What you need to know about the cost and accessibility of mental health care in America (2023)

As Covid-19 continues to rage and almost a year since the murder of George Floyd, it's once again Mental Health Awareness month. With everything going on, the number of Americans experiencing anxiety and depression is up —42% of U.S. adults reported symptoms, up from 11% in previous years, according to a December survey from the U.S. Census Bureau.

As challenges like Covid-19 and the reckoning on racism continue to take a toll on Americans' mental health, it brings new urgency to some of the long-standing issues like the cost of accessibility of care. Here's what you need to know.

The cost of mental health

Nearly 1 in 5 Americans has some type of mental health condition.

Spending on mental health treatment and services reached $225 billion in 2019, according to an Open Minds Market Intelligence Report. That number, which is up 52% since 2009, includes spending on things like therapy and prescription medications as well as stays in psychiatricor substance abuse rehabilitation facilities.

It doesn't take into account indirect costs, such as lower workforce participation rates and decreased productivity. In fact, depression alone is estimated to account for $44 billion in losses to workplace productivity, according to a recent report from Tufts Medical Center and One Mind at Work.

And access to care can prohibitively expensive — even more so than physical health costs. An hour-long traditional therapy session can range from $65 to $250 for those without insurance, according to therapist directory GoodTherapy.org.

A more severe diagnosis, of course, carries heavier lifetime cost burdens. A patient with major depression can spend an average of $10,836 a year on health costs. Meanwhile, a person with diabetes taking insulin can spend $4,8000 to manage their condition.

Access to care is limited

Beyond the cost of mental health care, access to care is improving but still a big issue.

Access and coverage for mental health and substance abuse treatments have improved in recent years thanks to the 2008 Mental Health Parity and Addiction Equity Act, which barred health insurers from making coverage for mental health more restrictive than for physical ailments.That law and other legal and regulatory updates helped stop blatant discrimination against behavioral health care.

But there are still a lot of medical and insurance loopholes that exist that make it difficult for patients to get affordable care, says Angela Kimball, National Director of Advocacy and Public Policy at the National Alliance on Mental Illness.

And there are many other factors too, she says.

Mental health and substance use treatment centers and clinics, for instance, tend to be concentrated in urban areas. Rural parts of the country tend to lack access to more specialized treatment options — similar to the barriers that exist in traditional physical medicine.

In fact, more than 112 million Americans live in areas where mental health providers are scarce. States like Missouri, Arizona, South Dakota, Montana and Washington are among those with low rates when it comes to meeting the mental health needs of residents. On a national level, research shows that the U.S. is likely to continue to experience a shortage of mental health professionals through 2025.

Many providers also still operate outside the health insurance system, so for patients, they are out of network, which is expensive, says Carol Alter, the system medical director for behavioral health at Dallas-based Baylor Scott and White Health.

"Even with the number of psychiatrists and psychologists out there...there's nobody for people to go to," Alter says.

Indeed, just 56% of psychiatrists accept commercial insurance compared to 90% of other, non-mental health physicians. (Insurers pay licensed mental health professionals like psychiatrists lower negotiated rates for their services compared to physicians with similar backgrounds and experience levels, and they are subject to more paperwork.) As a result, those seeking mental health care are over five times more likely to seek care from an out-of-network mental health professional than for medical or surgical services.

These factors have real-life consequences, Alter says.

(Video) The Cost of Mental Health

"Oftentimes mental health disorders are under-diagnosed, and certainly undertreated. What generally happens is that most people don't get treatment for it, or they might get some treatment, but not effective treatment," she says.

In fact, less than half of Americans who have a mental disorder get proper treatment, according to National Institute on Minority Health and Health Disparities (NIMHD). Alter says only less than 10% of patients who have a mental health disorder actually get effective treatment.

And the numbers only get worse when you look at Black Americans — the percentage who are able to access treatment is only about half of that of white Americans, according to NIMHD.

(Video) The real reason American health care is so expensive

The changing landscape

So what are some of the solutions?

One way forward is to increase the training and collaboration between primary care doctors and mental health professionals, Alter says.

"The fact is that most mental health problems are presenting in primary care — they're not presenting to a mental health professional," she says. "There are things that can be done to help the primary care doctors diagnose and do that better. It's not only doable, it's actually where primary care is going."

Another changing dynamic is the use and expansion of telehealth and teletherapy amid the pandemic, which studies have shown can be effective in treating many mental health conditions. Online counseling services like Talkspace and BetterHelp can cost less than traditional in-person therapy with pricing ranging from $60 to $90 per week. And Talkspace is covered by many major insurers, including Cigna, Humana and Premera Blue Cross Blue Shield.

