Top 10 County Policy Priorities for Behavioral Health Reform
Author
Blaire Bryant
Naomi Freel
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County Behavioral Health Landscape
America’s 3,069 counties are integral to America’s behavioral health system. Counties annually invest over $130 billion in community health systems, including behavioral health services. Through 750 behavioral health authorities and community providers, county governments plan and operate community-based services for persons with mental illnesses and substance use conditions. County-based behavioral health systems exist in 23 states that represent 75 percent of the U.S. population.
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NACo Commission on Mental Health and Wellbeing
(2023-2024) Counties increasingly handle direct mental health service. NACo’s Commission on Mental Health and Wellbeing developed reports and united county leaders to address the mental health crisis through key policy priorities.
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Michelle Alyssa Go Act reintroduced in the 119th Congress, a critical step for county behavioral health systems
On September 18, the Michelle Alyssa Go Act was reintroduced in the U.S. House of Representatives. This bipartisan legislation aims to increase the number of federal Medicaid-eligible in-patient psychiatric beds from 16 to 36, providing critical support for individuals seeking treatment for mental health and substance use disorders.
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On September 18, the U.S. Senate passed the SUPPORT for Patients and Communities Reauthorization Act of 2025 (SUPPORT Act Reauthorization) (H.R. 2483) by voice vote, following House passage earlier this year. With strong bipartisan backing in both chambers, the legislation now heads to the President’s desk for signature.