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MHA report offers glimpse of state trends

February 15, 2018
by Rachael Zimlich, RN
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Substance use problems affect a significant portion of individuals with mental health disorders, and this link can be more pronounced in areas where support systems and access to care are limited. A new report examines state and regional trends in mental health, substance use and care access, in the hope of leading the way to increased advocacy and intervention.

Michele Hellebuyck, a program manager at Mental Health America, says the State of Mental Health in America 2018 report was compiled by calculating weighted scores of measures from the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Use and Health (NSDUH).  Mental Health America's analysis includes measures of alcohol dependence, marijuana use, heroin use and cocaine use over the past year in both adults and youths.

The report notes that 18% of adults nationally have a mental health condition, and about half of them have a concurrent substance use disorder. Half of those with mental health disorders go without treatment.

States with higher rankings in the report had better outcomes in most measures, meaning these states had lower rates of mental illness and substance use, and better access to care. Substance use rankings were compiled similarly.

States highest ranking overall in mental health for both adults and youths were:

  • Massachusetts
  • South Dakota
  • Minnesota

And the lowest ranking states were:

  • Arizona
  • Mississippi
  • Nevada

The states with the highest rankings—and better outcomes/lower usage rates—for alcohol dependence and illicit drug use combined were:

  • Mississippi
  • Utah
  • Iowa

The states with the lowest rankings—with higher usage or dependence rates—were:

  • Vermont
  • Alaska
  • The District of Columbia

Regionally, Hellebuyck says, Southern states had lower rates of alcohol dependence and drug use among adults, while Northeastern and some Western states had the highest rates.

The report also details usage of mental health services, revealing a workforce crisis created by increased access through the Affordable Care Act coupled with low compensation and high turnover for providers. Rural and low-income areas are most affected, according to the report.

The state-level data provide insight that could be useful in advocacy efforts, according to Mental Health America. “State-level data allows for a more nuanced look at the mental health disparities that are often shrouded by data presented through a national lens,” Hellebuyck says.

She cautions that the results of the study should not be viewed categorically, but from a larger perspective given the association among substance use, mental health and access to care.

“We cannot solely focus on the ranking of a state as it relates to one indicator, but step back and assess the bigger picture,” she says. “For example, despite some states holding a higher rank in the alcohol dependence and illicit drug use, they hold an overall lower rank—higher prevalence of mental illness and lower rates of access to care—when we consider other indicators. These are the distinctions that we do not want to overlook.”

She adds, “The State of Mental Health in America Report is a publication that serves as a call to action. In addition to tracking changes in prevalence rates and access to mental health care, we are understanding how these trends are affected by legislation and policy. Through this report, Mental Health America seeks to increase the dialogues and improve the outcomes for individuals and families with mental health needs.”

Rachael Zimlich, RN, is a freelance writer based in Ohio.



The National Rx Drug Abuse & Heroin Summit is the largest national collaboration of professionals from local, state, and federal agencies, business, academia, clinicians, treatment providers, counselors, educators, state and national leaders, and advocates impacted by prescription drug abuse and heroin use.

April 2-5, 2018 | Atlanta, GA