Best (and Worst) States for Youth Mental Health Care

Young people in the United States are facing a mental health crisis. According to the Centers for Disease Control and Prevention (CDC), more than one-third of American teens report persistent feelings of sadness or hopelessness and 15% have had an episode of major depression. Nearly 10% of children ages three to 17 have been diagnosed with anxiety or depression, and a 2023 study published in the Journal of Adolescent Health found that these rates are increasing over time. The U.S. Surgeon General issued an advisory in 2021 to call attention to youth mental health as an urgent public health issue, detailing contributing factors such as the pandemic and social media.

To explore the best and worst states for youth mental health care, MoneyGeek analyzed data from the U.S. Census Bureau, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the CDC, as well as Google trends data on searches for relevant mental health terms. We ranked states by access to and cost of mental health care, as well as mental health needs in the young population.

The South took the top two spots for best states for youth mental health, followed by two states in the Northeast. Although overall scores in the top states were similar, how states achieved high rankings differed.

Tennessee scored well on access to and cost of care while also having relatively lower rates of mental health conditions. South Carolina follows with extremely low rates of mental health issues and strong performance on access and cost.

Similarly, New Jersey had above-average scores for access and cost but very low rates of mental health conditions. Massachusetts, on the other hand, earned the top score for access and cost and just about average rates of mental health difficulties. Rounding out the top five, South Dakota bucked the Midwest’s performance trend with relatively strong scores across multiple dimensions.

Three of the five worst states for youth mental health care are located in the Midwest. Although North Dakota has about average rates of youth mental health issues, the state struggles with access and cost. The state has an especially low number of mental health providers (30 providers per 100,000 people) and a relatively high percentage of youth with private insurance that doesn't cover mental health or emotional problems (14%).

Minnesota and Iowa have more balanced results, with both landing in the bottom five due to low scores on access and cost and rates of mental health issues. Although states have many more mental health providers per capita than North Dakota and average or above average mental health facility capacity, both were at the bottom in terms of cost.

There are clear differences in the prevalence of mental health conditions by state. Similarly, access to and cost of mental health care vary widely based on the availability of mental health providers and facilities. MoneyGeek ranked the best and worst states for these two dimensions below.

Though the Northeast generally has a high cost of living, five of the six New England states were in the top seven states for access and cost (with three of them tied for fifth place overall). All five of these Northeastern states have high or extremely high rates of mental health burdens, but the states are relatively well-equipped to handle widespread mental health needs. Massachusetts tops this list with the highest score for access and cost, largely due to high numbers of mental health providers per capita (194) and low rates of kids whose private insurance doesn’t cover their mental health needs (6%).

The Southern states appearing in the bottom five nationally were well below the national average for number of youth mental health facilities and overall number of mental health providers while still having relatively high costs. Texas, in particular, had extremely low numbers of mental health facilities (seven per 100,000 minors) and a high rate of children whose private insurance did not cover the costs of mental health care (19%).

Note: Rhode Island, Vermont and Maine are tied for No.5 in the "Best States for Mental Health Treatment Access and Cost" list above.

The West and South dominated the list of states with the lowest rates of mental health difficulties. California took the top spot, with the highest possible score on this measure. California’s youth are relatively less likely to have had a major depressive episode than the national average, and families are relatively less likely to live in a household with at least one child who has mental health needs.

Meanwhile, some of the best states for access to mental health care were among those with the highest rates of mental health issues. For example, Vermont ranks fifth in terms of access to and cost of youth mental health care, but it has the highest rates of youth mental health problems in the country. The state has the third-highest percentage of youth who have experienced at least one major depressive episode (21%) and the fourth-highest percentage of households where at least one child struggles with mental health (25%).

Children are facing mental health challenges at unprecedented rates. But no matter where you live, there are ways to close the gap between the care that’s available and the care your child needs:

Don’t be afraid to ask for help. If your child is in crisis, contact the 988 Suicide and Crisis Helpline.

To explore and rank the best states for youth mental health services by state, MoneyGeek considered eight metrics across two categories: access and cost, and prevalence. We ranked each state in every metric before calculating a final ranking score through a weighted average for each category. Each metric was given a full weight except for the following: the number of youth mental health treatment facilities per 100,000 people under 18 and the percentage of total mental health facilities that accept youths were both half-weighted. The state with the highest final score ranks as the best state for mental health services.

Access and Cost

• Number of mental health treatment facilities catering to individuals up to age 17, measured per 100,000 people under 17. Data comes from the Department of Health and Human Services 2021 National Substance Use and Mental Health Services Survey.
• Percentage of total mental health facilities that accept youth under 17. Data comes from the Department of Health and Human Services 2021 National Substance Use and Mental Health Services Survey.
• Mental health providers per 100,000 people. Data comes from the 2021 Census ACS PUMS Microdata and the Census Bureau’s 2021 1-year American Community Survey.
• Percentage of youth with private insurance that did not cover mental or emotional problems. Data comes from Mental Health America’s Youth Ranking for 2023.
• Average percentage of survey respondents that struggled with mental health costs. The survey included two questions: one asking if participants needed therapy but didn't receive it due to cost in the past 12 months, and the other inquiring about delays in therapy due to cost in the past 12 months. Data comes from the National Center for Health Statistics National Health Interview Survey for 2022.

Prevalence

• Percentage of youth with at least one major depressive episode. Data comes from Mental Health America’s Youth Ranking for 2023.
• Average search volume for mental health services. This measures Google Trends search volume for the following keywords: “Child Anxiety” and “Child Depression.” Data covers the 12-month period from November 29, 2022, to November 2023.
• Percentage of households where at least one child struggles with mental health. Data comes from the United States Census Bureau Household Pulse Survey from October 18 to October 30, 2023.

Our data illustrates the disparities in youth mental health services across various states, identifying the best and worst states across different criteria. See the data that shaped our story below.