Ranking America's Mental Health: Report Discussion
These data indicate significant variation among the states in the levels of depression and in its most tragic consequence, suicide. Rates of depression among the states vary from around seven percent in the least depressed states to over 10 percent in states where residents report the highest levels of depression. This represents nearly 40 percent variation from the least to most depressed state. Even more dramatic differences are noted in suicide rates. The state with the lowest suicide rate, New York, loses approximately six persons per 100,000 citizens per year while Alaska loses over 23 individuals per 100,000 residents, representing a nearly 300 percent difference in rates.
While many factors likely contribute to these differences which are not represented in the state summary data employed in these analyses, a clear and compelling theme emerges from the data included. The availability of and access to mental health services improves mental health outcomes. This is particularly true for suicide, where less difficulty in obtaining needed care, actual utilization of services, and the availability of a professional workforce are all related to decreased rates of death. Similarly, access to health insurance - a key variable in obtaining care - is also related to decreased rates of suicide.
As would be expected, states with greater rates of depression also had greater utilization of mental health treatment and pharmacy services. Where individuals reported fewer barriers to accessing care and lower levels of unmet needs, the rates of depression were lower than in states where individuals reported more difficulty receiving care.
Assuring access and resource availability, therefore, are two areas where public policy must be focused. Current efforts in many states to expand the availability of health insurance as well as discussions of universal coverage in the presidential campaigns may represent important opportunities to improve Americans' mental health status and, thereby, improve the productivity and well being of the nation. In that vein, it is critical that parity in the coverage of mental health services with general health services accompany the expansion of insurance coverage. These analyses indicate that states with comprehensive or full parity coverage had access rates that exceeded those with limited or no parity by about 20 percent (i.e., 11.4 percent utilization versus 9.4 percent). Since greater access is associated with lower suicide rates, these differences may be translated into lives saved. The study results suggest full insurance coverage with a mental health benefit at parity with general health as two critical policy options.
A related policy concern involves the availability of a professional workforce to address these issues. Federal funds for training mental health professionals have been dramatically reduced during the last decade. Severe workforce shortages of specific disciplines (e.g., child psychiatrists), as well as overall shortages of the professional workforce are predicted during the next decade. These data would argue for a federal strategy to ensure an adequate workforce that meets diverse needs across the country to assure that the beneficial effects of an available workforce be more equitably distributed across the states thereby improving the mental health status and reducing suicide rates across the nation.
Numerous studies have highlighted the deleterious effects of depression on population health and productivity. Persons who are depressed miss more work, are less productive at work, and do more poorly in school and at home than persons who are not depressed. Persons with other chronic illnesses like diabetes, hypertension, or cardiac disease in addition to their depression have much poorer courses of illness, have much greater costs of care, and ultimately experience poorer outcomes - including excess rates of mortality. Depression robs peoples' lives of both quality and quantity. However, effective treatments are available and these data argue that when individuals can more easily access care, the personal and social damage wrought by depression can be controlled. We must demand equity in access to care and in the availability of mental health professionals across the United States in order to reduce the wide variations among states in depression and suicide.
Despite the fact that some states do better than others on rates of depression and suicide, no state can be satisfied with their current status. All of these rates can be driven lower by improving insurance coverage, ending discriminatory practices in insurance, providing public education to encourage needed service use, and assuring that qualified professionals are available to serve everyone in need. We cannot be satisfied with the status quo in any state. It is in the interest of every American to assure the mental health of all Americans.
Working with its nationwide affiliate field and partner organizations, Mental Health America plans to educate and demand action from federal and state policymakers on these supportive policies that clearly improve the mental health of all Americans.
For More Information:
For more information, contact your local Mental Health America affiliate or the national Mental Health America office.
Page last updated: 11/28/2007
