County and local officials play a critical role in funding, implementing and coordinating a local continuum of care to support people during a behavioral health crisis. Counties allocate $100 billion annually to community health systems – including behavioral health support – and provide services through 750 behavioral health authorities and community providers. To inform local decision making, the National Association of Counties (NACo) and the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD) developed a chart of funding opportunities across federal, state and county governments and non-government sectors. Counties can blend and braid these resources to build a robust, accessible and sustainable behavioral health crisis continuum of care.

This funding chart can help county leaders identify possible funding streams to build and strengthen local behavioral health crisis response continuums. The funding sources reflect opportunities across behavioral health, criminal legal and related systems. Due to the cross-sector nature of crisis response, some sources focus on certain populations, like youth, while others target a certain supportive piece of the crisis continuum, like workforce or training.

The Behavioral Health Continuum of Care

The three elements of the continuum of care – Someone to Contact, Someone to Respond and Somewhere Safe to Go – are outlined in the National Guidelines for Behavioral Health Crisis Care, a roadmap to develop a robust array of services.

Someone to Contact

The first part of a crisis continuum includes 24-hour staffed crisis call centers that provide immediate care and resources for individuals experiencing a behavioral health emergency. These call centers are equipped to take all calls/texts/chats, triage the immediate concern to assess additional needs and coordinate connections to care.

Someone to Respond

The second part of a crisis continuum includes mobile crisis teams (MCTs). Sometimes called crisis response teams or units, MCTs are community-based, face-to-face interventions that provide the least restrictive services to a resident wherever they are physically located. MCTs provide stabilization and treatment as well as deflect individuals away from the criminal legal system and emergency departments. These teams can include a combination of behavioral health clinicians, paramedics, peer support specialists, social workers and/or trained law enforcement.

Somewhere Safe to Go

The third part of a crisis continuum includes crisis receiving and stabilization centers that offer a different level of treatment than the options available over the phone or through an MCT when experiencing a behavioral health emergency. While the design and details vary, these centers often provide community members with access to out- and in-patient services, peer support networks, withdrawal management, medication adjustment, counseling, therapy and/or longer-term residential care. Many centers offer a dedicated first responder drop-off area and accept referrals and walk-ins.

Image of Crisis-response-graphic.png

How to Use the Chart

The chart is categorized by five types of funding sources: federal, state, federal/state and county governments and non-government sectors. The federal funding section is further broken out by federal agency. These sources may provide direct or pass-through funding to counties. Each source is accompanied by a summary, potential uses across the continuum – Someone to Contact, Someone to Respond and Somewhere Safe to Go – and a county example where available.

Federal Funding

Substance Abuse and Mental Health Services Administration (SAMHSA)

Funding Source

Summary

Potential Uses

County Example

State Mental Health Block Grant

This funding is allocated to state mental health agencies, with pass through to county governments, and includes a five percent set-aside for evidence-based crisis systems.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Chester County, Pa. (Pop. 534,413) received $300,000 from the Pennsylvania Department of Human Services, which originated from the state mental health block grant and the Consolidated Appropriations Act of 2021, to support the 988 transition.

Williamson County, Tenn. (Pop. 247,726) is using funds to launch and support a mental health clinician as part of a co-response team.

Hennepin County, Minn. (Pop. 1,281,565) received $225,000 to support crisis services.

988 Suicide and Crisis Lifeline

This funding supports the infrastructure of the 988 Lifeline network operations including backup, specialized services and chat and text centers.

Someone to Contact ✓

Carver County’s (Minn.) (Pop. 106,922) crisis program received certification to participate in the Lifeline network in 2020 and subsequently received a grant to support the statewide 988 transition.

Certified Community Behavioral Health Centers (CCBHCs) (funded in combination with Center for Medicare and Medicaid Services)

CCBHCs provide a range of behavioral health services including 24-hour crisis services and 988 call centers.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Chautauqua County, N.Y. (Pop. 127,657) has two CCBHCs, as well as a 24-hour crisis hotline and warmline. The county received additional funding to improve access to community-based recovery services, expand mobile crisis teams with a youth specialist and offer peer specialist services.

Montgomery County, Md. (Pop. 1,062,061) received nearly $2 million to expand access to services and increase the number of mobile crisis teams.

