TRILLIANT HEALTH RESEARCH / STUDIES

Behavioral Health Demand Is High and Increasing, With Growth Distributed Across a Wide Range of Diagnoses

Demand for behavioral health services is increasing, driven by a combination of escalating need, improved access, reduced social stigma and evolving screening recommendations. At the same time, provider shortages pose a persistent problem, along with inconsistent coverage policies and affordability challenges. As utilization of behavioral health services continues to grow, understanding both the volume of care utilization and its distribution across conditions and patient populations is critical to understanding how the behavioral health landscape will continue to evolve.

Background

The U.S. behavioral health crisis is accelerating, characterized by the increasing prevalence of mental illness and alcohol substance use disorders (SUD) alongside persistent gaps in workforce supply and access to timely care. Nearly one in four American adults live with a mental illness and more than one in six Americans live with SUD – more than 48,000 people die by suicide each year and 129,562 die by drug- or alcohol-induced causes.^1,2 Collectively, behavioral health conditions are a leading driver of disability, lost productivity and premature death across demographic groups.³ The economic burden of behavioral health conditions in the U.S., including healthcare services, lost wages, criminal justice involvement and premature death, exceeds $300B annually, with some estimates far exceeding that amount.⁴

Much of the behavioral health crisis is concentrated among younger populations. Rates of anxiety and depression among children and adolescents have increased in recent years. Among children and adolescents, the prevalence of anxiety increased from 7.1% in 2016 to 10.6% in 2022, while the prevalence of depression increased from 3.2% to 4.6% in the same period.⁵ The governmental and societal response to the COVID-19 pandemic exacerbated these trends, intensifying social isolation, disrupting access to school and community and contributing to sustained increases in behavioral health service utilization.⁶ These effects have persisted beyond the pandemic, suggesting a structurally higher level of behavioral health need among the younger population.⁷

Importantly, most behavioral health conditions are treatable, and early intervention can significantly influence long-term outcomes. However, access to care remains challenging, as more than half of adults (79.0%) living with a mental illness do not receive treatment.⁸ This unmet need, in part, is driven by provider shortages, fragmented systems – where behavioral health services are often siloed from primary and medical care – societal stigma and inconsistent coverage of behavioral health services and treatments. The Health Resources and Services Administration (HRSA) projects that by 2038, only the supply of psychiatric nurse practitioners will exceed demand (108% adequacy), while all other major behavioral health professions are projected to be inadequately supplied, including psychologists (48%) and adult psychiatrists (50%).⁹ While stigma surrounding some mental health conditions and SUD has declined in recent years, it remains a problem for certain conditions and populations. More specifically, evidence suggests that public acceptance of more common conditions like depression has improved, but stigma associated with more severe conditions such as schizophrenia or SUD persists and, in some cases, has worsened.¹⁰ As a result, stigma and beliefs about self-reliance continue to deter people from seeking behavioral health care.¹¹ Cost also remains a major barrier to accessing behavioral health treatment, cited by 65.2% of adults with unmet mental health needs and 45.3% with SUD, with many also reporting insufficient insurance coverage.¹²

Preventive screening guidelines increasingly emphasize early identification of behavioral health conditions across populations. The U.S. Preventive Services Task Force (USPSTF) recommends routine screening for anxiety and depression among both adults and adolescents, as well as screening for substance use and suicide risk.¹³ These recommendations reflect a shift toward integrating screening into primary care, with the goal of identifying conditions earlier and initiating treatment before symptoms worsen or lead to more severe outcomes. However, expanded screening may also contribute to increased diagnosis rates, particularly for more mild or even subclinical conditions, raising considerations about appropriate thresholds for diagnosis and the potential for overtreatment.

Meaningful advancements in prevention, early identification and access to evidence-based treatment would have a significant impact on health outcomes, quality of life, healthcare spending and workforce productivity. Therefore, this study examines the fastest-growing behavioral health conditions in recent years, analyzing diagnosis-level trends in share of utilization and patient demographic characteristics.

Analytic Approach

National all-payer claims data were leveraged to examine commercial behavioral health visit volume from 2018 to 2024. Behavioral health visits were categorized by ICD-10 condition chapters and then further stratified by diagnosis. Utilization was assessed using percent change in rate of visits per 1,000, share of diagnosis-level visit volume and average number of visits per patient. Patient characteristics, including average age and gender, were also examined.

