While New Jersey has recently been proactive in ensuring access to mental-health coverage, whether insurance companies are meeting those needs is a more complicated question.

In 2019, New Jersey passed a parity law requiring insurance companies cover mental-health conditions and substance-use disorders at the same level as physical conditions. Data from 2021 show New Jersey insurance providers have the highest out of network rate in the nation, at nearly 50% of all costs for behavioral-health care.

Matt Camarda, advocacy and public-policy director for the National Alliance on Mental Illness of New Jersey, said it often comes down to compensation.

"Insurers don't always do the best job when it comes to reimbursement rates for the providers within those networks," he said, "and so oftentimes, whether it's a therapist or psychiatrist, folks are discouraged from joining those networks. "

The state Department of Banking and Insurance is responsible for ensuring parity laws are being followed.

Data show New Jersey leads the nation in the number of psychiatrists, with the percentage of need met at more than 72%. Provider access has also recently gotten a boost with New Jersey joining interstate compacts for psychology and counseling. Legislation to join the Social Workers interstate compact has passed the Assembly and is now under consideration in the Senate.

Camarda said these kinds of compacts can help both patients and providers.

"It might be a situation where military families have to move periodically," he said, "and so a spouse might have a counseling role in one state and have to move to a different state, but they would like to still be able to practice their counseling services with some of the same people."

While interstate compacts may help improve access for patients in the state, these compacts also open up New Jersey-based practitioners to serve patients in other states.

Some 125,000 children in Michigan struggle with major depression, which can hinder learning, behavior and relationships, according to a recent survey. Research shows the benefits of school-based services to connect them with the care they need.

Together with parents, school mental health resources can help keep kids safe.

Scott Hutchins, who manages the behavioral health unit for the Michigan Department of Education, stresses the importance of these services, especially in light of the pandemic and school shootings.

"Those needs have only been exacerbated since COVID and those other violent tragedies," he said. "So, what mental-health services do is, they allow us to break down the barriers that students need to get the care that they need."

However, the state needs more of these professionals. Michigan has one school psychologist per almost 2,200 students. The recommended ratio is one for every 500 students. The state also requires school districts to include suicide-prevention hotline contact information on IDs for students in grades 7 through 12.

Statistics show youths receiving school-based mental-health services are six times more likely to complete treatment than those receiving community-based services.

Angela Kimball, chief advocacy officer for the nonprofit mental health advocacy group Inseparable, noted that funding is one key challenge in expanding the school mental-health workforce.

"In order to become a licensed professional," she said, "you not only have to pay for schooling, but there's also periods of supervision - where people are essentially working for free and having to pay for supervision as they work towards their credentials."

Kimball said groups like hers are pushing for policies to improve staff ratios and encourage people to consider mental-health careers. In the meantime, if you or someone you know is in crisis, call 988 to be connected with a trained counselor, available 24/7.

About half of youths experiencing depression in Illinois are not receiving treatment. While the state ranks fairly well nationwide when it comes to youth mental health, officials say there is room for improvement.

Andrea Durbin, CEO, Illinois Collaboration on Youth, said anxiety and depression are at an all-time high, especially with LGBTQ youths and those in immigrant families.

"This is a time for us to be compassionate and empathetic and to embrace folks who are feeling this way and to be supportive, and understand where this is coming from and what our responsibility as adults is to protect them," she said.

The state's Children's Behavioral Healthcare Transformation Initiative passed in 2022. It emphasizes the importance of proactive mental-health screening in schools, similar to vision and hearing tests. Now, a new state law requires yearly mental-health screenings for seventh through 12th grade students.

Despite this progress, barriers to community-based mental-health services for youths still exist and include cost, transportation, insurance issues and stigma.

Angela Kimball, chief advocacy officer with Inseparable, said school-based services that provide different levels of support are one of the most effective tools for supporting student mental health and improving access to care.

"We are starting to see some improvements in student mental health, and that's very encouraging, but the need is still very, very high," she explained. "So we can't let our foot off the pedal now. We really need to do everything we can to build the workforce and to make sure students are supported."

She said youth who get school-based services are six times more likely to complete treatment and have improved long-term education and work outcomes. Yet currently, most state schools don't have the recommended ratio of mental-health staff to students. State-funded programs such as the Behavioral Health Workforce Center are working to address the provider shortage. Kimball added that state policies and initiatives that continue to provide solutions to any roadblocks to mental-health services are crucial to providing youths the care they need.

More than 3 million New Yorkers have a diagnosed mental illness but only around one in three can get the care they need to treat it.

The barriers stem from many factors, like so-called "fail first" policies, which require people to try an insurer-preferred medication first, before covering the original prescription.

Matthew Shapiro, senior director of government and cultural affairs for the New York State Chapter of the National Alliance on Mental Illness, said another issue is what are known as "ghost networks."

"In some cases, up to 75% of providers that the insurance company gives to their client don't actually exist," Shapiro pointed out. "They're no longer practicing in the area. We call that 'ghost coverage,' where they're telling you coverage is there and it's not."

A 2023 New York State Attorney General report found 86% of providers listed on health plan networks are not valid listings. The report recommended state regulators crack down on insurers to maintain consistent and accessible levels of care for all. Another barrier is low mental health care reimbursement rates for providers.

As mental health issues rise nationally, insurance coverage needs to meet the moment. Federal laws like the Mental Health Parity and Addiction Equity Act and the Affordable Care Act ensure behavioral health coverage is on par with other health care.

David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said loopholes in the laws still have to be closed.

"What mental health advocates across the country and in states are pushing for is to make sure when a doctor is recommending treatment, the health plan has to cover those services when they're consistent with what the standards of care are," Lloyd explained.

The biggest challenge to closing loopholes is lawmakers finding the political will to do so. Lloyd added the overall goal is to align providers' and insurers' standards of care, so patients get the treatment they need.