The U.S. employs about 795,000 core behavioral health clinicians (counselors, mental health social workers, marriage and family therapists, psychologists and psychiatrists) for 60 million adults with a mental illness, roughly 76 adults per clinician. About 151 million people, 44% of the country, live in a federally designated mental health shortage area. The gap is widest in Georgia, Nevada, Texas and Mississippi by clinicians per resident, and in Montana, Wyoming and South Carolina by share of residents in shortage areas. Counselor jobs are projected to grow 18% by 2035, five times the rate for all jobs, and every one of those hires has to get licensed first.
Most workforce statistics in behavioral health get repeated without a source or a date. We went to the federal datasets directly: the Bureau of Labor Statistics for who is employed, SAMHSA’s National Survey on Drug Use and Health for who needs care, HRSA for where shortages are formally designated, and CDC for outcomes. Every figure below links back to its source, and the state table at the bottom can be sorted by any column.
The national picture
BLS counted 491,930 substance abuse, behavioral disorder and mental health counselors, 132,810 mental health and substance abuse social workers, 75,990 clinical and counseling psychologists, 66,740 marriage and family therapists and 27,980 psychiatrists in May 2025. Together that is 795,450 people, or one for every 430 U.S. residents. Counselors are six in ten of them, which is why counselor licensure has more effect on access than any other single credential.
On the demand side, SAMHSA estimates that 23.1% of adults, 60.1 million people, had a diagnosable mental illness in the past year, and 5.6% had a serious mental illness. Another 48.4 million people aged 12 and older had a substance use disorder, and 81% of those who needed substance use treatment did not get it. Divide adults with a mental illness by the core workforce and you get about 76 per clinician nationally. That ratio ignores that some people need no treatment and some clinicians are part time, but it is a consistent way to compare states.
HRSA’s shortage designations tell the same story from the other direction. As of September 29, 2026 there were 7,022 active mental health Health Professional Shortage Area (HPSA) designations. The geographic and population designations cover about 151 million people, and HRSA calculates that about 7,000 additional practitioners would be needed just to lift them. HRSA’s own figure at the end of 2025 was about 137 million people, so the covered population is still growing.
Demand for care is rising faster than the illness rate
CDC’s National Health Interview Survey shows where the pressure is coming from. The share of adults who got counseling or therapy from a mental health professional rose from 9.5% in 2019 to 14.0% in 2024, a 47% increase in five years. Among adults 18 to 34 it went from 12.0% to 20.2%. Over the same years the share of adults who regularly feel anxious moved only from 11.1% to 12.2%, and the share who regularly feel depressed stayed near 5%. More people are seeking care, from a workforce that has not grown at that pace.
Need is uneven inside states, too. CDC’s PLACES county estimates put frequent mental distress (14 or more bad mental health days in the past month) at 11.5% of adults in the least affected counties and 25.7% in the most affected; nationally about 41 million adults report it. Our county need lookup returns any county’s figures with citations you can use in a grant narrative.
The strain shows up in emergency departments. From September 2025 through August 2026, visits for suspected suicide attempts among 12 to 17 year olds made up 854 of every 100,000 ED visits, 63% above the 2019 rate, according to CDC’s National Syndromic Surveillance Program.
Where the gap is widest
By clinicians per resident, the thinnest workforces are in the South and the interior West. Georgia has one core clinician for every 903 residents, more than twice the national rate, followed closely by Nevada and Texas. At the other end, Massachusetts has one for every 237 residents and California one for every 265.
By share of residents living in a shortage area, the ranking looks different. In 24 states, at least half of residents live in a mental health HPSA. Montana’s designations cover its entire population, Wyoming and South Carolina are at 96%, and Indiana is at 93%.
In absolute terms, the most practitioners needed to lift designations are in Florida (622), California (604) and Texas (599), followed by Illinois (374).
Why the two rankings disagree
Utah is a good example. It has one core clinician for every 315 residents, better than most states, yet 84% of Utahns live in a mental health shortage area. The two measures count different things. HPSA designations are scored mainly on the ratio of residents to psychiatrists within a defined service area, and they are drawn around rural counties, low-income populations and safety-net facilities. The BLS ratio counts the whole licensed-track workforce across the state, most of it concentrated in metro areas.
So a state can have plenty of counselors in its cities and still have most of its counties formally short of psychiatric care. For hiring and grant writing, the useful question is usually the local one: is your service area designated, and how many licensed clinicians can you realistically recruit into it? The states that rank poorly on both measures, Nevada, Mississippi, South Carolina and New Mexico, have the hardest version of the problem.
Look up your state
The pipeline is the constraint
BLS projects employment of substance abuse, behavioral disorder and mental health counselors to grow from 533,400 to 631,400 between 2025 and 2035, an 18.4% increase with about 50,500 openings a year. Marriage and family therapists are projected to grow 13.5%, clinical and counseling psychologists 11.8%, and mental health and substance abuse social workers 10.3%. All occupations combined are projected to grow 3.5%.
