The Biggest Barriers to Accessing Youth Mental Health Care

Shortage of Qualified Mental Health Professionals

For parents and educators alike, one of the biggest barriers is simply the supply of providers. About 37% of the U.S. population, or 122 million Americans, live in areas experiencing shortages of mental health professionals. Indeed, 60% of youth with major depression do not receive any mental health treatment. According to the American Psychological Association (APA), only 4,000 out of more than 100,000 U.S. clinical psychologists are child and adolescent clinicians, and school psychologists are in short supply. The National Association of School Psychologists (NASP) recommends a ratio of 1 school psychologist per 500 students, but they currently estimate a ratio of 1 per 1,211 students.

With 375 students, my biggest fear is missing a kid. What if a kid tells me they are hurting themselves and I didn’t get a chance to see them because of the amount of other duties that I am doing?’
Curtis Darragh IV, Middle School Counselor, Danbury, Conn.

Professional standards recommend at least one counselor and one social worker for every 250 students, but 90% of public schools do not meet this target, leaving over 15 million children and adolescents in need of mental health services. Within any given school district, there is a shortage of therapists overall, and certainly of therapists that kids can relate to. And for parents, equally daunting are the physical and financial obstacles to accessing those mental health professionals.

The Cost of Care

Only 34% of parents in our study say they can afford mental health services for their children. And we see notable income disparities, with 33% of parents with household incomes of less than $75,000 saying “I definitely cannot afford it” versus 8% of those with household incomes of over $125K.

The impact of these disparities is apparent when we drill down on who has actually obtained help for their children. 36% of parents in our study have gotten mental health services for their children once, and 30% more than once. However:

• Only 26% of parents with annual household incomes of less than $75,000 have gotten therapy for their child once, as opposed to 84% of those with household incomes of greater than $75,000.
• 44% of parents with annual household incomes of less than $75,000 have never gotten mental health services for their child, more than double the percentage of parents with incomes of $125,000 or higher.

But regardless of income, 70% of parents in our study are paying over $100 per counseling session, which makes it unaffordable for many families. After all, the national median family income for the United States for fiscal year 2021 was $79,900 before taxes, and the average family income was $87,864. Even with a gross monthly income of $6,650-$7,000 (with average and median family incomes being significantly lower for Black, Native American, and LatinX families), most have little left over to spend on ongoing therapy.

This also helps to explain why 48% of educators in our study say that “Families are not following through with outside referrals due to time or financial constraints.”

Weak Therapeutic Alliances

While 51% of educators try to match students to therapists based on race, ethnicity, and other factors, 61% say it’s difficult to do so. Indeed, 28% say they lack counselors who are fluent in their students’ first language. This problem is particularly acute in more rural districts (44%).

Therapy is not just about getting a therapist, it’s about getting a therapist that you as the client vibe with, that you feel safe with, that you feel comfortable with.’
Emily Zavala, LCSW, PPSC, Subject Area Coordinator, Mental Health and Wellness, East Side Union High School District

That’s why even when schools are able to provide students with some mental health services at no direct cost to them, 46% of parents in our study cite “Difficulty finding a therapist my child could relate to in terms of culture, race, ethnicity, gender, personality, LGBTQ, and other factors” as a challenge.

Time to Care

Given that families are even more likely to seek mental health care in times of crisis, the consequences of long wait-times may be especially severe. In our study, of the parents obtaining mental health services for their kids through school, 46% cite the lack of available therapists outside of school hours as a challenge, and 43% complain of long wait times.

Educators echo and amplify those challenges:

• 98% have a waitlist
• 69% report an average waiting time of at least 3 weeks to get a student into counseling when services are provided by the school
• 68% say that three weeks is the average wait time for out-of-school services as well.

This can be dangerously long for a child in distress.

Time away from work is also a major challenge for parents, especially for those earning hourly wages. 82% of parents spend at least 1-2 hours transporting their children to therapy, and of that group, 41% spend 3-4 hours per session.

When you combine the lost wages that many parents incur taking children to and from therapy with the cost of the services itself, it’s no surprise that parents struggle with affordable access.

Read the full report, The State of Youth Mental Health & Our Schools, 2022.