AUSTIN, Texas (KXAN) — A recent study has ranked Texas as the worst state for mental healthcare in the U.S. and claimed the state has the highest percentage of uninsured adults with mental illness.

The study, conducted by Forbes, evaluated states on the availability of mental health services and the barrier to accessing those services. Along with the aforementioned metric, Texas also ranked the highest for the “highest percentage of adults with a cognitive disability who could not see a doctor due to cost” and “highest percentage of youth who had a major depressive episode in the past year and did not receive treatment.”

Forbes Digital Public Relations Manager Zoi Galarraga said that the study weighed these three metrics over the other four.

“They were a better reflection of needing mental health services and lacking access to care, than just number of mental health treatment centers per 10,000 businesses, for example,” Galarraga said. “We essentially provided a heavier weighting to any metrics that clearly indicated a lack of access to care.”

The other factors used in the rankings were:

• Number of mental health treatment centers per 10,000 businesses;
• Percentage of children with private health insurance that doesn’t cover mental or emotional problems;
• Percentage of adults with a mental illness who didn’t receive treatment in the past year; and,
• Percentage of adults who needed counseling or therapy specifically in the past month and did not receive it.

Galarraga said that the study provides awareness of where the state is in terms of mental health services.

Local provider reacts to study

For St. Edwards’s University Director of Counseling Services Molly Wang, Texas’ ranking isn’t surprising.

“I started my career in mental health over 10 years ago when I worked for an advocacy nonprofit called National Alliance for Mental Illness. At that time, we knew very well that Texas ranked 49th out of 50,” Wang said. “So it sounds like things have not changed, but have actually gotten worse.”

Wang’s department provides short-term counseling to students and refers students to other local providers for longer-term care if necessary. However, a lack of local providers means that students are not able to get the best care.

“Individuals come to counseling for all sorts of reasons. Sometimes they come to counseling, and they uncover that they require long-term individual counseling,” Wang said. “When we refer students out to the community, it looks like one of two ways, we usually refer them to a private provider…if the student cannot pay for the counseling services, then we refer them to community providers. We noticed that when we refer students out to those agencies, because of the funding streams that those agencies have, there are long waitlists.”

The best-case scenario for students on a waitlist? Six weeks, Wang said, time that can further deteriorate a student’s mental health.

“When it comes to developing coping skills, it’s usually not just like a one-time thing that someone can develop and graduate from over the course of short-term therapy, they need to work on it long term,” said Wang, comparing it to diabetes management. “When someone has to wait between the last session and the next session, sometimes their symptoms can worsen to the point where they find themselves in crisis again.”

This can sometimes mean care at an emergency room or psychiatric hospital.

“They’re hospitalized and end up with a lot more stressors and the result of that experience,” Wang said. “Without timely intervention and [with] delayed treatment, then the condition can worsen. If their condition worsens, sometimes they can get arrested, or they can end up doing some real damage, like getting into a car accident from substance abuse. What happens after that is that they end up involved in other systems that are very complicated to untangle from.”

Can Texas dig itself out?

Legislation can be a part of the solution, but it will take a lot of effort to reverse the erosion. During her time working in community mental health, Texas declined Medicaid expansion, which Wang said left many without access to care.

“We have decades of underfunding…it’s going to be slow even on legislation,” Wang said. “it takes more than individual counselors, or counseling services, or mental health services, to improve mental health. It really does involve a community approach.”

This “community approach” involves efforts to improve food security, suicide prevention, housing stability and general affordability, according to Wang.

“All of those things contribute to mental health,” Wang said, “It’s not just someone having access to mental health care. I think you need an individual approach, we need an expansion of more individual counseling services, we also need a community-based approach with expansion of people being able to meet their basic needs.”