State of Mental Health in America report highlights trends about access, disparity

Even prior to the COVID-19 pandemic, more than half of the adults with mental illness (27 million) and 60 percent of children with major depression did not receive the treatment they need. In addition, even in states with the greatest access to health care, nearly one in three are not getting it.

These statistics are just a few derived from the State of Mental Health in America report by the non-profit Mental Health America with data collected from the Mental Health Services Administration, the Centers for Disease Control and Prevention and Department of Education in all states and the District of Columbia during 2018-2019.
Information reflective of the COVID-19 pandemic will not be available until next year’s report.

According to Maddy Reinert, MHA’s senior director of population health and lead author, a major takeaway from the data is the need to prioritize children’s mental health. She noted the trend of worsening child and adolescent mental health has existed, especially for youth of color, prior to COVID-19.

For example, in 2019, more than 2.5 million youth had severe major depression. The rate was highest among youth who identified as more than one race, at 14.5 percent. This population was also less likely to receive treatment—with Asian youth the least likely—and youth of color with depression, including Native American, multiracial, and Black youth more likely to receive services in education settings.

“It is imperative that we ensure every child in need of mental health care has access to quality, representative care, and that schools and communities receive enough sustainable financial support to promote mental health where it is most likely to reach children at greatest risk,” Reinert said.

Overall, New England states ranked as having lower prevalence of mental illness and higher access to care. The measures considered in the rankings included substance use disorder in the past year, serious thoughts of suicide, major depressive episodes, and more.

The rankings that took into account numbers of youth and adults with mental illness and access to care had Massachusetts in first (meaning less illness, better access), Connecticut in fourth, Vermont in fifth and Maine in eighth.

Rhode Island was ranked 11th and New Hampshire in 13th. State rankings between 1-13 indicate the best circumstances.

Also, Vermont, Massachusetts, and Maine, for example, ranked first, second, and third in having access to insurance and mental health treatment, while New Hampshire, Rhode Island, and Connecticut were sixth, seventh, and ninth, respectively.

One of the significant changes in rankings happened In Rhode Island, where the percentage of adults with cognitive disability who could not see a doctor because of cost decreased from 25.71 percent in 2017-2018 to 18.48 percent in 2018-2019, and the percentage of adults with mental illness reporting unmet need decreased from 27.9 percent in 2017-2018 to 25.4 percent in 2018-2019.

Having the New England states ranked within the top quartile of states was not a surprising finding, according to Reinert.

Factors influencing those rankings include mental health workforce availability as well as the states being smaller, she said.

“Their policy changes may be easier to implement given their small population size and higher possibility of homogeneity in their geography, as opposed to larger states which may have to deal with urban or desert populations where access to care may be more of an issue,” Reinert said.

What was surprising, she said, is that some New England states that are close in proximity and geography can rank very differently in certain categories.

For example, Vermont ranked 47th or 5.66 percent and Maine ranked 43th at 5.44 percent in rates of suicidal ideation and both had increases in rates of adults with serious thoughts of suicide from last year’s report.

On the other hand, Connecticut ranked 11th at 4.46 percent, Rhode Island ranked 14th at 4.59 percent and New Hampshire ranked 21st at 4.68 percent, each experiencing a decrease in the percentage of adults with serious thoughts of suicide from last year’s report, she noted.

She said that in addition to COVID-19 potentially causing numbers to rise next year, the pandemic was coupled with traumatic changes to people’s social environments, financial hardship, housing and food insecurity, death of loved ones, changes to work and schooling environments, and increased household stress that may have led to increases in interpersonal violence.

During this time, the U.S. also experienced increasingly visible race-based violence, including the harassment and killing of Black and Asian community members, Reinert said. “Each of these experiences can cause an acute stress response that may lead to future mental health problems if not addressed early.”

She said the concerns about access to health care will be most significant in states and among populations like BIPOC (Black, indigenous, and people of color) communities that were disproportionately impacted by the pandemic and barriers to accessing mental health care.

Additionally, based on data from SAMHSA’s National Survey on Drug Use and Health, in 2020 there was an increase in the percentage of adults with a mental illness and adults with a serious mental illness, as well as an increase in the percentage of adults reporting an unmet need for treatment.

Among adults with any mental illness, the largest increases in unmet need were among individuals who identified as two or more races (4.4 percent increase from 2019-2020) and American Indian and Alaska Native (3.6 percent increase from 2019-2020).

While increases have been highlighted and exacerbated by COVID-19, Reinert said they are a continuation of trends experienced before the pandemic.

“These trends will not reverse even once COVID-19 is under control in the United States, and require a sustained response at the national, state, and community levels,” she said.

She added that psychologists and other mental health professionals can use the information from the report to better understand who is at greatest risk for mental health concerns or are facing the greatest barriers to care and translate that into how they are serving their patients.

Reinert said the data can also help professionals advocate for better programs and treatment options in their states.

“Highlighting states with low rates of mental health concerns and high rates of access to care allows us to explore the policies, programs, or interventions that are being implemented successfully in those states and apply them to others,” she added.