Mental Health EHRs: The Complete Comparison Guide (2026)

Short answer: There is no best mental health EHR, there's a best one for your practice size. Solo therapists should look at SimplePractice or Sessions Health. Insurance-heavy practices should look at TherapyNotes. Group practices past about ten clinicians should look at platforms built for multi-clinician operations, because that's where every solo-first product breaks in the same predictable places.

This guide is organized around practice size, because that's the variable that actually decides the answer.

Start here: what size are you?

• Solo. What matters most: Ease of use, mobile, client portal, price. Look at: SimplePractice, Sessions Health, TheraPlatform.
• 2 to 5 clinicians. What matters most: Above, plus basic roles and shared scheduling. Look at: SimplePractice, TherapyNotes, Jane App.
• 5 to 15 clinicians. What matters most: Supervision, permissions, billing volume. Look at: TherapyNotes, Valant, purpose-built group platforms.
• 15 to 50 clinicians. What matters most: Payroll modeling, observability, per-seat economics. Look at: Group-built platforms; Valant, ICANotes, Oasys.
• 50+. What matters most: Enterprise reporting, multi-location, integrations. Look at: Group/enterprise platforms.

The four things that break as you grow

Every practice that outgrows its EHR outgrows it in the same four places. Knowing them in advance is most of the evaluation.

1. Permissions (breaks around 5)

Once you have an office manager, a biller, and clinicians who shouldn't see each other's caseloads, all-or-nothing admin access stops working.

2. Supervision (breaks around 15)

Most platforms require supervisor sign-off on all supervisees regardless of credential status, including provisionally licensed clinicians who are independently credentialed with payers and don't legally require a co-signature. One practice asked us: "if it's a supervisee, you have to sign off on everything. Is there a way to differentiate that?"

3. Payroll (breaks around 15, and it's the expensive one)

The largest hidden cost in this category. One group practice:

"About 20 hours a week of our billing manager goes into converting the information in [our EHR] into a payroll ledger."

Half a full-time role, permanently, because the software can't express a contractor revenue split or a salaried arrangement with an hourly minimum plus commission.

4. Per-seat economics (breaks around 30)

"There's a point where it's going to get too expensive, because it's a cost per user, they don't offer an enterprise package."

And most platforms charge full seat price for unlicensed interns. Some practices carry more trainees than licensed clinicians.

The platforms

SimplePractice

Best for: Solo and very small practices. Strengths: Best mobile app in the category, polished interface, broad practitioner support, large ecosystem. Weaknesses at scale: "Works quite well for a solo provider, but then really when you start growing, that's when it falls apart." Forced sign-off for all supervisees; interns at full price; couples/family records don't link; VOB "barely functional"; no API.

TherapyNotes

Best for: Insurance-heavy, compliance-driven practices up to ~20 users. Strengths: ONC-certified. Structured documentation. Support that long-tenured users defend unprompted: "exceptional customer service. I gauge them as a high integrity organization." Weaknesses at scale: Per-user pricing with no enterprise tier; per-claim, per-ERA and per-text-reminder fees (one group practice: a monthly bill in the low thousands); no native payroll; limited integrations; revised signed notes reportedly lack full change history; no straight migration path out.

Jane App

Best for: Multi-disciplinary clinics mixing mental health with PT, chiro, and similar. Strengths: Outstanding scheduling; strong all-round product. Weaknesses: Less targeted at mental-health-specific group workflows like supervision.

Valant

Best for: Behavioral health groups prioritizing back-office reporting. Strengths: Purpose-built for behavioral health groups; strong business operations. Weaknesses: Documentation experience is the recurring objection. A practice that nearly signed pulled back after clinician feedback: "the interface for the paperwork is pretty cumbersome." Their summary: "I believe they can fix all kinds of problems on the back end. But then what we would lose is the documentation on the front end."

ICANotes

Best for: High-acuity and psychiatric settings. Strengths: Highly structured, button-driven psychiatric documentation. Weaknesses: Constraining for clinicians who want narrative flexibility.

Sessions Health

Best for: Solo and small practices wanting a modern, affordable product. Strengths: Clean, well-priced, actively developed. Weaknesses: Smaller feature surface for group operations.

TheraNest

Best for: Small to mid practices. Weaknesses: Migration experiences reported to us have been poor, one practice moving from another system described it as "a nightmare. Very complex. And we couldn't get the support we needed despite paying extra for the white glove onboarding service. Things were migrated over and done incorrectly."

Migration is the question we are asked about most. Rather than make promises in a blog post, ask us directly what moving your particular system would involve, what comes across, and what happens to appointments already booked.

How to actually evaluate one

Demos are designed to look good. These five tests aren't:

1. The group session test. Run one group with eight attendees. Count the actions to

produce eight correct claims. Solo-built platforms make you do it eight times.

1. The supervision test. Ask them to configure one intern requiring co-sign and one

provisionally licensed clinician who doesn't. Watch whether it's possible.

1. The payroll test. Give them your actual compensation structure, splits, minimums,

commissions, and ask them to produce a payroll ledger. Not a report. A ledger.

1. The amendment test. Amend a signed note, then ask to see the change history. You

want who unlocked it, why, and the before and after. Oasys keeps all four; several platforms keep none.

1. The export test. Ask how you'd get your data out in three years. The answer tells

you how they think about lock-in.

1. The clinician test. Put two clinicians in front of it before you sign. The practice

that nearly bought Valant learned this the useful way.

The migration question

The reason practices stay on platforms they've outgrown isn't inertia. It's risk.

Group practices in this category typically carry 8 to 11 years of records. One the better part of a decade in; another 11 years across 11 locations. Failed migrations are common and remembered: one attempt was "awful. Bad. So bad." Two clinicians at one practice had previously worked somewhere whose botched implementation ended in the entire staff being furloughed.

Which is why we hear this sentence, in a dozen different forms:

"We can't do it twice."

Ask any vendor: will you build a migration path for my system, or hand me an importer? Does it carry assessments and intake forms, not just notes? What happens to appointments already on the calendar? Can I see the migrated data before I sign? Who does the work?