5 Worst Cities In US To Live: Mental Illnesses And Cost

A positive mental state is essential for our everyday well-being. Anxiety, stress, and depression can significantly impact our health and ability to perform at work, at home, or in social situations. Some cities and states are better equipped to handle the growing mental health crisis in the US than others.

It is not easy to provide a definitive answer as to which 5 cities in the US are the worst to live in for mental health. The criteria differ from one study to the next. We will examine multiple studies to show how and why cities and states made the lists of best and worst in the US.

Number of People Suffering from Different Mental Health Problems.

According to Forbes Advisor, more than 50 million Americans have some form of mental illness, with more than half of these adults not receiving treatment. The reasons for lack of treatment can vary, and often include the following:

• Lack of health insurance coverage
• High costs
• Too few mental health treatment locations

In 2021, the National Institute of Mental Health estimated that over one in five US adults (57.8 million over age 18) lived with a mental illness. That is 22.8% of all adults in the United States. You can learn more about how the NIMH gathered their results by clicking the link above. The two categories used for criteria are:

• Any Mental Illness (AMI): behavioral, emotional, or mental disorder, ranging from no impairment to mild, moderate, or severe
• Serious Mental Illness (SMI): behavioral, emotional, or mental disorder resulting in serious functional impairment, substantially interfering with or limits one or more major life activities

The following information focuses on adults with any mental illness. 

• Females had a greater prevalence of mental illness than males with a 27.2% to 18.1% incidence rate.
• Younger adults in the 18-to-25-year range topped the chart with 33.7%. However, they were least likely to seek help, with only 44.6% receiving mental health services.
• Men and women between 26 and 49 years of age came in at 28.1%. They were also the most likely group to seek mental health services, at 48.1% – still less than half.
• Adults over 50 had the lowest incidence with 15.0%, and 47.4% of them reached out for help.
• In total, of the 57.8 million adults with mental illness, only 26.5 million (47.2%) received some form of mental health service during the year. Females were more likely than males to seek help, with a comparison of 51.7% to 40.0%. 

The following information focuses on adults with serious mental illness 

• 14.1 million adults over 18 (5.5% of all adults) in the US were estimated to have SMI in 2021. 9.1 million, or 65.4%, received mental health treatment that year.
• Females had a greater prevalence of serious mental illness than males with a 7% to 4% incidence rate. Women were also more likely to receive treatment than men – 67.6% compared to 61.3%.
• Younger adults in the 18-to-25-year range topped the chart with 11.4%. They again had the lowest percentage of receiving treatment at 57.9%.
• Men and women between 26 and 49 years of age came in at 7.1%, with 67.0% receiving mental health treatment. 
• Adults over 50 had the lowest incidence with 2.5% but the greatest percentage receiving treatment at 71.0%.

What Are the Known Components of Our Mental Health?

Mental health encompasses many different areas, not just depression. Mental illness can include depression, anxiety disorders, schizophrenia, eating disorders, addictive behaviors, bipolar disorder, mood disorders, phobias, seasonal affective disorder (SAD), and more. According to the CDC, there may be more than 200 types of mental illness affecting people.

There are three primary components to mental health: 

• Behavioral – how you engage with the world around you, substance abuse disorders, emotions, and behaviors affecting well-being
• Cognitive – encompasses learning, reasoning, memory, communication, paying attention, critical thinking, speech, etc. 
• Emotional – awareness of and how you cope with positive and negative feelings, managing life events and challenges

Mental illnesses or disorders can be long-lasting, episodic, or occur over a short time. They can be due to many factors, including:

• Chemical imbalances in the brain
• Biological factors
• Alcohol or drug use
• A traumatic event, such as abuse, assault, witnessing violence
• Ongoing medical conditions
• Isolation or loneliness 

Certain hormones can have a significant impact on mental health, as they promote or inhibit the release of endorphins, serotonin, and other neurotransmitters. According to Medzone, the situation often gets worse when we also have some internal issues such as hormonal imbalance. It can increase anxiety, stress, passivity, and depression. Luckily, there are successful treatments available from hormone professionals that can restore balance and reduce these feelings.

