To determine the ranking, Mental Health America analyzed the prevalence of mental illness in each state and the District of Columbia using statistics on adults and youth with a diagnosed condition, serious thoughts of suicide, and substance-abuse problems.
The group evaluated the ease of accessing care by evaluating the percentage of adults and youth with mental illness who reported not receiving treatment, having an “unmet need,” and not being able to see a doctor because of costs.
Minnesota, Massachusetts, Connecticut, Vermont, and South Dakota scored the highest. Only Oregon ranked lower than Arizona.
In some ways, Arizona is on the right track, said Michael Shafer, president of Mental Health America’s Arizona chapter.
“If you’re really, really poor or really, really mentally ill, the services are regarded as some of the better in the country,” he said.
Among behavioral health professionals, Arizona’s robust Medicaid program is considered a model for its integration of mental health and substance-abuse services. For those who don’t qualify for Medicaid and have severe mental illnesses, such as schizophrenia, following decades of litigation, Arizona agreed in 2104 to increase services, including offering employment and housing support.
But when it comes to people with less severe — more common — conditions (like depression or anxiety), services still are poor, Shafer said. Challenges are similar, he said, for those whose mental illness or addiction hasn’t “gotten so bad they’ve lost their family, lost their job, and become indigent.”
One problem, he said, is that not enough primary-care physicians are screening for mental illness and referring patients to specialists until the disease has progressed much too far. Often, people with low-level mental-health or substance-abuse issues go without a diagnosis for nearly a decade. The disease progressively worsens and, by the time it’s caught, “it has gotten so bad it is equivalent to cancer that has metastasized,” he said.
“As an advocate, our hope over the next 10 to 15 years is to see referrals for early, low-level mental-health issues becoming just as normal, just as routine as getting a referral to see an oncologist, an OBGYN, or a proctologist,” he said.
But even if physicians referred patients more frequently, there still are hurdles.
For one: There aren’t enough people trained to provide mental-health services.
Arizona has more than 100 mental-health-professional shortage areas, which means the federal government officially has declared there are not enough providers to treat the population. In these areas, there is just one psychiatrist for every 30,000 people.
This means people who are actively suicidal are often forced to wait months before they can get treatment, said Theresa Nguyen, director of policy and programming for Mental Health America.
“Sometimes, depending on the time of the year, it’s more than three months. Sometimes it’s: ‘We can’t even put you on a waiting list because it’s too long, but maybe you can call back,’” she said. “That’s not OK.”
Cost also remains a barrier.
More than 45 percent of U.S. adults who needed mental healthcare in 2014 but did not get it listed “could not afford cost” as the primary reason, according to the Substance Abuse and Mental Health Services Administration. By comparison, just 7.2 percent were concerned about the stigma of people finding out they had a mental illness.
Mental disorders was the third most costly condition among adults in 2012, states the U.S. Department of Health & Human Services, following trauma-related care and cancer.
While Arizona saw dramatic improvements in the number of people enrolled in health insurance following the implementation of the Affordable Care Act, state residents still are less likely to have coverage than every other state except Nevada and Texas.
Most private insurance providers also don’t cover as many different types of therapies as public insurance, Nguyen said. Many times, the only help available is the “standard 50-minute therapy session,” she said — but this might not be the best treatment.
“Now, most of the specialty care we have is oriented toward the very rich, who can self pay, or the very, very poor who qualify for Medicaid,” she said. “For a lot of people in the middle, it’s a struggle.”