What defines a state with good mental health? Does that label rely on a low prevalence of mental illness among the state’s residents? Are states with good mental health the ones with the most treatment facilities or most affordable insurance and health care options?

There isn’t just one way to quantify a state’s mental health. Areas with good mental health can have a low prevalence, great access to care or both. Their approach is not only to help those in need but also attempt to prevent incidents from becoming long-term illnesses, such as anxiety or depression.

Four states in particular (Maine, Massachusetts, Vermont and South Dakota) stand out from the rest of the country. Depending on which research is analyzed, each of the four states could be the best in the U.S. for mental health.

Three main statistical sources are used in this article. Each one focuses on a different aspect of mental health in America: the number of facilities per residents, rankings of each state’s prevalence and access to care, and how much each state government spends on mental health care.

Maine, Massachusetts, Vermont and South Dakota each finished at the top of at least one ranking. In which specific ways did each of these states set the standard for mental health care?

Maine: Where There Are Treatment Options Everywhere

The Substance Abuse and Mental Health Administration facility locator lists how many mental health treatment locations are in each of the 50 states and the District of Columbia. The Recovery Village paired that figure with each state’s 2018 population, provided by World Population Review, to reveal the treatment facility-to-population ratio.

Maine has around 1,341,000 residents and 143 facilities. That’s a facility for every 9,381 residents, which is the most per-capita treatment centers in the country.

This statistic shows that Maine’s residents have plenty of treatment options from which to choose. Additionally, the facilities are well-dispersed throughout the state, so people from each area can find treatment if needed.

Just having a plethora of treatment facilities is not enough to make a state the best for mental health. Maine has to — and does — rank well in other key areas.

Mental Health America ranks each state on the prevalence of mental illness and access to care. The 2018 report is based on data from 2013–2016 regarding how many people suffered from a mental illness, how many people did not receive treatment and how many mental health professionals were in each state, among other statistics.

Mental Health America ranked the state eighth overall — 40th for prevalence and fourth for access to care. Why did the state do so well for access? Around 59 percent of its adult residents with a mental illness received treatment, the largest percentage of any state. Maine also ranked well for other factors related to access:

  • The percentage of adults who reported that their needs were met (11th)
  • The percentage of adults with a disability who could afford doctor visits (11th)
  • The percentage of youth who had a major depressive episode and received treatment (second)
  • The number of mental health professionals per resident (third)

How much the state’s government spends on mental health care could be one reason why people can afford and receive effective treatment. The KFF Henry J. Kaiser Family Foundation ranked each state’s annual per-capita spending up to 2013, the final year included on the website. Mental Health Policy compared each state government’s percentage of total spending that went toward mental health care in 2012 and 2013.

According to these sources, Maine spent $345.36 per resident and allocated 5.6 percent of its total budget to providing necessary resources for its residents. Both were the highest numbers in the country.

“Mental health funding is critical, especially for the research and cure for different mental illnesses,” reads an article on the website World Atlas. “Besides, funds are needed for the daily operation of clinics and centers that cater to patients with mental illnesses. Such funds help to improve the provisions of mental health care services and access to such services, which in turn helps a lot of people who suffer from any mental health disorders.”

Maine’s high number of treatment options per resident, easy access to care and impressive government spending on mental health all attribute to the state’s strong mental health. However, Maine is not the only state that excels in these areas. Massachusetts has its own reasons to be considered the best for mental health.

Massachusetts: Where Care Is Affordable and Available

According to Mental Health America’s data, Massachusetts is the best. The state ranked first in the overall rankings, largely due to a No. 2 ranking in access to care.

How did Massachusetts do so well? The state has the largest percentage of adults with a mental illness who are insured, close to 97 percent, a full 1.6 percent above No. 2-ranked District of Columbia. Whether through private insurance or the state’s Medicaid program, residents are able to afford insurance that covers mental health. According to the U.S. News & World Report, Massachusetts is the best state in the country for health care access.

