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- New research analyzed seven data points to reveal the worst states for mental health care.
- Texas topped the list as the worst state for mental health care for a second time in two years, while Vermont was ranked as the best state for mental healthcare.
- Experts offer advice on what to look for in health insurance plans regarding mental health coverage and how to access mental healthcare without insurance.
Where you live may determine the kind of mental health care you can access.
For instance, if you’re in Vermont, you’re in good shape, but if you’re in Texas, not so much, according to Forbes Advisor Health Insurance, which analyzed seven data points to reveal the worst states for mental health care.
For the second year in a row, Texas tops the list of worst states due to having a large population of uninsured adults with mental illness and having significant barriers to mental health resources. Vermont ranks as the best.
Six of the top 10 worst states for mental health care are located in the South, whereas five of the top 10 best states for mental health care are in the Northeast.
“Research reports that mental health care is significantly influenced by a person’s beliefs and their place of residence, with urban and northern states having more positive overall mental health,” Deborah Serani, PsyD, psychologist and professor at Adelphi University, told Healthline.
The top 5 states for the worst and best mental healthcare
Below are the top rankings, according to Forbes Advisor Health Insurance.
Worst States for Mental Health Care
- Texas
- Georgia
- Alabama
- Florida
- Mississippi
Best States for Mental Health Care
- Vermont
- Connecticut
- Rhode Island
- Pennsylvania
- Massachusetts
The disparity between the South and the Northeast underscores the need for more investment and attention to mental health infrastructure in the most underserved states, said Jason Metz, lead insurance editor at Forbes Advisor.
“It’s a positive federal policy that health insurance plans cover mental health, but the study emphasizes significant gaps still exist when it comes to regional access to care,” he told Healthline.
Why Texas ranks the lowest for mental health care
Texas tops the list as the worst state for mental health care for the second time in two years due to a combination of factors that create significant barriers to accessing treatment, said Metz.
“The state has a high rate of uninsured adults with mental health illness, 21.4%, the second highest in the U.S. Additionally, nearly 75% of youth with depression do not receive mental health services, and 19.4% of youth with private insurance lack coverage for mental health problems,” he told Healthline.
Financial barriers also factor into the ranking, with nearly one-third of those with a mental illness unable to afford a doctor’s visit.
“Texas has a limited mental health infrastructure, ranking the third lowest in the number of treatment centers, with only 8.4 per 10,000 businesses,” said Metz. “Overall, two-thirds (62.3%) of adults with mental illness in Texas go untreated, highlighting the state’s challenges in mental health care.”
Serani noted that socio-cultural beliefs with regard to mental health care also play a part. Statistically speaking, she said people who live in the South tend to have beliefs that seeking help for mental health suggests personal weakness and would harm their reputations.
“Clinically called public stigma and self-stigma, these assumptions prevent others from getting the help they need,” she said.
Why Vermont ranks highest for mental health care
Vermont has great access to services, comprehensive insurance coverage, and strong support for mental health initiatives, said Metz.
“The state has a well-developed mental health care system, with 34 treatment centers per 10,000 businesses—only bettered by 4 states,” he said. “Vermont also has lower rates of uninsured individuals with a mental illness (6%), with more residents having health insurance that covers mental health services, reducing financial barriers to care.”
The state also has one of the lowest percentages of untreated mental illnesses (43%), demonstrating its healthcare system’s ability to meet the mental health needs of its population.
Reduced stigma around mental health may also have influence, noted Serani.
“People in the Northeast are socialized in ways that asking for help is not viewed as a vulnerability, so mental health care and treatment are accessed more,” she said.
Does stigma affect how well states treat mental health care?
Sarah Davis, senior managing editor at Forbes Health, said while the stigma traditionally associated with mental health conditions is beginning to dissipate, it still exists and can impact insurance coverage.
She pointed to a 2024 study in The Lancet that found structural stigma of mental health disease refers to the “inequitable deprioritization, devaluation, and othering of mental health and substance misuse health (compared with physical health)” in healthcare systems.
“The study notes an example of this as a hospital emergency department having a patient-to-nurse ratio of 3:1 for physical health patients but a 6:1 ratio for mental health patients,” Davis told Healthline.
The 2008 Mental Health Parity and Addiction Equity Act requires certain health plans to provide physical and mental health benefits equally.
