Mental health and behavioral disorders in children have become one of the fastest-growing items of health care costs in the United States. New research from the University of California, San Francisco, published on December 15, 2025, in the journal JAMA Pediatrics, shows that mental health, substance use disorders, and other behavioral care accounted for as much as 40 percent of all health care expenditures for children in 2022. This is a share that is almost twice as high as in 2011, which clearly indicates that the burden of mental health disorders has moved to the very center of family budgets.

The authors analyzed eleven years of national data on health care costs for children aged 6 to 17, tracking the period from 2011 to 2022. During that period, total spending on children's behavioral health reached $41.8 billion in 2022. Behind that large amount lies a very concrete blow to household finances: families paid about $2.9 billion out of pocket for their children's mental and behavioral health services, which makes up more than a quarter of the total cost-sharing they pay for all children's health care.

Particularly concerning is the fact that costs borne directly by families for behavioral health are growing significantly faster than the rest of the system. According to the analysis, direct household spending on children's mental health grew on average by 6.4 percent annually, while the costs of other types of medical care grew at an average rate of 2.7 percent annually. In other words, the part of the health system related to children's mental health is "pulling ahead" twice as fast as the rest.

The lead author of the study, pediatric emergency medicine physician Ashley Foster from UCSF Benioff Children's Hospitals, warns that such dynamics place families in an increasingly difficult position. According to her, families with at least one child who has behavioral or mental difficulties are about 60 percent more likely to face a high financial burden related to health care, and 40 percent more likely to find themselves in an "extreme" financial situation – when more than 10 percent of total household income goes solely to the care of the child's mental health. In practice, this means that families often have to delay other expenses, go into debt, or reduce spending on basic needs so that children can get the help they need.

Broader background: every fifth child diagnosed with a mental or behavioral health problem

The rise in costs does not happen in a vacuum. In the same decade, a steady increase in the number of children with diagnosed mental and behavioral conditions has also been recorded. Data from federal US public health institutions show that, according to surveys conducted in 2021 and 2022, almost one in five children aged 3 to 17 has received a diagnosis of a mental, emotional, or behavioral disorder at least once in their life. The most common diagnoses relate to anxiety disorders, behavioral disorders, and depression, with anxiety and behavioral problems being particularly pronounced in school-aged children.

The latest data from the National Survey of Children's Health for 2023 further confirm the scale of the problem among adolescents. It is estimated that more than 5.3 million young people aged 12 to 17 – or 20.3 percent of that population – had a current, diagnosed mental or behavioral difficulty, including anxiety and depressive disorders and behavioral problems. Anxiety is by far the most common diagnosis (16.1 percent of adolescents), followed by depression (8.4 percent), while about 6.3 percent of young people have diagnosed behavioral problems.

Even more important is the trend over time: between 2016 and 2023, the prevalence of diagnosed mental and behavioral conditions in adolescents increased by roughly a third – from 15 to more than 20 percent. In the same period, diagnosed anxiety increased by more than 60 percent, and depression by almost 50 percent. Such a jump does not necessarily mean that children have "suddenly become sicker," but also that mental health is talked about more, that parental awareness is greater, and that children are more often referred for assessment. However, for the health care system and family finances, the result is the same: more children are entering treatment, costs are rising, and family budgets are increasingly struggling to withstand that wave.

At the same time, research shows that a significant portion of adolescents still have unmet needs. Although most young people who need counseling or therapy manage to see a specialist at least once a year, approximately 20 percent report unmet needs for mental health care. Even more alarming, the share of adolescents whose parents report having difficulties finding or organizing necessary treatment is growing significantly – from less than half in 2018 to about 61 percent in 2023. This means that the path from diagnosis to concrete help is becoming increasingly complex, bureaucratically difficult, and often financially painful.

The pandemic as a turning point: from national emergency to partial recovery

The COVID-19 pandemic was superimposed on the already existing children's mental health crisis. As early as 2021, leading professional organizations of pediatricians and child psychiatrists declared a national emergency in child and adolescent mental health, warning of a dramatic increase in depression, anxiety, suicidal thoughts, and self-harm. Hospital data from the early pandemic period showed an increase in emergency department visits for psychiatric reasons: in children aged 5 to 11, these visits increased by about a quarter, and in young people aged 12 to 17 by more than 30 percent compared to the pre-pandemic period. A higher number of suspected suicide attempts was also recorded, especially among adolescent girls.

Prolonged school closures, isolation, loss of routine, and fear of illness hit children and young people hard. At the same time, many were left without access to usual forms of support – school counselors, extracurricular activities, sports, and safe socializing with peers. Due to epidemiological restrictions, the health system suddenly had to find new ways of providing services.

As schools gradually reopen and the system adapts, the first more optimistic signs are appearing. A recent analysis of health claims in a large group of children in California showed that the return to in-person school is associated with a significant reduction in diagnosed cases of anxiety, depression, and attention disorders. In the nine-month period following the reopening of schools, the probability of a child receiving a new mental disorder diagnosis fell by more than 40 percent, and costs of psychiatric care, including medication for attention deficit disorder (ADHD), decreased by 5 to 11 percent. Nevertheless, these data refer to a short-term recovery after an extreme situation and do not erase the fact that the baseline level of mental difficulties in young people is still higher than before the pandemic.

Shift in treatment methods: home care, outpatient clinics, and telehealth

The UCSF research does not only deal with total amounts, but also with where the money actually goes. The authors show that the structure of care provision has also changed in the last decade. Spending on home health care services for children with behavioral difficulties grew on average by 25 percent annually, while costs for face-to-face outpatient, non-hospital visits grew by about 11 percent annually. This confirms that an increasing part of treatment takes place outside of hospitals, in the community and on the doorstep – which is often closer to the needs of families, but also financially demanding.

