That ranking is the highest among southern states, far surpassing Kentucky’s regional neighbors. Second-best in the south is Oklahoma at No. 28, followed by No. 35 Louisiana, No. 37 Virginia, No. 38 North Carolina, No. 40 Arkansas, No. 43 South Carolina, No. 45 Tennessee, No. 47 Mississippi, No. 48 Georgia, No. 49 Florida, No. 50 Alabama and No. 51 Texas.

The rankings include information such as the percentage of adults with any mental illness who did not receive treatment, those reporting an unmet need, those who are uninsured and those with a cognitive disability who could not see a doctor because of costs.

Gretchen Roof is the vice president of clinical services at Four Rivers Behavioral Health in Paducah. She said some of the common barriers to mental health care are barriers found in other aspects of everyday life.

“One of the barriers for people that I have found are just the basic barriers,” she said. “Not everybody has a car, so transportation to and from an appointment is a real challenge. Some people work one or two jobs, so they don’t have 9-to-5 schedules. Not everybody is blessed to have a job where they can just say, ‘I’m going to take two hours off and go to an appointment.’

“One of the things that I’ve seen evolve over the years — and I started working here in 2000 and I worked in a private psychiatric hospital before then — is the whole ideas of having many doors, many pathways to care, making it as easy as possible to get treatment.”

Roof said that people coming to FRBH can be a walk-in emergency, where they can see a professional as an emergency appointment without having been a client beforehand.

“One of the other nice things is that if you call and have made an appointment, when we’re talking to you on the phone, we’re triaging that from our perspective,” she said. “Do we need to say, ‘Come on in today’ or can we just arrange an appointment that fits your schedule?”

Roof said that the stigma surrounding mental health issues seems to be lessening among the general public, helping to remove that barrier to access to mental health.

“It takes a lot of courage for somebody to say, ‘I think I’m depressed’ or ‘I think I’m hallucinating,’ ” she said. “Imagine telling your friends or your family that. It’s even harder to walk through the door of a mental health center.

“…I think that (stigma) is pretty reduced now. You have so many celebrities coming out and saying, ‘I have body dysmorphic issues’ or ‘I have depression’ or ‘I’m a survivor of suicide’ or ‘I’ve struggled with addiction all my life.’ So, I think that when you see people you admire in the public and they’re acknowledging something, that takes away the shame. I think it’s fantastic that people do that.”

Roof said that people are more educated now about the symptoms of mental health issues, helping them to determine if they need to seek a mental health professional.

“They know what depression probably feels like,” she said. “If you are hearing or seeing things, or responding to stimuli that other people don’t experience, you know that there’s an issue.

“Getting help, I think, sometimes, is about a family member or friend. What I say is: Don’t necessarily look for a specific symptom, but look for a change in somebody. Somebody, who is usually quiet, being more euphoric could be early mania or bipolar. Somebody, who is usually active, being more reclusive and not going out much, looking sad and not caring about the way they look — we all see those and know those are signs of a mental health issue, but saying to that person, ‘It looks like you’re having some struggles. Do you want to talk about that?’ and not just ‘If you’re having a problem, let me know’ — really communicating ‘I’m OK with that conversation; I want to help you.’ ”

Four Rivers Behavioral Health has a crisis line that connects people with mental health professionals who can recommend resources to deal with a person’s mental health issues. That toll-free number is 1-800-592-3980.

Roof also referenced the current Suicide Prevention Lifeline, which is 1-800-273-TALK(-8255).

“The best thing that’s coming out — I think it’s on July 16 — is a number called 9-8-8,” she said. “You don’t have to know 1-800-LIFELINE or one of these phone numbers anymore. All you have to do is dial 9-8-8, much like we dial 9-1-1 for the police, and that will take you straight to Lifeline or take you to a crisis line.

“It’s fantastic. We have been in the planning stages at the state level for probably six months to a year. We really expect that our call volume — which ranges from around 350 a month — will go to around 450. That will be around our norm.”

Eric Friedlander, the Secretary of the Health and Family Services Cabinet, said one of the greatest ways of opening access to mental health care was Medicaid expansion.

“In 2013, there were about 800,000 folks who received their health care coverage through Medicaid,” he said. “Today, it’s doubled; it’s about 1.6 million. We have a relatively low uninsured rate for a state our size and location. I think that’s a big deal (for access to mental health care).”

According to that same Mental Health America report, Kentucky ranks second in the nation for uninsured people receiving mental health care, with only 4.2% of adults with any mental illness being uninsured. The national average is 11.1%.

“I think that’s the thing that drove our overall ranking (for access to mental health care),” Friedlander said. “If you look at things like folks with depression and mental health cases, Kentucky, unfortunately, ranks pretty high there, too. We have a lot of folks who have behavioral health issues.

“Like recently in western Kentucky, after the tornadoes and thunderstorms rolled through, it causes anxiety. We’ve seen it too often.”

Friedlander said that Medicaid is probably the largest payer of behavioral health care in Kentucky.

“If it weren’t for Medicaid, we wouldn’t even be close to the mental health system we have now,” he said. “We have a long way to go, but it makes access much better.”

Friedlander said another factor in having better access to mental health care was opening up TeleHealth, which allows people access to a mental health care provider over the phone, tablet or computer from home. He said that really helped provide access during the heart of the COVID-19 pandemic.

“A lot of times, transportation is a giant issue in Kentucky,” Friedlander said. “Being able to open up TeleHealth the way that we have really helped us and helped a lot of folks get access.

“Also, during the pandemic, we opened up an easier path to get Medicaid for a little bit. It was called presumptive eligibility. About 100,000 people signed up for it. We’ve cut back on it now, but it was important during the pandemic.”

Friedlander agreed with Roof that the stigma surrounding mental health care is lessening.

“There’s no stigma with ‘I’ve got a bad heart’ or there’s no stigma with ‘I need to get a knee replaced’ — a physical illness,” he said. “That’s really how we should think about behavioral health. We’ve got a long way to go, and part of it is that stigma.

“There are more tools available now. We’ve learned in the field a lot of different things over the past 20 years, and we’ve made a lot of strides. If you were feeling physically bad, you wouldn’t hesitate to go to a doctor, so if there’s a mental health thing going on, we shouldn’t hesitate to see a mental health professional. It’s the same thing.”

For information about Four Rivers Behavioral Health in Paducah, visit 4rbh.org or call 270-442-1771 or 1-866-442-1771.

Information about Mental Health America can be found at mhanational.org. Rankings can be found at that site by clicking the “State of Mental Health in America” link in the upper left portion of the homepage.