“[But] the National Alliance of Mental Health points out parity laws mean nothing if there are factors like inadequate provider network coverage in certain geographical areas, which you can see in our survey findings,” said Davis.
What to consider when choosing a mental health insurance plan
To ensure proper coverage, Metz said consider the following.
Confirm the health plan covers local mental health providers
If you have a provider in mind, it’s always best to confirm it’s in-network with the plan you’re considering.
“In-network versus out-of-network providers will make a difference on how much you pay for care,” Metz said.
Consider all the associated costs of the plan
Health insurance costs include both your monthly premium and all of your out-of-pocket costs.
“So when comparing health insurance quotes, review all costs like copays, deductibles, coinsurance, and out-of-pocket maximums,” said Metz.
Review the plan’s prescription drug coverage
Many health insurance companies include prescription drug coverage, but the covered medications and your copay can vary by plan.
“If you’re already taking medication, confirm its coverage with the potential plan,” said Metz.
Consider virtual healthcare coverage
While treatment for mental health services is generally preferred to occur in person, Serani said the pandemic proved that virtual therapy can be effective too.
“So, if you’re homebound, live too far from mental health resources, or can’t find a mental health practitioner that has a specialty in your concerns, the option to get treatment virtually opens many more possibilities,” she said.
Know if you need a referral for mental health care
Some health insurance plans require a referral from a primary care provider for mental health services.
“For example, an HMO usually requires referrals for most types of specialized coverage, while a PPO and EPO do not,” said Metz.
What mental health coverage typically includes
When choosing an insurance plan for mental health care, Serani said to choose a plan with an out-of-network benefit so you can go to a specialist.
“You really want to find someone who has training in the issues with which you are struggling,” she said.
If you must stay in-network, Serani said there are ways to access expert mental health care if there isn’t a specialist in your network.
“The insurance term called a single case agreement can help you work with a trained mental health specialist that you may not be able to find in your HMO network,” she said.
Below are some of the services that the best insurance plans for mental health cover, said Metz.
Talk therapy includes specific therapy modalities like general counseling, cognitive behavioral therapy, and dialectical behavioral therapy. “If you’re meeting one-on-one with a therapist or psychologist, the session is typically covered by insurance, less out-of-pocket costs,” said Metz.
Inpatient hospitalization involves intensive mental health treatment, which can be voluntary or involuntary. “You stay in a hospital or facility for a short period and receive continuous care through individual and group therapy, medication management, and coping strategies,” Metz said.
Partial hospitalization includes a structured program of psychiatric treatments during the day only.
Substance misuse treatment addresses drug and alcohol addiction. “Health insurance plans may cover talk therapy, medication management, 12-step programs, or medical detox for people going through substance abuse treatment,” said Metz.
Emergency psychiatric care or crisis intervention might include self-harm or overdose treatment, however coverage varies by plan.
Medication coverage usually includes at least partial coverage of pharmaceutical treatment for mental health disorders, with some plans requiring a copay or other out-of-pocket costs for these medications.
How to access mental health services without insurance
In Serani’s book, “Living with Depression,” she included the below options for accessing mental healthcare if you don’t have insurance.
Sliding scale and pro-bono services
Many psychotherapists make accommodations to see children and adults at low fees or pro-bono fees.
“Check with local mental health organizations to discover which professionals offer low or no-fee sessions,” said Serani.
University programs
Frequently, university and college programs will offer psychotherapy to children and adults at low fees.
“Generally staffed by graduate students earning degrees in related psychotherapy fields, the treatment takes place in the university setting,” she said.
Postdoctoral or postgraduate psychotherapy centers
Consider working with an already licensed mental health expert who is pursuing a postgraduate degree in psychotherapy. Similar to university centers, they offer low-fee treatment, yet the sessions commonly occur in the therapist’s office.
“By and large, these professionals have a desire to become even more specialized in the field of psychotherapy, and they seek training programs to hone their skills,” Serani said.
State and county clinics
There are over 1,500 free clinics in the United States, providing health services to children and adults who have no health care coverage.
“As a rule, you go through a clinic screening where your overall health is evaluated. With regard to mental health, a case manager helps you get to a therapist,” said Serani.
Non-profit mental health organizations
Reach out to nationwide non-profits such as the National Alliance on Mental Illness, Mental Health America,or Bring Change to Mind to ask for support and resources. Additionally, online services like the 988 Suicide & Crisis Lifeline offer free help around the clock.
