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Mental Health in America - Ranking Guidelines

The following information provides a guideline about: 1) how we chose our data, 2) how we ranked our data, and 3) important information about the national surveys were we acquired and analyzed our data.
 

This data and accompanying chartbook present a collection of data that provides a baseline for answering some questions about how many people in America need and have access to mental health services. The data and table include state and national data and sharable infographics.

MHA Guidelines

Given the variability of data, MHA developed guidelines to identify mental health measures that are most appropriate for inclusion in our ranking. Indicators were chosen that met the following guidelines:

  • Data that are publicly available and as new as possible to provide up-to-date results.
  • Data that are available for all 50 states and the District of Columbia. 
  • Data for both adults and youth. 
  • Data that captured information regardless of varying utilization of the private and public mental health system.
  • Data that could be collected over time to allow for analysis of future changes and trends.

Our 2017 Measures

  1. Adults with Any Mental Illness (AMI)
  2. Adults with Dependence or Abuse of Illicit Drugs or Alcohol
  3. Adults with Serious Thoughts of Suicide
  4. Youth with At Least One Past Year Major Depressive Episode (MDE)
  5. Youth with Dependence or Abuse of Illicit Drugs or Alcohol
  6. Youth with Severe MDE
  7. Adults with AMI who Did Not Receive Treatment
  8. Adults with AMI Reporting Unmet Need
  9. Adults with AMI who are Uninsured
  10. Adults with Disability who Could Not See a Doctor Due to Costs
  11. Youth with MDE who Did Not Receive Mental Health Services
  12. Youth with Severe MDE who Received Some Consistent Treatment
  13. Children with Private Insurance that Did Not Cover Mental or Emotional Problems
  14. Students Identified with Emotional Disturbance for an Individualized Education Program
  15. Mental Health Workforce Availability

A Complete Picture

While the above fifteen measures are not a complete picture of the mental health system, they do provide a strong foundation for understanding the prevalence of mental health concerns, as well as issues of access to insurance and treatment, particularly as that access varies among the states. MHA will continue to explore new measures that allow us to more accurately and comprehensively capture the needs of those with mental illness and their access to care. 

Ranking

To better understand the rankings, it's important to compare similar states. Factors to consider include geography, size, and political affiliation. For example, California and New York are similar. Both are large states with densely populated cities and tend to be Democratic leaning. They are less comparable to less populous or Republican leaning states like North Dakota, Alaska, or Wyoming. Keep in mind, both New York City and Los Angeles alone have more residents than North Dakota, South Dakota, Alaska, and Wyoming combined.

The rankings are based on the percentages or rates for each state. States with positive outcomes are ranked higher than states with poorer outcomes.  The overall, adult, youth, prevalence and access rankings were analyzed by calculating a standardized score (Z score) for each measure, and ranking the sum of the standardized scores. For most measures, lower percentages equated to more positive outcomes (e.g. lower rates of substance use or those who are uninsured).  This year, there are two measures where high percentages equate to better outcomes.  These include Youth with Severe MDE who Received Some Consistent Treatment, and Students Identified with Emotional Disturbance for an Individualized Education Program.  Here, the calculated standardized score was multiplied by -1 to obtain a Reverse Z Score that was used in the sum.  All measures were considered equally important, and no weights were given to any measure in the rankings.

Along with calculated rankings, each measure is ranked individually with an accompanying chart and table. The table provides the percentage and estimated population for each ranking. The estimated population number is weighted and calculated by the agency conducting the applicable federal survey. The ranking is based on the percentage or rate. Data are presented with 2 decimal places when available. The tables include the District of Columbia (DC).  

Due to limitations in sample size for year 2014, the measures for Youth with MDE who Did Not Receive Mental Health Services and Youth with Severe MDE who Received Some Consistent Treatment are from sample year through 2013. 

Survey Limitations

Each survey has its own strengths and limitations.  For example, strengths of both SAMHSA’s National Survey of Drug Use and Health (NSDUH) and the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) are that they include national survey data with large sample sizes and utilized statistical modeling to provide weighted estimates of each state population. This means that the data is more representative of the general population.  An example limitation of particular importance to the mental health community is that the NSDUH does not collect information from persons who are homeless and who do not stay at shelters, are active duty military personnel, or are institutionalized (i.e., in jails or hospitals). This limitation means that those individuals who have a mental illness who are also homeless or incarcerated are not represented in the data presented by the NSDUH. If the data did include individuals who were homeless and/or incarcerated, we would possibly see prevalence of behavioral health issues increase and access to treatment rates worsen. It is MHA’s goal to continue to search for the best possible data in future reports. Additional information on the methodology and limitations of the surveys can be found online as outlined in the glossary.

 

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