Report says Texas ranks last in U.S. for mental health care access, but data has limitations

After a gunman killed 19 children and two teachers in a shooting at Robb Elementary School in Uvalde, Texas, Gov. Greg Abbott linked mental health issues and school shootings. 

“We as a state, we as a society, need to do a better job with mental health,” he said. 

Abbott’s statement drew criticism from advocacy groups like the National Alliance on Mental Illness (NAMI).

“Mental illness is not the problem. It is incorrect and harmful to link mental illness and gun violence, which is often the case following a mass shooting,” NAMI wrote in a statement following the shooting. 

Public figures, including Texas gubernatorial candidate Beto O’Rourke and author Meena Harris have also criticized the state since the shooting, claiming that it ranks last in the nation for access to mental health care. 

THE QUESTION

Is Texas ranked last in the nation for access to mental health care?

THE SOURCES

• Spokesperson for Beto O’Rourke
• 2022 report from Mental Health America
• Household Pulse Survey from the National Center for Health Statistics (NCHS) and U.S. Census Bureau
• Kaiser Family Foundation (KFF) analysis of 2019 and 2020 mental health data

THE ANSWER

This claim needs context. A 2022 report from Mental Health America ranks Texas as last in the nation for access to mental health care – but there are limitations to the data. Additionally, other sources rank Texas higher in areas related to mental health care access. 

WHAT WE FOUND

A spokesperson for O’Rourke told VERIFY in an email that he was referring to nonprofit Mental Health America’s annual Access to Care ranking when he made his statement about Texas coming in last for access to mental health care. 

The ranking indicates “how much access to mental health care exists within a state,” which includes access to insurance, treatment and special education, quality and cost of insurance, and mental health workforce availability, Mental Health America says. 

In the nonprofit’s 2022 report, Texas ranks No. 50 overall in the nation, behind Alabama, and No. 51 when Washington, D.C., is included. 

The report ranks accessibility to mental health care in U.S. states based on nine categories, including the percentage of adults with any mental health illness who did not receive treatment and the amount of available mental health providers in the state.

In several of those categories, Texas ranked last, including for adults with a mental illness who are uninsured at 21.5%; adults with a cognitive disability who couldn’t see a doctor due to cost at more than 40%; and for youth who didn’t receive treatment at approximately 73%, according to the report.

But the state fared better in some categories. Texas ranked No. 19 for adults with a mental illness who reported an unmet need, with 24% of people indicating they were not able to receive the treatment they needed.

Mental Health America also looks at workforce availability, including psychiatrists, psychologists and licensed clinical social workers, among other mental health professionals. 

Massachusetts is the top state for mental health workforce availability with a rate of 150 people for every one mental health provider, the report says. Alabama ranks last with a rate of 920:1, and Texas is second-to-last with a rate of 830:1. 

Mental Health America acknowledges there are limitations to the data, including the fact they were gathered through 2019 – prior to the COVID-19 pandemic. Data reflective of the pandemic won’t be available until 2023, the nonprofit said.

But “higher-ranked states may have been better prepared to deal with the mental health effects of the pandemic at its start," the nonprofit says. 

While VERIFY couldn’t find other data sources that focus on multiple facets of access to care, like Mental Health America, there are some surveys and analyses that cast Texas in a more favorable light in specific areas.  

The Household Pulse Survey, conducted by the National Center for Health Statistics (NCHS) and U.S. Census Bureau, shows that Texas ranked No. 15 out of U.S. states for people who needed counseling or therapy but did not get it in the last month, with 12.7% of people reporting an unmet need compared to nearly 21% in Washington, D.C., which was ranked the worst at  No. 1. The responses were gathered from April 27 through May 9, 2022. 

Kaiser Family Foundation (KFF) also published an analysis of 2019-2020 data from the Substance Abuse and Mental Health Services Administration (SAMHSA) restricted online data analysis system (RDAS), National Survey on Drug Use and Health (NSDUH), and Substance Abuse and Mental Health Data Archive.

KFF found that Texas ranked among the top 10 states with the lowest percentage of adults who reported an unmet need for mental health treatment at No. 7.