Every one of those openings needs a graduate degree, two to four years of supervised practice in most states, and a passing score on a national licensing exam. Our comparison of 306 licensure pathways found supervision floors that vary widely by state, and first-time pass rates on the major exams leave a meaningful share of candidates retesting. Associates who stall at the exam stay on the payroll at a lower billing rate, or leave the field. The fastest way to add capacity in a shortage area is often to license the associates you already employ.
What employers and programs can do with this
- Use the state and HPSA figures in grant narratives. HRSA and SAMHSA workforce funding asks applicants to document need. Designation status, practitioners needed and the local clinician ratio are the numbers reviewers expect, and they are public.
- Check whether your sites are designated. Clinicians working at National Health Service Corps approved sites in HPSAs can qualify for federal loan repayment, which is a recruiting tool most job posts never mention. HRSA’s shortage area lookup checks any address.
- Budget for licensure, not only hiring. Exam prep and supervision support are allowable costs in several federal workforce programs. Our grant-funded programs page has the language funders accept.
Every state, sortable
Select a column heading to sort. Frequent mental distress is the share of adults reporting 14 or more days of poor mental health in the past month (CDC BRFSS 2024; Tennessee*, which has no 2024 BRFSS estimate, and the U.S. row use CDC PLACES county estimates). A dagger (†) marks states where BLS did not publish one or more of the five occupations; those are counted as zero, so the clinician count is slightly low.
| Alabama † | n/a | n/a | n/a | 60% | 148 | 23.0% | 15.9 | 18.0% |
| Alaska | 1,690 | 436 | 76 | 83% | 26 | 24.0% | 30.6 | 15.7% |
| Arizona † | 14,790 | 515 | 97 | 53% | 202 | 24.6% | 18.9 | 14.2% |
| Arkansas | 4,210 | 740 | 147 | 37% | 52 | 26.6% | 18.7 | 19.9% |
| California | 148,700 | 265 | 44 | 31% | 604 | 21.6% | 9.5 | 14.9% |
| Colorado | 18,900 | 318 | 64 | 67% | 126 | 26.4% | 21.1 | 15.2% |
| Connecticut | 10,560 | 349 | 65 | 52% | 113 | 23.7% | 9.2 | 13.9% |
| Delaware | 2,990 | 354 | 61 | 48% | 47 | 22.1% | 12.3 | 16.1% |
| District of Columbia † | 2,300 | 302 | 70 | 18% | 8 | 29.0% | 5.5 | 13.3% |
| Florida | 40,800 | 575 | 93 | 52% | 622 | 20.8% | 13.7 | 15.6% |
| Georgia † | 12,520 | 903 | 169 | 50% | 183 | 25.2% | 14.1 | 16.1% |
| Hawaii † | 2,750 | 521 | 79 | 34% | 19 | 19.8% | 13.9 | 12.6% |
| Idaho | 4,050 | 501 | 90 | 63% | 55 | 24.5% | 20.2 | 15.6% |
| Illinois | 31,250 | 407 | 69 | 68% | 374 | 22.2% | 10.9 | 13.0% |
| Indiana | 17,150 | 407 | 77 | 93% | 233 | 25.3% | 16.7 | 16.9% |
| Iowa | 5,580 | 580 | 110 | 59% | 83 | 25.0% | 15.7 | 14.9% |
| Kansas | 4,870 | 611 | 107 | 40% | 50 | 23.7% | 18.3 | 15.9% |
| Kentucky | 10,250 | 449 | 85 | 60% | 144 | 25.3% | 18.0 | 18.4% |
| Louisiana † | 7,800 | 592 | 106 | 62% | 125 | 24.1% | 13.5 | 19.8% |
| Maine † | 4,050 | 349 | 75 | 33% | 23 | 26.7% | 16.8 | 16.4% |
| Maryland | 15,040 | 417 | 72 | 45% | 136 | 22.7% | 9.7 | 14.2% |
| Massachusetts | 30,150 | 237 | 47 | 8% | 25 | 24.9% | 7.8 | 13.3% |
| Michigan | 18,040 | 561 | 103 | 46% | 185 | 23.6% | 13.6 | 17.0% |
| Minnesota | 17,440 | 334 | 57 | 46% | 119 | 22.5% | 14.0 | 14.0% |
| Mississippi | 3,470 | 851 | 130 | 78% | 98 | 20.5% | 15.2 | 13.5% |
| Missouri | 11,240 | 558 | 109 | 43% | 136 | 25.7% | 18.2 | 17.5% |
| Montana † | 2,810 | 407 | 80 | 100% | 52 | 25.6% | 25.7 | 16.3% |
| Nebraska | 4,280 | 471 | 83 | 53% | 29 | 24.1% | 15.9 | 13.4% |
| Nevada † | 3,680 | 892 | 168 | 82% | 177 | 24.6% | 18.4 | 18.1% |
| New Hampshire | 4,500 | 315 | 70 | 11% | 5 | 27.7% | 16.4 | 15.0% |
| New Jersey | 24,660 | 387 | 53 | 8% | 29 | 18.1% | 6.7 | 13.2% |
| New Mexico † | 3,380 | 629 | 116 | 76% | 80 | 23.9% | 23.4 | 18.2% |
| New York | 54,910 | 364 | 62 | 20% | 243 | 21.9% | 8.3 | 14.2% |
| North Carolina | 18,780 | 596 | 96 | 36% | 221 | 21.4% | 14.3 | 14.7% |
