"It was a good moment, the kind you would like to press between the pages of a book, or hide in your sock drawer, so you could touch it again."

These cherished moments of peace and clarity Alabama native and Fairhope resident Rick Bragg mentions in his memoir "All Over but the Shoutin'" stand in stark contrast to the struggles faced by many in Alabama today.

Recently, Mental Health America (MHA) released its annual report, "The State of Mental Health in America 2024," revealing disparities in mental health care access and prevalence of mental illness across the country. MHA, the leading national nonprofit focused on mental health promotion and illness prevention, has compiled comprehensive data from all 50 states and the District of Columbia to provide a detailed snapshot of the nation's mental health status.

The report seeks to answer critical questions about the mental health landscape in the U.S., including the prevalence of mental health and substance use issues among adults and youth, access to insurance and mental health care, and the barriers to accessing necessary services. Key findings from the report include:

Prevalence of mental illness: Nearly 23% of adults, equivalent to almost 60 million Americans, experienced a mental illness in the past year. Additionally, 5% of adults and 13% of youth reported serious thoughts of suicide.

Youth mental health: One in five youth had at least one major depressive episode (MDE) in the past year. Of these, over half (nearly 3 million youth) did not receive treatment, and 65% of those who did receive treatment reported that it helped.

Substance use disorders: 18% of adults had a substance use disorder in the past year, with 77% not receiving treatment.

Access to care: One in four adults experiencing frequent mental distress could not see a doctor due to cost, marking a 2% increase from the previous report. Moreover, 10% of adults and 8.5% of youth have private insurance that does not cover mental health services.

Mental health workforce: The report highlighted a significant shortage of mental health providers, with 340 people for every one mental health provider in the U.S.

The report is part of MHA's ongoing effort to inform public education, research, advocacy and public policy, aiming to create a world where all people and communities have equitable opportunities for mental well-being. The data collected helps measure community mental health needs, access to care and outcomes, allowing for the evaluation of federal and state policies' impact on mental health services.

For more information, visit https://mhanational.org.

OVERALL RANKING

MHA's report also includes a state-by-state overall ranking, with Alabama placed 39 out of 51, indicating a higher prevalence of mental illness and lower rates of access to care. States ranked 1-13 show lower prevalence of mental illness and higher access to care, while those ranked 39-51 demonstrate the opposite.

• Adult rankings: Alabama had a ranking of 36.
• Youth rankings: Alabama ranked 32.

PREVALENCE OF MENTAL ILLNESS

Adults with any mental illness (AMI):

• 23.08% of adults experienced a mental illness in the past year, equivalent to nearly 60 million Americans.
• 5.86% experienced a severe mental illness.
• In 2022, completely rural counties had the highest percentage of adults reporting AMI (25.7%). Large metro counties had the lowest percentage (22.1%).
• Rural communities often face increased risk factors for poor mental health and barriers to accessing care, including higher rates of poverty, food insecurity and less access to preventative services and providers.
• Alabama was ranked 25, with 24.09%, or 931,000 adults, experiencing AMI.

Adults with substance use disorder in the past year:

• 17.82% of adults in the U.S. had a substance use disorder in the past year, totaling over 45 million people.
• 11.28% had an alcohol use disorder.
• 9.41% had a drug use disorder. In 2022, marijuana was the most common substance, with 6.9% of adults having a marijuana use disorder.
• Alabama was ranked 2, with 15.19%, or 587,000 adults, experiencing substance use disorder.

Adults with serious thoughts of suicide:

• 5.04% of adults reported experiencing serious thoughts of suicide, equating to over 12.8 million people.
• The number of suicide deaths in 2022 was the highest ever recorded in the U.S.
• Only 15% of adults experiencing suicidal ideation attributed it to the COVID-19 pandemic in 2022, with higher rates among Black and Hispanic adults.
• Alabama ranked 32, with 5.44%, or 210,000 adults, experiencing serious thoughts of suicide.

YOUTH PREVALENCE OF MENTAL ILLNESS

Youth with major depressive episode (MDE):

• 20.17% of youth (ages 12-17) reported suffering from at least one MDE in the past year.
• 15% experienced an MDE with severe impairment, affecting their functioning at work, school, or home.
• Alabama ranked 14, with 19.41%, or 76,000 youth, experiencing an MDE.

