in suicidal ideation among adults, from 4.36% in 2021-2022 combined data to 6.07% in 2022-2023.

Adults with SUD who needed but did not receive treatment

In 2022-2023 combined data, over three-quarters (77.09%) of all adults with a substance use disorder (SUD) did not receive the treatment they needed. Over 80.00% of adults who needed care did not receive it in California, Georgia, and Illinois, the three lowest-ranked states.

Most adults with SUD who sought or considered treatment in 2023 but did not ultimately receive it said it was because they thought they should have been able to handle their drug or alcohol use on their own (74.10%), they weren’t ready to start treatment (65.60%), and/or they were not ready to stop or cut back using alcohol or drugs (60.10%).⁸ To best support individuals who may need treatment for SUD but are not ready to stop using substances, states must continue to invest in services to reduce overdose rates, such as distribution of opioid overdose reversal treatments and fentanyl test strips. These services are critical to keep individuals safe and save lives while expanding access to treatment and lasting recovery.

There were significant improvements in reducing other barriers to substance use care from 2022 to 2023. The percentage of people reporting they did not receive SUD treatment because they did not know how or where to get it decreased by 11.80%, from 48.90% in 2022 to 37.10% in 2023. The percentage of people reporting their health insurance did not cover alcohol or drug use treatment also decreased, from 40.10% in 2022 to 28.60% in 2023.⁹

These reductions are likely due to large state and federal investments in substance use awareness and increasing access to treatment providers and programs in 2022 and 2023. However, the significant cuts to Medicaid passed in 2025 threaten improvements in access to substance use care.¹⁰ At the state level, Medicaid funding must be protected to maintain progress in expanding access to substance use treatment.

Adults with AMI who are uninsured

In 2022-2023, 9.20% of adults with any mental illness (AMI) in the U.S. were uninsured, totaling over 5 million people. Nine of the states with the highest rates of uninsured adults were in the southern U.S. In Texas (ranked 51) nearly 1 in 5 adults with AMI did not have health insurance.

Medicaid is the largest payer for behavioral health care in the U.S. In 2023, 26% of all adults with a mental illness or substance use disorder were covered by Medicaid, totaling 22 million adults.¹¹

In 2025, Congress passed the H.R. 1, the One Big Beautiful Bill Act, which included significant cuts to Medicaid and coverage through the Affordable Care Act (ACA) marketplace.¹² According to the Congressional Budget Office (CBO), these provisions will cause about 15 million people to lose their current health coverage. This includes 10 million people who are estimated to become uninsured due to Medicaid and ACA marketplace cuts, and 4.2 million who will lose coverage due to cuts to premium tax credit enhancements that lower the cost of health insurance.¹³ People who are uninsured are more likely to forgo needed mental and physical health care, leading to worse outcomes over time.¹⁴

Individuals with mental health and substance use conditions are exempt from work requirements and will not have to pay copays for mental health services under H.R. 1. However, these cuts are still likely to significantly limit access to health care for adults with behavioral health conditions and result in worsening outcomes. Nearly 70% of Medicaid enrollees with a mental illness also have at least one chronic health condition.¹⁵ While mental health services are exempt from copays under H.R. 1, many physical health services are not, so people with mental health conditions may be forced to forgo care for their chronic conditions due to cost. H.R. 1 also limits states’ ability to raise or implement provider taxes and reduces existing provider taxes in expansion states. The CBO estimates that this change alone could cut $191 billion in federal spending cuts over the next 10 years, likely forcing states to cut reimbursement and available services, including behavioral health services.¹⁶

Adults reporting 14+ mentally unhealthy days a month who could not see a doctor due to costs

In 2023, 26.58% of adults who reported experiencing 14 or more mentally unhealthy days each month were not able to see a doctor due to costs. This was a 2% increase over 2022 and a 4% increase over 2021.

In Texas (ranked 49), more than 4 in 10 people with frequent mental distress could not afford to see a doctor in 2023. Most of the states with the least access to affordable health care were located in the southeastern U.S.

Cost is one of the main reasons people forgo needed mental health care. In 2023, over half (59.80%) of adults with a mental illness who sought or thought they needed mental health care said the reason they did not receive it was because they thought it would cost too much.¹⁷ Further, a 2025 poll by the Kaiser Family Foundation found that 18.00% of adults who delayed or skipped care reported that their health got worse as a result.¹⁸ To reduce rates of mental health crises and ensure the best outcomes for recovery, states must combat the rising costs of health care. This requires both short-term solutions, such as financial assistance for residents, and long-term solutions, such as limiting payer and provider costs through legislation and regulatory processes.¹⁹

Adults with AMI reporting an unmet need for treatment

In 2022-2023 combined data, 1 in 4 adults with any mental illness (AMI) in the U.S. reported an unmet need for mental health treatment in the past year. Unmet need is defined as seeking treatment or thinking they should receive treatment but not receiving it.

In Wyoming (ranked 51), nearly 4 in 10 adults with AMI had an unmet need for mental health treatment in 2022-2023.

Each year, SAMHSA’s National Survey on Drug Use and Health (NSDUH) asks respondents who did not receive mental health treatment about their reasons for not receiving care. In 2023, the most common reason adults reported that they did not receive treatment was that they thought they should have been able to handle their mental health, emotions, or behavior on their own (70.50%). The second most common reason was that they thought treatment would cost too much (59.80%).²⁰

Many adults also reported a lack of access to or awareness of treatment providers. Nearly half (48.60%) of adults reported they did not know how or where to get treatment in 2023, and 40.70% reported they could not find a treatment program or a health care professional that they wanted to go to.²¹

Adults with AMI with private insurance that did not cover mental or emotional problems

In 2022-2023 combined data, 9.60% of adults with AMI had private health insurance that did not cover mental health treatment – totaling nearly 3 million people in the U.S.

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that insurance coverage of mental health and substance use disorder benefits be no more restrictive than coverage of benefits for medical or surgical care.²² However, people continue to have to pay more out-of-pocket for mental health care than physical health care. A 2021 study found that adults who were treated for depression or anxiety had almost twice the out-of-pocket spending as those who did not have a mental health condition.²³ In 2024, the Biden Administration finalized new rules to strengthen and incentivize enforcement of MHPAEA, which were a supplement to the original rules finalized in 2013.²⁴ However, in 2025, the Departments of Labor, Health and Human Services, and the Treasury announced that they would not be enforcing the new rules, and had plans to rescind or modify them, undermining access to behavioral health services for youth and adults across the U.S.²⁵ Without enforcement from the federal government, states bear the primary responsibility to enforce MHPAEA.