America is doing a poor job addressing the needs of the mentally ill, earning a D grade in a new report by the National Alliance on Mental Illness released Wednesday.

The report grades each state on access to medicine, housing and family education within the public mental health system for adults. The national average is a D, the same as the last time the report was issued in 2006.

Since 2006, grades for 14 states rose, while grades dropped for 12 states. Oklahoma had the most improvement, rising from a D to a B. Meanwhile, South Carolina’s grade went from a B to a D.

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NAMI representatives worry that despite the sorry state of services across the country, things could get worse as the tight economy cramps state budgets.

“Too many people living with mental illness end up hospitalized, on the street, in jail or dead,” said NAMI executive director Michael J. Fitzpatrick. “We need governors and legislators willing to make investments in change.”