Deaths from suicide, alcohol, and drug—known as “deaths of despair”—rose in all states from 2005 to 2016, according to a new report by the Commonwealth Fund.

Average life at birth in the United States declined for a second year in a row, driven in large part by a spike in deaths from opioid and other substance abuse as well as suicide, the report found. Rates of these deaths rose all states, doubling or more in Delaware, New Hampshire, New York, Ohio, and West Virginia.

The report also found gaps in mental health care are pervasive, according to U.S. News & World Report. Up to one-quarter of adults with a mental illness reported a need for care that wasn’t met between 2013 and 2015. Up to one-third of children needing mental health treatment in 2016 did not receive it, according to their parents. Across states, 41 percent to 66 percent of adults with symptoms of a mental illness (some of whom may not have been diagnosed) received no treatment during that period.