Counties are facing an acute escalation of the mental and behavioral health crisis. In a recent NACo survey, 75 percent of counties reported an increase in the incidence of behavioral health conditions over the past year and 89 percent reported an increase compared to five years ago. While counties work to respond, the financial and human cost of behavioral health is compounding across all county systems: 80 percent of counties indicated that they incurred associated costs in the legal system (courts and jails), 77 percent in law enforcement and 54 percent in the health system and hospitals.

Counties are integral to the local behavioral health system of care, investing $163 billion each year in community health, hospitals and social services, as well as $107 billion in justice and public safety systems. In at least 33 states, counties may provide traditional behavioral health services, but county leaders in every state are confronting the need to innovate when it comes to mental health, whether in county courts, jails, juvenile justice systems, hospitals, parks, libraries, housing and homelessness services or other service areas – especially other services to youth.

Despite the severity of the crisis and its strain on our resources, counties across the nation are: (1) Persevering in expanding direct or indirect behavioral health service systems to care for our residents, and (2) Advocating for federal and intergovernmental policies that support our goal of serving residents and addressing the mental and behavioral health crisis.

Download the Executive Summary Download Full Report

Related News

US Capitol
Advocacy

U.S. Congress passes reconciliation bill: What it means for counties

On July 3, the U.S. Congress passed sweeping budget reconciliation legislation. 

Elderly woman sitting alone on bench in autumn park
County News

Podcast: Counties fight social isolation

As awareness of social isolation spreads, Sen. Chris Murphy (D-Conn.) and Loudoun County, Va. Chair Phyllis Randall discuss the role of government in combatting the problem.

flouride
County News

Fluoride in drinking water: History, safety and benefits for community health

The EPA sets and regulates a maximum level of fluoridation in public water systems, but the federal government cannot require states or localities to fluoridate their water, nor can it remove fluoridation in jurisdictions where it is already policy.

Image of Capitol-panorama_2.jpg
Advocacy

U.S. Senate passes amended reconciliation bill text: What it means for counties

On July 1, the U.S. Senate narrowly passed their version of sweeping budget reconciliation legislation.

THE_County Countdown_working_image-4.png
Advocacy

County Countdown – June 30, 2025

Every other week, NACo's County Countdown reviews top federal policy advocacy items with an eye towards counties and the intergovernmental partnership. This week features the Senate reconciliation debate, transparency on sanctuary designations and more.

bike
Advocacy

NACo submits recommendations on the 2026 National Drug Control Strategy

On June 20, NACo submitted formal comments to the White House Office of National Drug Control Policy (ONDCP) to help shape the development of its 2026 National Drug Control Strategy. This strategy serves as the nation’s blueprint for reducing illicit drug use, and the ONDCP plays a central role in coordinating federal drug policy across government agencies.