A Report on America’s Health Care System for Adults with Serious Mental Illness
Grading the States 2009: A Report on America’s Health Care Sytem for Adults with Serious Mental Illness
Overview | State by State | Findings | Recommendations | Methodology | Full Report | Media | How You Can Help | Discuss
Overview & Grades    |    Key Findings    |    Policy Recommendations    |    Conclusion

Executive Summary

The Grades

In 2006, NAMI published Grading the States: A Report on America’s Mental Health Care System for Serious Mental Illness, to provide a baseline for measuring progress toward the transformation envisioned by the New Freedom Commission. In 2006, the national average was a D grade.

Three years later, this second report finds the national average to be stagnant—again a D. Fourteen states have improved their grades since 2006, but not enough to raise the national average. Twelve states have fallen back. Twenty-three states have stayed the same.

Oklahoma improved the most, rising from a D to a B; South Carolina fell the farthest, from a B to a D.

Overall, the grade distribution for 2009 is:

  • Six Bs
  • Eighteen Cs
  • Twenty-one Ds
  • Six Fs

Compare 2006 and 2009 grades of each state

Most of the information on which the 2009 grades are based was compiled and analyzed in 2008. As state legislatures work on budgets for 2009-2010, much of the work accomplished since 2006, no matter whether it occurred in states earning a B or an F, is now on the chopping block.

The grades are based on 65 specific criteria. Each state received grades in four categories, which then comprise the overall grade.

State mental health agencies were the primary source of information for the report, responding to a NAMI survey in August 2008. Other data were drawn from academic researchers, health care associations, and federal agencies.

NAMI conducted a nationwide Web-based survey, which drew over 13,000 responses from consumers and family members. The results were not used in the grading process, but helped inform the report. Some consumer and family comments from the survey accompany state narratives in Chapter 5. NAMI volunteers also conducted a "Consumer and Family Test Drive" of state mental health agency Web sites and telephone resources to measure the ease (or difficulty) of access to information—which is the first challenge in finding help when it is needed.

The Information Gap

This report presents 10 characteristics of a life-saving, cost-effective, evidence-based mental health care system, and discusses specific programs. A critical concern is the need for greater data to help drive decision-making.

An information gap exists in measuring the performance of the mental health care system. To some degree, states are groping blindly in the dark while seeking to move forward.

The fault begins at the federal level, where the U.S. Department of Health and Human Services' (HHS) Substance Abuse & Mental Health Services Administration (SAMHSA) has failed to provide adequate leadership in developing uniform standards for collecting state, county, and local data.

This report provides the nation's most comprehensive, comparative assessment of state mental health care systems to date. But more information on performance and outcomes is needed.

Continue to Key Findings  >>

"Recovery is a team effort…It takes 'a village' as they say to assist an individual in recovery. A psychiatrist and medications alone are not the answer."
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Mike Fitzpatrick, NAMI Executive Director

Consumer and Family Member Comments
view photos from Grading the States