Mental Health and the Role of the States

Millions of Americans have one or more forms of mental illness. These conditions have wide-ranging health, economic, and social consequences. For example, mental illness is a major factor in homelessness and incarceration. And serious mental illness—defined as a mental, behavioral, or emotional disorder that causes significant functional impairment that substantially interferes with or limits one or more major life activities—costs the country about $200 billion in lost earnings annually.

Researchers from the State Health Care Spending Project—a collaboration between The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation—sought to better understand the country’s mental health challenges and, in particular, the states’ role in addressing them.

Read the full report.

Key Findings

  • 18.5% of American adults had a mental illness in 2013

    In 2013, an estimated 44 million American adults (18.5 percent of the population 18 and older) had had a mental illness in the past year. Of these, patients with a serious mental illness—defined as any mental, behavioral, or emotional disorder that substantially interfered with or limited one or more life activities—numbered 10 million. Mental illnesses include schizophrenia, depression and anxiety, and bipolar disorder.

  • 60% of spending on mental health treatment in the US was by public sources in 2009

    In 2009, the most recent year for which data are available, the United States spent $147 billion on mental health treatment. A majority of the spending, 60 percent, came from public sources, such as Medicaid, state and local governments, Medicare, and federal grants. Private sources, including commercial health insurance and individual out-of-pocket spending, made up the rest.

  • $35.5 billion is what state and local gov’ts spent on mental health treatment in 2009

    In addition to state dollars spent on mental health treatment of Medicaid enrollees, states and localities spent $22 billion on other mental health care in 2009. Besides state mental health agencies, these dollars were directed to child protective services, criminal justice entities, schools, housing authorities, and substance abuse agencies. Adding these contributions to state Medicaid mental health numbers brings the total of state and local spending up to $35.5 billion. Although total non-Medicaid state and local mental health spending increased from 1986 to 2009, its share of total mental health spending fell from 27 to 15 percent and is projected to continue decreasing at least through 2020. This decline is due in part to increased coverage of mental health treatment by other payers, including Medicaid, Medicare, and private insurance.


Media Contact

Sarah Leiseca

Manager, Communications