Recent research has evaluated seven key data points to identify the states with the most inadequate mental health care. For the second consecutive year, Texas has been ranked as the worst state for mental health care, while Vermont has been recognized as the best state for mental health services. Experts provide insights on what to consider when selecting health insurance plans that cover mental health care and how individuals can access mental health services even without insurance. Your geographical location significantly influences the mental health care options available to you.
If you’re residing in Vermont, you’re likely to have better access to mental health services, whereas living in Texas presents numerous challenges, according to a study by Forbes Advisor Health Insurance that analyzed seven critical data points.
Texas has been named the worst state for mental health care for a second time due to a high population of uninsured adults experiencing mental illness and considerable barriers to accessing mental health resources. In contrast, Vermont holds the top spot for providing the best mental health care.
Interestingly, six of the ten worst states for mental health care are situated in the Southern United States, while five of the ten best states are found in the Northeast.
“Research indicates that an individual’s mental health care experience is heavily influenced by their beliefs and geographic location, with urban and northern states generally reporting better mental health outcomes,” commented Deborah Serani, PsyD, a psychologist and professor at Adelphi University, in an interview.
Top 5 States for Worst and Best Mental Health Care
The following rankings are provided by 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 contrast between the South and Northeast highlights the urgent need for increased investment and focus on mental health infrastructure in the states that are most underserved, stated Jason Metz, lead insurance editor at Forbes Advisor.
“While federal policies mandating mental health coverage in insurance plans are a step in the right direction, this study reveals significant gaps in regional access to care,” he shared.
Why Texas Ranks Lowest in Mental Health Care
Texas has once again secured its position as the state with the worst mental health care due to a variety of factors that hinder access to treatment, according to Metz.
“The state has a notably high percentage of uninsured adults with mental health conditions, currently at 21.4%, which is the second highest in the nation. Moreover, almost 75% of young individuals suffering from depression do not receive necessary mental health services, and 19.4% of youths with private insurance are lacking coverage for mental health issues,” he noted.
Financial constraints also contribute to this ranking, as nearly one-third of individuals with mental illnesses report being unable to afford a doctor’s visit.
“Texas’s mental health infrastructure is quite limited, ranking third lowest in terms of available treatment centers, with only 8.4 centers per 10,000 residents,” Metz explained. “Overall, two-thirds (62.3%) of adults with mental illness in Texas remain untreated, underscoring the state’s significant challenges in mental health care.”
Serani pointed out that socio-cultural attitudes toward mental health also play a critical role. People in the South, statistically, may view seeking mental health assistance as a sign of weakness, potentially harming their social standing.
“This phenomenon, known as public stigma and self-stigma, prevents many individuals from obtaining the help they desperately need,” she added.
Why Vermont Excels in Mental Health Care
Vermont is noted for its excellent access to mental health services, comprehensive insurance coverage, and robust support for mental health initiatives, according to Metz.
“The state boasts a well-established mental health care system, with 34 treatment centers for every 10,000 residents—only outperformed by four other states,” he stated. “Furthermore, Vermont has a lower percentage of uninsured individuals with mental health conditions (6%), and more residents benefit from health insurance that includes mental health services, which helps to alleviate financial barriers to care.”
Vermont also records one of the lowest rates of untreated mental illness (43%), reflecting its healthcare system’s effectiveness in addressing the mental health needs of its citizens.
The state’s reduced stigma surrounding mental health may also contribute to its success, according to Serani.
“Residents in the Northeast are typically socialized to view seeking help not as a weakness but as a necessary step, leading to greater access to mental health treatment,” she remarked.
Does Stigma Impact State Mental Health Care Treatment?
Sarah Davis, senior managing editor at Forbes Health, noted that while the stigma historically associated with mental health conditions is gradually lessening, it persists and can still affect insurance coverage.
She referenced a 2024 study published in The Lancet, which discussed the concept of structural stigma in mental health. This form of stigma involves the “inequitable deprioritization, devaluation, and othering of mental health and substance misuse care compared to physical health” within healthcare systems.
“The study highlights examples such as a hospital emergency department maintaining a patient-to-nurse ratio of 3:1 for physical health patients while having a 6:1 ratio for those with mental health needs,” Davis explained to Healthline.