| North Dakota † | 1,700 | 470 | 79 | 58% | 18 | 23.0% | 18.1 | 12.6% |
| Ohio | 27,300 | 436 | 80 | 45% | 218 | 23.9% | 14.7 | 17.0% |
| Oklahoma † | 7,960 | 518 | 86 | 62% | 115 | 22.6% | 20.0 | 18.6% |
| Oregon | 12,210 | 350 | 88 | 39% | 80 | 31.6% | 20.4 | 19.0% |
| Pennsylvania | 40,440 | 323 | 60 | 7% | 36 | 23.9% | 13.9 | 16.0% |
| Rhode Island † | 3,660 | 305 | 62 | 37% | 15 | 25.8% | 8.3 | 14.5% |
| South Carolina † | 7,600 | 733 | 109 | 96% | 227 | 19.8% | 15.9 | 15.2% |
| South Dakota | 2,200 | 425 | 68 | 70% | 34 | 21.8% | 22.8 | 13.8% |
| Tennessee | 14,290 | 512 | 104 | 41% | 217 | 27.0% | 17.2 | 19.3%* |
| Texas | 36,330 | 873 | 130 | 44% | 599 | 20.7% | 14.0 | 15.7% |
| Utah | 11,230 | 315 | 60 | 84% | 90 | 26.7% | 19.7 | 15.5% |
| Vermont † | 1,710 | 377 | 90 | 0% | 0 | 29.1% | 18.2 | 15.1% |
| Virginia | 25,050 | 354 | 62 | 25% | 128 | 23.1% | 12.5 | 15.7% |
| Washington † | 19,370 | 413 | 88 | 70% | 248 | 27.9% | 15.0 | 16.3% |
| West Virginia | 3,620 | 488 | 108 | 45% | 89 | 28.1% | 16.2 | 19.3% |
| Wisconsin | 12,100 | 494 | 94 | 29% | 69 | 24.5% | 14.2 | 17.2% |
| Wyoming † | 1,160 | 508 | 96 | 96% | 22 | 24.7% | 27.7 | 15.4% |
| United States | 795,450 | 430 | 76 | 44% | 6,978 | 23.1% | 13.7 | 16.5% |
How we built this
Core behavioral health clinicians are the sum of five BLS occupations: substance abuse, behavioral disorder and mental health counselors (SOC 21-1018), marriage and family therapists (21-1013), mental health and substance abuse social workers (21-1023), clinical and counseling psychologists (19-3033) and psychiatrists (29-1223). BLS OEWS counts wage and salary jobs, so self-employed clinicians in private practice are not included, which understates every state by a few percent. Adults with a mental illness are SAMHSA’s model-based state totals for 2023–2024; state estimates carry confidence intervals, so small differences between states are not meaningful. Shortage-area population and practitioners needed sum HRSA’s geographic, population and high-needs geographic mental health HPSAs in Designated or Proposed for Withdrawal status, the same statuses HRSA counts in its own summaries. Suicide rates are CDC provisional age-adjusted rates for the 12 months ending in the second quarter of 2025, the most recent period with state detail.
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See Employer Solutions →Sources & further reading
- U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025 (state and national estimates). bls.gov
- U.S. Bureau of Labor Statistics, Employment Projections 2025–2035, Table 1.2. bls.gov
- SAMHSA, 2023–2024 NSDUH: Model-Based Estimated Prevalence for States and estimated totals tables. samhsa.gov
- Health Resources and Services Administration, HPSA Detail, Mental Health (data download, pulled September 29, 2026). data.hrsa.gov
- HRSA, Find Shortage Areas by Address. data.hrsa.gov
- U.S. Census Bureau, State Population Estimates, Vintage 2025. census.gov
- CDC, Behavioral Risk Factor Surveillance System: Mental Health Indicators (2024). data.cdc.gov
- CDC National Center for Health Statistics, National Health Interview Survey: Mental Health Indicators (2019–2024). data.cdc.gov
- CDC, PLACES: Local Data for Better Health, County Data (2025 release). data.cdc.gov
- CDC National Syndromic Surveillance Program, Mental Health-Related Emergency Department Visit Rates (through August 2026). data.cdc.gov
- CDC National Center for Health Statistics, Quarterly Provisional Estimates for Selected Indicators of Mortality. data.cdc.gov
- KFF, Mental Health Care Health Professional Shortage Areas (HRSA data as of December 31, 2025). kff.org
- Triad, How Long Does Licensure Take? Supervision Timelines Across All 51 US Jurisdictions. triadhq.com/blog
- Triad, Licensure Exam Pass Rates. triadhq.com/pass-rates
All data in this article comes from U.S. federal agencies and was pulled or verified on September 29, 2026; the CDC mental health figures were added October 8, 2026. Ratios, rankings and totals across datasets are Triad’s calculations.