Youth with substance use disorder in the past year

• 8.95% of youth in the U.S. had a substance use disorder.
• 3.32% had an alcohol use disorder, and 7.17% had a drug use disorder.
• Alabama ranked 10, with 7.82%, or 31,000 youth, experiencing a substance use disorder.

Youth with serious thoughts of suicide:

• 13.16% of youth (over 3.4 million) reported serious thoughts of suicide.
• Significant racial disparities exist, with the highest rates among Native Hawaiian or Other Pacific Islander youth (25%) and those of more than one race (20%).
• Alabama ranked 21, with 13.23%, or 52,000 youth, experiencing serious thoughts of suicide.

Youth flourishing:

• Only 60.5% of youth ages 6-17 in the U.S. meet all three criteria for flourishing, which include interest in learning new things, finishing tasks they start and staying calm when faced with a challenge.
• Alabama ranked 43, with 56.70%, or 420,313 youth, meeting the criteria for flourishing.
  

ADULT ACCESS TO CARE RATINGS

Adults with substance use disorder who needed but did not receive treatment:

• Alabama ranked 10, with 72.15%, or 510,000 adults, not receiving needed treatment.
• Nationally, 76.90% of adults did not receive needed treatment.

Adults with AMI who are uninsured:

• Alabama ranked 44, with 14.40%, or 132,000 adults, uninsured.
• Nationally, 10.10% of adults are uninsured.

Adults reporting 14+ mentally unhealthy days a month who could not see a doctor due to costs:

• Alabama ranked 49, with 33.24%, or 233,201 adults, unable to see a doctor due to costs.
• Nationally, 24.58% of adults could not see a doctor due to costs.

Adults with AMI with private insurance that did not cover mental or emotional problems:

• Alabama ranked 44, with 15.80%, or 66,000 adults, facing this issue.
• Nationally, 10.20% adults faced this issue.

YOUTH ACCESS TO CARE

Youth with MDE who did not receive mental health services:

• Alabama ranked 36, with 58.70%, or 42,000 youth, not receiving needed services.
• Nationally, 56.10% of youth did not receive needed services.

Youth with private insurance that did not cover mental or emotional problems:

• Alabama ranked 25, with 7.50%, or 11,000 youth, facing this issue.
• Nationally, 8.50% youth faced this issue.

Students (K+) identified with emotional disturbance for an individualized education program (IEP):

IEPs are critical for ensuring that youth with disabilities can receive the individualized services, supports and accommodations to succeed in a school setting.

• Alabama ranked 50, with a rate of 1.55 (per 1,000 students), or 1,127 students.
• Vermont ranked highest with a rate of 28.01 (per 1,000 students).
• Nationally, the rate is 6.67.

Mental health workforce availability:

• Alabama ranked 51, with a rate of 800 individuals per mental health provider.
• Nationally, the rate is 340 individuals per provider.

Youth with MDE who reported treatment or counseling helped them:

• Alabama ranked 11, with a rate of 75.60, or 21,000 youth, reporting that treatment helped.
• Nationally, the rate is 65.

Percentage of parents reporting their child lives in a supportive neighborhood (2021-2022):

• Alabama: 60.50%
• Nationally: 56%

Reasons for not receiving mental health treatment among youth ages 12-17 with a past-year major depressive episode (2022):

Respondents were asked to choose all that apply.

• Thought they should have been able to handle their mental health, emotions or behavior on their own: 86.90%
• Worried about what people would think or say: 59.80%
• Worried about privacy: 57.80%
• Did not know how or where to get treatment: 55.50%
• Thought no one would care if they got better: 53.90%
• Did not think treatment would help: 51.50%
• Thought their family, friends, or religious group would not like it if they got treatment: 48.20%
• Afraid of being committed to hospital or forced into treatment against their will: 45.00%
• Not ready to start treatment: 44.50%
• Thought they would be told they needed to take medication: 39.40%
• Did not have enough time for treatment: 34.80%
• Thought it would cost too much: 33.30%
• Could not find a treatment program or healthcare professional they wanted to go to: 30.20%
• Had problems with transportation, childcare, or getting appointments: 24.20%
• Did not have health insurance coverage: 13.30%
• Thought that if people knew they were in treatment, bad things would happen: 13.30%
• No openings in treatment program or with healthcare professional: 11.70%
• Health insurance would not pay enough of costs: 8.80%