Mental Health and Substance Use Disorder Expenditures in the US

Abstract

Importance Understanding spending on mental health could help inform policymakers on decisions about where to direct mental health care resources and help evaluate whether spending aligns with public health priorities. Despite this, the magnitude and distribution of mental health expenditures in the US remain poorly characterized. Objective To estimate aggregate mental health expenditures by sociodemographic characteristics, type of insurance, mental health disorders, and type of service. Design, Setting, and Participants This was a cross-sectional analysis of the 2021-2023 Medical Expenditure Panel Survey (MEPS), an annual, nationally representative survey of the civilian noninstitutionalized US population. Analyses focused on individuals who made at least 1 outpatient mental health visit in 2021, 2022, or 2023. Data analysis was conducted from August 2025 to January 2026. Exposure Outpatient mental health visits. Main Outcomes and Measures Overall and per-100-person expenditures stratified by sociodemographic characteristics and diagnostic categories. Results The analysis included all survey participants (N = 67 532 person-year observations; mean [SD] age, 39.8 [0.25] years; 35 608 [50.7%] female) and identified those with reported outpatient mental health visits in 2021, 2022, and 2023 (n = 15 407; mean [SD] age, 45.0 [0.36] years; 9500 [60.0%] female). The estimated annualized aggregate total health care expenditures as measured in the MEPS in 2021-2023 were $2.5 trillion (95% CI, $2.3 trillion to $2.7 trillion), with $174 billion (95% CI, $152 billion to $196 billion) in mental health expenditures representing 7.0% (95% CI, 6.4%-7.7%) of all medical expenditures. This represented an annual mean of $523 (95% CI, $474-$571) per person overall and $2473 (95% CI, $2266-$2679) per person among those with any treated mental health disorder. Mood disorders and anxiety and fear-related disorders accounted for the highest aggregate expenditures ($74 billion [95% CI, $62 billion to $86 billion] and $69 billion [95% CI, $58 billion to $81 billion], respectively). Expenditures per treated individual were highest for substance use disorders ($9569 [95% CI, $6943-$12 195]), schizophrenia ($9370 [95% CI, $6685-$12 055]), and bipolar disorders ($7382 [95% CI, $6027-$8737]). Overall, expenditures on ambulatory services accounted for $107 billion (95% CI, $93 billion to $121 billion), while expenditures on medication accounted for $36 billion (95% CI, $31 billion to $40 billion) and those for home health care and inpatient treatment accounted for $20 billion (95% CI, $11 billion to $29 billion) and $12 billion (95% CI, $8 billion to $15 billion), respectively. Conclusions and Relevance This cross-sectional study found that expenditures on mental health disorders in the US vary widely at the per-person and population levels, but they are consistently low relative to the societal burden of mental disorders. Research that leads to more effective treatments, decreases provision of low-value care, and supports better matching of patients’ impairment with the appropriate level of care could help optimize treatment access while controlling expenditures.