Mental health in America is at a breaking point. Despite growing awareness and advances in prevention and treatment, access to care remains elusive for millions. Rising insurance costs, provider shortages, and policy rollbacks threaten to make an already dire situation even worse. The result is a nation where mental health struggles ripple outward — affecting not just those who are unwell, but entire communities and the economy at large.
Access to Care: A System on the Brink
According to the latest State of Mental Health in America report by Mental Health America (MHA), more than 5 million adults with mental illness were uninsured in 2022–2023, and one in four adults with a mental illness reported an unmet need for treatment (MHA, 2025). Access is particularly dire for low-income and rural populations, where providers are scarce and costs are often prohibitive.
The National Academies of Sciences, Engineering, and Medicine (NASEM) underscored the scale of the crisis earlier this year, warning that indicators of mental and behavioral well-being are worsening across the U.S. Their 2025 report calls for a coordinated, evidence-based expansion of preventive interventions, but also acknowledges that “the infrastructure — funding, workforce, data systems, and partnerships — needed to deliver these solutions remains inadequate” (NASEM, 2025).
Without adequate funding and coordination, even the best interventions fail to reach those most in need.
The Policy Shift That Could Price People Out of Care
At the heart of the issue lies policy. The American Psychological Association Services (APA Services) recently highlighted several 2025 policy changes that could substantially reduce access to mental health and substance use disorder services (APA Services, 2025).
Among the most consequential is H.R. 1, the “One Big Beautiful Bill Act”, passed on July 4, 2025, which cuts federal Medicaid funding by 15% — or roughly $1 trillion — over 10 years. The Congressional Budget Office estimates that nearly 15 million Americans will lose coverage as a result. Because states are not required to cover behavioral health services under Medicaid, these cuts will likely lead to a massive loss of access across the country.
Equally troubling is the administration’s decision in May 2025 not to enforce mental health parity regulations finalized under the previous administration. Those rules were designed to ensure that insurers treat mental health conditions the same as physical ones. Without enforcement, insurers can once again limit access or raise out-of-pocket costs for mental health care — effectively pricing out millions who rely on coverage for therapy or medication.
The likely outcome? Higher insurance costs for those who remain covered and even greater barriers to treatment for the uninsured and underinsured.
The Maternal Mental Health Crisis: A Warning Sign
The Policy Center for Maternal Mental Health released a sobering follow-up to its 2023 report, showing that counties with “severe” maternal mental health risk have tripled since 2023, and that 84% of birthing-aged women still live in maternal mental health resource shortage areas (Policy Center MMH, 2025).
While the number of trained providers has more than doubled, those increases are concentrated in lower-risk counties. The areas most at risk — including large parts of Texas, Alabama, Louisiana, Oklahoma, and Tennessee — remain critically underserved.
These findings underscore how structural inequities and resource gaps deepen mental health disparities. When new mothers cannot access care, the consequences extend far beyond the individual: family stability, early childhood development, and even community economic health all suffer.
When Mental Illness Affects Everyone
The costs of America’s mental health crisis are not abstract. They are measured in lost lives, lost workers, and lost potential. As Dr. Marcella Alsan, co-chair of the National Academies’ committee, put it, “The costs associated with our nation’s mental health and substance use crises are unbearably high, measured in lost and shattered lives of children, parents, siblings, and friends, and in lost workers, human potential, and economic productivity.”
When more people become mentally unwell — because they cannot afford care, find a provider, or navigate insurance — even those who are mentally healthy feel the impact. Workplaces lose productivity, families experience stress and burnout, and social systems become strained. Public health economists estimate that untreated mental illness costs the U.S. economy hundreds of billions of dollars each year in lost productivity and increased health spending.
In short, mental health is not just a personal issue — it’s a public one.
Building Forward: What Needs to Happen
The evidence and warnings are clear. To move forward, policymakers, insurers, and health systems must:
- Restore and expand funding for Medicaid and community-based mental health services.
- Reinstate and enforce mental health parity regulations to ensure equitable insurance coverage.
- Invest in provider workforce development, especially in rural and high-risk maternal health areas.
- Implement evidence-based prevention programs — from school-based interventions to community resilience initiatives — as recommended by the National Academies.
Without these changes, the U.S. risks deepening its mental health divide — one where care is available only to those who can afford it, while millions continue to fall through the cracks.