Report cards are out: Most states get a poor or failing grade foremergency and mental health care

A state-by-state survey conducted by the American College of Emergency Physicians (ACEP) has found widespread gaps in emergency care in the United States. Access to emergency care is seriously limited in many states, with no excess capacity to cope with disasters and with frequent shunting of patients from one hospital to another when emergency department beds are full, as they often are.¹

On the ACEP's report card, the emergency medicine system of the United States as a whole earned a grade of "C-." No state scored either an "A" or an "F" for its overall grade. California, Massachusetts, Connecticut, and the District of Columbia led the nation with an overall grade of "B." Rating worst in the nation with overall grades of "D+" or "D" were Alabama, Arizona, Arkansas, Idaho, Indiana, New Mexico, Oklahoma, South Dakota, Utah, Virginia, Washington, and Wyoming. More than 80% of states earned poor or near-failing overall grades ("C+" to "D").

States did just as badly on a national survey of mental health care, conducted by the National Alliance on Mental Illness (NAMI).² That state-by-state analysis of mental health care systems is the first to be undertaken in 15 years. Every US state was scored on 39 specific criteria, resulting in an overall grade and four subcategory grades for each state. The national average grade is "D." Five states received a grade in the "B" range, eight received an "F", and none received an "A."

1. American College of Emergency Physicians. The national report card on the state of emergency medicine. Available at: http://my.acep.org/site/PageServer?pagename=wp1_state_national. Accessed April 11, 2006

2. National Alliance on Mental Illness. Grading the states 2006 report. Available at: http://www.nami.org/gtstemplate.cfm?section=grading_the_states&lstid=681. Accessed April 11, 2006