US State Sponsored Therapy: A Guide From The Experts

One of the first things we learned while we were researching the public mental health system in the U.S. is that there are huge differences among state mental health systems.

In some states, publicly-funded providers offer therapy to just about anyone who wants it. Other states have almost impossibly strict eligibility criteria for public mental health services.

Some states don’t offer individual therapy through their public mental health programs at all, focusing instead on providing crisis intervention and high-intensity services.

The public mental health system acts as an information clearinghouse where you can learn about local mental health resources. It’s often a great place to start when you’re looking for affordable mental health care near you.

The people who answer mental health helplines and work at walk-in clinics have comprehensive knowledge of local mental health resources. Even if you’re not eligible for public mental health services, they can often help you find other affordable options and give you free referrals.

You can find the numbers for your local, regional, and state mental health crisis and information lines in your state’s article.

These services are publicly funded. This means they are financed by Medicaid and grant funds which are in turn financed by taxes and other types of state and local revenue.

Each state’s system is managed on the state level. This means that the services the public mental health system provides, and who is eligible for them, vary widely from state to state.

In some states, the mental health system is partially or mostly privatized. This means the state mental health department licenses privately-owned agencies to provide publicly-funded services and distributes public funds to them.

In other states, the system is partly or fully public. This means the agencies that provide publicly-funded services are directly run and funded by the state and are staffed by state employees.

The community-based public mental health system in the United States has a rich history of public service dating back to the 1960s. It was designed to be, and remains, a “safety net” to get people the help they need no matter what their financial circumstances might be.

The public mental health system provides essential clinical mental health services like therapy and medication management. It also provides intensive and specialty services that aren’t available anywhere else or that are hard to find at private agencies, like assertive community treatment.

As this list shows, the public mental health system provides a comprehensive range of mental health services. Some services, like assertive community treatment, are designed primarily for people with severe mental health conditions, while some services, like therapy, serve a wider range of clients.

As part of the intake process, clinicians at publicly-funded mental health agencies help clients figure out which services they need.

In most states, public mental health services and public substance use disorder services are managed by the same state behavioral health department. While our listings focus on mental health treatment providers, some of the providers in our listings offer both mental health and substance use disorder treatment. The crisis and information lines we list provide referrals for substance use treatment as well as for mental health treatment.

Eligibility for public mental health services varies widely from state to state.

Some publicly-funded providers offer mental health services to just about anyone who wants help with a personal issue and lives in the area they serve.

Other state systems limit services to people who have severe and persistent mental illness (SPMI) and/or to people who have significantly limited financial resources. (This often means those whose income places them just above, at, or below the Federal Poverty Level).

You can find out how strict or open eligibility is in your state by checking out our article on your state’s system. Go here to find a list of links to all of our state mental health system articles.

Systems vary not just from place to place, but over time. Some state systems have changed their areas of focus, the services they offer, and their eligibility criteria in just the last ten years.

Many states cut mental health funding after the 2007-2009 recession. This means they limited or eliminated public mental health services they once provided. (On the other hand, some states increased mental health funding to address social issues that worsened after the recession.)

As a result, some publicly-funded agencies no longer offer mental health services to people with milder conditions or symptoms. Some don’t offer individual therapy at all any more. Instead, they focus on emergency services and intensive services for people with SPMI.

(So, if you just want to see a therapist once a week, you may or may not be able to do that at your local publicly-funded mental health agency. It depends on the state you live in.)

Given all these differences between states, we can’t make a single set of recommendations for everyone. However, there are some things that all (or nearly all) state systems have in common.

Publicly-funded outpatient mental health programs provide eligibility assessments, and some provide them for free. So, if you’re frustrated or stuck in your search, they can be a great place to go. Even if you’re not eligible, you can often get a referral to another affordable local provider.

Before you go, you should call the agency to explain what you’re looking for and to ask whether they can help you and give you an assessment or a referral. (Be sure to ask if the assessment is free, and if not, what it costs. Phone assessments are nearly always free.)

Many state mental health programs provide therapy to eligible clients. Some provide therapy to anyone in the local area who wants it, even if they don’t have a mental health condition and just want help dealing with everyday issues like stress or relationship conflicts.

Others only provide therapy to people with moderate to severe mental health conditions. Some don’t provide individual therapy at all.

Because publicly-funded agencies focus on clinical mental health treatment, they probably aren’t the best choice if you’re looking for a therapist to help you with personal growth goals that aren’t related to a mental health condition.

On the other hand, they can absolutely be a great choice if you need clinical treatment to address a mental health condition. Publicly-funded agencies provide updated training to clinicians to ensure they are providing effective, evidence-based services. For example, many public agencies provide the full suite of DBT services, including individual therapy, skills training, and DBT groups. This can be hard to find in the private sector.

If you want to find out about your state’s mental health system, we can’t recommend any better website than our own. That’s not really a brag—we took on this project because no other site was providing this information.

Every state mental health department has a webpage about their mental health system. However, these pages are confusing to navigate and often fail to answer important questions. Many don’t tell you who is eligible or even which providers are actually part of the public system!

