Mental Health

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

Our region has seen a recent increase in mental distress frequency, drug use and suicides, exacerbating the existing mental health challenges across the Houston region. 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

One out of 13 adults in Texas experience a major depressive episode

Mental illnesses are common in the United States. About 21% of U.S. adults (52.8 million) lived with a mental illness in 2020. The prevalence of mental illness was higher among women (25.8%) than men (15.8%). Young adults aged 18–25 had a higher prevalence of mental illness (30.6%) than older adults (19.5%). 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 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 50% to 75% 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, 5.2% of adults (13.1 million) experienced serious mental illness in 2019.

Not only young adults, but youth aged 12–17 also report higher levels of serious mental illness compared to older adults. In 2019 and 2020, 16.4% 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 lower than that in adults aged 26 and up (6.9%). In Texas, the rates for youth experiencing a major depressive episode is 17.1%, higher than the U.S. average.

The economic costs of mental illness can be broken into two categories: direct and indirect. The direct costs include medication, therapy, and hospitalization or other outpatient treatment. Indirect costs accounts for lost productivity and income loss.⁶ Depression alone is estimated to account for $44 billion in losses to workplace productivity.⁷ It has been estimated that the economic costs of severe mental illness reached $317 billion in the U.S.⁸ For individuals with a severe mental illness the lifetime financial burden is $1.85 million.⁹

Overall, a national analysis of states across seven measures ranked Texas 13^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. In Texas, 16.3% of adults (3.3 million) are experiencing a mental illness, compared to 18.6% nationally. However, among youth experiencing severe major depression, Texas ranked in the middle of the list, with 9% of the youth population (211,000) coping with depression, which often co-occurs with other issues like substance abuse or chemical dependency, anxiety and disorderly behavior.

COVID-19 and natural disasters have a significant impact on our mental health

By any measure, COVID-19 has made 2020 and 2021 very challenging years. Almost 75% of adults reported the pandemic had a negative effect on their emotional or mental health. Children may be particularly at high risk for longer term anxiety and depression as a result of the pandemic.

The proportion of adults in the Houston Metropolitan Statistical Area (MSA) that have felt nervous, anxious, or on edge for at least more than half the days of a week has remained elevated throughout the pandemic. A Census Bureau survey found that at the end of Summer 2021, 24% of adults reported anxiety symptoms for at least half the days of the week — similar to rates from the beginning the survey began in Spring 2020.

Beyond COVID-19, disasters have been shown to affect mental health.¹⁰ In recent years, Houstonians have experienced a number of events that have had negative effects on their mental health — namely the seven federally declared natural disasters in Houston that have occurred since 2015. For example, following Hurricane Harvey, residents experienced an increase of 1.3 days a month of poor mental health.¹¹

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.¹²

Between 2016 and 2019, the average number of mentally unhealthy days increased in Texas and the U.S. overall. The national average number of poor mental health days reported in the past 30 days was 4.5 in 2019, an increase from 3.8 in 2016. While Texas has a lower average number of poor mental health days at 4.2, it’s almost a full day increase from 3.4 days in 2016.

In general, the three-county area reports slightly fewer mentally unhealthy days than the national average. Adults in Harris County reported an average of 3.6 days in 2019 with poor mental health — the lowest among the three counties — while adults in Fort Bend and Montgomery counties reported an average of 3.9 and 4.2 days, respectively. The average number of mentally unhealthy days in Fort Bend and Montgomery counties increased almost a full day between 2016 and 2019, while Harris County remained relatively unchanged.

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.¹³ 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.^14,15

The proportion of adults experiencing frequent mental distress in Texas increased to 12.1% in 2019 from 10.6% in 2016. Harris and Montgomery County have a higher percentage of adults who reported 14 or more days of poor mental health in a one-month period in 2019 (13.1% and 13.6%) compared to Fort Bend County (10.9%).

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

Both in Texas and in the nine-county Houston Metropolitan Statistical Area, women experience more days of poor mental health than men. The Black population in Texas is more likely to report five or more days of poor mental health, compared to white and Hispanic populations. In contrast, Hispanic residents in Houston are more likely to have reported five or more days of poor mental health.

Substance abuse in the Houston region 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.¹⁶

Residents in the Houston area reported similar levels of binge drinking as the national average in 2019. About 15.5% of adults in Fort Bend reported binge drinking in the month compared to almost 18% in Harris and Montgomery counties and the U.S. overall.

In the U.S., more than one in four adults living with mental health problems also has a substance use problem. These issues affect people across the country regardless of background or age.

In Texas, the rate of illicit drug use in 2019-20 is lower for all ages compared to the nation. About 24% of American young adults between 18- and 25-years-old reported using illicit drugs in 2020 compared to 16% in Texas. However, drug use among adults older than 25 increased by 2 percentage points in the state and 2.4 points in the country between 2017-18 and 2019-20.

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

Mental health disorders can lead to suicide, though the 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,^17,18 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.¹⁹

In 2020, suicide was the 11th leading cause of death in the U.S. However, it was the second leading cause of death among American youth and young adults, ages 10–34.

Suicide accounted for the loss of 2,735 lives in the three-county area between 2017 and 2020, an increase of 15% compared to the time period between 2013 and 2016. Between 2001-04 and 2017-20, the number of suicides has increased 139% in Fort Bend County, 40% in Harris County, and 107% in Montgomery County. However, Fort Bend and Montgomery counties have also experienced substantial population growth during that time period.

In order to account for population differences, the number of suicides per 100,000 people in the region (suicide rate) is a better indicator of suicide prevalence. The suicide rate has also increased over the last two decades to 11.2 per 100,000 residents from 10.3 in 2001-04. This rate remains lower than in Texas, where there were 16.3 suicides per 100,000 residents in 2017-20. Between 2001 and 2020, the suicide rate increased 30% in Texas.

Montgomery County’s suicide rate in 2017-2020 is the highest in Houston’s three-county region at 16.3 suicides per 100,000 residents — much higher than Fort Bend (10.4) and Harris (10.7) counties, although Harris County has the highest total number of suicides in the region.

While mental illness is more prevalent among women, men are more likely to attempt suicide, and they die by suicide at a rate 3.6 times that of women. In particular, white males account for most suicides across all age groups.

The suicide rate per 100,000 men during the 2017–2020 period is 10.7% higher than that during the 2013–2016 period in Texas. The suicide rate per 100,000 males in Montgomery County is 26.4, well above the rate of 21.7 for the state overall.

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.²⁰ 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 136 million people across the country live in mental health professional shortage areas (HPSAs). And in Texas, more than 15 million people live in HPSAs, with only 32.9% of the need being met. 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 7,700 registered mental health providers were practicing in Houston’s three-county area in 2021, a 39% increase from 2017, and availability has improved across all geographies over this time period. This translates to roughly 800 residents for every one provider — slightly lower availability than the state (759:1) and below half the mental health provider availability seen across the nation (350:1). In fact, Texas is at the bottom of national rankings for access to mental health treatment. Among the three counties, Harris County’s mental health services are more accessible than those in Fort Bend or Montgomery counties. 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.²¹

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