Skip to main content
No access
Article
Published Online: 10 April 2024

Self-Pay Outpatient Mental Health Care for Children and Adolescents, by Socioeconomic Status

Publication: Psychiatric Services

Abstract

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.

Get full access to this article

View all available purchase options and get full access to this article.

Supplementary Material

File (appi.ps.20230524.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services

History

Received: 23 October 2023
Revision received: 31 December 2023
Revision received: 19 January 2024
Accepted: 25 January 2024
Published online: 10 April 2024

Keywords

  1. Child psychiatry
  2. Out-of-pocket costs
  3. Self-pay
  4. Outpatient treatment
  5. Mental Health Services
  6. Psychotherapy

Authors

Affiliations

Lindsay N. Overhage, B.A. [email protected]
Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Overhage, Flores, Cook); M.D.-Ph.D. Program (Overhage) and Department of Psychiatry (Benson, Flores, Cook), Harvard Medical School, Boston; Division of Psychotic Disorders, McLean Hospital, Belmont, Massachusetts (Benson).
Nicole M. Benson, M.D., M.B.I.
Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Overhage, Flores, Cook); M.D.-Ph.D. Program (Overhage) and Department of Psychiatry (Benson, Flores, Cook), Harvard Medical School, Boston; Division of Psychotic Disorders, McLean Hospital, Belmont, Massachusetts (Benson).
Michael W. Flores, Ph.D., M.P.H.
Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Overhage, Flores, Cook); M.D.-Ph.D. Program (Overhage) and Department of Psychiatry (Benson, Flores, Cook), Harvard Medical School, Boston; Division of Psychotic Disorders, McLean Hospital, Belmont, Massachusetts (Benson).
Benjamin Lê Cook, Ph.D., M.P.H.
Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Overhage, Flores, Cook); M.D.-Ph.D. Program (Overhage) and Department of Psychiatry (Benson, Flores, Cook), Harvard Medical School, Boston; Division of Psychotic Disorders, McLean Hospital, Belmont, Massachusetts (Benson).

Notes

Send correspondence to Ms. Overhage ([email protected]).
This study was presented in part at the Cambridge Health Alliance annual Academic Poster Session, Boston, September 28, 2023.

Competing Interests

Dr. Benson serves on the Epic Behavioral Health Specialty Steering Board, and her spouse works for Cerevel Therapeutics. The other authors report no financial relationships with commercial interests.

Funding Information

This work was supported by NIMH (grants P50 MH126283, T32 MH019733, and R01 MH122199), the National Institute on Aging (NIA; grant T32AG51108), and the Brain & Behavior Research Foundation Young Investigator Grant.The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of NIMH, NIA, NIH, or the Brain & Behavior Research Foundation.

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

There are no citations for this item

View Options

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

View options

PDF/ePub

View PDF/ePub

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Share article link

Share