We wanted to create a webpage that answered all the practical questions you might have about where to access care and whether the system is right for you. So, we did some deep research and wrote an article answering these questions for every state. Go here to find your state’s page.

From the beginning, the purpose of the public mental health system has been to provide a safety net to keep individuals and the public safe and healthy. A social safety net ensures that people who need care can get it regardless of their income or ability to pay.

Many people with serious mental illness (SMI) cannot live in the community without support. Many elements of the public system were designed with them in mind. The earliest psychiatric hospitals provided a safe place for people with SMI to live. The system we have now focused on helping people with SMI live in the community instead of in an institution.

Unfortunately, not all states have embraced this expanded vision of a mental health system that’s for everyone. Whether a state’s mental health system serves a full range of clients depends on that state’s philosophy of care and the level of funding it invests in its mental health system.

The first efforts to provide publicly-funded mental health care in the United States began in the 1800s, when the first asylums were built. Public need for mental health care inspired state governments to step in and provide public facilities for people who couldn’t afford private ones.

In the ensuing decades, these facilities were converted into state psychiatric hospitals. Some older state hospitals have been renovated and remain in use, while others have been replaced and rebuilt. They now focus on providing short-term acute care. In either case, while the type of care they provide has changed, state hospitals continue to provide publicly-funded inpatient mental health care to this day.

The shift from institutional to community-based care began in the 1950s with innovations in treatment that made it possible to manage severe mental illness outside of institutions. The shift to community care picked up pace during the deinstitutionalization movement of the 1960s.

The first publicly-funded outpatient mental health agencies in the U.S. were called community mental health centers (CMHCs). Most of them were established in the 1960s after President John F. Kennedy signed the 1963 Community Mental Health Centers Act into law. This created federal funding for states to build CMHCs or to convert established outpatient facilities into CMHCs.

As more CMHCs were built, funding for psychiatric hospitals was reduced. This was reinforced when Medicaid was established in 1965. Medicaid provides funding for community-based care but not for mental health care delivered in institutional settings.

Since the 1960s, many laws have been passed that have changed how the system is funded and run. However, the structure of the system has remained the same since the mid-1960s. States are required to provide comprehensive community-based mental health services to be able to receive matching federal funding for their public mental health programs.

In addition, states that fail to provide adequate community-based public mental health care can be found guilty of violating the 1990 Americans with Disabilities Act (ADA). With the 1999 Olmstead decision, the United States Supreme Court ruled that unnecessarily confining people with mental health conditions to institutions violates the ADA.

The main cause of the mental health crisis in America is that many states chose to reduce mental health funding in the wake of the 2007 recession, even as demand for mental health services was increasing.

Recurrent crises have spurred a flurry of efforts to update and improve public mental health services. States are seeking to make their systems more efficient so they can serve a wider range of people while controlling costs.

This is similar to what influenced system change in the 1950s and 1960s. Institutional care was not only becoming increasingly publicly unpopular, it was also becoming unmanageably expensive. Mid-century innovations in mental health treatment not only made the system more effective—they cost states less, too.

State mental health programs are using telehealth to address long-standing issues with access to care, especially in remote areas. Telehealth technology has been especially helpful in addressing the nationwide shortage of psychiatrists, which is particularly acute outside of major cities.

With telehealth technology, states can expand psychiatric and specialty care to remote locations. It also helps them cut back on travel time and costs. Many states expanded tele-mental health options in their public mental health systems during the coronavirus pandemic, and these changes look like they’re here to stay.

Thanks to the integrated care movement, states are increasingly funding efforts to embed mental health care in primary care clinics and to offer primary care in specialty mental health clinics. These efforts intensified after the passage of the 2010 Affordable Care Act, which increased funding for federally qualified health centers (FQHCs) that offer mental health care.

This has almost created a second publicly-funded mental health system, as integrated mental health services are becoming standard in FQHCs. Federally qualified health centers have been particularly effective in expanding publicly-funded mental health services to people who don’t have SMI. In fact, if your state’s traditional mental health system isn’t the right fit for you, we recommend looking up local FQHCs and learning about other integrated care providers in your area as an alternative option.

We spent over two years working on our epic project to cover the United States public mental health system. We’re proud of what we’ve accomplished. We’ve published 52 state mental health guides—one for every single state in the U.S., as well as for the District of Columbia and Puerto Rico.

When we started, we thought we could simply write an overview of the system and link to other websites that had clear information about where and how to access it. But we couldn’t—because those websites didn’t exist.

We now know why. It took a lot of time and work to answer even the most basic questions about the mental health system in the United States. Many state mental health department websites don’t even say who is eligible or the physical locations where you can go to access state-funded mental health care.

We had to read hundreds of newspaper articles, academic research papers, and e-books, along with those government websites, to figure out:

• How the system works,
• Who the system is for, and
• Where you actually go to access it.

Before us, no one had ever done that research (at least no one that we know of). While we’ve done it now, and are proud, we know we can’t rest on our laurels. It will take ongoing work to check for when there are changes to each state’s system and to update our articles accordingly.

Our ultimate hope with this project is to increase access to mental health care for people all across America. By helping us keep our pages up to date, you help us realize this vision!