Substance Abuse Prevention and Treatment Block Grant (SABG)

This funding is distributed to 60 eligible states and territories, that can pass through funding to counties, to plan, implement and evaluate substance use disorder education, prevention, harm reduction, treatment, recovery support and crisis response services.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Alameda County, Calif. (Pop. 1,682,353) uses funding to support local community-based organizations such as a recovery housing program.

State Opioid Response Grant

This funding addresses the opioid crisis by providing resources to states and territories, that can pass through to counties, for increasing access to substance use care and crisis services.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Bexar County, Texas (Pop. 2,009,324) uses funding to strengthen first response to overdose and connect people to care.

Mental Health Awareness Training Grant

This funding can be used to train emergency services personnel, law enforcement, fire department personnel, veterans and others to identify persons with a mental health disorder and employ crisis de-escalation techniques.

Someone to Contact ✓

Someone to Respond ✓

Madison County, N.C. (Pop. 21,193) received $250,000 to train 500 residents to identify, support, safely de-escalate and engage youth and adults experiencing a behavioral health crisis.

Cooperative Agreements for Innovative Community Crisis Response Partnerships

This funding helps high-need communities – those where mobile crisis services are absent or inconsistent – establish or enhance mobile crisis teams.

Someone to Respond ✓

Somewhere Safe to Go ✓

 

Rural Emergency Medical Services Training Grant

This funding can be used to recruit and train EMS personnel in rural areas with a particular focus on addressing mental illness and/or substance use disorders.

Someone to Respond ✓

Clay County, W.Va. (Pop. 8,051) received a $136,166 grant to provide training for EMS providers on mental illness and substance use disorders.

Services Grants Program for Residential Treatment for Pregnant and Postpartum Women

This funding provides comprehensive substance use disorder treatment services, recovery support services and harm reduction, including crisis intervention.

Someone to Respond ✓

Somewhere Safe to Go ✓

 

Enhancement and Expansion of Treatment and Recovery Services for Adolescents, Transitional Aged Youth, and their Families

This funding seeks to enhance and expand comprehensive treatment, early intervention and recovery support services for adolescents (ages 12-18) and transitional aged youth (ages 16-25). It requires recipients to provide wraparound services, which includes crisis intervention.

Someone to Respond ✓

Somewhere Safe to Go ✓

 

Department of Justice (DOJ)

Funding Source

Summary

Potential Uses

County Example

Edward Byrne Memorial Justice Assistance Grant (JAG)

This funding can support several uses including mental health and related law enforcement/corrections programs such as crisis intervention teams.

Someone to Respond ✓

Somewhere Safe to Go ✓

New Castle County, Del. (Pop. 570,719) received $749,000 to expand the Hero Help Addiction and Behavioral Health Unit to respond to people experiencing a behavioral health crisis.

Connect and Protect: Law Enforcement Behavioral Health Response Program

This funding supports law enforcement and behavioral health cross-system collaboration to improve public health and safety responses and outcomes for individuals with behavioral health conditions.

Someone to Respond ✓

Escambia County (Fla.) (Pop. 321,905) Sheriff’s Office received a $549,000 grant to form two co-responder teams.

Community Policing Development (CPD) Grants

This funding is used to advance the practice of community policing.

Someone to Respond ✓

Johnson County, Kan. (Pop. 609,863) received $187,000 to add a mental health clinician to the Sheriff’s Office.

State and Local Law Enforcement Assistance: STOP School Violence

Among other uses, this funding supports the development and deployment of school threat assessment and intervention teams and specialized training for school officials in responding to people experiencing mental health crises.

Someone to Contact ✓

Someone to Respond ✓

Hudson County, N.J. (Pop. 724,854) received almost $860,000 for a school violence prevention and mental health continuum program. It will provide guidance, training, technical support and professional development opportunities to students, teachers and other school staff.

Justice and Mental Health Collaboration Program (JMHCP)

This funding supports innovative cross-system collaboration for individuals with mental illnesses and/or co-occurring mental illness and substance use disorders who encounter the justice system.

Someone to Respond ✓

Somewhere Safe to Go ✓

Boulder County, Colo. (Pop. 330,758) received funding to support a co-responder team, the Boulder Early Diversion Get Engaged (EDGE).  

Athens-Clarke County, Ga. (Pop. 128,671) partners with a local behavioral health crisis center that includes a stabilization unit which discharges 100 percent of the people receiving services to safe places and connections to care.

