07 Nov The State of Mental Health in America 2023: Adult Prevalence and Access to Care

Without good data, it’s hard to get a clear picture of just about anything. But when it comes to mental and behavioral healthcare, it’s non-negotiable. Analyzing information to find trends and patterns gives us a better understanding of mental health conditions, which ultimately leads to better treatment outcomes.

Fortunately, mental health advocates at Mental Health America have been committed to providing comprehensive behavioral health data for both youth and adults in the United States. 

MHA recently released its 2023 State of Mental Health in America survey which includes a deep dive into the prevalence of mental health and barriers to care. This information is invaluable in helping clinicians understand the challenges they collectively face and the areas that require additional resources. 

A note about the 2023 data: As with previous reports, there is a lag between data collection and published findings. The information presented in the 2023 survey was collected in 2020 and is the first iteration of the report with data cumulated during the COVID-19 pandemic. As a result of limitations on data collection efforts imposed by the pandemic, as well as changes and updates to the DSM-IV, the authors of the survey analysis stress that figures from the 2023 survey cannot accurately be compared to data from previous years.  

Key Takeaways from the 2023 Study

• 21% of adults are experiencing at least one mental illness. That’s roughly 50 million people.
• 55% of adults with a mental illness have not received any treatment.
• 5.44% of adults experience severe mental illness. 
• Over 12.1 million adults (4.8%) have reported serious thoughts of suicide. This figure more than doubles when surveying adults who identify as two or more races.
• The states faring the poorest included Kansas, Arizona, and Oregon, which all report high percentages of adults with mental illness and thoughts of suicide. 

 
Current Trends in Adult Mental Health

The findings in the 2023 MHA survey are consistent with the majority of data reported over the last several years. Statistics show that mental health conditions are on the rise while access to care is becoming even more difficult, especially among those groups who are marginalized. 

Here are some of the more significant trends that researchers across the United States are seeing with regard to our collective mental health and well-being in 2023. 

The Prevalence of Mental Illness is Increasing. While it’s difficult to compare numbers from the 2023 survey to previous years, researchers are in agreement that Americans from all walks of life reported increased distress and mental health concerns during the pandemic. 

According to a separate survey conducted by the National Center for Health Statistics, 40% of Americans reported symptoms of anxiety and depression in 2020 compared to just 11% in 2019. The uncertainty and fear surrounding the pandemic undoubtedly played an enormous role in this increase. 

However, it isn’t just symptoms of anxiety and depression that have skyrocketed. In this year’s survey, more than 12 million adults reported serious thoughts of suicide. People have understandably struggled when removed from the stability of friends and family and subjected to new and unusual stressors and we’re seeing that in the data.

Untreated Substance Use Disorders. In the absence of care, many people turned to substances like alcohol and drugs as a coping mechanism if they could not or would not access treatment. In this year’s survey, almost 11% of adults reported abusing alcohol, while 6.82% reported abusing illicit drugs. Of this combined number, less than 7% are seeking treatment for their substance use disorder.

 There are many factors that have contributed to the rise in untreated substance use disorders. These include:

• Interruptions in harm reduction programs
• Isolation
• Worsening economic conditions
• Growing mental health concerns

 
Unfortunately, the rise in untreated substance use disorders has also contributed to an increase in overdose risk factors, with more than 93,300 overdose deaths occurring in the United States in 2020. 

Difficulties in Accessing Care. One of the most concerning findings from this year’s survey was that while more people are reporting mental health concerns, only 28% were able to find the care they needed. Some of the most common barriers to finding and getting mental health care services include the following:

• No affordable options, reported by 42% of respondents
• Lack of awareness about where to go for services, according to 27% of respondents
• No time to get treatment, cited by 19% of respondents

 
Nationally, that leaves more than 14 million individuals who recognize that they need help, but cannot find the right behavioral healthcare provider or agency.

While access to care is challenging across the entirety of the United States, it is much more difficult in Indiana, Nevada, and Arizona, which reported that between 36% and 39% of their population cannot access care. 

Variations by State

Nationwide, there is a growing demand for mental health services and insufficient workforce availability, and there are still vast differences in how various states handle and impact mental health care. On average, there are 350 people living in the United States for every available mental health provider. In states like Massachusetts and Alaska, there is one mental health provider for every 140 to 160 citizens. But, in states like West Virginia, Texas, and Alabama, that same clinician may be expected to serve between 670 and 850 individuals.

The areas with low workforce availability also tend to have the highest number of mentally unhealthy adults who cannot afford to see a doctor. This frequent, untreated mental distress has been associated with poor outcomes such as chronic illnesses and increased mortality. 

According to the study authors, the best way to begin improving this inequity is to address workforce reimbursement. Lower reimbursements have led to inadequate wages that have caused mental health providers to leave these lower-paying jobs for other disciplines. In order to keep people in these high-demand jobs, this needs to be redressed.

Final Thoughts

The data presented in the 2023 State of Mental Health in America survey magnifies specific areas that require our care, attention, and advocacy.

When looking at adult outcomes (the 2023 youth mental health outcomes will appear in a subsequent blog), it’s clear that states with the easiest access to care, like Vermont, Massachusetts, and Illinois, all ranked within the top ten of the lowest prevalence of mental illness. This includes:

• Adults with substance use disorders in the past year
• Adults with serious thoughts of suicide
• Adults who did not receive treatment for their mental illness

 
This information also reinforces what we already know to be true – access to affordable mental health care, regardless of where you live, is critical. Clinicians may be able to help widen access to their practices by conducting more outreach and partnering with a wider network of primary care physicians to make referrals easier. They may also want to institute briefer interventions, which have shown promising outcomes. 

It will take time to understand the long-term impacts COVID-19 has had on the overall state of mental health in America. But it is easy to see in the short term that the pandemic has touched off an unprecedented mental health crisis that was already at a critical level, and changes need to be made at a state level to meet the growing demands for mental and behavioral health services.

The demand for mental health treatment is forecasted to remain very high for the foreseeable future. If you’re stretched thin for resources as you try to accommodate more patients who need care, consider using a behavioral health-specific EHR to help manage your everyday workflows. Contact us today to learn how NextStep Solutions tools and technology have helped the behavioral health community thrive.