People searching for “the cost of therapy” usually want a single number — a per-session price they can budget around. The honest answer is that no such number exists in any authoritative form. There is no federal survey or government dataset that publishes an official “average cost of a therapy session” in the United States. Prices vary by provider type, credential, region, insurance status, and setting, and any figure you see quoted online is an estimate, not an official statistic.
What the government does measure is something more useful: how cost actually shapes whether Americans get care at all. And on that question the data is clear and specific. In 2024, an estimated 61.5 million adults — 23.4% of the adult population — had any mental illness, yet only 52.1% of them received treatment (SAMHSA, 2024). That leaves roughly 48% of adults with a diagnosable condition receiving no mental health care in a given year.
Cost sits near the top of the reasons why. This article frames the cost of mental health care the way the data allows — through the treatment gap, the barriers people report in their own words, and the reimbursement and out-of-network disparities that push mental health bills higher than comparable medical care.
The Treatment Gap: About Half Go Untreated
The starting point for any conversation about cost is how many people never make it into care. According to the 2024 National Survey on Drug Use and Health, 61.5 million adults had any mental illness, and 32.0 million of them — 52.1% — received mental health treatment in the past year (SAMHSA, 2024). The remaining share, close to half, went without.
The gap narrows for the most severe cases but never closes. Among the 14.6 million adults with serious mental illness in 2024, 70.8% received treatment — still leaving roughly 29% untreated (SAMHSA, 2024). These are not people who tried care and quit. For most, treatment never began. Understanding why means looking at the reasons people give when asked directly.
Why People Skip Treatment: The Reasons They Report
The NSDUH asks adults who needed but did not receive mental health treatment why they went without, and allows them to select more than one reason. The results reframe the cost question entirely. The single most common reason was believing they could handle the problem themselves — a self-sufficiency belief, not a price tag. But cost was close behind, cited by nearly two-thirds of respondents.
| Reason for not receiving needed treatment | Share reporting it |
|---|---|
| Believed they could handle it themselves | Most common (percentage not reported) |
| Thought it would cost too much | 65.2% |
| Did not think treatment would help | 58.7% |
| Did not know how or where to get treatment | 49.2% |
| Not ready to start treatment | 48.1% |
| Did not have enough time | 47.9% |
| Could not find a program or professional they wanted | 45.0% |
| Health insurance would not pay enough | 39.9% |
| Worried what people would think | 26.4% |
| Worried it would not be kept private | 23.4% |
Source: SAMHSA, 2024 NSDUH. Respondents could select multiple reasons.
Two of these barriers are directly financial. “Thought it would cost too much” was the second most common reason overall at 65.2%, and a separate concern — “health insurance would not pay enough” — was cited by 39.9% (SAMHSA, 2024). Together they describe a population that often has coverage on paper but still expects to pay more than they can manage. That expectation is not irrational. It reflects how mental health benefits are actually structured and paid.
The Out-of-Network Problem
The clearest evidence that mental health care costs more to access comes from claims data analyzed by RTI International, which compared behavioral health visits with medical and surgical visits across commercial insurance claims from 2019 through 2021 (RTI International, 2024).
| Type of visit | Likelihood of being out-of-network vs. medical/surgical |
|---|---|
| Behavioral health office visit (overall) | 3.5x more likely |
| Psychiatrist office visit | 8.9x more likely |
| Psychologist office visit | 10.6x more likely |
An out-of-network visit is where costs balloon. When a provider is outside a plan’s network, the patient typically faces higher cost-sharing, may be billed the balance, and sometimes pays the full fee out of pocket. RTI found that behavioral health office visits were 3.5 times more likely to be out-of-network than medical or surgical visits — and for the two provider types most central to mental health care, the disparity was far larger: psychiatrist visits were 8.9 times more likely and psychologist visits 10.6 times more likely to fall out-of-network (RTI International, 2024). For uninsured and underinsured populations, who already face the widest access gap, an out-of-network provider can put care out of reach entirely.
Why Providers Leave Networks: The Reimbursement Gap
Providers do not go out-of-network at random. The same RTI analysis found that in-network reimbursement for medical and surgical office visits averaged 22% higher than for behavioral health visits (RTI International, 2024). When a plan pays meaningfully less for a therapy hour than for a comparable medical visit, fewer clinicians accept that plan — and patients absorb the difference.
This pattern is long-standing, and the historical data helps explain how it took hold. Even before the current provider shortage, psychiatrists accepted insurance at strikingly low rates. In 2009–2010, only 55.3% of psychiatrists accepted private, non-capitated insurance, compared with 88.7% of physicians in other specialties; their Medicaid acceptance was 43.1% versus 73.0% for other physicians (Bishop et al., 2014). The trend worsened over time: the share of psychiatrists accepting private insurance fell from 72% in 2005 to 55% by 2015 (Mark et al., 2018). These are dated figures — labeled here by year because insurance-acceptance rates shift — but they document a structural reluctance that predates today’s demand surge and helps explain why so many patients end up paying out-of-network prices. The narrowness of behavioral health networks is a major driver of the broader therapist shortage that patients experience as long waits and few in-network options.
Public coverage carries the heaviest load in this system. Medicaid is the single-largest payer of behavioral health services in the United States (National Academies, 2024), spending more than $58 billion on mental health care and covering 26% of adults with any mental illness or substance use disorder (Commonwealth Fund, 2025). That makes reimbursement policy — and network adequacy — a central determinant of whether low-income Americans can afford care at all.
