Dallas Ranks #1 in the Country, But Not for the Reason You Might Think
Behavioral Health
June 28, 2022
Dallas Ranks #1 in the Country, But Not for the Reason You Might Think
Stressed woman in the car

A recent study by CertaPet ranked Dallas as the city with the worst mental health in the U.S. And it doesn’t stop there. Three other Texas cities (Houston, San Antonio, and Austin) were also included in CertaPet’s Top 10 list. So why does Texas have four spots on this list of cities with the worst mental health? Dustin Webb, a licensed clinical social worker and administrator of behavioral health for Texas Health Dallas weighs in on the subject.

The Study

The CertaPet researchers decided the most efficient way to go about ranking the best and worst cities for mental health was by identifying which factors would contribute to mental health, such as access to and the cost of mental health care, as well as the overall quality of life in each state.

They used seven factors in total and they ranged from things like therapy session rates to prescription costs, from the number of residents per one mental health provider to the overall well-being of the community.

Finally, a specific weight was given to each factor and they tallied up the scores for each city. The highest score a city could receive was 50 points.

Here’s the lineup:

  • Denver, CO was named the best city for mental health in the U.S., with 40 points.
  • Out of the Top 10 U.S. cities for worst mental health, Dallas, TX ranked number one, with a score of 23.5.
  • Texas cities Houston, San Antonio, and Austin took the second, fourth, and ninth spots respectively on the list of worst cities for mental health. 
    • Houston’s score was 23.7, San Antonio was at 24.9, and Austin was at 26.5.

“I wouldn’t say I was surprised [to see the findings],” Webb admits. “I’ve seen several approaches to measuring the mental health care delivery system for the country and in Texas. In most approaches, the gaps in our system in Texas contribute to a low ranking.”

Why Texas Is Hit So Hard

“Texas has the highest uninsured rate in the country,” says Webb. “Additionally, people with mental illness are insured at lower rates compared to other citizens.”

The fact of the matter is that uninsured individuals are less likely to seek out and receive mental health treatment.

And not only that, Webb says that nationally, Texas is in the bottom third for Medicaid share.

“Texas doesn’t take as many opportunities to enroll more people in Medicaid compared to some other states.”

When you look at those factors alone, it’s easy to see why many Texans aren’t able to access the resources they need.

The next thing to look at is high costs. 

According to CertaPet, prescription costs in Texas are at an all-time high, contributing significantly to the low scores for the four cities that made the list.

Treatment in general, for mental health or otherwise, is costly.

“Texas does not enforce patient responsibility financial maximums to the degree that other states do, so it can be more expensive here compared to other states like, say, Colorado,” Webb explains.

Another piece of the puzzle is the fact that there is a shortage of mental health providers in Texas. 

“I heard in conversation recently that estimates are that we are 600 psychiatrists short of what we would need to meet the demand in the state,” he adds. “That’s not accounting for the rapid population growth we are seeing.”

It’s impossible for higher-education schools to keep up with the ever-growing need for mental health providers.

And speaking of mental health providers, Webb states that many are electing to drop insurance panels and instead move to private practices. By doing this, they can see fewer patients and avoid dealing with insurance companies, all while making the same amount of money, and sometimes even more.

Webb mentions that this isn’t a problem unique to Texas, but it does exacerbate an already difficult situation and prevents even more people from getting the help they need.

Lastly, Texas’s mental health treatment laws are average at best, and instead of treating individuals with severe mental illness, they often end up being incarcerated at high rates.

“What happens is that people experiencing a mental health crisis are often picked up by police and taken to a local jail if their behavior is conveyed as assaultive or if it’s associated with a crime that has been committed,” explains Webb.

Some credit should be given though, he notes, since state and local governments have been working with law enforcement to prevent this from happening so frequently. 

“Police have been given more training on assessing mental health crises and on de-escalation. Some areas have formed crisis teams staffed by therapists and nurses that respond to calls with the police.”

Mental Health Care for Texans

So what does Webb recommend for those in Texas who are seeking mental health care?

He admits that he knows how hard it is to find treatment. Many people give up trying to find mental health care on their own due to how difficult it is. But he says that knowing where to start is important.

“All counties in Texas have a Local Mental Health Authority or Local Behavioral Health Authority who are responsible for making sure that its residents can access mental healthcare.”

Webb says they can help you find resources to start, or if they aren’t able to help you directly, they will get you in contact with someone who can. 

“Substance Abuse and Mental Health Services Administration has a great treatment locator for those who want to look online. Other organizations like the National Alliance on Mental Illness, the Depression Bipolar Support Alliance, [or] Mental Health America can help with the search as well.”

Finally, Webb advocates for programs like the one offered at Texas Health Behavioral Health, where intakes are provided free of charge. 

Intakes are helpful for individuals to determine what type of treatment they need and with whom, which is a key place to start.


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