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DENVER (KDVR) — Colorado is one of the lowest-ranked states for mental health, according to a survey by Mental Health America, in part because it is the state with the highest percentage of adults facing a substance abuse problem.

Overall, Colorado ranks 46th in the nation for mental health. Only Alaska, Oregon, Idaho and Nevada rank worse.

Mental Health America, a Virginia-based non-profit, analyzed 15 different metrics for each U.S. state to give them overall mental health rankings. It addresses post-pandemic mental health statistics, but the state-by-state rankings were compiled from survey responses through 2018.

MHA’s data came from national surveys from the U.S. Department of Education, the U.S. Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration.

As with-all survey data, MHA acknowledges that its data isn’t intended to be a definitive source of all things mental health in the U.S., but rather a good guide. Self-reported data is not accurate in the way diagnostic data is, but paints a broad picture.

The results “are not a complete picture of the mental health system,” wrote MHA, but “they do provide a strong foundation for understanding the prevalence of mental health concerns, as well as issues of access to insurance and treatment, particularly as that access varies among the states.”

Colorado ranks 31st in MHA’s access to care portion, near the middle of the pack. Where it really stands out is in mental health prevalence.

Colorado has a higher percentage of adults with substance abuse disorders than any U.S. state, and that by a fair margin. Almost 12% have a problem, which is 1.5% higher than Vermont, the next-closest state.

This isn’t the only area Colorado has one of the worst national ranks. It is near the bottom of the pack in adult mental health, adult suicidal ideation and youth substance abuse as well.

Colorado has one-fifth of its adults in distress, with 21.5% having some kind of mental illness. This is the eighth-highest in the country.

Colorado’s adults are also having thoughts of self-harm more than most. The state ranks third for the highest percentage of adults who have had serious thoughts about suicide with 5.5%.

Youth have some slightly cheerier outcomes.

Colorado ranks 23rd-lowest for youth with major depression and 12th-lowest for the percentage of youth that have had a severe major depressive episode.

Still, substance abuse seems not to know any age in the Centennial State. Colorado has the third-highest rate of youth with substance disorders. One out of every 20 Colorado youths reports a substance use disorder.