A new study looked at several key factors to determine which states are the best or worst in terms of mental health care. Alexander Spatari/Getty ImagesA new study analyzed seven data points to reveal the worst states for mental health care. Texas ranks as the worst state for mental health care for the second time in two years, and Vermont ranks as the best state for mental health care. Experts offer advice on what to look for in your health insurance plan regarding mental health coverage and how to access mental health care without insurance.
Where you live may determine the type of mental health care available to you.
For example, if you’re in Vermont, you’re in good health, but if you’re in Texas, you’re not as healthy, according to Forbes Advisor Health Insurance. We analyzed seven data points to reveal the worst states for mental health care. .
Texas has topped the list of worst states for the second year in a row due to its large number of uninsured adults with mental illnesses and significant barriers to mental health resources. Vermont ranks highest.
Six of the top 10 states with the worst mental health care are in the South, and five of the top 10 states with the best mental health care are in the Northeast.
“Research shows that mental health care is greatly influenced by a person’s beliefs and place of residence, with urban areas and northern states having better overall mental health,” said Professor of Psychology at Adelphi University. academic Dr. Deborah Cerrone told Healthline.
According to Forbes Advisor Health Insurance, the top rankings are:
Worst states for mental health care Texas Georgia Alabama Florida Mississippi Best states for mental health care Vermont Connecticut Rhode Island Pennsylvania Massachusetts
Jason Metz, chief insurance editor at Forbes Advisor, said the disparity between the South and the Northeast highlights the need for more investment and attention to mental health infrastructure in the most underserved states.
“While it is a positive federal policy for health insurance to cover mental health, research highlights that significant disparities still exist in access to care in the community,” he told Healthline.
For the second time in two years, Texas has topped the list as the worst state for mental health care due to a combination of factors that create significant barriers to accessing treatment, Metz said.
“The state has the highest uninsured rate among adults with mental illness, at 21.4%, the second highest in the nation.Furthermore, nearly 75% of youth with depression do not receive mental health services and have private insurance. 19.4% of young people who do not receive compensation ‘for mental health issues,’ he told Healthline.
The ranking also takes into account financial barriers, with approximately one-third of people with mental illness unable to afford to see a doctor.
“Texas has limited mental health infrastructure, ranking third from the bottom in the number of treatment centers, at just 8.4 treatment centers per 10,000 establishments,” Metz said. “Overall, two-thirds (62.3%) of adults with mental illness in Texas do not receive treatment, highlighting the state’s challenges in mental health care.”
Cerrone noted that sociocultural beliefs about mental health care also play a role. Statistically speaking, people living in the South are more likely to believe that seeking mental health help suggests personal weakness and will damage their reputation, she said.
“These beliefs, clinically known as public bias or self-bias, prevent others from getting the help they need,” she says.
Vermont has good access to services, comprehensive insurance coverage and strong support for mental health initiatives, Metz said.
“The state has a well-developed mental health system, with 34 treatment centers per 10,000 businesses, and only four states have improved on this,” he said. “Vermont also has a low rate of uninsured people with mental illness (6%) and more residents have health insurance that covers mental health services, reducing financial barriers to care. ”
The state also has one of the lowest rates of untreated mental illness (43%), demonstrating the ability of the state’s health care system to meet the mental health needs of its population.
Cerrone points out that decreasing stigma around mental health may also be playing a role.
“People in the Northeast are socialized in a way that asking for help is not seen as a vulnerability, which makes mental health care and treatment more accessible,” she says.
Sarah Davis, senior editor at Forbes Health, said that while the stigma traditionally associated with mental health conditions is starting to fade, it still exists and can impact insurance coverage. Ta.
She describes the structural stigma of mental health illness as “the unfair deprioritization, devaluation, and other aspects of mental health and substance abuse health (compared to physical health)” in the health care system. He pointed to a 2024 study in The Lancet that found that
“The study points to an example of a hospital emergency department where the patient-to-nurse ratio for physical health patients is 3:1 compared to 6:1 for mental health patients. ,” Davis told Healthline.
