A new report that ranks mental illness and mental health services at the state level reveals some surprises, The Washington Post reports. Some states with the lowest rates of mental illness and substance abuse are in the South, even though southern states also score low on measures of physical health.

The new report, released by the advocacy group Mental Health America, found Florida, Alabama, Texas and Georgia have the lowest rates of mental illness. Nine of the 10 states with the lowest rates of substance abuse are also in the South, the group found.

Five northern states—Massachusetts, Vermont, Maine, North Dakota and Delaware—received the overall highest scores when prevalence of mental illness was compared with access to care.

Paul Gionfriddo, President and CEO of Mental Health America, noted, “There’s not a difference, in some respects, in what we call the ‘liberal’ states and the ‘conservative’ states. It doesn’t matter what the perspective is [from which] you approach creating mental health services. It matters that you put the investment into mental health services.”

Overall, no states are doing very well in terms of mental health care, he said. “I think the main takeaway is that our country as a whole, and the states…could be doing a whole lot more on behalf of people with mental health needs,” he said. “When you look overall at all of the data, I don’t think there is a single state where you can say our population is healthy, and they have good access [to mental health services].”

The data from the report was compiled before the Affordable Care Act went into effect.

The report found 42.5 million Americans (18 percent) said they had some kind of mental illness, while about 20 million (8.5 percent) said they had a problem with substance use. In addition, 8.8 million (3.8 percent) said they had serious thoughts of suicide.