2025 Youth Mental Health Care Deserts: A National Look at Therapy Staffing Gaps in Schools
Students are reporting higher levels of anxiety, depression, and emotional distress than ever before. Yet, in too many parts of the country, there is simply no one at school to help.
School psychologists, counselors, therapists, and social workers are often a student’s first, most accessible, and sometimes only line of support. But across the nation, a growing number of schools are facing a stark reality: they do not have enough qualified professionals to meet the needs of their students. In rural and underserved areas, shortages have created regions of youth mental health care deserts, where students who need this support overwhelm the supply of qualified professionals.
These deserts aren’t caused by a lack of demand, but by barriers in access, from geographic isolation and hiring difficulties to widespread shortages in available talent. When schools can’t find or retain the therapy professionals they need, students pay the price, and that cost often shows up in chronic absenteeism, academic decline, and behavioral issues.
At VocoVision, our mission is to ensure that every student, regardless of where they live, can access the services they need to thrive. To identify where access to youth mental health support is most lacking and to shine a spotlight on the severity of this national issue, we are releasing our 2025 Youth Mental Health Deserts findings.
About the Research
To understand where student therapy access is most lacking, VocoVision developed a state-by-state index using the latest available data from federal agencies, including the U.S. Department of Education, HRSA, SAMHSA, and CMS. The index combines seven weighted factors across three key categories: youth mental health needs, access to care, and in-school support staffing.
The chosen indicators consider the diverse sources of staffing shortages, ranging from rates of untreated youth mental health issues to rural school enrollment and school psychologist staffing ratios. Each factor was scored and scaled to create a comparative ranking, revealing which states face the most critical gaps in school-based therapy support.
Youth Mental Health Care: Top 5 Deserts
The following five states emerged as the most in need of immediate intervention. Education departments in these states are struggling with a combination of limited provider availability and rural populations that compound access issues for students in crisis.
Alabama
- School Psychologist Ratio: Alabama ties with Mississippi and New Mexico for the worst ratio in the nation, with over 7,500 students for every school psychologist.
- School Counselor Shortage: Alabama experiences the 12th-worst school counselor staffing shortage, meeting only 80% of projected demand—a 1 in 5 shortage across the state.
- Unserved Youth in Crisis: Over half (58.7%) of youths who experienced a major depressive episode in the past year did not receive any mental health services, the 14th highest rate of untreated youth nationwide.
- Mental Health Provider Ratio: Alabama has the most severe provider shortage in the U.S., with just one provider for every 846 residents.
- Rural Student Population: Nearly 4 in 10 students (39.4%) attend school in rural areas, where in-person mental health support is often unavailable—the 7th highest rural enrollment rate nationally.
Mississippi
- School Psychologist Ratio: Like Alabama and New Mexico, Mississippi has more than 7,500 students per school psychologist, making it one of the three worst states for in-school psychological support.
- Mental Health Provider Ratio: Mississippi has the 10th most severe shortage, with one provider per 543 people.
- Rural Student Population: Nearly half (47.5%) of Mississippi students attend rural schools—the 3rd highest rural rate in the nation—compounding access issues in already underserved areas.
New Mexico
- School Psychologist Ratio: New Mexico shares a severe lack of school psychologist staffing with Alabama and Mississippi, with over 7,500 students per psychologist.
- School Counselor Shortage: New Mexico ranks 2nd nationally for shortage severity, with only 57% of projected counselor staffing needs met—a 43% shortfall.
- Unserved Youth in Crisis: An alarming 7 in 10 students (69.6%) who faced a major depressive episode in the past year did not receive any care, placing New Mexico at 4th highest for untreated youth in crisis.
Arizona
- School Counselor Shortage: Arizona ranks 3rd worst, filling only 60% of school counselor demand—a 2 in 5 shortage across schools.
- Unserved Youth in Crisis: More than two-thirds (67.2%) of Arizona youths who experienced a mental health episode in the past year did not receive support, ranking 7th highest in the nation.
- Difficulty Accessing Youth Mental Health Care: Nearly 1 in 3 parents (33.7%) reported difficulty getting their child the mental health care they needed—the 5th highest rate nationally.
- Mental Health Provider Ratio: Arizona faces the 4th worst provider access, with one mental health provider per 662 residents.
West Virginia
- School Psychologist Ratio: With 1 psychologist per 1,791 students, West Virginia has the 15th most strained psychologist-to-student ratio in the U.S.
- Mental Health Provider Ratio: Ranks 3rd worst nationally, with one provider per 670 people.
- Rural Student Population: Approximately 42.6% of students attend rural schools—the 5th highest rate in the country—exacerbating access issues in isolated communities.
