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. Among these adults, over 20% report needing, but not receiving, mental health counseling or therapy. This need for services is coming at a time when mental health resources are 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 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 symptoms have increased during the COVID-19 pandemic. Average biweekly data for October 2020 found that 37.7% 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 in October 2020 were New Mexico (43.7%), Nevada (42.6%), Kentucky (42.4%), Louisiana (41.4%), and California (41.2%).
  • The states with the lowest percentage of adults reporting symptoms of anxiety and/or depressive disorder in October 2020 were North Dakota (29.4%), South Dakota (30.0%), Minnesota (30.7%), New Hampshire (31.2%), Iowa (31.5%).

Among adults who reported symptoms of anxiety and/or depressive disorder, 22.5% reported needing, but not receiving, counseling or therapy, based on data from October 2020.

  • 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 in October 2020 were Colorado (28.0%), Michigan (27.4%), Missouri (27.3%), Utah (26.6%), and Oregon (26.2%).
  • 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 in October 2020 were Hawaii (15.8%), South Dakota (16.0%), North Dakota (17.3%), Wyoming (17.8%), and New Hampshire (18.4%).

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 in 2018 were 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 in 2018 were 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 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 in 2018 were 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 in 2018 were 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 were 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 were 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.

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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.