U.S. Child Mental Health Care Need, Unmet Needs, and Difficulty Accessing Services, 2023–2024

Diagnosed mental health conditions among children increased by 35% from 2016 to 2023.¹ Furthermore, almost 40% of children ages 12–17 with a major depressive episode did not receive treatment in the past year.² Reported barriers include financial costs, limited provider availability, and logistical challenges.³ However, reports on household-level perspectives on mental health treatment for children are limited.⁴ We use recent, nationally representative data to quantify household-level child receipt of and difficulty accessing mental health treatment.

METHODS

We used the nationally-representative U.S. Census Bureau’s Household Pulse Survey from June 2023 to September 2024.⁵

Measures

We categorized households as having children (age<18) with a treatment need, defined by parent report of at least one child needing mental health treatment in the past four weeks; an unmet need, defined as a parent report of least one child in the household not receiving needed mental health treatment; and difficulty accessing care, defined as a parent reporting it being very difficult to access mental health treatment, or that they were altogether unable to access treatment (eTable 1).

Statistical Analysis

All analyses were survey-weighted, including frequencies and multivariable logistic regressions, in which we examined the above outcome measures. Independent variables in the models included household and parent characteristics, and child’s schooling type (eTable 2).

To aid interpretation, we report adjusted predicted probabilities. Analyses were conducted in Stata v18 (StataCorp). This study was approved by the lead author’s IRB and adhered to STROBE guidelines.

RESULTS

Among 173,174 households, 19.6% (N=40,020) reported having a child needing mental health treatment. 24.8% of households with a perceived need reported unmet need, and 21.8% of households with unmet need reported difficulty accessing treatment as a reason for unmet need. Among households with children who received treatment, 16.6% reported finding it difficult to access (Figure 1).

Figure 1.

Total N and Weighted Percentages of Study Outcomes

Among the 40,020 households with perceived treatment need, unmet need was significantly higher among multi-child households than among single-child households, in households with homeschooled children compared to households with children in public school, and for all other races/ethnicities compared to Non-Hispanic Whites (Table 1).

Table 1.

Probability of Unmet Need and Difficulty Accessing Services for Children in the U.S., 2023–2024

Domain	Unmet Needa	Had a very difficult time receiving careb	Did not receive care due to difficultyc
	% (95% CI)	% (95% CI)	% (95% CI)
Parent Insurance Type
Private (Ref)	22.03 (20.88, 23.18)	16.94 (15.93, 17.94)	31.25 (27.84, 34.66)
Medicaid	25.98 (24.22, 27.74)**	16.31 (14.62, 18.01)	39.97 (34.37, 45.56)*
Other	25.77 (24.02, 27.52)**	15.62 (14.06, 17.18)	30.26 (25.59, 34.93)
Uninsured	40.56 (36.07, 45.05)**	19.21 (13.37, 25.04)	40.38 (32.16, 48.59)*
Household Structure
Only 1 child (Ref)	21.01 (19.77, 22.24)	16.33 (15.23, 17.43)	35.38 (31.38, 39.39)
More than 1 child	27.78 (26.60, 28.95)**	16.90 (15.90, 17.89)	32.20 (28.99, 35.40)
Only 1 adult (Ref)	25.13 (23.06, 27.19)	19.64 (17.57, 21.71)	28.65 (23.86, 33.44)
More than 1 adult	25.22 (24.21, 26.23)	16.09 (15.30, 16.89)**	34.19 (31.10, 37.29)*
Parent Race / Ethnicity
NH AA/Black	38.66 (35.66, 41.66)**	13.13 (9.88, 16.37)*	25.83 (19.91, 31.75)*
Hispanic/Latinx	31.20 (28.64, 33.75)**	16.34 (13.96, 18.73)	29.01 (23.23, 34.78)
NH White (Ref)	18.27 (17.46, 19.09)	17.26 (16.43, 18.09)	36.64 (33.29, 40.00)
NH Otherd	31.65 (29.06, 34.25)**	16.99 (14.77, 19.21)	34.61 (27.95, 41.28)
Child Education Type
Public only (Ref)	25.38 (24.39, 26.38)**	16.73 (15.92, 17.53)	33.78 (30.83, 36.74)
Private only	19.75 (17.36, 22.15)	16.46 (14.07, 18.85)	27.47 (20.02, 34.92)
Homeschool only	30.93 (27.40, 34.45)**	16.11 (12.97, 19.25)	36.69 (27.68, 45.71)

^*P-value <0.05,

^**P-value<0.001

^aA household was considered to have an unmet need if at least one child in the household who needed treatment did not receive care

^bProportion was estimated among households with children who all received necessary mental health care treatment (N = 31,246)

^cProportion was estimated among households with children where no children received necessary health care treatment (N = 5,085). Parents who reported only some children in the household received treatment could not answer the difficulty question for both the child(ren) who received care and did not receive care. Therefore, we cannot accurately estimate this proportion.

^dNon-Hispanic Other races includes Asian alone, any other race alone, or any race in combination. Race categories are defined by the survey.

^eModels were also adjusted for parent education level and parent mental health status

Single-adult households were more likely than multi-adult households to report difficulty getting care. Proportions reporting not receiving care due to difficulty were similar (~40%) among uninsured and Medicaid-covered households, and both were higher than other types of insurance. Difficulty getting care was less common among Non-Hispanic African American/Black households than among Non-Hispanic White households.

DISCUSSION

This nationally representative study shows that, in 1 in 5 U.S. households, parents perceived a need for child mental health treatment and, of these, about a quarter reported an unmet need, with 16.6% parents who accessed care reporting difficulty, and 21.8% citing difficulty as the reason their child(ren) did not receive care. This burden was even greater for single-parent and multi-child households. Schools serve as a pathway to identifying and addressing child mental health problems, and our finding that 30% of households with homeschooled children have an unmet need for mental health treatment is concerning.

Our findings highlight uninsured households and households with Medicaid both reporting high rates (40%) of not receiving treatment due to difficulty, suggesting Medicaid coverage may not adequately address mental health treatment access. States should continue pursuing strategies to eliminate barriers to mental health care for children, including child mental health workforce development initiatives and efforts to support child mental health interventions in primary care.⁶

Study limitations include use of cross-sectional and self-reported data, and an inability to distinguish various causes of difficulty accessing care. Despite these limitations, this study provides up-to-date information on the state of need and unmet need for child mental health care throughout the U.S.