The State of Mental Health in America

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 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. 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.

The measures we use are:

1. Adults with any mental illness (AMI) in the past year

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

3. Adults with serious thoughts of suicide in the past year

4. Youth with at least one major depressive episode (MDE) in the past year

5. Youth with SUD in the past year

6. Youth with serious thoughts of suicide in the past year

7. Youth 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 reporting an unmet need for treatment

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

13. Youth with private insurance that did not cover mental or emotional problems

14. Youth with MDE who did not receive mental health services

15. Youth who have not had a preventive doctor’s visit in the past year

16. Students identified with emotional disturbance for an individualized education program (IEP)

17. Mental health workforce availability

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.

All measures included in each of these rankings were considered equally important in calculating the aggregate rankings, and no additional weights were given to any measure. However, there are more measures of Access (10) than Prevalence of Mental Illness (7), so the Overall Ranking is slightly more representative of access to care in the U.S.

Yes, this year’s results can be compared to previous years. 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.

The Overall, Adult, Youth, or Access to Care rankings cannot be compared to previous years, because there were changes to some of the indicators used to create the rankings. However, each individual indicator can be compared to last year’s reports, so we can track changes over time.

Most of the indicators in this year’s report are calculated from 2022-2023 combined data, but it may vary by indicator based on methodological differences.

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. For more information on each of the indicators, visit the Indicator Glossary at: https://mhanational.org/the-state-of-mental-health-in-america/glossary/

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.

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.