Earlier this week, we released the 2026 Behavioral Health Report, which examines the most important emerging and persistent trends in behavioral health. The data make clear that the behavioral health crisis is one of the most urgent and under-addressed challenges in the U.S. Nearly one in four American adults lives with a mental illness, and more than 48,000 people die by suicide each year – yet more than half of adults with a mental health condition do not receive treatment. Rising rates of anxiety and depression among young adults, growing social isolation and the lingering effects of the governmental and societal response to the COVID-19 pandemic suggest the crisis will only intensify in the years ahead without meaningful systemwide intervention.
Behavioral health prevalence increased substantially during and after the COVID-19 pandemic, with any mental illness affecting nearly one in four adults by 2024. Young adults ages 18-25 have the highest burden (33.2%), while adults ages 26-49 are experiencing the fastest growth in prevalence. While United States Preventive Services Task Force (USPSTF) guidelines emphasize screening and early identification of behavioral health issues, early identification is insufficient without accessible treatment. Cost and health insurance coverage remain two of the most cited barriers to accessing mental health and substance use disorder (SUD) treatment.
At the same time, the behavioral health workforce has not been able to keep pace with the demand for behavioral health services. Nationally, the mental health professional adequacy rate is just 27.3%, and by 2038, projected demand is expected to exceed supply by approximately 36,780 full-time equivalents (FTEs) in adult psychiatry and 99,780 FTEs in mental health counseling.
Given the dynamic nature of behavioral health supply and demand, this analysis examines longitudinal trends in behavioral health treatment and prescribing patterns.
National all-payer claims data were leveraged to examine behavioral health treatment and prescribing patterns between 2018 and 2024. For each year, commercially insured patients with a history of anxiety and/or depression were segmented into one of four treatment categories: psychotherapy only, medication only, both medication and psychotherapy or no treatment. To further examine trends in behavioral health prescribing, patient volume by drug class – stimulants, anxiolytics, antipsychotics, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and mood stabilizers – were analyzed. Additionally, prescription volume was segmented by provider type: psychiatrist (MD/DO), primary care physician (MD/DO), allied health provider (nurse practitioner (NP) or physician assistant (PA)), OB/GYN physician (MD/DO) and all other providers.
From 2018 to 2024, treatment patterns for patients with anxiety and/or depression remained relatively stable. However, the share of patients not receiving treatment increased from 19.0% to 22.4%, peaking at 25.1% in 2020 (Figure 1). Simultaneously, the proportion of patients receiving both therapy and medication decreased from 25.2% in 2018 to 20.0% in 2024, while the proportion of patients receiving medication only increased from 17.8% to 19.4%. Throughout the period, patients receiving therapy ranged from 33.7% in 2020 to 38.2% in 2024.
From 2018 to 2024, patient volume for behavioral health-related medications increased by more than 20% across drug classes. The share of patients taking stimulants increased the most (53.3%), followed by antipsychotics (45.4%) (Figure 2). While anxiolytics represent the medication class with the highest overall patient volume, this class grew least quickly (22.6%).
Growth in patient volume was generally higher across behavioral health medication classes from 2018 to 2024, with rates varying across classes by age and sex. Growth in stimulant use was particularly pronounced among women ages 18-44 (93.6%) (Figure 3). For anxiolytics, percent increases ranged from 39.6% among men ages 18-44 to 11.6% among men and women ages 45-64. Except for a slight decline among adolescent males, patient volume for mood stabilizers increased across all categories of age and gender, increasing the most (43.4%) among women ages 18-44.
Prescribing patterns for behavioral health medications have shifted substantially in recent years. From 2018 to 2024, allied health providers (i.e., NPs and PAs) became the most common prescribing provider type, increasing from 20.7% to 34.3% of total prescription volume (Figure 4). Psychiatrists were the third highest prescriber in 2024, behind primary care providers. Together, allied health providers and primary care physicians accounted for 65.9% of prescription volume in 2024. The shift in prescribing patterns by allied health likely reflects changing scope of practice laws and the growing number of NPs and PAs specializing in behavioral health.
The rise in patients who are not receiving treatment for their behavioral health conditions, now representing more than one in five individuals with anxiety and/or depression, is particularly concerning given the well-documented consequences of delayed or absent care. Untreated mental illness already costs the U.S. economy a projected $477.5B annually, a figure projected to exceed $1.3T by 2040.1
The consequences of untreated behavioral health conditions are extensive. Behavioral comorbidities have been shown to exacerbate the acuity and cost of treating physical conditions, such as diabetes and hypertension. Additionally, patients who frequently cycle through inpatient and emergency department settings can incur exponentially higher healthcare costs.2 As anxiety and depression screenings and diagnoses increase, the inability of the healthcare system to manage these needs will drive continued cost growth and clinical risk.
The rapid growth in stimulant use, especially among women ages 18-44, warrants further analysis. While some of this increase likely reflects improved recognition and diagnosis of attention-deficit/hyperactivity disorder (ADHD) and related conditions, it also raises questions about appropriate screening practices, prescribing standards and the potential for overdiagnosis and overtreatment. The emergence of direct-to-consumer (DTC) mental health platforms has also coincided with significantly increased e-prescribing rates of stimulants, particularly among young adults, despite ongoing stimulant shortages and heightened regulatory scrutiny. More specifically, this trend raises concerns about potential health risks associated with off-label stimulant use, including cardiovascular effects, dependence and misuse, particularly among individuals without a clinically established need. Comorbid behavioral health conditions among ADHD patients, such as anxiety, mood disorders and SUD, further underscore the importance of careful prescribing and monitoring practices.
Similarly, the accelerating shift in prescribing toward allied health providers reflects both a pragmatic response to physician shortages and a structural evolution in behavioral health care delivery. As NPs and PAs assume a larger share of behavioral health prescribing, investment in training, supervision frameworks and clinical decision support becomes increasingly important to maintaining care quality.
These findings underscore the need for policymakers to strengthen and enforce mental health parity requirements, invest in workforce development and support care integration models that connect behavioral and physical health. Payers and providers should improve transitions of care, particularly following high-acuity episodes, and expand access to evidence-based, guideline-concordant treatment.