The 2008 Mental Health Parity and Addiction Equity Act mandates that certain health plans provide equal benefits for both physical and mental health.
“However, the National Alliance on Mental Illness emphasizes that parity laws are ineffective if there are systemic issues like inadequate provider networks in specific regions, which is evident in our survey findings,” Davis added.
Key Considerations When Selecting a Mental Health Insurance Plan
To ensure adequate coverage, Metz recommends the following:
- Verify Coverage of Local Mental Health Providers: If you have a specific provider in mind, confirm their participation in the network of the insurance plan you’re considering. “Choosing between in-network and out-of-network providers significantly impacts your out-of-pocket expenses,” Metz emphasized.
- Evaluate the Plan’s Total Costs: Consider all expenses associated with the health insurance plan, including monthly premiums and out-of-pocket costs. “When comparing insurance quotes, assess all costs such as copays, deductibles, coinsurance, and out-of-pocket maximums,” Metz advised.
- Examine Prescription Drug Coverage: While most health insurance policies include prescription drug benefits, the specific medications covered and associated copays can vary by plan. “If you are currently taking medication, ensure it is included in the coverage of your potential plan,” Metz recommended.
- Explore Virtual Healthcare Options: Although in-person treatment is typically preferred, the pandemic has demonstrated that virtual therapy can also be effective. “If you are homebound, live too far from mental health services, or cannot find a specialist, virtual treatment options can significantly expand your access to care,” Serani noted.
- Be Aware of Referral Requirements for Mental Health Care: Some health insurance plans necessitate a referral from a primary care provider for mental health services. “For instance, an HMO usually requires referrals for most specialized coverage, whereas PPO and EPO plans do not,” Metz explained.
Typical Inclusions in Mental Health Coverage
When selecting an insurance plan for mental health care, Serani suggests opting for a plan that includes out-of-network benefits to facilitate access to specialists.
“You should seek a provider who is trained in the specific issues you are facing,” she recommended.
If you are limited to in-network providers, Serani indicated that there are ways to access expert mental health care even when specialists are not available in your network. “The insurance term ‘single case agreement’ can help you work with a qualified mental health specialist outside your HMO network,” she stated.
According to Metz, here are some services that the best insurance plans for mental health typically cover:
- Talk Therapy: This encompasses various therapy modalities such as general counseling, cognitive behavioral therapy, and dialectical behavioral therapy. “Generally, if you meet with a therapist or psychologist one-on-one, insurance will cover these sessions, minimizing your out-of-pocket costs,” Metz noted.
- Inpatient Hospitalization: This involves intensive mental health treatment that can be voluntary or involuntary, requiring a short stay in a hospital or facility to receive continuous care, including individual and group therapy, medication management, and coping strategies, according to Metz.
- Partial Hospitalization: This program provides structured psychiatric treatments during daytime hours only.
- Substance Misuse Treatment: Coverage may include various approaches such as talk therapy, medication management, 12-step programs, or medical detox for individuals undergoing substance abuse treatment, Metz elaborated.
- Emergency Psychiatric Care: This may involve crisis interventions for self-harm or overdose situations, although coverage can vary by plan.
- Medication Coverage: Most plans offer at least partial coverage for medications prescribed for mental health disorders, with some requiring a copay or other out-of-pocket expenses.
How to Access Mental Health Services Without Insurance
In her book Living with Depression, Serani outlines various options for obtaining mental health care without insurance:
- Sliding Scale and Pro-Bono Services: Many psychotherapists offer reduced fees or pro-bono sessions. “Reach out to local mental health organizations to identify professionals who provide low or no-fee services,” Serani suggested.
- University Programs: Universities and colleges often provide psychotherapy services at low costs, typically staffed by graduate students training in related fields. “These sessions are conducted in a university setting,” she noted.
- Postdoctoral or Postgraduate Psychotherapy Centers: Consider seeking therapy from licensed mental health professionals who are pursuing postgraduate degrees in psychotherapy. Similar to university programs, these centers often provide low-fee treatments, typically in the therapist’s office. “These professionals usually strive to specialize further in the field of psychotherapy,” Serani added.
- State and County Clinics: The U.S. is home to over 1,500 free clinics that offer health services, including mental health care, to uninsured individuals. “Typically
