Access to Mental Health Services in the Eighth District Lags U.S.

While the residents of Eighth Federal Reserve District statesEighth District states are Arkansas, Illinois, Indiana, Kentucky, Mississippi, Missouri and Tennessee. face similar levels of mental illness as do residents in the rest of the U.S., they experience more barriers to accessing mental health services.

Mental health affects how we think, feel and act. Mental illness not only increases the risk of physical illnesses such as diabetes, heart disease and stroke, but it also reduces labor force participation, job performance and even wages. Each year, 5 million to 6 million workers lose, fail to seek or cannot find employment because of mental illness. Among those who do work, mental illness decreases annual income by between $3,500 and $6,000. Additionally, childhood exposure to a mother with poor mental health is a significant predictor of educational attainment, income and criminal behavior, contributing to the vicious cycle of intergenerational poverty. Treating mental illness can improve overall well-being, increase job retention, decrease sickness absences and increase work productivity.

Mental Illness in the Eighth District

Prevalence of mental illness in Eighth District states ranges between 20.5% of the population in Tennessee and 22.6% of the population in Arkansas, somewhat higher than the national average of 20.8%.Data were collected between 2019 and 2020, from Mental Health America 2023 Statistics. Furthermore, suicide rates in Eighth District states averaged 4.8%, reaching 5.8% in Indiana. Youth (ages 12-17) prevalence of major depressive episodes (MDEs) ranged from 14.9% in Kentucky to 18.1% in Illinois, making the latter a high-severity state relative to the rest of the country.

Prevalence of Mental Illness in the Eighth District

SOURCE: Mental Health America, State of Mental Health in America 2023 Statistics.
NOTES: Any mental illness (AMI) includes having a diagnosable mental, behavioral or emotional disorder, other than a developmental or substance use disorder, as assessed by the Mental Health Surveillance Study. These estimates are based on indicators of AMI rather than on direct measures of diagnostic status. State prevalence of youths with major depressive episodes (MDEs) means youths (ages 12-17) reported suffering from at least one MDE in the past year.

Access to Mental Health Services Lags in the Eighth District

While the rates of mental illness in the Eighth District are close to average national levels, access to treatment in District states is low relative to the rest of the country. Access to care can be hindered by the cost of services, whether a family has insurance, logistical barriers like time and travel, and the availability of providers. In 2023, Arkansas, Indiana, Mississippi, Missouri and Tennessee all rank among the worst 15 states in terms of overall access to mental health services, according to data from Mental Health America. In contrast, Illinois is one of the best states nationwide in terms of access to care.

In Arkansas, Mississippi and Missouri, almost 30% of adults reporting at least 14 mentally unhealthy days in a month could not see a doctor because of costs. The lack of access to mental health care for youths is even more striking: In all Eighth District states—except Illinois—more than half of youths with an MDE in the past year did not receive mental health services; this rate reached above 70% for Tennessee and Kentucky.

Lack of mental health service providers contributes to poor access. According to the U.S. Department of Health and Human Services’ March 2023 Designated Health Professional Shortage Areas (HPSAs) Statistics (PDF) report, only 12.4% of the mental health need in Missouri is met, followed by 16.8% in Tennessee—much lower than the U.S. average of 27.4%. Across the Eighth District’s entire seven states, more than 30 million people—70% of the total state populations—live in mental HPSAs, in contrast to less than 50% nationwide. Some of the most affected regions include Knox County, Martin County, Pike County and Daviess County (all in Indiana), with less than one mental health professional for every half-million people.The suggested ratio of population to mental health professionals is 30,000 to 1, and for areas with unusually high needs, the suggested ratio is 20,000 to 1.

Rural and urban areas have, on average, similar mental illness prevalence. Nevertheless, mental health needs often are not met in many rural communities. Rural areas account for more than 60% of total U.S. mental health HPSAs.It is worth mentioning that while rural areas make up most of the designated regions, they account for only 23% of the total population designated as living in HPSAs in the U.S.

Low-Income Households Struggle with Mental Health

Using data from the U.S. Census Bureau’s 2023 Household Pulse Survey, we found that more than 38% of low-income households in Eighth District states exhibited symptoms of anxiety (worrying, nervousness and being on edge) to a degree associated with diagnoses of generalized anxiety disorder. Comparatively, only 18% of high-income households fell into that category.For the purposes of this article, we designated families earning less than $50,000 in annual income as low income and those earning more than $100,000 as high income. This pattern in the Eighth District mirrors the story for other U.S. states, both for anxiety and depression also.Similarly, this pattern holds for symptoms associated with diagnoses of major depressive disorder (little interest in doing things, feeling down, and hopelessness), with almost a third of low-income respondents suffering depression relative to less than 15% of high-income respondents.

Lack of access to mental health services also is prevalent among low-income populations, with costs and stigma being possible explanations. Additionally, lack of knowledge regarding where to go for services, concerns about confidentiality, the belief that one can handle the problem without external help, and a lack of time for treatment are also significant reasons for unmet needs. For rural residents, distance to services is an additional hurdle. Addressing mental health problems is a key ingredient of economic mobility, given intergenerational cycles of poverty and poor health.

Improving Mental Health Could Have Economic Benefits

The economic burden of mental illness on society is large, and research has suggested that overall savings would outweigh the costs for treatment. One study estimated that adults with major depressive disorder imposed an economic toll on society of $326.2 billion in 2018, with treatment accounting for only 11% of total costs. Improving the affordability of mental health treatment, expanding the behavioral health workforce and removing barriers to seeking care could all affect the economy’s productive capacity. Seeking support when in need is the first step toward mentally healthy communities.

Notes

1. Eighth District states are Arkansas, Illinois, Indiana, Kentucky, Mississippi, Missouri and Tennessee.
2. Data were collected between 2019 and 2020, from Mental Health America 2023 Statistics.
3. The suggested ratio of population to mental health professionals is 30,000 to 1, and for areas with unusually high needs, the suggested ratio is 20,000 to 1.
4. It is worth mentioning that while rural areas make up most of the designated regions, they account for only 23% of the total population designated as living in HPSAs in the U.S.
5. For the purposes of this article, we designated families earning less than $50,000 in annual income as low income and those earning more than $100,000 as high income.
6. Similarly, this pattern holds for symptoms associated with diagnoses of major depressive disorder (little interest in doing things, feeling down, and hopelessness), with almost a third of low-income respondents suffering depression relative to less than 15% of high-income respondents.