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More than half of all Americans in need of mental health care actually get it – but some states are way worse than others when it comes to mental health coverage, according to a new study.

Massachusetts, Vermont, South Dakota, and Minnesota rounded out the top five. And the report lists Nevada as the worst state for mental health care services. Joining Nevada at the very bottom of the list are Arkansas, Arizona, Oregon, and Alabama.

Researchers used 15 different criteria to create the list. The study used data collected at the state level from 2011 to 2014.

According to the study, Nevada falls last on the list due to a dire shortage in care providers.