The State of Mental Health in America report highlights the latest national data and provides state-level rankings on mental health and well-being in the U.S. Through this report, Mental Health America offers critical insights to drive policy, improve care, and support people living with mental health conditions across the country.
The following information provides a guideline about: 1) how we chose our data, 2) how we ranked our data, and 3) important information about the national surveys where we acquired and analyzed our data.
This report provides a state-level snapshot of mental health needs, access to care, and outcomes in the U.S. The findings are meant to help inform policy and program planning, analysis, and evaluation. The data and tables include state and national data.
Given the variability of data, MHA developed guidelines to identify mental health measures that are most appropriate for inclusion in our ranking. Chosen measures met the following guidelines:
The majority of measures in this report represent data collected up to 2023, the most recent year that data were available for analysis. Measures included in the analysis are:
While the above 17 measures are not a complete picture of the mental health system, they do provide a strong foundation for understanding the prevalence of mental health concerns, as well as issues of access to insurance and treatment, particularly as that access varies among the states. MHA will continue to explore new measures that allow us to capture more accurately and comprehensively the needs of those with mental illness and their access to care.
To better understand the rankings, it is important to compare similar states.
Factors to consider include geography and size. For example, California and New York are similar. Both are large states with densely populated cities. They are less comparable to less populous states like South Dakota, North Dakota, Alabama, or Wyoming. Keep in mind that the size of states and populations matter. Both New York City and Los Angeles alone have more residents than North Dakota, South Dakota, Alabama, and Wyoming combined.
The rankings are based on the percentages for each state collected from the most recently available data. The majority of measures represent data collected up to 2023. 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 two measures where high percentages equate to better outcomes: “Youth flourishing,” and “Students identified with emotional disturbance for an individualized education program.” 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 to indicate significance.
Along with calculated rankings, each measure is ranked individually with an accompanying chart and table. The table provides the percentage and estimated population for each ranking. The estimated population number is weighted and calculated by the agency conducting the applicable federal survey. The ranking is based on the Z scores. Data are presented with two decimal places when available.
The measure “Youth who have not had a preventive doctor’s visit in the past year” was added to the measure list in this year’s report. This measure was added as an upstream measure of access to mental health care, as preventive primary care visits are often the first or only place adolescents receive mental health screenings that allow for early identification and intervention.
The measure “Adults with AMI who reported an unmet need for treatment” was added back into this year’s rankings. It had been removed from the rankings last year because SAMHSA made changes to the mental health and substance use treatment questions in 2022. State-level data is reported in two-year pairs, and data from 2022 could not be combined with data from 2021. The data for this measure is now available again with this 2022-2023 year-pair state-level data release.
Two measures were missing data for one or more states. For the measure “Students identified with emotional disturbance for an individualized education program,” data for Iowa and New Mexico was not available. Data from Iowa was not available due to data quality concerns. Data for New Mexico was not available because data on the number of school age (ages 5-21) children with disabilities was not submitted to the EDFacts system by the deadline for the 2023-2024 school year. For the measure “Adults with 14+ mentally unhealthy days a month who could not see a doctor due to costs,” data was not available for Kentucky and Pennsylvania because these states were unable to collect enough data to meet minimum reporting requirements for the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). When data was missing for a measure, the state was excluded from the ranking for that measure. For the Overall, Adult, Youth, Prevalence, and Access to care rankings, if a state was missing data for one of the measures within the ranking, additional weight was redistributed to the measures that did have data.
Each survey used in this report has its own strengths and limitations. For example, a key strength of SAMHSA’s National Survey on Drug Use and Health (NSDUH), CDC’s Behavioral Risk Factor Surveillance System (BRFSS), and HRSA’s National Survey of Children’s Health (NSCH) is that they include national survey data with large sample sizes and utilize statistical modeling to provide weighted estimates of each state population. This means that the data are representative of the general population. A limitation of particular importance to the mental health community is that the NSDUH does not collect information from people who are experiencing homelessness and who are not staying in shelters, are active-duty military personnel, or are institutionalized (i.e., in jails or hospitals). This limitation means that those individuals who have a mental illness who are also experiencing homelessness or are incarcerated are not represented in the data presented by the NSDUH. As a result, these data likely represent the minimum number of individuals experiencing behavioral health conditions and/or lacking access to care in each state. If the data did include individuals who were experiencing homelessness and/or were incarcerated, we would likely see the prevalence of behavioral health issues increase and access to treatment rates worsen. It is MHA’s goal to continue to search for the best possible data in future reports. Additional information on the methodology and limitations of the surveys can be found online as outlined in the glossary.
Most of the data analyzed in this report were gathered through 2023. This report reflects the most current survey data that have been reported by the states and made available to the public. During the COVID-19 pandemic, the national surveys used to create the State of Mental Health in America report experienced numerous methodological changes. This means that the data in the 2023 and 2024 State of Mental Health in America reports cannot be compared with earlier years, or used to track rankings over time. The 2025 State of Mental Health in America report uses survey data collected with the same methods that were reported in the 2024 report, so trends can be compared between these two reports.
State-level data for the NSDUH and the NSCH are calculated using two years of combined data to ensure there is sufficient sample size for each state. All state-level measures using NSDUH and NSCH data represent data combined from the 2022 and 2023 surveys. National data for 2024 was available for six of the 17 measures: “Adults with any mental illness (AMI) in the past year,” “Adults with substance use disorder (SUD) in the past year,” “Adults with serious thoughts of suicide in the past year,” “Youth with at least one major depressive episode (MDE) in the past year,” “Youth with SUD in the past year,” and “Youth with serious thoughts of suicide in the past year.” The 2024 national data was reported in the text when available. Even for those measures where 2024 national data is available, the tables report 2022-2023 combined data, as those data were the most recently available at the state-level. The measure “Students identified with emotional disturbance for an individualized education program” is based on Department of Education data from the 2023-2024 school year. BRFSS data and data for the measure “Mental health workforce availability” were calculated using a single year of data. BRFSS data was collected in 2023 and “Mental health workforce availability was collected in 2024.