Best (and Worst) States for Youth Mental Healthcare

Young people in the United States are living through 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. The advisory named contributing factors such as the pandemic and social media.

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, to identify the best and worst states for youth mental healthcare. MoneyGeek ranked states by access to and cost of mental healthcare, as well as mental health needs in the young population.

The South took the top two spots among the best states for youth mental health, followed by two states in the Northeast. Overall scores in the top states were similar, but how each state reached its ranking differed.

Tennessee posted an access and cost score of 83.8 and a prevalence score of 74.8. South Carolina’s access and cost score is lower, at 61.8, but its prevalence score of 95.9 ranks among the best in the country.

New Jersey’s access and cost score is 68.9. Its prevalence score of 82.9 reflects low rates of mental health conditions. Massachusetts’ access and cost score of 100 is the highest in the country, and its prevalence score of 50.4 sits close to the midpoint among all states. South Dakota rounds out the top five. The state bucks the Midwest’s overall trend, with an access and cost score of 69.7 and a prevalence score of 78.

Three of the five worst states for youth mental healthcare are in the Midwest. North Dakota has close to average rates of youth mental health issues, but the state’s challenge is access and cost. It has just 30 mental health providers per 100,000 people, among the lowest rates in the country. And 14% of its youth have private insurance that doesn’t cover mental health or emotional problems.

Minnesota and Iowa have more balanced results. Both land in the bottom five because of low access and cost scores combined with higher rates of mental health issues among youth. Both states have far more mental health providers per capita than North Dakota and average or above-average mental health facility capacity. Still, they rank at the bottom for cost.

The prevalence of mental health conditions, and access to and cost of mental healthcare, both vary widely by state. Access and cost depend largely on the availability of mental health providers and facilities. MoneyGeek ranked the best and worst states for these two dimensions below.

The Northeast has a high cost of living. Even so, five of the six New England states were in the top seven states for access and cost, with three tied for fifth place. All five of these Northeastern states have high or extremely high rates of mental health burdens, yet the states are 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 in the bottom five nationally were well below the national average for the number of youth mental health facilities and the overall number of mental health providers. Costs there were still high. 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 didn’t cover the costs of mental healthcare (19%).

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

The West and South led the list of states with the lowest rates of mental health difficulties, and California topped it with the highest possible score on this measure. Its youth are less likely than the national average to have had a major depressive episode, and its families are less likely to include a child with mental health needs.

Some of the best states for access to mental healthcare also have the highest rates of mental health issues among youth. Vermont, for example, ranks fifth for access to and cost of youth mental healthcare, but it has the highest rate of youth mental health problems in the country. The state has the third-highest share of youth who have had at least one major depressive episode, at 21%. It also has the fourth-highest share of households with at least one child who struggles with mental health, at 25%.

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

MoneyGeek considered eight metrics across two categories, access and cost and prevalence, to rank the best states for youth mental health services. We ranked each state in every metric before calculating a final ranking score through a weighted average for each category. Every metric carried a full weight except two, which were half-weighted: the number of youth mental health treatment facilities per 100,000 people under 18, and the percentage of total mental health facilities that accept youth. 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 who 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 about delays in therapy due to cost over the same period. 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 these 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.

The table below shows the data behind this analysis. It covers disparities in youth mental health services and the best and worst states across several criteria.