State Differences in Child Mental Health Care
Nationally, 21% of caregivers reported that their child had unmet mental health needs, and 46% reported difficulty in accessing care.
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Between 2010 and 2020, rates of child and youth suicide increased steadily, and by 2018, suicide was the second leading cause of death for youth ages 10 to 24. Surges in mental health needs in children and adolescents during the COVID-19 pandemic prompted the American Academy of Pediatrics to declare a National Emergency in Child and Adolescent Mental Health in 2021. Though the pandemic has retreated into the rearview, the sharp increases in children and teens presenting to hospital emergency rooms in serious psychological distress over the past five years has recentered children’s access to mental health care as an urgent public health issue.
Approximately 16 to 20% of children in the United States have a mental health problem, but only half of these children use mental health services. Nationwide, rates of unmet need for mental health care vary across racial and ethnic groups, ranging from 15% for White children to over 30% for Black children. Common barriers to mental health services include cost, location, administrative barriers, and limited capacity. Because states have substantial freedom in designing their behavioral health service system—including who gets to be a mental health provider, what kind of services they can provide, and how those services are financed—barriers can vary significantly across state jurisdictions.
To understand mental health access variation across state boundaries, our research team analyzed data from a national survey, the National Survey of Children’s Health. For each of the 50 states and Washington D.C., we estimated the probability that a parent of a child with a mental health problem would report that, in the last 12 months: 1) their child did not see a mental health provider but needed to see one, and 2) they experienced any challenges or problems accessing mental health care. We also compared how much the probability of parents reporting these experiences varied by state of residence with how much they varied across other social and demographic characteristics, including race, income, and type of health insurance.
Nationally, 21% of caregivers reported that their child needed mental health care but did not receive it, and 46% reported difficulty in accessing care. Rates of unmet need ranged from as low as 8% in Montana to 32% in Utah. Reports of challenges in accessing mental health care were high overall, ranging from 28% of caregivers reporting difficulty in Hawaii to 57% in Texas. The image below maps out how hard it is for parents to get mental health care for their kids in different states. Lighter colors mean it is easier to find help, while darker colors mean it is harder.
Our study also showed that where a child lives matters more than their race, how much money their family makes, or what kind of insurance they have. As such, a child’s state of residence may compound their risk of unmet need if they also have other disadvantages associated with unmet mental health need, such as low-income or complex medical needs. In a follow-up study, we found that racial and ethnic disparities in unmet need and challenges accessing care also vary across states. Caregivers of Black or Hispanic children reported lower rates of unmet need than caregivers of White children in some states, but the opposite in other states.
Inability to access mental health care can result in a range of poor health and social outcomes, including increased risk of suicide. Because a family’s location combines with other life circumstances (such as wealth, race, or education) to make it easier or harder to access mental health care, it is essential to examine the laws and systems in each state to understand drivers of unmet mental health need in children and youth. This may include assessing the impact of a wide range of state policies or features (e.g., service funding approaches, location of service providers, or mental health service eligibility standards) on mental health service access. Research examining structures within states that contribute to inequities across state lines may help to uncover longstanding practices in poorly performing states. And successful practices in states with low rates of unmet mental health need can be identified and disseminated to advance mental health equity for children.