The Mental Health Parity Act and Addiction Equity Act of 2008 mandates certain health plans that provide equal physical health and mental health benefits.
“[But]the National Mental Health Alliance points out that the Equality Act means nothing if there are factors such as inadequate provider network coverage in a particular geographic area. That’s what we see in the research,” Davis said.
To ensure proper coverage, Mets said he will consider the following:
Make sure your health plan covers your local mental health provider
If you have a provider in mind, it’s always best to make sure it’s in the network of the plan you’re considering.
“There is a difference in how much you pay for care between in-network and out-of-network providers,” Metz said.
Consider all costs associated with your plan
Health insurance costs include monthly premiums and full out-of-pocket costs.
“So when comparing health insurance quotes, review all costs, including copays, deductibles, coinsurance, and out-of-pocket limits,” Metz says.
Check your plan’s prescription drug coverage
“If you are already taking a medication, check the coverage of that medication in your potential plan,” Metz said.
Consider virtual medical coverage
While mental health services generally prefer in-person treatment, the pandemic has proven that virtual therapy can also be effective, Cerrone said.
“So if you’re homebound, live far from mental health resources, or can’t find a mental health professional who specializes in your concerns, getting treatment is a real option. “It opens up even more possibilities,” she said.
Know if you need a mental health care referral
Some health insurance plans require a referral from a primary care provider for mental health services.
“For example, HMOs typically require a referral for most types of specialty coverage, but PPOs and EPOs do not,” Metz says.
When choosing an insurance plan for mental health care, Cerani said, choose one that includes out-of-network benefits so you can see a professional.
“You really want to find someone who is trained in the issue that you are struggling with,” she said.
If you must stay in-network, Cerrani said there are ways to access professional mental health care even if you don’t have one in-network.
“An insurance term called a single-case contract can help you work with trained mental health professionals who may not be found in your HMO network,” she said.
According to Metz, these are some of the services that the best insurance plans for mental health cover.
Talk therapy includes specific treatments such as general counseling, cognitive behavioral therapy, and dialectical behavior therapy. “When you meet one-on-one with a therapist or psychologist, the session is usually covered by insurance and your out-of-pocket costs are low,” Metz says.
Hospitalization includes intensive mental health treatment, either voluntary or involuntary. “They stay in a hospital or facility for a short period of time and receive ongoing care through individual and group therapy, medication management, and coping strategies,” Metz said.
Partial hospitalization involves a structured program of daytime-only psychiatric treatment.
Substance abuse treatment deals with drug and alcohol dependence. “Health insurance plans may cover talk therapy, medication management, 12-step programs, or medical detox for people undergoing substance abuse treatment,” Metz said.
Emergency psychiatric care and crisis intervention may include treatment for self-harm and overdose, but coverage varies by plan.
Medication coverage typically includes at least partial coverage of drug treatments for mental health disorders, and some plans require copays or other out-of-pocket payments for these medications.
Cerrone’s book Living with Depression provides the following options for accessing mental health care if you don’t have insurance:
Sliding scale and free service
Many psychotherapists are happy to see children and adults for a low or no fee.
“Contact your local mental health agency to find out which professionals offer low-cost or free sessions,” Cerrone said.
university program
University programs often offer psychotherapy for children and adults at a low cost.
“Typically staffed by graduate students with degrees in relevant psychotherapy fields, treatment takes place on campus,” she said.
Postdoctoral Fellowship or Graduate Psychotherapy Center
Consider working with an already licensed mental health professional who is pursuing a graduate degree in psychotherapy. Similar to university centers, they offer low-cost therapy, but sessions typically take place in a therapist’s office.
“Generally, these professionals have a desire to further specialize in the field of psychotherapy and are seeking training programs to hone their skills,” Cerrone said.
State and county clinics
There are more than 1,500 free clinics in the United States that provide medical services to children and adults without health insurance.
“As a general rule, you will undergo a clinic screening that assesses your overall health. When it comes to mental health, your case manager will help you see a therapist,” Cerrone said.
