National Alliance on Mental Illness
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The State of Public Mental Health Services Across the Nation

Grading the States US Grade: DState by state, this assessment of our nation’s public mental health services finds that we are painfully far from the high-quality system we envision and so desperately need. While some states are making consistent efforts to improve, the great majority are making little or no progress. NAMI’s principal finding is clear: the state of mental health services in this country is simply unacceptable.

A Mostly Dismal Report Card

As in 2006, our nation earned an overall grade of D. Yet there are certainly some improvements across the country to be noted:

  • Fourteen states increased their overall score over the past three years; one more state earned a B; and two fewer states failed outright.
  • In many cases, NAMI found state mental health agencies making valiant efforts to improve systems and promote recovery despite rising demand for services, serious workforce shortages, and inadequate resources.
  • Many states are adopting better policies and plans, promoting evidence-based practices, and encouraging more peer-run and peer-delivered services.

But these improvements are neither deep nor widespread enough to improve the national average. The grades for almost half the states (23) remain unchanged since 2006, and 12 states have fallen behind.

The top-performing states—and there were only six of them—received a B grade. Yet even these states are hardly in a position to celebrate since there is no doubt that many of their residents living with serious mental illnesses are not receiving the services and supports they need. Further, while the “B states” scored better than others on a series of measures, their performance shares a critical limitation with all the states: they do not know what share of people in need their systems serve, or how well people fare once they are served. It is a tragic reality that no state in the nation is able to pass this true test of a mental health system’s performance.

As in 2006, the majority of states earned a C or a D grade (18 and 21 states, respectively). These states present a mix of strengths and weaknesses as their category-specific grades reveal. Finally, NAMI finds that public mental health care systems in six states are failing outright—in few of the categories we examined are they performing at even the lowest acceptable levels. These six failing states include South Dakota, which chose not to participate in the survey.

Indeed, this report card is dismal. Without a significant commitment from our nation’s leaders—in Washington, among governors, and in state legislatures—state mental health agencies will continue to struggle to provide even minimally adequate services to people living with serious mental illnesses.

download complete findings (PDF)

"Recovery is a unique process for each person. It means having a better quality of life, hope, and resiliency."