But some of the recent teletherapy expansion is based on emergency legislation and guidelines that waived many existing restrictions, including the ability for mental health professionals to practice across state lines. There's an open question as to whether the waivers will remain in place when the pandemic ends and whether Medicare, Medicaid and commercial insurers will continue to cover these services at the same levels.

Another area that's ripe for change is Medicare, Kimball says. Right now, Medicare offers one of the worst coverage options for those with mental health and substance use issues.

(Video) Accelerating and Enhancing Behavioral Health Integration through Digitally Enabled Care

Medicare, for example, has a 190-day lifetime limit on psychiatric inpatient care. And while that may sound like a lot, it's woefully inadequate for those who are diagnosed with severe or chronic mental health conditions at a young age.

Additionally, studies show Medicare does not offer a robust network of mental health professional, covering only about 23% of psychiatrists in the U.S.

Making changes to Medicare could not only improve coverage for participants, it could also spur changes throughout the insurance industry. "As a federal program it often serves as sort of the baseline that can really prompt commercial insurers in terms of what they're going to do," Kimball says.

And while Kimball says she's hopeful that legislative and regulatory changes are on the horizon, she's concerned about getting care and treatment to those who need it today. For those looking for affordable mental health services, there are a number of organizations that can help.

Kimball's organization, NAMI, has a helpline that offers free assistance and advice Monday through Friday, 10 a.m. to 8 p.m. ET. You can reach the helpline at 1-800-950-6264. The organization also offers a free, 24/7 crisis text that can be accessed by texting NAMI to 741-741.

The Substance Abuse and Mental Health Services Administration, which is a government agency, provides a treatment locator to help patients find low-cost treatment facilities across the country.

The National Association of Free & Charitable Clinics and non-profit the Open Path Psychotherapy Collective also provide locator tools to help find mental health services at discounted rates.

If you're currently employed, it's also worth exploring whether your company offers mental health benefits through an employee assistance program that may provide discounted or free services.

"People today recognize the need for mental health and substance use care," Kimball says, but adds that the U.S. really needs to think about health care delivery in this country. "We need private insurers on board and we need to level the playing field so it's not just public programs that are holding all the water."

Don't miss: 51% of young Americans say they feel down, depressed or hopeless—here’s how advocates are trying to help

(Video) Improving Access to Mental Health Services in the United States - Dr. Brittany Rivero

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FAQs

What do you need to know about the cost and accessibility of mental health care in America? ›

The cost of mental health

Nearly 1 in 5 Americans has some type of mental health condition. Spending on mental health treatment and services reached $225 billion in 2019, according to an Open Minds Market Intelligence Report.

How accessible is mental health care in the US? ›

Nearly half of the 60 million adults and children living with mental health conditions in the United States go without any treatment. People who seek treatment must navigate a fragmented and costly system full of obstacles. As a result, many people cannot access mental health care when they need it most.

How much does mental health care cost in the United States? ›

Around $280 billion were spent on mental health services in 2020, about a quarter of which came from the U.S. Medicaid program.

How can we make mental health more accessible? ›

Module 8: Improving Mental Health Care
  1. Limit the number of mental hospitals.
  2. Build community mental health services.
  3. Develop mental health services in general hospitals.
  4. Integrate mental health services into primary health care.
  5. Build informal community mental health services.
  6. Promote self-care.

What are three common barriers to mental health care? ›

(1) Common barriers to mental health care access include limited availability and affordability of mental health care services, insufficient mental health care policies, lack of education about mental illness, and stigma.

What is the most common mental health issue in America? ›

The most common are anxiety disorders major depression and bipolar disorder. According to the Anxiety and Depression Association of America, this disorder is highly treatable, but only around 37 percent of those affected actually receive treatment. It is common to be diagnosed with both anxiety and depression.

Why is mental health care not accessible? ›

Mental healthcare is especially difficult due to lingering social stigmas and scarcity of services. Subsequently, those with mental health impairment tend to be complex patients, which may convolute delivery of services.

What are the primary challenges in providing adequate mental health care with the US health system? ›

Key Barriers Limiting Patient Access to Mental Healthcare
  • Mental health clinician shortage.
  • Limited mental health access parity.
  • Fragmented mental and physical health access.
  • Social stigma and limited mental health awareness.
7 Aug 2019

Is mental health care free in America? ›

Community Mental Health Centers offer low-cost or free care on a sliding scale to the public. Typical services include emergency services, therapy and psychiatric care for adults and for children.

Why is mental healthcare expensive? ›

This tactic compounded with already low rates of network participation by mental healthcare professionals is a primary driver for why higher cost, out-of-network care is over three times more common for mental health than general medical care.

