It’s no secret that the events of 2020 dredged up a slew of uncomfortable feelings like fear, sadness, anxiety, and stress for many Americans. It’s fair to say that collectively, America’s mental health has been drained from battling the deadly COVID-19 virus. Compounding things, increased isolation has prevented us from finding outlets to speak about mental health issues and seek professional help.
The deterioration of mental health in America, exacerbated by the pandemic, has prompted a new (but tired) wave of advocacy for de-stigmatization, improved access to care, and open dialogue around the unseen suffering that so many face but are afraid to admit. What’s more, this isn’t the first time Americans have cried out for the betterment of the country’s broken mental health care system.
Mental health in America has been dogged by a nightmarish history of failure. Patients have been cast aside, either in prisons, institutions, or the streets. Unsafe and controversial procedures have been attempted on unwilling or unassuming patients. Medications have had mottled results and been priced far out of reach of the average consumer. The public has cast an unapproving eye on those with illnesses they can’t control.
Thankfully, over the years, mental illnesses have slowly become more supported and understood. However, we still have a long way to go. From criminalization of mental health to mounting costs for prescriptions and therapy, roadblocks remain between Americans in mental decline and the help they need—whether it be an emotional support animal, a life-altering medication, or just a friendly face.
Of course, some states are more progressive than others in providing care for those who seek it. In pursuit of charting the landscape for mental health in America, we at CertaPet analyzed the 50 most populous cities to find out which are the best for mental health treatment.
To determine the best and worst cities for mental health care, we identified seven important ranking factors that pertain to the accessibility and cost of mental health care as well as quality of life in each state. Then we assigned weights to these factors, below, and added up the scores for each city. The totals were compared against each other to determine our rankings.
Therapy Session Rate by State
Total Prescription Charges by State
Mandatory Treatment Laws Grade by State (Score)
Criminalization of Mental Illness by State (Score)
Poor Mental Health Days by County
Overall Community Wellbeing
The Best Cities for Mental Health
Denver, CO, is the number one city for mental health, with a commendable score of 40 out of a possible 50. It’s not just close proximity to the serene Rocky Mountains that makes Denver great for mental health, either. The state of Colorado in general boasts a very low average therapy session rate of $115 and total prescription charges of $3,197,004,648. That last figure may seem high, but comparatively, only 7 other cities in our analysis managed to beat it. Additionally, Denver County features one mental health provider per 170 residents, making care not only relatively cheap but also accessible to the masses.
The second best city for mental health is Salt Lake City, UT with a city score of 37.4. Minneapolis, MN is the third best city for mental health with a city score of 36.9. Owing to the metro’s high score are MN state laws that establish when involuntary treatment is appropriate for the severely mentally ill. Minnesota allows the use of court-ordered treatment in the community, contributing to a glowing A+ grade (the best in our analysis) for it’s mandatory treatment legislature. Minnesota is also a leader among states with a low ratio of 1.2 patients who are incarcerated for every 1 that is hospitalized. Although it is important to note that while better than most, Minnesota joins every other state in incarcerating more individuals with severe mental illness than it hospitalizes.
Seattle, WA, and Hartford, CT, tie for third as well with scores of 36.9. Some cities, though, didn’t fare so well in our analysis.
The Worst Cities for Mental Health
Texas fills four spots on our list of the top 10 worst cities for mental health with Dallas, Houston, San Antonio, and Austin all scoring low. Florida follows suit with Jacksonville, Tampa, Orlando, and Miami making the list. Why are the Lonestar State and Sunshine State so far behind their peers in prioritizing mental health?
Well, everything is bigger in Texas, including prescription costs. Texans pay $23,370192,711 annually for prescription medication. The state also has middling mandatory treatment laws and a bad track record of incarcerating nearly 8 individuals with severe mental illness for each one it hospitalizes. With records of the mentally ill being mistreated and even abandoned in American jails, this speaks volumes for Texas.
In Florida, therapy costs $142 per session on average, which is higher than most of the states we analyzed. Furthermore, access to care is throttled by relatively few providers for the population. For example, Miami has only one mental health provider per 590 residents while Tampa only has one per 550 residents. This means care is both expensive and hard to secure compared to other states we analyzed.
The Best Cities for Access to Mental Health Care
While we acknowledge there are many barriers to satisfactory mental health care from insurance coverage to financial wellbeing to the inability to secure a psychiatric service dog, we measured access to mental health care purely by the number of providers available to each city’s residents.
Surprisingly, we saw a three-way tie between New York, NY, San Francisco, CA, and Portland, OR. Each metro boasts a provider for just 110 residents. In fact, every city in the top 10 has one provider for 200 or less residents. For some perspective, Birmingham, AL has just one provider per 1,200 residents. This geographic disparity in access to mental health care puts unequal pressure on those with mental illnesses who call states like Alabama home.
Next we took a deep dive into another form of mental health care—prescriptions.
The Best Cities for Cost of Prescriptions
Whether suffering from mild depression or schizophrenia, having dependable and consistent access to medication can be life-changing. Unfortunately, mental health medications in America aren’t cheap considering the average American spends $1,200 per year on prescription medications.
Providence, RI, and Washington DC, are by far the most progressive when it comes to fairly pricing prescription medications. Rhode Island and the District of Columbia are the only two states with less than a billion dollars in prescription costs—$595,083,087 and $843,934,957, respectively. The runner up is Portland, OR, with $1,707,642,773.
Our analysis has revealed that there is still work to be done to make caring for mental conditions as common as casting a broken bone. Yet, it also showcased several shining examples of progression toward that very goal.
Regardless of where you live, it’s important to remember that you deserve adequate and appropriate mental health care no matter your condition. And if you believe an emotional support animal or psychiatric service dog might be part of your ideal care plan, we have education and resources that can help you make that determination.