Bernalillo County, NM Takes Control of Behavioral Health System

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After several highly-publicized police shootings involving people with mental illnesses, Bernalillo County Commissioners decided to step up and do something about it. Last fall, they asked voters for a tax increase to support better behavioral health services. The increase was strongly supported by voters, and in February, the Board of Commissioners passed a new tax that is anticipated to raise $16 to $17 million toward these services. Commissioners are working with a consultant and other local government partners to develop a business plan for a governing structure for administering these funds effectively.

Like many counties across the country, Bernalillo County does not have its own mental health authority; the state acts as this authority by providing Medicaid reimbursements, but little additional supports. The state has high Medicaid enrollment rates since they expanded in 2014, but a fragmented behavioral health service network in Bernalillo County – and much of the rest of the state – has left many people who need treatment unable to access it, especially in more rural areas of the county and state.

Nowhere has this been more prevalent than with individuals with mental illnesses in jail. Like many counties across the country, Bernalillo County, N.M. has an overcrowded jail, and they have had one for some time. The Bernalillo County Metropolitan Detention Center has been under a federal lawsuit for 20 years, creating a real incentive for reducing the number of people housed within. Two years ago, County Commissioners started working with the courts, public defender, district attorney, and the jail to reform their case processing system, an effort led to a nearly 50 percent reduction in their jail population. But despite this progress, one segment of the population has not seen as clear results: at least 40 percent of people in the jail have mental health or substance abuse treatment needs.

This statistic is not new or surprising to many who operate county jails, but that doesn’t make it any less disturbing. While Bernalillo County provides behavioral health services in their jail, people are currently released without any ties to community-based services or case management. At least 60 percent of people in the jail either are enrolled in Medicaid or are eligible for Medicaid coverage. A new law that just passed in New Mexico (Senate Bill 42) will end the current practice of terminating Medicaid coverage when people enter jails and will also allow people to apply for Medicaid prior to their release to reduce the disruption in services. The new law is expected to be implemented within a few months.

This is a great step in the right direction, but County Commissioners want to do more. In April, the County Commissioners passed a resolution to organize a working group of county, city, state, and private stakeholders to identify current behavioral health services in the county and discuss how they might collaborate both in contributing and distributing funds for these services. Bernalillo County Commissioners also passed a resolution to join Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails. Top priorities include reentry and case management for people being released from jails and creating and funding a crisis response center as an option for keeping people out of jails in the first place. Implementing these policies and programs will be a challenge, as there are no quick solutions to these issues. Bernalillo County Commissioners and their partners are hopeful that they will be able to find a workable solution to providing more and better treatment services to people with behavioral health needs in the county to reduce community costs, reduce the number of people in jails, and produce better recovery outcomes for people with mental illnesses.

Stepping Up is a national initiative to reduce the number of people with mental illnesses in jails, and the result of a partnership between NACo, the Council of State Governments Justice Center and the American Psychiatric Foundation. For more information, visit

About Nastassia Walsh (Full Bio)

Associate Program Director – Community Health and Justice

Nastassia Walsh is Associate Program Director for Community Health and Justice at the National Association of Counties (NACo). In this role, she oversees educational programming, peer-to-peer engagement and technical assistance on strategies related to health, behavioral health, justice, public safety and other related topics. 

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  • The Stepping Up Initiative

    In May 2015, NACo and partners at the CSG Justice Center and APA Foundation launched Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails.

    Learn More