Brookings. The economic value of policies and programs to support children’s mental health
Published on March 17, 2026, this research paper by Richard G. Frank and Chloe Zilkha — from Brookings’ Center on Health Policy — examines the economic return on public investment in children’s mental health. The study focuses on Pennsylvania as a case study, though its findings carry broader implications across the United States. Using the Marginal Value of Public Funds (MVPF) framework, the authors treat spending on health coverage and school-based programs as long-term investments. This analysis is especially timely given recent federal policy changes that threaten Medicaid coverage and school-based health programs for low-income children.
The Mental Health Landscape for Children
The scale of the challenge is significant. About 14.5% of children in Pennsylvania and 16.8% nationally had any mental, emotional, or behavioral (MEB) disorder in 2023. Anxiety is the most prevalent condition, affecting around 11% of children in both Pennsylvania and the United States. Access to care, however, remains insufficient. In Pennsylvania, 43% of children with MEB disorders did not receive care to treat their mental health condition. Notably, about one in five adolescents experienced a major depressive episode in the past year, and roughly 3 to 4% attempted suicide. Taken together, these figures underscore the urgency of effective, well-funded interventions.
Medicaid Expansions: A Strong Return on Investment
The authors assess evidence from three policy areas, starting with Medicaid expansions for children in the 1980s and 1990s. Results are compelling. The combination of lower mortality, greater educational attainment, and higher earnings allows taxpayers to recoup $0.58 per $1 spent on Medicaid expansion. When applying the MVPF framework to Pennsylvania data, the authors estimate that beneficiaries obtained $1.97 per $1 of net public spending on expanded Medicaid eligibility. Congressional Budget Office estimates point to an even higher MVPF of 4.11 — meaning $4.11 of beneficiary value for each dollar spent. Early investments in children’s health coverage therefore generate substantial downstream fiscal and social returns.
School-Based Programs and Early Childhood Interventions
Beyond Medicaid, the paper also examines school-based mental health programs and early childhood interventions. Program selection, the authors emphasize, is critical. There are a large number of interventions in school-based programs and community contexts for which the evidence suggests that the programs are unlikely to be effective, let alone cost-effective. Therefore, the choice of programs given the context is extremely important to realizing potential benefits. For evidence-based programs, however, the analysis consistently shows that early childhood and school-based interventions pay for themselves over the long term through improved educational outcomes, reduced reliance on public assistance, and higher future earnings.
Policy Implications
The authors conclude that public investment in children’s mental health is not only morally justified but economically sound. The MVPF framework demonstrates that well-designed programs generate benefits to recipients that exceed their net cost to government. Accordingly, reductions in Medicaid coverage or school-based health funding carry hidden long-term fiscal costs that outweigh short-term savings. While the analysis centers on Pennsylvania, many of its observations and policy implications apply broadly across the United States.
Reference:
Frank, R. G., & Zilkha, C. (2026, March 17). The economic value of policies and programs to support children’s mental health. Brookings Institution. https://www.brookings.edu/articles/the-economic-value-of-policies-and-programs-to-support-childrens-mental-health/