The 25 counties with the least access to mental health care in the nation

The country's mental health is taking center stage in the minds of Americans as the worst of the COVID-19 pandemic fades into the background.

In the U.S., 53% of adults said mental health was their top health concern, according to an Ipsos poll published this fall. They join residents of 30 other countries polled by Ipsos reporting similar concerns about health in their nations. That increase in concern is, in part, a result of the traumatic, isolating effects of the pandemic heightening the attention Americans pay to their own mental health, experts say.

"You have an increased awareness of the importance of it, you have an increase in people seeking it, and you now have an increased number of people realizing they're having challenges accessing it," Texas Counseling Association president Katherine Bacon, who holds a doctorate in counselor education, told Stacker.

It's a challenge felt most acutely by about 30% of the U.S. population which lives in an area with a federally designated shortage of mental health providers, according to the Department of Health and Human Services.

To identify areas of the country most in need of solutions for expanded mental health care access, Stacker analyzed data from the Centers for Medicare & Medicaid Services, the Census Bureau, and the Centers for Disease Control and Prevention to rank the counties with the least access to mental health care in the U.S.

For Alaska and Louisiana, "county" is used to denote boroughs and parishes, respectively. Counties are ranked by those that had the largest ratio of residents for every mental health care provider. This analysis includes statistics on each county's uninsured population and the number of poor mental health days per month that residents report, though they did not factor into the ranking.

Counties in Texas make up roughly 1 in every 4 of the top 25 counties in the country with the fewest mental health care providers for the population residing there. But it's hardly unique. Other states with large rural regions also rank poorly for access to mental health care, according to CMS data. Even in urban areas, those seeking mental health support can face difficulty finding a practitioner close enough to visit between work shifts or family responsibilities, as well as difficulty securing consistent transportation.

Access to care isn't just a problem for a few. Nearly 1 in 5 Americans lives with a mental health condition of some sort in any given year, according to mental health advocacy nonprofit Mental Health America. Nearly half of U.S. residents will meet the criteria of having a diagnosable mental health condition in their lifetimes.

Groups like Bacon's Texas Counseling Association are advocating at the state level for measures that would expand access to mental health care resources in the wake of a pandemic that emphasized its importance for millions. The Texas association is especially interested in ways to increase the shortage of professionals in the mental health care space, which Bacon identifies as the biggest challenge for accessing care.

That begins, she said, with shoring up insurance reimbursement rates so that practitioners can expect to earn a living wage. Whether the patient is covered by private insurance, Medicare, or Medicaid, the insurer often doesn't cover the full cost for behavioral health care expenses, leaving underpaid providers to absorb those costs, Bacon said. Some providers even refuse to join insurance networks as "in-network" providers because those networks don't compensate them enough for their care.

But the group is also advocating for its state to join a compact that allows mental health professionals licensed elsewhere to practice in other member states through telehealth programs. The Counseling Compact requires legislative approval to join and is aimed at expanding access and providing more opportunities for counselors to maximize earnings. It's made up of 31 member states (as of Dec. 13, 2023), including several with counties featured in the top 25 worst for access such as Georgia, Alabama, and Tennessee.

In places where broadband access is sufficient, telehealth can expand access to mental health care tremendously, Bacon said. "The more research that comes out on the effectiveness of telehealth, the more we see it's comparable to in-person."

In addition to high demand and low supply of professionals providing this care, the cost of care can be insurmountable for residents who lack any health insurance. Many of the counties that have the least access to mental health care professionals also have higher-than-average rates of uninsured residents. Across all counties, an average of 11.7% of residents report being uninsured, according to the Census Bureau.

A 2018 study from the National Council for Mental Wellbeing suggested that there are more barriers to mental health care that are prevalent across the country besides a lack of access to professional help, including social stigmas, high costs, insufficient insurance coverage, and a lack of awareness about resources.

For people struggling to find a provider accepting clients nearby, Bacon recommends seeking out the nearest state-funded Local Mental Health Authority, which can provide mental health care services in addition to so-called "wraparound" services like financial assistance for medications.

Read on to see which counties are feeling the effects of the behavioral health specialist shortage most acutely.