Man struggling with mental health in Texas

Mental illness is common among American adults and youth, but access to quality mental health care is far from equal across all states. 

Texas is one state that has consistently ranked low in terms of mental health care across several years and multiple studies carried out on the matter. 

One of the more recent reports by the nonprofit Mental Health America from 2023 found that Texas ranked #46 in the nation overall, with high rankings in some categories and coming in dead last for others. 

It is important to note, however, that these numbers and rankings are affected by a number of factors and that there are also several positives to consider about mental health care in Texas. 

Why Is Texas Ranked Low for Mental Health by SAMHSA?

Texas has ranked low across reports from both Mental Health America (MHA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) for mental health.

There are a few reasons why this is the case, and a couple of reasons as to why some of the related numbers can be considered misleading.  

Texas Lacks Access to Quality Mental Health Care for All

The area where Texas ranks the lowest is in access to mental health care, for which it ranks #51 and is the worst state out of all 50 states plus the District of Columbia (Washington, D.C.). 

Other states that rank low in this category are Arizona and Alabama, and the states which rank best in this category are Vermont and Massachusetts. 

Access ranking is determined by factors like the number of adults with any mental illness who are uninsured and the number of youths with at least one major depressive episode in the past year who did not receive mental health treatment. 

The fact that Texas ranks at the very bottom of this list across multiple studies indicates that a lack of mental health care access is a large problem for both adults and youth in need of this type of care. 

SAMHSA Behavioral Health Report Does Not Include Medicaid Spending

It is often quoted from a SAMHSA Behavioral Health Report from 2015 that Texas ranks #49 in terms of mental health expenditures. 

Essentially, this is how much the state of Texas spends on mental health care for its residents, including in treatment, prevention, and education. 

This report did not take into account the state’s Medicaid spending, however, which more than doubles the amount spent on per-person expenditures and would instead place Texas at #33 in overall rankings for this metric. 

SAMHSA Report Leaves Out DSRIP Payments

The SAMHSA Behavioral Health Report also leaves out payments from the DSRIP, or Delivery System Reform Improvement Program. 

With both Medicaid spending and DSRIP payments included in the calculations, Texas actually places as high as #27 in terms of mental health expenditures.

What Factors Affect the Mental Health Ranking for Texas?

The low rankings for mental health care treatment in Texas are also related to a number of other factors. 

Fortunately, many of the factors listed below have great room for improvement in terms of raising the mental health rankings for Texas. 

Health Insurance

One major contributing factor to the low mental health rankings in Texas is a high rate of uninsured adults and a limited number of health insurance options for children. 

With so many adults and youth who are uninsured, it should come as no surprise that Texas would then rank so low in terms of access to care, as this care would likely be unaffordable or unavailable to those without proper health insurance. 

Quality of Mental Health Care Providers

Another issue related to the access to mental health care for Texans is a difficulty in finding quality mental health providers. 

Among the adults who are factored into the low access of mental health care in Texas are adults who reported having at least 14 days a month where they felt mentally unhealthy but could not see a doctor due to cost. 

This indicates limitations in the amount of quality mental health professionals that are available to people without insurance or who cannot afford luxury treatment in Texas. 

Lower Overall Need for Treatment

The area where Texas ranks the best is in terms of prevalence of mental illness, for which it ranks #3 according to the MHA 2023 report. 

What this translates to is an overall lower need for mental health care treatment in Texas, as both adults and youth have overall lower rates of mental illness, substance use disorders, major depressive episodes, and thoughts of suicide. 

This trend is somewhat common in southern states, as other southern states that rank in the top ten for this area are Georgia, South Carolina, and Florida. 

Unmet Mental Health Care Needs

Another area where Texas ranks positively is in unmet mental health care needs, for which it ranks #19. 

This number is important, as it indicates that the lack of mental health care access in Texas is not necessarily hurting its citizens as much as might be expected, because the care is much less needed than it is in other states. 

Why Texas Ranks High for Unmet Mental Health Treatment Needs

There are a couple of possible reasons related to why Texas ranks high for unmet mental health treatment needs.

The most obvious is that Texas has an overall lower need for mental health care, as both adults and youth rate low in prevalence of mental illness. 

In relation to this lower need, Texas also has less mental health treatment centers overall. This number is also affected by a high overall population in Texas and a prevalence of low-population rural areas. 

A 2019 study by the Meadows Mental Health Policy Institute also pointed out several reasons why this may be the case:

How to Improve the Mental Health Treatment Crisis in Texas

In order to improve mental health care treatment in Texas, the biggest area that calls for improvement is in access to mental health care, as well as access to services like suicide prevention and housing stability. 

This is especially true for adults with severe mental illness and for youth with major depression, for which Texas ranks lower than all other states. 

Furthermore, access to quality mental health care treatment has never been more needed on a national level than after the Covid-19 pandemic, and locally after the Uvalde shooting tragedy. 

This is where mental health care facilities like Navita Health come in, who are taking a different approach to mental health care with a special focus on providing excellent care for Texan youth. 

Find Quality Mental Health Care in Texas

If you are among the adults and youth in Texas in need of healing and mental health care that is transformative and customized for your unique needs, look no further than Navita Health. 

We are proud to offer a variety of mental health services that are compassionate, evidence-based, and always individualized for every guest who walks through our doors. 

And with new locations opening in San Antonio and The Woodlands, we are here to serve all residents of Texas from Austin to Dallas to Houston. 

Reach out to Navita today to learn how we can offer a different approach for your mental health care needs.


Forbes Health. “Mental Health Statistics and Facts.” Retrieved from: Accessed on February 22, 2024. 

Meadows Mental Health Policy Institute. “Texas and Behavioral Health Rankings – September 2022.” Retrieved from: Accessed on February 22, 2024. 

Mental Health America. “Ranking the States 2023.” Retrieved from: Accessed on February 22, 2024. 

Spectrum News 1. “Study ranks Texas last for access to mental health resources.” Retrieved from: Accessed on February 22, 2024. 

The Rees-Jones Foundation. “Mental Health Access in Texas.” Retrieved from: Accessed on February 22, 2024.