Interactive Tools for Analyzing County-Level Mental Health Care Affordability and Availability
This site provides interactive visualizations of county-level mental health care availability (AVI) and affordability (AFI) across the United States. Users can explore geographic patterns, examine associations with county characteristics, and evaluate affordability under alternative payment scenarios.
We constructed two county-level indices to capture complementary dimensions of mental health care access: an Availability Index (AVI) and an Affordability Index (AFI). The AVI reflects the local supply of providers relative to population size, whereas the AFI captures the financial burden of initiating psychotherapy relative to household economic capacity.
The Availability Index measures the density of mental health providers relative to the county population, serving as an indicator of service capacity available to residents. Higher AVI values indicate greater service availability.
The AVI represents the number of providers per 100,000 residents. For example, an AVI of 100 indicates that a county has 100 listed providers for every 100,000 people in its population. Provider counts are deduplicated, and population estimates are from the U.S. Census Bureau Population Estimates Program (July 1, 2024).
The Affordability Index estimates the baseline financial burden of accessing psychotherapy based on posted cash session fees and local economic conditions. Higher AFI values indicate lower affordability (i.e., greater cost burden).
We operationalized treatment cost as the median posted session fee multiplied by ten, representing a standardized benchmark course of initial care. Disposable income approximates financial capacity after accounting for essential living expenses. Living costs are estimated using the Economic Policy Institute's Family Budget Calculator, which models locally specific costs for housing, food, transportation, childcare, healthcare, taxes, and other necessities.
The AFI is expressed as a percentage. For example, an AFI of 3% indicates that ten psychotherapy sessions represent 3% of a household's median disposable income in that county. In the calculator tool, AFI values are winsorized at the 5th and 95th percentiles to improve visualization while maintaining data integrity. Counties with negative disposable income (where living costs exceed median household income) are assigned the 95th percentile value, representing the highest financial burden.
Both the Availability Index (AVI) and Affordability Index (AFI) are grouped into quintile-based categories for visualization: Low (0-20th percentile), Low Average (20-40th percentile), Average (40-60th percentile), Above Average (60-80th percentile), and High (80-100th percentile). These categories represent a county's relative position within the national distribution of each index.
Important Note on AFI Category Interpretation: The Affordability Index (AFI) is mathematically defined as a burden-based measure, where higher AFI values indicate higher financial burden and lower affordability. However, for the purposes of the interactive map, AFI categories are reversed in interpretation so that color meanings are consistent with the Availability Index (AVI).
Specifically, AFI quintile categories are mapped to represent relative affordability rather than raw burden:
Counties in the "High" AFI category represent counties with higher affordability (lower financial burden), meaning households spend a smaller share of their disposable income on mental health services.
Counties in the "Low" AFI category represent counties with lower affordability (higher financial burden), meaning households face greater economic strain when accessing care.
This inversion is applied only at the visualization layer to ensure that darker or "higher" color categories consistently represent more favorable access conditions across both indices.
AVI Interpretation: The Availability Index (AVI) follows standard interpretation: higher AVI values and higher AVI categories indicate greater provider availability per capita.