In the first state-by-state analysis produced in 15 years, there were no As, only five Bs and eight states received failing grades. Connecticut and Ohio topped the list, while Iowa, Idaho, Illinois, Kansas, Kentucky, Montana, North Dakota and South Dakota were at the bottom.
"Treatment works, if you can get it, and if states get it right," said Ken Duckworth, medical director of the National Alliance on Mental Illness at a news conference Wednesday unveiling the report, States: A Report on America's Health Care System for Serious Mental Illnesses. "Unfortunately, too many states are willing to risk premature deaths," he said.
The nation can improve its grade by increasing the funding tied to performance, spending more money on treatments that are proven effective and making mental-health services more consumer friendly, Duckworth said.
Most Americans who suffer from serious forms of mental illness like severe depression and schizophrenia eventually end up in need of at least some state mental health services, and when they fail, the personal and economic costs are enormous.
Patients who do not receive adequate care are at best less productive, and at worst can end up homeless or in jail.
A third of the nation's 600,000 homeless are seriously mentally ill, and in many jurisdictions, correctional facilities have become the largest providers of mental health treatment. Of the approximately $200 billion mental healthcare costs each year, only about half comes from direct treatment costs.
The rest represents the costs to businesses and taxpayers of untreated and mistreated mental illness.
In the study, states were graded on infrastructure, services and recovery supports with special emphasis on information.
"Access to treatment depends on access to information," Duckworth said. States that scored poorly featured impenetrable websites, especially for non-English speakers, and unhelpful hotlines.
"When 40 states can't pass a pop quiz on providing basic information to the people whom they are supposed to serve, then the system is in trouble," Duckworth said.
The alliance is hoping its latest report will get the attention of both state governments and members of Congress, as did its initial report did 15 years ago, especially in light of a recent round of harmful Medicaid cuts, NAMI Executive Director Michael Fitzpatrick told United Press International.
"For years afterward, policymakers would point to (the organization's first report) as a checklist of policies," he said.
The report offers a menu of best practices, including adequate funding and capacity, cultural competence, and evidence-based care.
"Some good things are happening even in abysmal states," Duckworth said, including creative programs like low-income housing financed by real estate transaction fees in Illinois, and a telephone triage system for mentally ill Kentucky inmates that is financed by drunk-driving fines.
The report also highlights the need for so-called "parity laws" that require health insurance to offer the same coverage for mental illness as other conditions.
"Even if people have private insurance, they still use parts of the public system," Fitzpatrick said. "Congress should pass parity. It would take some pressure off states and allow people to buy their own services."
Failures in the mental health safety net affect everyone, said Patty Duke, a former television star and author of the book Brilliant Madness, about her own struggle with manic depressive disorder.
"I'm surviving a life-threatening illness," Duke said. "Many do not, such as those without celebrity and fortune who have to depend on the public healthcare system."
"Who knows when one of us will be forced to rely on states who have received C, D or even failing grades in this report," she said.