Behavioral health utilization increased substantially from 2018 to 2024, with anxiety disorder care fueling much of that growth, according to Trilliant Health.
The health data analytics and market research firm's latest report outlines a 62.6% jump in behavioral health utilization, based on any visit associated with a behavioral health diagnosis code.
Between 2008 and 2024, the prevalence of mental illness increased by almost 6 percentage points. About a quarter of adults had any mental illness in 2024, Trilliant found, though in adults 18-25 exhibit the highest prevalence both in terms of any mental illness (33%) and serious mental illness (16%).
Anxiety disorders accounted for the highest visit volume and experienced the fastest growth, up 89% from 2018 to 2024. Anxiety disorders in women aged 18-44 were also the highest utilization category in 2024.
It’s possible those figures are increasing because more screening is happening, acknowledged Trilliant Health Chief Research Officer Allison Oakes, Ph.D.
“We’re always trying to disentangle these increases in utilization to understand: Okay, what is new behavioral health need, what is need that’s always sort of been there [but care was inaccessible], … what part of that increased utilization could have something to do with overdiagnosis?" Oakes told Fierce Healthcare.
Multiracial individuals have the highest prevalence across major behavioral health conditions, the report found, including any mental illness (36%) compared to white (25%) and Black (20%) individuals, and substance use disorder (25%) compared to white (19%) and Black (18%) individuals.
In terms of the fastest-growing medications, stimulants were at the top, with the share of patients taking them growing 53% from 2018 to 2024. This was followed by antipsychotics, growing 45% in the studied time period. The number of patients receiving medication-only treatment is up nearly two percentage points for the period studied, per Oakes. The portion of patients receiving both therapy and medication decreased.
“Prescription-first sort of approaches to behavioral health are becoming a little bit more common,” Oakes said.
The proportion of telehealth volume attributed to behavioral health in 2024 was nearly 66%. That’s up from 18% in 2018. Despite this, telehealth’s dominance in both medical and behavioral health is plateauing compared to the early days of the COVID-19 pandemic, per Oakes.
The report also looked at workforce shortages in behavioral health, projecting a full-time equivalent shortfall of 99,780 in mental health counseling by 2038. The 2025 national mental health professional adequacy rate was 27%. This was calculated by dividing the number of psychiatrists available to serve a given area by the number of psychiatrists that would be needed to eliminate the shortage area, as designated by the U.S. Health Resources & Services Administration. In individual states, adequacy was as low as 6% (West Virginia) and as high as 52% (New Jersey).
For providers, the report recommended establishing and maintaining a consistent relationship with patients to support continuity of care; to develop awareness of risk factors and proactively monitor for behavioral changes; and to understand high-value care pathways, including timely and appropriate treatment.
Finally, the report looked at the vastly variable commercial negotiated rates from UnitedHealthcare for individual and group psychotherapy codes. Based on health plan price transparency data, Trilliant found 7x variance for the same CPT code, depending on the provider. For example, individual psychotherapy might range from $78 to $542, the report found.
Some outliers in the data even suggest rates could vary as much as 20x for the same service. This reflects existing reports of reimbursement variation. “We see this across the board within healthcare,” Oakes noted. For instance, hospitals are known to have different prices between their chargemaster rates, negotiated rates and their cash-pay rates.
Price transparency data is messy, Oakes cautioned, and may contain what’s known as "zombie rates"—outdated or irrelevant rates. “Part of the game is just sorting through the data and sorting out the signal to noise,” Oakes said.
For payers, the report recommended ensuring broad coverage and network adequacy for providers, designing reimbursement structures that incentivize outcomes over volume and proactively managing members with complex conditions.
“What the data make clear is that incremental responses are insufficient. Ultimately, every stakeholder will need to reorient around a common standard: value for money,” the report concluded. “In behavioral health, that means measuring success not by the volume of services delivered or premiums collected, but by whether the system is producing better outcomes at a sustainable societal cost.”