3. Maine
> Pct. of adults with serious mental illness: 5.2%
> Total adults with serious mental illness: 56,000 (11th lowest)
> Pct. of adults abusing alcohol or illicit drugs: 8.2% (8th lowest)
> Poverty rate: 13.9% (22nd lowest)

Maine is one of only four states where an estimated more than one in every 20 adults suffer from serious mental illness. Accounting for less serious forms of psychiatric illness, more than one in every five adults report some form of mental illness, the seventh largest proportion in the country. Roughly 87,000 Maine adults reported at least one major depressive episode within the past year, or 8.1% of the population, the highest percentage of all states.

Residents of rural areas not only need to travel further to health facilities, but also they may be more vulnerable to social isolation — a major driver and component of a number of mental illnesses. High proportions of Mainers live in very rural areas, which may help partially explain the state’s high prevalence of serious mental illness.

2. Vermont
> Pct. of adults with serious mental illness: 5.3%
> Total adults with serious mental illness: 27,000 (5th lowest)
> Pct. of adults abusing alcohol or illicit drugs: 10.1% (5th highest)
> Poverty rate: 12.0% (13th lowest)

Approximately 27,000 Vermonters are beset with serious mental illnesses, comprising 5.3% of the state’s adult population, the second highest percentage of all states. Mental illness in the United States has been largely misunderstood, underfunded, and under-treated — even for those with health insurance. In Vermont, however, the legislature last year enacted Senate Bill 139, a law intended to improve access to and quality of mental health services. Health insurance coverage in the state, which at about 93% is nearly the highest in the nation, may in the future be more valuable to the mentally ill. The state also enacted a law in 2015 prohibiting some state residents from possessing firearms due to mental illness.

People with mental health disorders are more likely to abuse alcohol or other substances than individuals without serious mental illnesses. Of adults in Vermont, 10.1% report abusing or dependence on alcohol or illicit drugs, the fifth highest share nationwide.

1. West Virginia
> Pct. of adults with serious mental illness: 5.4%
> Total adults with serious mental illness: 79,000 (15th lowest)
> Pct. of adults abusing alcohol or illicit drugs: 9.2% (19th highest)
> Poverty rate: 18.1 (10th highest)

Serious mental illness is treated with therapy, as well as with drugs such as anti-psychotics, anti-depressants, and mood stabilizers. In West Virginia, 21.8 medications are prescribed per resident in a single year, the second highest per capita prescriptions in the country and significantly higher than the national level of 12.7 prescriptions per capita. The 9.2% share of West Virginia adults dependent on illicit drugs or reporting alcohol abuse within the past year, while slightly higher than the national prevalence, is not especially high. However, 2.6% of adults in the state report needing but not receiving treatment for illicit drug use, the fourth highest such percentage nationwide.

According to the CDC, psychological distress is far more common among people living in poverty than it is among financially stable individuals. The typical West Virginia household earns $41,576 annually, nearly the lowest median household income in the nation. The poverty rate of 18.1% is also among the highest in the country. Such conditions may have contributed to the high prevalence of serious mental illness in the state.