Changes in mental health can happen at any time, especially when life-changing incidents such as death, divorce, or job loss occur. Economic hardship, caring for a relative, working long hours, and dealing with other stressors can lead to a decline in mental health. When the situation improves, or when steps are taken to reverse these issues and feelings, positive mental health can return. 

Top 5 Worst Cities in the US for Mental Health

Compiling any list of the 5 worst cities in the US for mental health can be challenging. Every organization has specific factors it uses in its calculations. We will present a few of them here and highlight the factors and discrepancies used.

1. CertaPet

Up first, we have the list from CertaPet, which used seven ranking factors: therapy session rate by state, total prescription charges by state, mandatory treatment laws grade by state (score), criminalization of mental illness by state (score), number or residents per 1 mental health provider by county, poor mental health days by county, and overall community wellbeing. 

While the top 5 best cities were Denver, CO, Salt Lake City, UT, Minneapolis, MN, Seattle, WA, and Hartford, CT, respectively, the 5 worst cities on the list were the following:

• Dallas
• Houston
• Jacksonville
• San Antonio
• Tampa

Prescription costs were the highest in Texas, which also had a record of incarcerating nearly 8 people with severe mental illness for each one hospitalizes.  

The cost for therapy sessions in Florida is also higher than in most other states, with an average cost of $142 per session. Also, access to care is hindered by relatively few providers for the population size, making care both hard to secure and expensive. 

2. Forbes Advisor

Next, we look at Forbes Advisor, which used the following criteria for ranking states: 

• % of adults needing counseling or therapy but did not get it within 4 weeks of the survey
• % of mental health treatment locations per 10,000 businesses
• % of adults with any mental illness that did not receive mental treatment in the past year
• % of uninsured adults with any mental illness
• % of adults with cognitive disability who did not see a doctor during the prior year due to medical costs
• % or youth with a major depressive episode in the previous year without receiving mental health care
• % of children with private health insurance that does not cover emotional or mental issues

Forbes Advisor also looked at the percentage of adults in the state reporting any mental illness in the past year and those who reported having a serious mental illness. 

Not surprisingly after reading the last list, Texas tops the list of states with the worst mental health care, including having the highest percentage of uninsured adults with any mental illness. Texas also has the highest percentage of adults with a cognitive disability who could not seek medical care due to cost. They also have the fifth lowest number of mental health centers in the US.

Florida, which came in fifth, is also on this list, as well, with the distinction of having the second-highest percentage of adults who did not receive treatment for mental illness in the past year. Five other southern states, including Mississippi, Alabama, Georgia, and South Carolina round out the top 6. Arizona, Wyoming, Tennessee, and Idaho complete the top ten list. Montana, while not having the worst care, does top the list for the highest prevalence of mental illness.

The best mental health care can be found in the northeast states of Vermont, Massachusetts, Rhode Island, Pennsylvania, Connecticut, and Maine. Residents in Vermont and Maine live in states that are in the top 5 for most seasonal depression. Clearly, they recognize that as they offer excellent mental health care. 

3. Men’s Health

Finally, we look at Men’s Health 2021 study that analyzed 100 major American cities for per capita mental healthcare providers, fit-brain behaviors, deaths due to substance abuse and mental health disorders, and self-reported mental health status. They uses numerous sources to gather their facts and created a top 100 list of cities with the best mental health.

Their top 10 list of the best cities for mental health is as follows:

1. Oakland, CA
2. San Francisco, CA
3. San Jose, CA
4. Durham, NC
5. Anaheim, CA
6. Bridgeport, CT
7. Washington, DC
8. Seattle, WA
9. San Diego, CA
10. Minneapolis, MN

Half of the cities on the top 10 list are in California, with Los Angeles coming in at number 14. 

Of the cities previously mentioned in other lists for having the worst mental health care, here are where they ranked on this list:

30. Houston, TX
31. San Antonio, TX
32. Dallas, TX
33. Jacksonville, FL
34. Tampa, FL

If you live in a city that does not have a high positive ranking for mental health services, it is especially important to understand your options and seek care when it is needed.

Conclusion

Maintaining positive mental health is crucial to overall well-being. Resources are available to help you cope with any mental health issues. Whether dealing with behavioral, cognitive, or emotional concerns, options exist to help you receive vital treatment and care. 

If you or a loved one is feelings anxious, depressed, or stressed, please reach out for help.