Ranked: School Mental Health Shortages by State
Explore how the states compare for youth mental health support and access to crucial school professionals:
| Rank | State | Shortage Score |
|---|---|---|
| 1 | Alabama | 66.10 |
| 2 | Mississippi | 62.91 |
| 3 | New Mexico | 58.70 |
| 4 | Arizona | 57.62 |
| 5 | West Virginia | 56.03 |
| 6 | Indiana | 55.32 |
| 7 | Iowa | 53.52 |
| 8 | North Dakota | 52.49 |
| 9 | South Dakota | 52.00 |
| 10 | Missouri | 51.10 |
| 11 | Kansas | 50.64 |
| 12 | Minnesota | 49.72 |
| 13 | Texas | 49.31 |
| 14 | Florida | 49.30 |
| 15 | Tennessee | 49.17 |
| 16 | South Carolina | 48.51 |
| 17 | Nevada | 48.49 |
| 18 | Arkansas | 47.79 |
| 19 | Michigan | 46.22 |
| 20 | Idaho | 46.20 |
| 21 | Georgia | 45.41 |
| 22 | Maine | 45.19 |
| 23 | Kentucky | 44.86 |
| 24 | Montana | 44.49 |
| 25 | Vermont | 44.12 |
| 26 | Wisconsin | 43.98 |
| 27 | Washington | 43.74 |
| 28 | Alaska | 43.43 |
| 29 | Oklahoma | 43.41 |
| 30 | Utah | 43.17 |
| 31 | New Hampshire | 42.43 |
| 32 | Oregon | 41.82 |
| 33 | Hawaii | 41.69 |
| 34 | North Carolina | 39.70 |
| 35 | Nebraska | 39.37 |
| 36 | Virginia | 39.31 |
| 37 | Ohio | 37.24 |
| 38 | Colorado | 36.56 |
| 39 | Pennsylvania | 35.12 |
| 40 | Delaware | 34.98 |
| 41 | California | 34.94 |
| 42 | New Jersey | 34.60 |
| 43 | New York | 33.24 |
| 44 | Wyoming | 33.22 |
| 45 | Louisiana | 32.75 |
| 46 | Rhode Island | 31.69 |
| 47 | Maryland | 30.46 |
| 48 | Massachusetts | 30.21 |
| 49 | Illinois | 27.87 |
| 50 | Connecticut | 27.73 |
Closing the Gap
At VocoVision, our goal is to drive conversation and awareness to help schools, families, and community members on unique school staffing solutions designed to bring critical care to the students who need it most.
To close the youth mental health gap, districts must think beyond traditional staffing models. VocoVision helps schools overcome geographic and hiring barriers by connecting them with qualified, licensed school therapy professionals who work remotely, ensuring that no student goes without support simply because of where they live.
Whether your district is facing long-standing vacancies or seeking flexible, scalable solutions, our team is here to help you build a stronger, more accessible program. Learn more about VocoVision’s teletherapy services here.
For professionals who are passionate about making a difference, especially in underserved communities, VocoVision offers a wide range of remote therapy roles here.
Together, we can bring life-changing support to the students who need it most.
Data Sources and Methodology
To determine which states are most in need of school-based mental health professionals, VocoVision analyzed a range of data points sourced from trusted federal agencies, including the U.S. Department of Education (ED), the Health Resources and Services Administration (HRSA), and the Centers for Medicare & Medicaid Services (CMS). Each factor was weighted based on relevance and impact to create a composite score, ultimately ranking each state by its level of youth mental health access.
The index combines three key categories, Mental Health Indicators, Mental Health Access, and School Mental Health Support, outlined below:
Mental Health Indicators
- Youth Depression (10%): Percentage of children ages 3–17 diagnosed with depression.
Source: National Survey of Children’s Health, HRSA, Maternal and Child Health Bureau - Untreated Youth Depression (15%): Percentage of youths who experienced at least one major depressive episode in the past year and did not receive mental health services.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality
Mental Health Access
- Rural Student Enrollment (15%): Share of public school students enrolled in rural schools, where access to in-person professionals is often more limited.
Source: U.S. Department of Education, National Center for Education Statistics - Difficulty Accessing Youth Mental Health Care (15%): Percentage of parents reporting difficulty obtaining needed treatment or counseling for their child (ages 3–17).
Source: National Survey of Children’s Health, HRSA, Maternal and Child Health Bureau - Mental Health Provider Availability (15%): Population-to-provider ratio measuring the overall availability of licensed mental health professionals.
Source: CMS National Provider Identification Registry
School Mental Health Support
- Student-to-School Psychologist Ratio (15%): Number of students per employed school psychologist, indicating the capacity for individualized care.
Source: U.S. Department of Education, National Center for Education Statistics - School Counselor Staffing Adequacy (15%): Adequacy of school counselor staffing in 2024.
Source: HRSA, Health Workforce Projections