Twitter sentiments and mental health services in the United States

Current understanding of the expressions of people who have lived experiences of mental illness on social media about mental health services is limited, particularly relating to state-wide variations in these services. We examine whether associations exist between the availability of mental health services, Medicaid expansion, poverty, and sentiments expressed on Twitter by people who have social media markers that indicate their direct experience with mental health disorders. Statistically significant negative associations were found between the normalized Twitter sentiments and SAMSHA counts of mental health services reported for each of the 50 States from 2016 to 18 and Medicaid expansion status. The findings indicate that limited access to mental health services, which is often compounded in states that have not participated in Medicaid expansion, manifests itself on Twitter discussions around issues of mental health.