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Objective: Many parents struggle to find mental health care for their children, and many mental health clinicians do not accept insurance payments. The authors aimed to estimate the frequency and cost of self-pay psychotherapy and psychotropic medication management visits for youths and to determine how service use varies by family income. Methods: A descriptive cross-sectional analysis was performed among youths ages 5–17 years in the 2018–2020 Medical Expenditure Panel Survey. Specialist visits included those with psychiatrists, psychologists, social workers, and mental health counselors or family therapists. Results: Approximately one in five of 13,639 outpatient mental health specialist visits were self-pay, with psychologists (23% of visits) and social workers (24% of visits) most likely to see youths on a self-pay basis. Use of self-pay care was strongly associated with higher income, but even families earning <$28,000 per year utilized some self-pay care, at a median cost of $95 per visit. Self-pay visits were associated with slightly lower clinical need than insurance-covered visits, although this measure varied by income. Conclusions: The self-pay market for child mental health care potentially exacerbates inequities in access to care by burdening low-income families with high costs. Incentivizing mental health providers to participate in insurance for larger portions of their patient panels, for example, by increasing reimbursement rates and reducing paperwork, may help improve equitable access to mental health care. To the extent that reimbursement rates drive insurance acceptance, the frequency of self-pay mental health visits suggests that mental health services are underreimbursed relative to their benefit to patients and families. [ABSTRACT FROM AUTHOR]

The article "Financial Strain on and Systemic Barriers in Mental Health Treatment" by Michael W. Flores, Ph.D., M.P.H., discusses the challenges faced by individuals with high out-of-pocket spending on outpatient mental health treatment. The study highlights how financial constraints, stagnant wages, and rising costs impact access to mental health care, particularly for low-income individuals. The Affordable Care Act has expanded access to health insurance for low-income individuals, but barriers such as long wait times, limited provider networks, and high out-of-pocket costs still hinder access to mental health services. The article calls for policy changes to address these systemic barriers and promote mental health care as a fundamental right for all individuals. [Extracted from the article]