People in this state are also able to find psychiatrists, therapists, clinical social workers and counselors to provide treatment. Massachusetts ranked first for its workforce availability, with a mental health professional for every 200 residents.

The state also ranked well for the percentages of:

  • Adults with a mental illness who reported their needs met (second)
  • Adults with a mental illness who received treatment (fifth)
  • Adults with a disability who were able to afford doctor visits (sixth)
  • Youth with a major depressive episode who received treatment (seventh)
  • Youth with a severe major depressive episode who received consistent treatment (fifth)
  • Youth with private insurance who were covered for mental or emotional problems (first)

The people who need help are getting it, which is an important aspect in determining which state excels at mental health. Yet, one state topped Massachusetts in Mental Health America’s access-to-care ranking: Vermont.

Vermont: The Best at Identifying Youth in Need

If we’re only considering Mental Health America’s access-to-care ranking, then Vermont is the undisputed best. The state not only assists its residents in need but is also proactive in helping them at a young age.

The state ranked in the top five for most statistics related to access and led all in identifying which youth had a mental illness that affected their educational success. The people of Vermont also have plenty of facilities from which to choose to receive treatment at. There is a facility for every 11,772 residents, a ratio that ranks fourth in the country.

Part of the reason why Vermont does so well at providing access to care is that the state prioritizes mental health in its budget. Vermont ranked fourth in 2013 for per-capita spending on mental health care, $291.70 per resident, and allocated 3.5 percent of its budget to mental health, the eighth-most in the country.

Vermont residents also find appropriate treatment because health care is so affordable in the state. The U.S. News & World Report ranking of each state’s health care access listed Vermont fourth for health care affordability, which could be why so few people with a mental illness are uninsured or do not receive the necessary treatment.

Vermont did rank 46th for prevalence, meaning a large percentage of people in the state have a mental illness. However, the state has provided enough options and resources so that their current and future residents with mental illness can find quality treatment.

While a geographical pattern is forming — the first three states are all in the upper northeast of the country — South Dakota breaks that trend.

South Dakota: Where Mental Illness Is Rarest

While three states from one geographical region of the U.S. dominated the list, a member of the Great Plains has its own reasons for being the country’s best mental health.

The statistics behind South Dakota’s desirable ranking are different than the other states. While Maine, Massachusetts and Vermont all have prioritized making health care and mental health treatment accessible and affordable, South Dakota ranked well in just how few people struggle with a mental illness.

The state was first in Mental Health America’s prevalence ranking, one of the reasons why U.S. News & World Report actually ranked South Dakota as having the country’s best mental health. According to the report, approximately 8 percent of its residents have a mental illness. That’s much lower than the national average of 12 percent.

South Dakota’s youth are especially mentally healthy. The state ranked second and first for the percentage of youth with a major depressive episode and the percentage of youth with a severe major depressive episode, respectively. South Dakota ranked in the top half of every category related to the prevalence of mental illness in adults.

If anyone does need help though, options are available. South Dakota has a treatment facility for every 19,082 residents, ranking 11th in the nation. Those facilities are spread throughout the state too, meaning any resident, no matter where they live, can find help nearby.

The state also ranked eighth in Mental Health America’s access-to-care category. Again, South Dakota does exceptionally well with making sure its youth are mentally healthy, with good rankings in:

  • The percentage of youth who have had a severe major depressive episode and received consistent treatment (second)
  • The percentage of youth with private insurance that covered mental or emotional problems (third)

There is no objective way to determine which state is the absolute best for mental health. Some people might want a low prevalence of mental illness. For others, a large number of treatment facilities per resident is the most important. Another group of people might value government spending on mental health the most. A few states excel in multiple ways.

If you live in one of these four states, be proud of how your state prioritizes mental health. If you live in one of the other 46 or the District of Columbia, giving more attention and resources to residents’ mental health might be needed.