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

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.

Medicines in hand
Advocacy

House E&C Committee advances SUPPORT Act reauthorization

On April 9, the U.S. House Energy and Commerce Committee marked up the SUPPORT for Patients and Communities Reauthorization Act of 2025. The bipartisan bill aims to reauthorize critical programs that target overdose prevention amid the renewal of the opioid crisis Public Health Emergency declaration.

birdflu
County News

Bird flu update: What county leaders should know

As of April 7, there have been 70 confirmed cases of bird flu in the United States, but no person-to-person spread has been detected. 

CARES Act
Advocacy

HHS issues termination notices for health grant funding

On March 25, the U.S. Department of Health and Human Services (HHS) sent letters to state authorities and counties with direct grant funding announcing the immediate termination of several pandemic-related grants, which was previously set to run through September 2025. 

Upcoming Events

A young Mother and her son visit the doctor together.
Webinar

Supported Mothers, Thriving Children: Connecting Maternal Health and Child Wellbeing

Counties can significantly improve children's health and wellbeing by supporting maternal mental health through a variety of key strategies. In this webinar, speakers will explore examples of local policies and programs that bolster county efforts to holistically address child wellbeing through focusing on maternal mental health and substance use. Participants will gain insights into local options for addressing maternal mental health needs and substance misuse, learn about the challenges and triumphs experienced by county programs, and discover new opportunities to strengthen their local children’s health services.

public health
Webinar

Federal Reforms to Medicaid Financing: What Counties Should Know (Part 1)

This two-part webinar series will examine the vital role Medicaid plays in supporting county-administered behavioral health and primary care services.

public health
Webinar

Federal Reforms to Medicaid Financing: What Counties Should Know (Part 2)

This two-part webinar series will examine the vital role Medicaid plays in supporting county-administered behavioral health and primary care services.

re
Webinar

Ask a Public Health Expert: The Resurgence of Measles

Join NACo on Thursday, May 15 at 2 p.m. ET for a webinar on the resurgence of measles and what county leaders need to know. As outbreaks emerge across the U.S., this session will cover the history of measles, the importance of vaccination, current trends and how counties can respond effectively. The hour-long webinar will feature a 30-minute expert presentation followed by 20 minutes of audience Q&A. Don't miss this opportunity to hear from public health experts and get your questions answered.