Mental Health

Mental health conditions are common in the region, yet residents struggle to access mental health services in Houston

Our region continues to see an increase in mental distress frequency, drug use, and suicides, exacerbating the existing mental health challenges across Houston. While the number of mental health care workers per resident has improved, our region’s access to professional mental health help remains significantly lower than the national rate.

The data

Nearly one in five teenagers in Texas experience a major depressive episode

Mental illnesses are common in the United States. About 23% of U.S. adults (61.5 million) lived with a mental illness in 2024. The prevalence of mental illness was higher among women (27%) than men (20%). Young adults aged 18–25 had a higher prevalence of mental illness (33%) than adults 50 and older (15%). White adults are more likely to report mental health issues than people of color.³ However, the consequences of mental illness in people of color may be more persistent, meaning even though they might have lower reported rates, they are less likely to seek mental health treatment (or receive effective treatment), and their mental health conditions might not improve over time.⁴ Lack of cultural understanding by providers and social stigma may contribute to the underdiagnosis of mental illness among people of color and the immigrant population. Mental health problems are also common among people in the criminal legal system. Estimates suggest between 60% to 70% of youth in the juvenile legal system meet the criteria for a mental health disorder.⁵

Mental illness varies in levels of severity. Serious mental illness is defined as a mental, behavioral or emotional disorder resulting in serious functional impairment that substantially interferes with or limits one or more major life activities. Nationwide, nearly 6% of adults (14.6 million) experienced serious mental illness in 2024.

Not only young adults, but youth aged 12–17 also report higher levels of serious mental illness compared to older adults. In 2022 and 2023, 19% of kids aged 12-17 reported having a major depressive episode — one of the most prevalent serious mental illnesses affecting both youth and adults. This is similar to the rate seen in young adults aged 18-25, but more than twice the rate seen in adults aged 26 and up. In Texas, the rates for youth experiencing a major depressive episode are 17%, slightly lower than the U.S. average.

Overall, a national analysis of states across seven measures ranked Texas 5^th for the prevalence of mental health, indicating a lower number of mental illness and substance abuse cases among the Texas population compared to other states and districts.

Residents in the Houston region report an increase in mental distress frequency

The average number of mentally unhealthy days — days involving significant amounts of stress, depression or other emotional distress — is a self-reported quality-of-life measure. Research has shown that it is a reliable estimate of an individual’s recent mental health condition and a predictor of future adverse health events. Counties with more unhealthy days were likely to have higher unemployment, poverty, and undesirable educational and health outcomes than counties with fewer unhealthy days.⁶

Between 2016 and 2022, the average number of mentally unhealthy days increased in Texas and the U.S. overall. Prior to 2022, the average number of poor mental health days within a month reported by Texas residents was lower than the national average. However, in 2022, Texas matched the U.S. with an average of 5.1 poor mental health days.

Prior to 2019, Harris and Montgomery counties reported slightly fewer mentally unhealthy days than the national average. As of 2022, adults in Harris County reported an average of 5.7 days with poor mental health and 5.7 days in Harris County. Fort Bend County residents have consistently experienced the lowest number of mentally unhealthy days at 4.6 in 2022.

Adults who experience frequent mental distress are those who report 14 or more days of poor mental health in the past month. Research has found a strong relationship between frequent mental distresses and clinically diagnosed mental disorders, such as depression and anxiety.⁷ Frequent mental distress is associated with unhealthy behaviors such as smoking and physical inactivity, risk factors such as housing and food insecurity, and is more common among women.^8,9

The proportion of adults experiencing frequent mental distress in Texas increased to 16% in 2022 from 12% in 2017. Harris and Montgomery counties have a higher percentage of adults who reported 14 or more days of poor mental health in a one-month period in 2022 (19%) compared to Fort Bend County (15%).

Many factors contribute to mental health, including our biology, personal experience and family history. However, certain populations report a higher frequency of mentally unhealthy days.

In the nine-county Houston Metropolitan Statistical Area (MSA), Texas, and across the U.S., women report experiencing more days of poor mental health than men, although the gap in the Houston MSA is smaller. Between 2019 and 2023, the rate of adults reporting poor mental health for 14 or more days within one month increased both nationally and in Texas across all demographic groups.

During the same time in the Houston MSA, this rate was flat for the overall population, decreased for female, Black, and Hispanic residents, and increased for male and white residents. In 2019 in Houston, Hispanic residents experienced the highest rates of frequent mental distress, and as of 2023, white residents in the Houston area experienced the highest rates of frequent mental distress.

Illicit drug use among young adults has increased

Alcohol consumption has been linked to poor mental health. People may use alcohol to relieve symptoms of stress, anxiety, and depression, but long-term alcohol use and binge drinking often leads to a worsening of mental health.¹⁰ The CDC defines binge drinking as adults who have at least five drinks (men) or at least 4 drinks (women) on one or more occasions during the previous 30 days.

Between 2019 and 2022, the percentage of adults who report binge drinking remained flat in Fort Bend, decreased in Harris County, and increased in Montgomery County. As of 2022, about 16% of adults in Fort Bend and Harris counties report binge drinking, whereas 19% of adults in Montgomery County do.

In the U.S., more than one in three adults living with any mental illness also has a substance use disorder, defined by the CDC as a treatable, chronic disease characterized by a cluster of symptoms indicating that the individual continues using the substance despite significant substance-related problems. Of adults with a serious mental illness, nearly half also has a substance use disorder. These issues affect people across the country regardless of background or age.

