Mental Health and Substance Use State Fact Sheets

The coronavirus pandemic and resulting economic downturn have taken a toll on mental health for many people, with over 30% of adults in the U.S. now reporting symptoms consistent with an anxiety and/or depressive disorder. KFF polling during the pandemic has consistently found large shares of the public saying that worry and stress related to the coronavirus have had a negative effect on their mental health. This is coming at a time when mental health resources were already strained, and people with mental health diagnoses often face barriers to care.

In this national summary and in the accompanying fact sheets, we examine national and state-level data on mental health both before and during the coronavirus pandemic. We find that mental health outcomes, access, and coverage vary substantially from state to state. For example, in 2017-2018, the share of adults with any mental illness ranged from 16.1% in New Jersey to 25.3% in Utah. In 2018, age-adjusted suicide rates ranged from 7.4 per 100,000 in the District of Columbia to 25.0 per 100,000 in New Mexico. 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 Any Mental Illness, 2017-2018

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 issues have increased during the COVID-19 pandemic. Average weekly data for June 2020 found that 36.5% of adults in the U.S. reported symptoms of anxiety or depressive disorder, up from 11.0% in 2019.

  • The states with the highest percentage of adults reporting symptoms of anxiety or depressive disorder are Louisiana (42.9%), Florida (41.5%), Oregon (41.3%), Nevada (39.1%), and Oklahoma (39.0%).
  • The states with the lowest percentage of adults reporting symptoms of anxiety or depressive disorder are Wisconsin (27.2%), Minnesota (30.5%), Nebraska (30.6%), North Dakota (30.9%), and South Dakota (31.0%).

Suicide is one of the top ten causes of death in the U.S. and has increased in almost every state over time. In 2018, the age-adjusted suicide rate was 14.2 per 100,000.

  • States with the highest suicide rates are New Mexico (25.0 per 100,000), Montana (24.9 per 100,000), Wyoming (24.8 per 100,000), Alaska (24.4 per 100,000), and Idaho (23.9 per 100,000).
  • States with the lowest suicide rates are the District of Columbia (7.4 per 100,000), New Jersey (8.3 per 100,000), New York (8.3 per 100,000), Rhode Island (9.6 per 100,000), and Massachusetts (9.9 per 100,000).

Deaths due to drug overdose have increased nearly fourfold from 1999 to 2018. In the U.S. overall, the 2018 age-adjusted death rate for all drug overdoses was 20.7 per 100,000.

  • States with the highest drug overdose death rates are West Virginia (51.5 per 100,000), Delaware (43.8 per 100,000), Maryland (37.2 per 100,000), Pennsylvania (36.1 per 100,000), and Ohio (35.9 per 100,000).
  • States with the lowest drug overdose death rates are South Dakota (6.9 per 100,000), Nebraska (7.4 per 100,000), Iowa (9.6 per 100,000), North Dakota (10.2 per 100,000), and Texas (10.4 per 100,000).

In 2017-2018, approximately one-third (34.3%) 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 are Alaska (54.9%), Louisiana (47.2%), Georgia (45.7%), Arizona (44.2%), and Missouri (43.0%).
  • The states with the lowest percentage of adults with SMI that did not receive mental health treatment are Tennessee (19.2%), South Dakota (23.9%), Vermont (23.9%), Washington (24.0%), and South Carolina (26.0%).

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 comparisons, visit our Mental Health and Substance Use Disorder data collection on KFF’s State Health Facts. The data collection allows for quick comparisons across states and for the creation of custom reports for select states and indicators.

Mental health and substance use disorders remain a key policy issue at the state level, especially in light of the COVID-19 pandemic. A recent analysis found that by 2029, there may be 75,000 more deaths due to suicide and alcohol or drug misuse as result of the pandemic and economic recession. The need for mental health care is continuing to increase even as many people have lost health insurance as a result of increased unemployment during the pandemic. 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.

Methods and Sources

Mental Illness Prevalence:

Substance Use and Deaths:

  • KFF analysis of Substance Abuse and Mental Health Services Administration (SAMHSA)'s restricted online data analysis system (RDAS), National Survey on Drug Use and Health (NSDUH), 2017 and 2018, Substance Abuse and Mental Health Data Archive.
    • The definitions of substance use disorder(s) in NSDUH align with the 4th edition of the Diagnostic and Statistical manual of Mental Disorders (DSM-IV) to define substance use disorder(s).
  • KFF analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2018 on CDC WONDER Online Database, released 2020. Data are from the Multiple Cause of Death Files, 1999-2018, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.html on February 13, 2020.

Suicide:

Mental Health Workforce:

Unmet Need and Barriers to Care:

  • KFF analysis of Substance Abuse and Mental Health Services Administration (SAMHSA)'s restricted online data analysis system (RDAS), National Survey on Drug Use and Health (NSDUH), 2017 and 2018, Substance Abuse and Mental Health Data Archive.

Private Insurance:

  • KFF analysis of Substance Abuse and Mental Health Services Administration (SAMHSA)'s restricted online data analysis system (RDAS), National Survey on Drug Use and Health (NSDUH), 2017 and 2018, Substance Abuse and Mental Health Data Archive.
  • KFF analysis of 2018 IBM Health Analytics MarketScan Commercial Claims and Encounters Database.
    • For the out-of-pocket spending in the Private Insurance section, a sample of medical claims provided by large employer plans obtained from the 2018 IBM Health Analytics MarketScan Commercial Claims and Encounters Database, were analyzed. Data is only among those under age 65. Disease definitions developed by the Healthcare Cost and Utilization Project (HCUP) were used to identify claims associated with mental health conditions.

Medicaid:

* Tests measuring statistical significance were at the p<0.05 level and all significant differences are noted with an asterisk.

For more information on sources and/or methods, please visit: https://www.kff.org/statedata/collection/mental-health-substance-use-disorder/.