As a children’s emergency room doctor in San Francisco, Ashley Foster has found herself treating an increasing number of adolescents for substance abuse, anxiety, depression and other behavioral health issues over the last decade. Often, they arrive at the hospital in crisis, she said.

Foster’s experience aligns with a well-known and disturbing trend in American health care: more children are having mental health problems. In 2023, 40% of high school students reported persistent feelings of sadness or hopelessness, and 20% had seriously considered attempting suicide, according to a Centers for Disease Control and Prevention study.

Studies also found that more young people are going to emergency rooms for care — an expensive option that can cost thousands of dollars.

Foster wondered how much that care was costing families and the broader U.S. health system. In a new study published Monday, she and a team of researchers found that the U.S. spent $42 billion on behavioral health care for youth in 2022 — about 40% of all health care spending on infants, children and teens. That share of spending doubled between 2011 and 2022, the study found.

“Behavioral health is no longer a niche part of pediatrics,” said Foster, using the term for children’s health care. “It’s accounting for nearly half of child health spending.”

The paper was published in the peer-reviewed medical journal JAMA Pediatrics, using a federal government database of health surveys from 2011 to 2022.

It also measured the financial toll on parents with children who are grappling with mental health conditions or addiction. Out-of-pocket spending for that care increased at more than twice the rate of other care, the study found. Having at least one child who needed behavioral health treatment was linked with “high and extreme financial burden,” according to the study.

“For families already stretched thin, this adds up really quickly,” Foster said.

This latest study adds to lots of others documenting the financial stress that a child’s mental health or addiction challenges can inflict on parents, said Mark Fishler, development officer of Parents Helping Parents, a nonprofit resource for parents raising children with disabilities.

“There’s definitely a financial toll,” he said.

Foster’s research found that families were spending more on home health visits and telehealth — phone or video appointments — as well as outpatient care. The availability of telehealth saw an “explosion” during the pandemic, she said. Meanwhile, spending on emergency visits stayed about flat. To Foster, that suggests that kids are seeking out behavioral health care more in their communities, rather than hospital departments like hers in San Francisco.

To ease the pain on families, Foster called on policymakers to strengthen insurance coverage, lower out-of-pocket costs, and think of behavioral health as essential for youth.

But she and treatment providers in the Bay Area noted a bright spot: More children are accessing mental health and addiction treatment in the first place.

Although the COVID-19 pandemic isolated children and adults — driving negative health outcomes — it did spur more conversation about mental health, said Mark Cloutier, chief executive officer of the behavioral health treatment network Caminar, which plans to open a new teen and family center in Palo Alto next week. That reduced stigma, he said, freeing up more people to seek help.

There’s still an “urgent need to improve affordability and access,” Foster, the researcher, said.

California has suffered from a critical shortage of behavioral health treatment providers for youth and adults alike. In May, California Gov. Gavin Newsom began distributing the first $3.3 billion in funds from Proposition 1, a 2024 ballot measure approved by a majority of voters. Those funds were slated to help build 19 addiction and mental health treatment centers in the Bay Area.

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