In Texas, the rate of illicit drug use is lower for all ages compared to the nation. In 2022–23, 19% of young adults aged 18 to 25 in Texas report using an illicit drug whereas 27% of that group across the country have used an illicit drug. However, the trends in illicit drug use across age groups are the same in Texas and the country overall:  among children 12 to 17, rates of illicit drug use increased from 2016–17 to 2018–19 and then decreased in 2022–23. For young adults aged 18 to 25 and adults 26 years and older, illicit drug use consistently increased between 2016–17 and 2022–23.

Rates and levels of suicide in the Houston region are on the rise

Mental health disorders can lead to suicide, though the majority of people who struggle with their mental health do not go this route — estimates indicate about 5–8% of people with a mental health condition attempt suicide,^11,12 though about 46% of people who die by suicide had a diagnosed mental health condition. In addition to mental health conditions, environmental risk factors such as prolonged or extreme stress and access to firearms or drugs can increase risk of suicide. Historical factors such as suicide attempts, childhood abuse, and family history of suicide can also increase the risk.¹³

In 2023, suicide was the 11th leading cause of death in the U.S. However, it was the second leading cause of attend for American children ages 10–14, 15–24, and young adults 25–34.

Suicide accounted for the loss of 3,064 lives in the three-county area between 2020 and 2023, an increase of 80% compared to the time period between 2000 and 2003. Between 2000–03 and 2020–23, the number of suicides increased 156% in Fort Bend County, 64% in Harris County, and 140% in Montgomery County. (Fort Bend and Montgomery counties have also experienced substantial population growth during that time period.)

In order to account for population differences, the suicide rate (calculated as the number of suicides per 100,000 people) is a better indicator of suicide prevalence.

The suicide rate in the three-county Houston region has also increased over the last two decades to 12.1 per 100,000 residents in 2020–23 from 10.1 in 2000–03. The 2020–23 suicide rate in the Houston area remains lower than in Texas, where there were 14.1 suicides per 100,000 residents, and the rate in Texas is slightly lower than in the nation overall (14.5 per 100,000). Between 2000 and 2023, the suicide rate increased 36% in Texas.

Montgomery County’s suicide rate is the highest in Houston’s three-county region and above the rate of Texas and the nation overall. In 2020–23, Montgomery County’s suicide rate was 17.1 per 100,000 compared to 11.9 in Harris County and 9.4 in Fort Bend County.

While self-reported mental illness is more prevalent among women, men are more likely to attempt suicide. Nationally, men died by suicide at a rate 3.8 times that of women in 2020–23. In particular, white males account for most suicides across all age groups.

The suicide rate per 100,000 men in Texas during the 2020–23 period is 36% higher than that in 2000–03. In all three counties and the state, the suicide rate for males increased more between 2000–03 and 2020–23 than for females, with the suicide rate for males increasing at a rate twice that of females in Fort Bend and Harris counties.

Availability of mental health services in Houston has improved, but remains lower than national rates

Nearly one in five adults has some form of mental health condition, contributing to increased financial costs, disability and death rates in recent years.¹⁴ However, the availability of mental health resources remains stagnant, as the supply of mental health providers cannot keep up with growing needs. In fact, about 122 million people across the country live in Mental Health Care Professional Shortage Areas (HPSAs). And in Texas, more than 13 million people live in HPSAs, with only 31% of the need being met. KFF estimates that an additional 614 health care practitioners could alleviate the mental health care professional shortage in the state.  These challenges are layered on top of low coverage rates for health insurance in Houston and across the state.

Mental health care providers include psychiatrists, psychologists, licensed clinical social workers, counselors, family therapists, providers that treat substance abuse and chemical dependency, and advanced nurse practitioners specialized in mental health care. These professionals provide essential care to both adults and children who have a mental disorder. To measure access across geographic units with different population sizes, we use the ratio of the population to mental health providers. The higher the ratio, the lower the access to mental health providers.

Typically, mental health professionals are concentrated in urban areas. About 10,600 registered mental health providers were practicing in Houston’s three-county area in 2024, more than double the number in 2016, and availability has improved across all geographies over this time period. Despite this growth, mental health care availability in Texas is half that in the U.S. overall. As of 2024, there are 590 residents for every one mental health provider in Texas compared to 300 to 1 nationally. In fact, according Mental Health America’s 2024 State of Mental Health Report, Texas ranks last among all 50 states and the District of Columbia in access to mental health care.

Harris County’s ratio of residents to mental healthcare providers is about on par with the state of Texas, while Fort Bend County has historically had the lowest access to mental health treatment. As of 2024, the availability in Fort Bend County (840:1) remained lower than in Montgomery County (780:1) both of which were lower Harris County (560:1). Low-income areas and rural communities have less access to mental health care in Houston because of fewer mental health treatment facilities and providers in general.¹⁵

Helpful Articles by Understanding Houston:

• It’s “Okay to Say™” That You or a Loved One Have a Mental Illness
• NAMI Executive Director, Advocate for a Broader Perspective on Mental Illness
• Key Insights From Our Mental Health Data Dive + Workshop
• Children’s Mental Health in the Context of the COVID-19 Pandemic
• Houstonians’ Experiences with Hurricane Harvey and the COVID-19 Pandemic