In 2012, Rhode Island’s youth mental health care system ranked 29th in the nation in a major survey of mental health data indicators. But in six years, the smallest state rocketed to fourth place because of a dramatic performance in getting adolescents and teens into treatment.
Rhode Island reduced the rate of untreated youth with depression aged 12 to 17 from 67.1 percent in 2012 to 39.5 percent in 2017. It also increased the rate of youth with severe major depressive episode (MDE) who received consistent treatment from 23.7 percent to 47.6 percent during this period.
Rankings of all 50 states and the District of Columbia are detailed in “The State of Mental Health in America 2020,” released by Mental Health America. The non-profit began tracking data indicators in the wake of legislative efforts to increase the number of insured Americans, improve the quality of care, and mandate equal treatment of mental health conditions and substance use disorders by insurance plans.
But an improvement in ranking doesn’t necessarily mean good news. The report shows the prevalence of mental illness in America has risen among youth but has remained relatively stagnant for adults since the passage of the Affordable Care Act (ACA).
Nationally, 59 percent of youth with MDE continued to go untreated in 2017.
“There’s still a ton of room for improvement and a ton more work that we need to do, especially in intervening for youth mental health,” said the report’s lead author, Maddy Reinert, MPH, program manager of population health at Mental Health America.
New England states generally performed well. Four of the region’s six states made the top 10 overall: Vermont ranked third followed by Rhode Island fourth; Massachusetts seventh; Connecticut 10th; New Hampshire 14th; and Maine 19th. Pennsylvania was the top ranked state, followed by New York.
Every New England state ranked in the top 10 for access to care with Vermont, Massachusetts and Rhode Island in first, second and third place respectively. All three states embraced the expansion of Medicaid under ACA at the start of 2014.
All six states also ranked high in mental health workforce availability, with Massachusetts first in the nation with one provider for every 180 residents. Providers were considered psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, and advanced practice nurses specializing in mental health care.
Lowest ranked Alabama had 1,100 residents for every provider.
New Hampshire was the top-ranked state for lowest prevalence (2.0 percent) of children with private insurance who lack mental health coverage for mental or emotional problems. Massachusetts was second (3.6 percent) and Vermont was third (4.0 percent). The national average is 8.1 percent.
But one day during the last week in February there were 36 adults and four children waiting in emergency departments across New Hampshire for an inpatient psychiatric bed, said National Alliance for the Mentally Ill New Hampshire Deputy Director Susan Stearns.
“We’ve seen a little bit of decline in those [ED] numbers which I think is due to the fact we’ve had strong collaboration, strong bipartisan support to try and correct that situation,” Stearns said. “But it did make me think like, gosh if we have that many people waiting and we rank that high, I hate to think what it’s like in other parts of the country.”
Stearns said the data show the tide turning for improving New Hampshire’s children’s mental health system of care thanks to more wraparound services for families with children who have serious emotional distress, which she said has decreased out-of-home placements and hospitalizations.
Youth with past-year MDE increased from 8.66 percent to 13.01 percent, the report said. That means more than two million youth have depression with severe impairment.
The report also showed that suicidal ideation among adults increased from 3.77 percent in 2012 to 4.19 percent in 2017. That means more than 10.3 million U.S. adults have serious thoughts of suicide.
The report identified 15 measures to present a snapshot for how many people in America need and have access to mental health services, using publicly available survey data from the Substance Abuse and Mental Health Services Administration (SAMHSA) the Centers for Disease Control and Prevention (CDC) and Department of Education.
Nationally, the prevalence rate of substance use disorder including illicit drug or alcohol dependence or abuse, in the past year decreased from 8.46 percent in 2012 to 7.68 percent in 2017 for adults and from 6.48 percent to 4.13 percent for youths over the same period.
Reinert called the decrease in the prevalence of substance use disorder for both youth and adults “heartening,” attributing it to public health and prevention efforts.
But all six New England states still had higher prevalence than the national average for adults and youth with substance use disorder.
For youth, New Hampshire ranked 26th with 4.25 percent and Massachusetts was 27th with 4.26 percent; Connecticut (35th) had 4.64 percent, Rhode Island (38th) had 4.69 percent; Maine (39th) was at 4.75 percent; and Vermont (46th) was 5.47 percent.
For adults, Maine ranked 34th with 8.36 percent while New Hampshire (38th) had 8.69 percent; Rhode Island (39th) and Connecticut (40th) both had 8.77 percent; Vermont (49th) had 9.99 percent and Massachusetts (50th) had 10.13 percent.
In Rhode Island, anti-stigma campaigns and community forums have spread the message that mental health issues need to come out of the dark, according to Randal Edgar, spokesman for the state’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.
“We have been a leader in promoting recovery, establishing recovery focused supports and services, expanded peer coaches and recovery centers,” Edgar wrote via email.
Nationally 10.3 percent of adults with any mental illness were uninsured. Massachusetts led the nation with only 2.7 percent of adults with a mental illness uninsured.
The 17 bottom ranking states with the exception of Louisiana had not expanded Medicaid at the time of the ranking, which used data from SAMHSA’s 2016-2017 National Survey of Drug Use and Health.
Maine was among them ranking 40th with 14.1 percent of adults with a mental illness who were uninsured. Maine expanded Medicaid in January 2019.
“The results of the study should also be considered in context,” Massachusetts Psychological Association Director of Professional Affairs Jennifer Warkentin, Ph.D. said via email. “For example, Massachusetts ranked number two in access to mental health care, and yet we continue to hear about people struggling to find access to an in-network outpatient therapist or an open bed in an inpatient unit.”
Because data included in the report was collected up to 2017, Warkentin noted it does not reflect more recent changes in each state, such as Massachusetts’ ban on conversion therapy for minors or a law that secures MassHealth coverage for former foster children through age 26 and requires insurance companies to update provider directories.