Parity on Paper, Not Yet in Force
The law meant to fix these disparities is the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, which bars health plans from imposing more restrictive financial requirements or treatment limits on mental health and substance use benefits than on medical and surgical benefits (CMS). In September 2024, federal regulators issued final rules strengthening MHPAEA, effective November 2024, adding requirements that plans conduct comparative analyses of the non-quantitative treatment limitations they apply to behavioral health (DOL, 2024).
That strengthening is currently on hold. On May 15, 2025, the Departments of Labor, Health and Human Services, and Treasury announced they will not enforce the 2024 MHPAEA final rule and intend to reconsider it (CMS, 2025). This is essential context for any claim about parity: the core 2008 law remains in effect, but the most recent enforcement mechanism designed to hold plans accountable for out-of-network and cost-sharing disparities is not currently being applied. For a fuller picture of how coverage rules translate into real-world costs, see our analysis of mental health insurance coverage statistics.
What the Cost Data Really Tells Us
Pulled together, the numbers tell a consistent story. Cost is not a fixed sticker price; it is a barrier that keeps roughly half of adults with mental illness out of care, cited by 65.2% of those who go without treatment (SAMHSA, 2024). Those expectations are grounded in how the system pays: behavioral health providers are reimbursed 22% less than medical providers, are far more likely to sit outside insurance networks, and — for psychiatrists especially — have long accepted insurance at low rates (RTI International, 2024; Bishop et al., 2014). The tools meant to close that gap exist in law but are, for now, not being enforced. That is a more accurate answer to “what does therapy cost” than any single dollar figure could be.
Frequently Asked Questions
What is the average cost of a therapy session?
There is no authoritative U.S. government source for an average per-session cost of therapy. Prices vary widely by provider type, credential, location, and insurance status, so any single figure quoted online is an estimate rather than an official statistic. The more meaningful data measures how cost affects access to care.
How many people skip mental health treatment because of cost?
Among adults who needed but did not receive treatment in 2024, 65.2% said they thought it would cost too much — the second most common reason overall. A separate 39.9% said their health insurance would not pay enough (SAMHSA, 2024).
Why is mental health care more likely to be out-of-network?
Behavioral health office visits were 3.5 times more likely to be out-of-network than medical or surgical visits, with psychiatrist visits 8.9 times and psychologist visits 10.6 times more likely (RTI International, 2024). A major driver is reimbursement: in-network medical visits paid 22% more than behavioral health visits, so fewer providers join networks.
Does insurance parity law require equal coverage for mental health?
The Mental Health Parity and Addiction Equity Act of 2008 bars plans from applying more restrictive financial requirements or treatment limits to mental health benefits than to medical ones (CMS). Federal regulators issued strengthened final rules in 2024, but announced in May 2025 that they will not enforce that rule while they reconsider it (CMS, 2025).
Who pays for most mental health care in the U.S.?
Medicaid is the single-largest payer of behavioral health services in the country, spending more than $58 billion on mental health care and covering 26% of adults with any mental illness or substance use disorder (National Academies, 2024; Commonwealth Fund, 2025).
Sources
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Substance Abuse and Mental Health Services Administration. Results from the 2024 National Survey on Drug Use and Health: Annual National Report. SAMHSA; 2025. https://www.samhsa.gov/data/sites/default/files/reports/rpt56287/2024-nsduh-annual-national-report.pdf
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Mark TL, Parish WJ. Behavioral Health Parity: Pervasive Disparities in Access to In-Network Care Continue. RTI International; 2024. https://www.rti.org/publication/behavioral-health-parity-pervasive-disparities-access-network-care-continue
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Centers for Medicare & Medicaid Services. Mental Health Parity and Addiction Equity Act (MHPAEA). CMS. https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
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U.S. Department of Labor, Employee Benefits Security Administration. Final Rules Under the Mental Health Parity and Addiction Equity Act (fact sheet). DOL; 2024. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/final-rules-under-the-mental-health-parity-and-addiction-equity-act-mhpaea
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Centers for Medicare & Medicaid Services. Statement Regarding Enforcement of the 2024 MHPAEA Final Rule. CMS; 2025. https://www.cms.gov/files/document/statement-regarding-enforcement-final-rule-requirements-related-mhpaea.pdf
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Bishop TF, Press MJ, Keyhani S, Pincus HA. Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care. JAMA Psychiatry. 2014;71(2):176-181. https://pmc.ncbi.nlm.nih.gov/articles/PMC3967759/
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Mark TL, Olesiuk W, Ali MM, Sherman LJ, Mutter R, Teich JL. Differential Reimbursement of Psychiatric Services by Psychiatrists and Other Medical Providers. Psychiatr Serv. 2018. https://psychiatryonline.org/doi/10.1176/appi.ps.201700271
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National Academies of Sciences, Engineering, and Medicine. Behavioral Health and Well-Being. NCBI Bookshelf; 2024. https://www.ncbi.nlm.nih.gov/books/NBK609444/
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Commonwealth Fund. Medicaid’s Role in Mental Health and Substance Use Care. Commonwealth Fund; 2025. https://www.commonwealthfund.org/publications/explainer/2025/may/medicaids-role-mental-health-and-substance-use-care