Mental Health and Substance Use State Fact Sheets

Throughout the pandemic, many people have experienced poor mental health, with over 30% of adults in the U.S. reporting symptoms of anxiety and/or depressive disorder, up from 11% of adults prior to the pandemic. Negative mental health outcomes have also affected children and adolescents; over 20% of school-aged children have experienced worsened mental or emotional health since the pandemic began. Substance use issues have also worsened – deaths due to drug overdose increased by nearly 30% from 2019 to 2020, primarily driven by opioids. This increase in mental health and substance use issues comes at a time when resources are already strained, and people with mental health diagnoses often face barriers to care. Among adults with symptoms of anxiety and/or depressive disorder during the pandemic, over 20% report needing, but not receiving, mental health counseling or therapy.

In this national summary and in the accompanying fact sheets, we examine national and state-level data on mental health and substance use both before and during the coronavirus pandemic. We find that mental health outcomes, access, and coverage vary from state to state. For example, prior to the pandemic, in 2018-2019, the share of adults with any mental illness ranged from 16.4% in New Jersey to 26.9% in Utah. In 2019, age-adjusted suicide rates ranged from 6.1 per 100,000 in the District of Columbia to 29.6 per 100,000 in Wyoming. Below, we highlight more findings from the national analysis. In the accompanying state reports, we present detailed state-level data for all fifty states and the District of Columbia.

Click on a state below to learn more.

Share of Adults With Symptoms of Anxiety and/or Depressive Disorder, September 29 – October 11, 2021

Key Findings

The state-level facts sheets explore the prevalence of mental illness and substance use and related deaths, and access, affordability, and costs of care. Key findings include:

Mental health symptoms have increased during the COVID-19 pandemic. From September 29 – October 11, 2021, 31.6% of adults in the U.S. reported symptoms of anxiety and/or depressive disorder, up from 11.0% in 2019.

  • The states with the highest percentage of adults reporting symptoms of anxiety and/or depressive disorder from September 29 – October 11, 2021 were Alaska (38.5%), Arkansas (37.8%), Oklahoma (37.7%), Rhode Island (37.3%), and Kentucky (36.2%).
  • The states with the lowest percentage of adults reporting symptoms of anxiety and/or depressive disorder from September 29 – October 11, 2021 were Wisconsin (22.9%), New Hampshire (23.5%), Minnesota (24.6%), South Dakota (24.7%), and Ohio (26.4%).

Among adults who reported symptoms of anxiety and/or depressive disorder, 26.9% reported needing, but not receiving, counseling or therapy, from September 29 – October 11, 2021.

  • The states with the highest percentage of adults who reported symptoms of anxiety and/or depressive disorder and had an unmet need for counseling or therapy from September 29 – October 11, 2021 were Kentucky (40.4%), Mississippi (34.7%), Oregon (34.5%), Colorado (33.6%), and Missouri (33.6%).
  • The states with the lowest percentage of adults who reported symptoms of anxiety and/or depressive disorder and had an unmet need for counseling or therapy from September 29 – October 11, 2021 were Wyoming (18.1%), Hawaii (18.6%), Wisconsin (18.8%), New Hampshire (19.4%), and New Jersey (19.5%).

Deaths due to drug overdose increased during the pandemic, primarily driven by synthetic opioid use. In the U.S., in 2020, there were 28.3 deaths due to drug overdose per 100,000, up from 16.6 per 100,000 in 2015.

  • States with the highest drug overdose deaths in 2020 were West Virginia (76.3 per 100,000), the District of Columbia (71.7 per 100,000), Kentucky (47.0 per 100,000), Maryland (45.6 per 100,000), and Delaware (45.5 per 100,000).
  • States with the lowest drug overdose deaths in 2020 were South Dakota (8.3 per 100,000), Nebraska (10.9 per 100,000), Iowa (13.2 per 100,000), Texas (14.3 per 100,000), and Montana (14.5 per 100,000).

Suicide is one of the leading causes of death in the U.S. and has increased in almost every state over time. In 2019, the age-adjusted suicide rate was 13.9 per 100,000.

  • States with the highest suicide rates in 2019 were Wyoming (29.6 per 100,000), Alaska (28.5 per 100,000), Montana (26.2 per 100,000), New Mexico (24.1 per 100,000), and Colorado (22.1 per 100,000).
  • States with the lowest suicide rates in 2019 were the District of Columbia (6.1 per 100,000), New Jersey (8.0 per 100,000), New York (8.3 per 100,000), Massachusetts (8.6 per 100,000), and Maryland (10.3 per 100,000).

In 2018-2019, approximately one-third (35.0%) of adults with serious mental illness (SMI) in the past year did not receive mental health treatment.

  • The states with the highest percentage of adults with SMI that did not receive mental health treatment were the District of Columbia (47.0%), Georgia (46.6%), Alaska (45.7%), Oklahoma (45.2%), and Texas (44.7%).
  • The states with the lowest percentage of adults with SMI that did not receive mental health treatment were Wisconsin (14.4%), North Dakota (19.7%), West Virginia (22.8%), South Dakota (23.9%), and Utah (24.4%).

Across all states, average out-of-pocket spending for adults with mental illness enrolled in large employer health plans is higher than average out-of-pocket spending for adult enrollees without mental illness ($1,347 vs. $671).

  • Average out-of-pocket spending for adults with large employer coverage who have a mental illness is highest in Connecticut ($1,753), Wyoming ($1,739), North Dakota ($1,698), Montana ($1,659), and Idaho ($1,617).
  • Average out-of-pocket spending for adults with large employer coverage who have a mental illness is lowest in Michigan ($998), Massachusetts ($1,048), California ($1,106), Iowa ($1,106), and Wisconsin ($1,113).

Note: For more state-level data, visit our Mental Health and Substance Use page on KFF’s State Health Facts. Through State Health Facts’ custom state reports, comparisons can be made across select states and indicators.

Mental health and substance use disorders remain a key policy issue at the national and state level, especially in light of the COVID-19 pandemic. The Build Back Better Act, recently passed in the House, designates funding for several mental health and substance use services, including suicide prevention, strengthening the mental health workforce, peer-support programs for individuals with substance use disorders, and mental health educational programs for school-aged children. Other recent legislation has also allocated funds towards mental health, including the American Rescue Plan Act. The need for mental health care has increased while many states continue to grapple with provider shortages and other issues related to delivery of care. This will likely exacerbate longstanding access to care issues for mental health and substance use treatment services. As policymakers address the many issues that the pandemic and economic crisis have created or highlighted, data will be pivotal to underpin policy action directed at addressing longstanding and developing issues in mental health care.

The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.