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