What is the average cost of therapy in the US? ›

The average cost of psychotherapy in the U.S. ranges from $100 to $200 per session (depending on the state), according to a 2019 report by SimplePractice, a practice management system for mental health professionals. When seeing a therapist in person, you're likely to be billed per session.

What are the challenges in accessing mental health services? ›

Poor awareness of mental disorders is the barrier that hampers the access and use of mental health services in most people with mental disorders. For instance, during the interviews, 8 out of 10 interviewed patients present a problem of poor knowledge about their mental health conditions.

What is the biggest challenge facing mental health professionals today? ›

Another of the major problems with the mental health system is long wait times. The longer the wait, the poorer the patient's mental and physical health, and the less interested they are in seeking treatment.
...
Accessibility
  • Lack of transportation.
  • Social stigma.
  • Insufficient information.
  • Inadequate bandwidth and internet.
14 May 2021

What are the biggest challenges in provision and access of mental health care today? ›

Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap.

How can we help mental health in America? ›

4 Big Ways We Can Change Mental Health Care in America
  1. From Mental Institutions to Prisons. ...
  2. Increase Mental Health Care Funding. ...
  3. Provide Better Care and Services in Jails and Prisons. ...
  4. Create More Community Centers and Inpatient Facilities. ...
  5. Provide Compassionate Care and Support. ...
  6. We're All Responsible for Mental Health Care.
27 Jan 2015

How are mental health services provided in the United States? ›

The federal government works in partnership with the states to address mental health. The federal role in mental health includes regulating systems and providers, protecting the rights of consumers, providing funding for services, and supporting research and innovation.

What are two barriers to mental health treatment? ›

We discuss six common barriers below.
  • Desire to Receive Care. ...
  • Lack of Anonymity When Seeking Treatment. ...
  • Shortages of Mental Health Workforce Professionals. ...
  • Lack of Culturally-Competent Care. ...
  • Affordability of Care. ...
  • Transportation to Care. ...
  • Resources to Learn More.
12 Feb 2019

How do you reduce barriers to mental health services? ›

Here are a few ways to demonstrate your commitment to improving access to mental health care and breaking down barriers:
  1. Invest in mental health benefits.
  2. Build a healthy work culture.
  3. Proactively combat stigma.
  4. Provide training for managers.
17 May 2022

What are 3 of the leading causes of mental disability in the USA? ›

What Environmental Factors Contribute to Mental Illness?
  • Death or divorce.
  • A dysfunctional family life.
  • Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness.
  • Changing jobs or schools.
25 Aug 2022

What is the biggest problem with mental health? ›

But while depression is the condition most will associate with mental health issues, and the leading cause of disability worldwide, it is not the number one mental health concern people face. That unwanted accolade goes to anxiety. An estimated 275 million people suffer from anxiety disorders.

Which states have higher barriers to accessing mental health care? ›

We know that many minority groups are less likely to seek out mental healthcare due to community stigma.
...
The States Where Residents are Least Likely to Seek Mental Health Care
  • Vermont.
  • Mississippi.
  • Colorado.
  • New Jersey.
  • West Virginia.
  • Kansas.
  • Ohio.
  • D.C.
8 Jul 2020

What are the 4 barriers to accessing health services? ›

Five key barriers to healthcare access in the United States
  • Insufficient insurance coverage. A lack of insurance often contributes to a lack of healthcare. ...
  • Healthcare staffing shortages. ...
  • Stigma and bias among the medical community. ...
  • Transportation and work-related barriers. ...
  • Patient language barriers.
27 Jul 2022

Why is funding for mental health important? ›

Discrete mental health funding streams provide the opportunity to pilot new models and treatments. Current funding is often predominantly research-focused, which is essential in growing our understanding of mental health conditions and strengthening the toolkit of effective, evidence-based strategies and treatments.

Is mental health America a good source? ›

Exceptional. This charity's score is 94.69, earning it a 4-Star rating.

What are some of the hidden costs of mental disorders? ›

These costs fall to the social care, education, housing, criminal justice and social security systems, and often they are especially felt by individuals with mental health problems and their families.

Why is therapy so expensive in the US? ›

In order to receive a license; therapists have to go through a lot of training and years before they can actually work. Lastly, counseling is expensive because there are many bills to pay: Rent and utilities. State licensure fees, each licensure requires annual fees to be paid.

Who cost of mental health? ›

Two of the most common mental health conditions, depression and anxiety, cost the global economy US$ 1 trillion each year.

Which is more important money or mental health? ›

Being in a stable financial situation resolves most of the problems of an individual, as they are in control of their finances and therefore at peace, mentally! Mental wellness on the other hand is quite subjective. According to experts, poor mental health often results in a lack of financial management skills.

