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

Medicines in hand
Advocacy

House passes SUPPORT Act reauthorization

On June 4, the U.S. House of Representatives passed the SUPPORT for Patients and Communities Reauthorization Act of 2025 (H.R. 2483) by a strong bipartisan vote of 366–57. The bill, which reauthorizes billions of dollars for critical programs that target overdose prevention, now heads to the Senate Committee on Health, Education, Labor and Pensions, where a version of the bill was overwhelmingly advanced with bipartisan support in the 118th Congress. 

bike
Advocacy

CMS increases oversight on states’ use of Medicaid funds for undocumented immigrants

On May 27, the Centers for Medicare & Medicaid Services (CMS) announced it is increasing federal oversight of state Medicaid programs to ensure compliance with federal law regarding the use of Medicaid funds for undocumented immigrants. 

measles
County News

Measles on the rise: What county officials need to know

Vaccination is the most effective defense against measles, and county leaders can use their voices to encourage uptake of the MMR vaccine.

Stethoscope on dollars
Advocacy

NACo offers new Medicaid resources as Congress advances Budget Resolutions with major Medicaid reform implications

On April 10, the U.S. House of Representatives voted to adopt a Senate-passed budget resolution, marking the next step in the budget reconciliation process. The proposed funding levels therein represent significant potential cost shifts to counties, particularly in the area of Medicaid financing. To help county leaders understand what’s at stake, NACo has developed two new resources.

THE_County Countdown_working_image-4.png
Advocacy

County Countdown – April 21, 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 ARPA reporting deadline, a budget reconciliation update and more

Image of GettyImages-1397838530.jpg
Advocacy

U.S. House reintroduces legislation to address the Medicaid Inmate Exclusion Policy

Two bipartisan bills aimed at addressing the Medicaid Inmate Exclusion Policy (MIEP) were recently reintroduced in the U.S. House of Representatives.