Findings

Between 2018 and 2024, the rate of behavioral health visits increased by 62.6%, from 828 to 1,346 per 1,000 people (Figure 1). Over that same period, the utilization rate for anxiety disorders increased by 89.3%, while other behavioral health visits (e.g., developmental disorders, speech and language disorders, eating disorders) and behavioral and emotional disorder visits (e.g., attention-deficit hyperactivity disorders (ADHD), conduct disorders) increased by 60.2% and 51.0%, respectively. Despite variation in growth rates, the overall distribution of behavioral health conditions has remained stable, with anxiety disorders consistently accounting for the highest rate of utilization (646.0 per 1,000), followed by mood disorders (e.g., depression, bipolar disorder) (297.0) and all other behavioral health conditions (e.g., developmental disorders, speech and language disorders, eating disorders, sleep disorders and dementia) (193.5).

Within the most common and fastest growing ICD-10 behavioral health chapter, there were 646.0 visits per 1,000 people for anxiety disorders in 2024, an 89.3% increase since 2018. Other anxiety disorders (e.g., generalized anxiety disorder, panic disorder) account for most anxiety-specific visit volume (53.5%) and 25.6% of all behavioral health volume (Figure 2). Since 2018, the rate of visits per 1,000 people for other anxiety disorders and obsessive-compulsive disorders (OCD) have increased most quickly – 109.8% and 111.1%, respectively. Growing by 69.6% since 2018, reaction to severe stress and adjustment disorders (e.g., post-traumatic stress disorder) is the second highest-volume diagnosis category among anxiety disorder visits (42.2%) and account for 20.2% of total behavioral health visit volume. In contrast, lower-volume diagnosis categories have grown more slowly, with visits for somatoform disorders (e.g., body dysmorphia, hypochondriasis) and other nonpsychotic mental disorders (e.g., depersonalization-derealization syndrome) increasing by 7.0% and 13.4%, respectively. Across anxiety-related diagnoses, average visits per patient range from 3.1 for other nonpsychotic mental disorders (e.g., depersonalization-derealization syndrome) to 8.4 for reaction to severe stress and adjustment disorders. Women account for most of all anxiety-related diagnoses, ranging from 57.9% for other nonpsychotic mental disorders to 76.6% for dissociative and conversion disorders (e.g., dissociative amnesia). The typical patient is in early adulthood, with an average age ranging from 28.4 years for phobic anxiety disorders to 38.7 for somatoform disorders.

All other behavioral health disorders represent a broad category including, but not limited to, developmental disorders, speech and language disorders, eating disorders, sleep disorders and dementia. Between 2018 and 2024, visits per 1,000 people increased by 60.2%, making it the second fastest growing ICD-10 chapter. Pervasive developmental disorders (e.g., autism, Asperger’s syndrome) comprise the largest share of all other behavioral health disorders (47.3%), compared to just 6.7% of all behavioral health visits (Figure 3). Since 2018, the rate of visits per 1,000 people for pervasive developmental disorders increased 77.7%, averaging 28.8 visits per year. In the same period, lower-volume diagnosis categories had larger increases in visits, including gender identity disorders (181.8%), specific personality disorders (e.g., antisocial personality disorder, borderline personality disorder) (130.7%) and mild intellectual disabilities (126.4%). Specific developmental disorders of speech and language are the second highest-volume diagnosis category among all other behavioral health disorder visits (27.2%) and account for 3.9% of behavioral health volume. Across all other behavioral health disorders, average visits per patient range from 1.5 for sleep disorders not due to a substance or psychological condition to 28.8 for pervasive developmental disorders. Within this category, patient characteristics are more heterogeneous – women account for just 32.0% of specific developmental disorders of speech and language and up to 87.8% of eating disorders, while average patient age ranging from 5.7 for specific developmental disorders of motor function to 46.0 years for sleep disorders not due to a substance or known physiological condition.

Within the third fastest growing ICD-10 behavioral health chapter, there were 116.3 visits per 1,000 people for behavioral and emotional disorders in 2024, a 51.0% increase since 2018. ADHD accounts for the overwhelming majority of behavioral and emotional disorders (88.3%), but only 7.6% of all behavioral health visits. Since 2018, the rate of visits per 1,000 people for ADHD increased 63.8%, the largest increase in this category. In contrast, lower-volume diagnosis categories have decreased, with visits for conduct disorder and tic disorder (e.g., Tourette’s) decreasing by 14.7% and 4.8%, respectively. Across behavioral and emotional disorders, average visits per patient range from 1.9 for other behavioral and emotional disorders with onset usually occurring in childhood and adolescence to 7.9 for disorders of social functioning with specific to childhood and adolescence. Adolescent females account for the minority of conduct disorders (32.8%) to 57.4% for emotional disorders with onset specific to childhood of volume per diagnosis category. Behavioral and emotional disorders have a relatively young patient population, with conditions like conduct disorders, emotional disorders with onset specific to childhood and disorders of social functioning with onset specific to childhood and adolescence most impacting children younger than 18.

