What is it about?

In the midst of a child mental health crisis, many families have trouble finding mental health care for their children. We find that 1 in 5 mental health visits for children and adolescents are paid for entirely by families, without the help of insurance. Higher income families use self-pay mental health care more than lower income families, but even families making less than $28,000 per year pay out of pocket for some kids’ mental health care.

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Why is it important?

Our findings suggest that families value mental health care more than insurers reimburse clinicians for it. Having care that is only available self-pay likely widens the gap by income in being able to access care.


Mental health care is unique compared to other areas of healthcare in that such a large portion does not go through insurance. To ensure that all families who need care for their children can access it, it will be critical going forward to make it easier for providers to participate in insurance, including things like increasing how much they get paid and reducing the amount of administrative work required. It also worried me to see that low-income families making paid out of pocket for some mental health visits.

Lindsay Overhage
Harvard University

Read the Original

This page is a summary of: Self-Pay Outpatient Mental Health Care for Children and Adolescents, by Socioeconomic Status, Psychiatric Services, April 2024, American Psychiatric Association,
DOI: 10.1176/appi.ps.20230524.
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