TEXAS — According to Forbes, more than 50 million Americans struggle with a mental illness. However, roughly 55% of adults with a mental illness don’t receive treatment.

Comparing all 50 states plus Washington D.C. along seven different metrics, Forbes determined that Texas is the worst state for mental health care.

The Lone Star State has the highest rate of adults with a mental illness who are uninsured at 21.5%. It is also home to the largest percentage of adults (40.65%) who have a cognitive disability but are unable to seek a doctor due to cost.

The stats don’t only apply to adults. Texas also has the highest percentage of youth (73.1%) who had a major depressive episode in the last year but did not seek treatment. The state also has the fifth lowest number of mental health treatment centers in the country, with about roughly 42 per 10,000 businesses.

The seven different metrics that Forbes used to compare each state include the percentage of adults who needed counseling or therapy from a mental health professional in the last four weeks but did not receive it, the percentage of children with private health insurance but doesn’t cover emotional or mental problems and the number of mental health treatment centers per 10,000 business.

Trends the Forbes study saw include that seven of the states with the worst mental health care are in the South, while seven of the states with the best care are in the East.

Following behind Texas on the list for worst states for mental health care are Mississippi, Alabama and Georgia. On the opposite end of the spectrum, some of the best states for mental health care include Vermont, Massachusetts, Rhode Island and Pennsylvania.

Montana topped the list with the highest rate of mental illness in the country, while New Jersey has the lowest rate of mental health issues.