Conclusion

Behavioral health utilization is high and increasing in the U.S., with growth distributed across a wide range of diagnoses. While common conditions such as depression, anxiety and ADHD continue to account for most visits, patterns of growth vary substantially across diagnoses, suggesting the emergence of a more heterogeneous behavioral health patient population. For example, as visits for other anxiety disorders (e.g., generalized anxiety disorder) have increased 109.8% since 2018, visits for less common conditions such as reaction to severe stress and adjustment disorders (e.g., PTSD), OCD, pervasive developmental disorders (e.g., autism), developmental disorders of speech and language and eating disorders have increased meaningfully. The broad nature of these increases underscores that demand growth is not concentrated to a handful of common diagnoses, reflecting disparate trends in prevalence, diagnosis and treatment.

These patterns point to a complex set of concerns underlying the behavioral health crisis: worsening mental health among younger populations and persistent provider shortages, paired with the potential for over-screening and overdiagnosis. Rising prevalence among adolescents and young adults has implications for lifetime healthcare utilization, workforce participation and disability – particularly as early-onset conditions are associated with more chronic and severe disease trajectories.¹⁴ Behavioral health provider shortages limit timely access to care, contributing to delayed treatment, greater reliance on emergency and acute care settings, provider burnout and increased disease severity at presentation.¹⁵ At the same time, expanded screening and heightened awareness may be driving increased identification of more mild or even subclinical conditions, raising questions about appropriate thresholds for diagnosis and the potential for overtreatment.¹⁶ These concerns suggest that rising utilization not only reflects increased demand, but also a structure imbalance in how behavioral health conditions are identified and managed.

At the same time, external factors – including economic instability, social isolation and the growing influence of social media –contribute to the observed growth in certain conditions, particularly anxiety, depression and stress-related disorders. Financial stressors and broader economic uncertainty are associated with increased prevalence of mood disorders, anxiety and SUD.¹⁷ Social media platforms, which are increasingly used to disseminate mental health information, further shape awareness, symptom recognition and care-seeking behavior, particularly given variability in the accuracy of online content.¹⁸ The governmental and societal response to the COVID-19 pandemic exacerbated an already worsening behavioral health crisis, driving sustained increases in behavioral health demand, which constrained the behavioral health provider supply. These effects have persisted beyond the public health emergency, particularly among younger populations, where rates of conditions such as depression, eating disorders and self-harm have increased disproportionately relative to the overall population.¹⁹ As behavioral health demand evolves, aligning workforce capacity and care delivery models will be critical to meeting the growing and increasingly diverse needs of patients. 

While increased behavioral health utilization may raise near-term healthcare spending, untreated mental illness already imposes a growing economic burden, costing the U.S. an estimated $477.5B in 2024 and projected to exceed $1.3T annually by 2040.²⁰ The majority of these projected costs will be driven by premature mortality ($911.1B ) and productivity losses ($252.3B), including unemployment, absenteeism and presenteeism, with additional spending tied to avoidable medical costs such as emergency department utilization and chronic disease burden.²¹ Expanded investment in behavioral health may yield downstream economic benefits, even as near-term utilization and spending increases.

Health economy stakeholders must address the worsening behavioral health crisis within the context of ongoing supply constraints. Providers, historically focused on managing high-volume conditions such as depression and anxiety, will need to expand care models to support more complex and heterogeneous diagnoses – including severe mental illness, comorbid physical conditions, less common disorders that require more visits, multidisciplinary care teams and specialized training.²² Payers will need to account for greater variation in care pathways and utilization intensity across conditions, as treatment for behavioral health conditions increasingly ranges from low-acuity outpatient therapy to intensive outpatient programs, inpatient care and long-term care coordination. This variability challenges traditional reimbursement structures and requires more flexible benefit design and network standards.

Policymakers, in turn, face increasing pressure to address not only overall workforce shortages but also gaps in specialty training and care access, particularly as Federal parity protections become less certain. The September 2024 update to the Mental Health Parity and Addiction Act (MHPAEA) – which requires health plans to treat mental health and substance use care equally to medical care – aimed to strengthen enforcement by prohibiting stricter nonquantitative treatment limitations (NQTLs) such as prior authorization or network restrictions.²³ However, the subsequent non-enforcement under the Trump Administration means insurers are no longer required to comply with MHPEA, introducing greater variation in payer practices, potentially exacerbating disparities in access to behavioral healthcare.²⁴ Addressing these challenges will require coordinated policy action to better align how behavioral health conditions are identified, reimbursed and treated – through strengthened parity enforcement, targeted workforce expansion and greater support for integrated, multidisciplinary care delivery models. Without this alignment, rising utilization will continue to outpace the healthcare system’s ability to deliver timely, high-value care.

Was this email forwarded to you? Subscribe to get our research first.