Two dimensions of access: Availability and affordability of mental health care across the United States.

directory, which provides consumer-facing data on fees and service location. We constructed county-level indices of availability (providers per 100,000 residents) and affordability (10-session cost relative to disposable income) across 2,565 U.S. counties. Results reveal a stratified mental health care landscape characterized by persistent rural-urban disparities and affordability burdens. At the same time, financial burdens were greater outside large urban areas, especially in the South. Although availability and affordability frequently overlap, important divergences emerge, including counties with providers present but financially inaccessible and vice versa. Regression analyses reveal that income is the strongest predictor across both indices, with income inequality, political partisanship, and racial/ethnic composition also shaping access. By integrating supply and cost, this study empirically reframes accessibility as multidimensional and identifies regions most affected by dual burdens. Findings highlight affordability as a distinct axis of accessibility and underscore the need for policy approaches that move beyond workforce expansion alone to address the structural, financial, and institutional conditions that constrain access to care. (PsycInfo Database Record (c) 2026 APA, all rights reserved).