How many people in the US can't afford therapy? ›

In 2018, about 5.8% of American adults believed they had an unmet need for mental health services during the past year—up from 4.7% in 2015. The rise was steepest among young adults ages 18 to 25, 12.7% of whom reported an unmet need for mental health services in 2018, up from 5.1% in 2015.

Do you have to pay for therapy in America? ›

Average Cost of Therapy

Therapy generally ranges from $65 per hour to $250 or more. In most areas of the country, a person can expect to pay $100-$200 per session.

How much is therapy in the US without insurance? ›

On average, a therapy session costs between $60 to $120 for an hour-long session for those who do not have health insurance.

What are the factors affecting influencing mental health? ›

There are so many factors that have an impact on our mental health, including genetics, family history, childhood experiences — and even big societal issues like violence, discrimination or poverty. And how those factors affect us can change over time.

What are the challenges in accessing mental health services? ›

Poor awareness of mental disorders is the barrier that hampers the access and use of mental health services in most people with mental disorders. For instance, during the interviews, 8 out of 10 interviewed patients present a problem of poor knowledge about their mental health conditions.

Why is mental health care not accessible? ›

Mental healthcare is especially difficult due to lingering social stigmas and scarcity of services. Subsequently, those with mental health impairment tend to be complex patients, which may convolute delivery of services.

What are the barriers to accessing support for mental health? ›

Barriers to accessing mental health support include difficulties in identifying and communicating distress, stigmatising beliefs, shame, a preference for self-reliance, and anticipation that help will be difficult to access.

What are some challenges to accessing mental health services in rural communities? ›

Barriers to Mental Health Treatment in Rural Areas
  • Desire to Receive Care. ...
  • Lack of Anonymity When Seeking Treatment. ...
  • Shortages of Mental Health Workforce Professionals. ...
  • Lack of Culturally-Competent Care. ...
  • Affordability of Care. ...
  • Transportation to Care. ...
  • Resources to Learn More.
12 Feb 2019

What is the biggest challenge facing mental health professionals today? ›

An article from Psychology Today observes, “Mental health professionals — particularly psychologists — do a poor job of monitoring their own mental health problems and those of their colleagues.” Psychologists, psychiatrists, and counselors may face the same issues as the general population, such as depression, marital ...

How do you reduce barriers to mental health services? ›

Here are a few ways to demonstrate your commitment to improving access to mental health care and breaking down barriers:
  1. Invest in mental health benefits.
  2. Build a healthy work culture.
  3. Proactively combat stigma.
  4. Provide training for managers.
17 May 2022

What is the biggest problem with mental health? ›

But while depression is the condition most will associate with mental health issues, and the leading cause of disability worldwide, it is not the number one mental health concern people face. That unwanted accolade goes to anxiety. An estimated 275 million people suffer from anxiety disorders.

What are the primary challenges in providing adequate mental health care with the US health system? ›

Key Barriers Limiting Patient Access to Mental Healthcare
  • Mental health clinician shortage.
  • Limited mental health access parity.
  • Fragmented mental and physical health access.
  • Social stigma and limited mental health awareness.
7 Aug 2019

How are mental health services provided in the United States? ›

The federal government works in partnership with the states to address mental health. The federal role in mental health includes regulating systems and providers, protecting the rights of consumers, providing funding for services, and supporting research and innovation.

What are two barriers that keep someone from accepting assistance? ›

Results. Fifteen qualitative and seven quantitative studies were identified. Young people perceived stigma and embarrassment, problems recognising symptoms (poor mental health literacy), and a preference for self-reliance as the most important barriers to help-seeking.

What can local governments do to improve mental health? ›

Local governments can promote positive mental health by investing in healthy housing, whether through the development of a healthy housing strategy, implementing housing quality standards, or including principles of healthy and inclusionary housing in community planning.

What are the impacts of mental health on the community? ›

Unaddressed mental health problems can have a negative influence on homelessness, poverty, employment, safety, and the local economy. They may impact the productivity of local businesses and health care costs, impede the ability of children and youth to succeed in school, and lead to family and community disruption.

Videos

1. Inaccessible Accessibility: Addressing Mental Health Disabilities In Higher Education
(Mental Health America Webinars)
2. How do we make mental health care more accessible via insurance plans?
(zynnyme Private Practice Experts)
3. Americans in Need: Responding to the National Mental Health Crisis
(Energy and Commerce Committee)
4. Mental Health in the United States: New Estimates from NCHS
(Centers for Disease Control and Prevention (CDC))
5. A Conversation on America’s Mental Health Crisis
(USC Price)
6. Mental Health in Rural America: Improving Access and Dismantling Barriers to Care in the Heartland
(The Kennedy Forum Illinois)
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