The most dramatic turnaround occurred with telehealth. The number of telehealth visits for children's mental health between 2020 and 2022 grew almost exponentially – on average by 99 percent annually. Teleconsultations became the dominant way of obtaining psychological and psychiatric help practically overnight during the pandemic, and later it turned out that even after the lifting of most epidemiological measures, they remain an important channel of care. A separate analysis of data on commercially insured individuals showed that in the first months of the pandemic, the number of tele-mental visits by children and young people increased more than 30 times, and that even in August 2022 it remained about 23 times higher than before the pandemic, even after classic, in-person visits had largely recovered.

For doctors and families, this represents a double reality. On the one hand, telehealth has enabled children in remote areas or families with logistical and financial obstacles to finally reach experts. On the other hand, technical barriers (access to stable internet, appropriate devices), differences in insurance rules, and the question of the quality of care in short online encounters remain open. Despite this, researchers estimate that telehealth for children's mental health is "here to stay": it is no longer a temporary solution for an emergency situation, but a stable part of a mixed model of care provision that combines online and in-person visits.

Why mental health costs are rising faster than the rest of health care

The UCSF research did not aim to explain all the reasons for the rise in costs in detail, but a combination of different data sources gives a fairly clear framework. The authors cite three key elements: more children with recognized difficulties, higher costs per visit, and greater access to care.

• More children with diagnosed difficulties. As anxiety, depression, and behavioral problems grow among children and young people, it is logical that the number of visits to psychologists, psychiatrists, and other experts is also growing. According to national data, almost 21 percent of children in the US aged 3 to 17 have had a diagnosis of a mental, emotional, or behavioral disorder at least once, and the share is even higher among adolescents. This directly increases the demand for services and costs.


• Growth in the price of individual services. In the US system, prices of specialist examinations, psychotherapy, psychiatric assessments, and medications are growing at a slow but steady pace. If additional costs related to new models of care – for example, multidisciplinary teams or specialized community programs – are added to that growth, the total amount that families and insurers pay per treatment episode becomes increasingly larger.


• Improved access to care and less stigma. As awareness of mental health increases, parents are more willing to seek help for their child, and schools, pediatricians, and communities more actively refer children to experts. Although this is a positive shift in public health, every additional diagnostic and therapy entails additional costs. Telehealth, for example, has removed barriers of distance, but has not reduced the cost of experts' labor.

It should also be added that insurance systems are still far from perfect parity between mental and physical health, although legislation in the US has formally required an equal level of coverage for years. In practice, parents encounter limits on the number of approved therapy sessions, different co-payment amounts, "narrow" networks of contracted service providers, and long waiting lists in public programs. All this means that part of the care is paid for privately, out of network, which further increases the share of costs falling on the shoulders of families.

What a high financial burden looks like in the daily life of families

The term "high" or "extreme" financial burden in research is often defined by the share of income that goes to health care. In the UCSF analysis, an extreme financial burden indicates a situation in which more than a tenth of total household income goes to the child's mental health costs – not to all health needs, but precisely to this segment. In such families, every new therapy, check-up, or change of medication becomes a subject of calculation and worry: will the insurance policy cover the cost, will it be necessary to give up some other expense or reach for a credit card.

Data from national surveys show that adolescents with diagnosed mental or behavioral difficulties are significantly more often absent from school due to health reasons, are more often victims of peer violence, and have greater difficulties in making and maintaining friendships. Parents of these children more often receive calls from school due to behavioral problems, and family life is additionally burdened by meetings with doctors, therapists, and school teams. On the financial side, this means a greater number of working days that parents must be absent from work, additional costs of transport, parking, care for younger siblings, but also indirect costs such as reduced income if one parent works part-time or quits their job to dedicate themselves to caring for the child.

At the same time, research shows that about 80 percent of adolescents who need mental health therapy still receive at least some form of treatment during the year, regardless of the type of insurance. This means that the system, despite all its flaws, manages to reach a large part of young people. But the fact that more than 60 percent of parents of children with diagnosed difficulties report difficulties in obtaining necessary care suggests that this access is achieved with significant effort and, in many cases, great cost to families.

What the latest trends and public policies say

The rise in children's mental health costs has not gone unnoticed by policymakers either. Analyses of state budgets show that children's behavioral health has become an important item in public spending planning: many states in their budgets for fiscal year 2025 foresee additional investments in programs for children's and adolescents' mental health, including the expansion of school counseling services, strengthening the capacity of child psychiatry, and developing community crisis teams. At the same time, there is discussion about the permanent inclusion of telehealth in standard financing models, so that online therapies and consultations would be stably covered by insurance even after the pandemic period.

At the level of professional recommendations, the emphasis is on several directions: early recognition of difficulties, integration of mental health into primary pediatric care, reduction of stigma, strengthening of school and community support programs, and creating financial models that do not punish families for seeking help in a timely manner. In addition, public health experts emphasize the importance of positive childhood experiences – stable and supportive relationships with adults, safe neighborhoods, inclusion in activities and the community – which are proven to reduce the risk of developing more severe mental disorders and can mitigate the effects of adverse experiences.

Although this new UCSF research deals exclusively with the United States, the message is broader: when children's mental health becomes the single largest item in family health costs, it is not only a medical, but also a social and economic issue. The way society organizes and finances mental health care for the youngest generations determines in the long term not only the health of individuals, but also educational outcomes, productivity, and social cohesion in the decades to come.