Comprehensive Opioid, Stimulant, and Substance Abuse Site-based Program (COSSAP)

This funding can be used to develop, implement or expand comprehensive efforts to identify, respond to, treat and support those impacted by illicit opioids, stimulants and other drugs.

Someone to Respond ✓

Niagara County, N.Y. (Pop. 212,666) received a $1.3 million grant to expand the Quick Response to Opioid Overdose Team to respond to overdoses of any drug type and add family peer support. The QRT will also expand referral sources beyond law enforcement.

Collaborative Crisis Response and Intervention Training Program

This funding supports training to prepare law enforcement and correctional officers to interact with people who have behavioral health conditions and/or intellectual, developmental or physical disabilities.

Someone to Respond ✓

Albany County, Wyo. (Pop. 37,066) received a grant to provide Crisis Intervention Team (CIT) training for the Sheriff’s Office to support responses to mental health related calls.

Department of Education

Funding Source

Summary

Potential Uses

County Example

Student Support and Academic Enrichment Grants

This funding supports authorized activities such as evidence-based drug and violence prevention programs, school-based mental health services, including partnerships with mental health or health care entities, and training for school personnel in suicide prevention and crisis management.

Someone to Respond ✓

Somewhere Safe to Go ✓

 

Health Resources and Services Administration (HRSA)

Funding Source

Summary

Potential Uses

County Example

Rural Communities Opioid Response Program (RCORP)

This funding supports rural communities to build capacity within the local behavioral health workforce.

Someone to Respond ✓

Somewhere Safe to Go ✓

Bladen County, N.C. (Pop. 29,606) received a $1 million grant to provide connections to community-based substance use services, including training and engaging with a peer specialist to provide in-person support.

Substance Use Disorder (SUD) Workforce Loan Repayment Program (LRP)

This funding provides scholarships and loan repayment to health care providers in exchange for service in a health professional shortage area. Eligible clinicians may receive up to $75,000 in student loan repayment in exchange for a three-year commitment to provide substance use disorder treatment services at National Health Service Corps (NHSC)-approved sites. Counties may employ these practitioners to enhance local workforce.

Someone to Respond ✓

Somewhere Safe to Go ✓

 

Rural Community Loan Repayment Program (LRP)

This funding provides scholarships and loan repayment to health care providers in exchange for service in a health professional shortage area. Eligible clinicians may receive up to $100,000 in student loan repayment in exchange for a 3-year commitment to provide SUD and opioid use disorder treatment services at program-approved sites. Counties may employ these practitioners to enhance local workforce.

Someone to Respond ✓

Somewhere Safe to Go ✓

 

Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP)

This funding supports workforce retention by providing up to $250,000 in loan repayment for clinicians and community health workers. Counties can also leverage the program as it recognizes SUD support services provided by behavioral health paraprofessionals as an eligible provider type and new community-based settings including crisis management centers.

Someone to Respond ✓

Somewhere Safe to Go ✓

 

U.S. Department of Agriculture (USDA)

Funding Source

Summary

Potential Uses

County Example

Rural Development Distance Learning and Telemedicine Grant Program

This funding helps rural communities use advanced telecommunications technology to support distance telemedicine.

Someone to Contact ✓

Someone to Respond ✓

Morton County, Kan. (Pop. 2,701) received funding to purchase and install stationary and portable medical examination equipment to provide diagnosis and care and opioid and substance misuse education.

Rural Development Community Facilities Grant, Loan, and Loan Guarantee Programs

This funding can support the purchase, construction and conversion of essential community facilities such as behavioral health clinics, hospitals or community centers in rural communities.

Somewhere Safe to Go ✓

Shenandoah County, Va. (Pop. 44,186) Supervisors endorsed the Northwestern Community Services Board’s plan to finance the purchase of a behavioral health facility through a low-interest, 40-year loan through USDA.

Other Funding

Funding Source

Summary

Potential Uses

County Example

American Rescue Plan Act (ARPA) Recovery Funds

ARPA included the Coronavirus State and Local Fiscal Recovery Fund which allocated $65.1 billion to counties across the nation for a variety of projects.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Douglas County, Colo. (Pop. 357,978) Commissioners allocated $138,000 to support 988.

Saline County, Kan. (Pop. 54,303) dedicated nearly $200,000 to support a mental health co-responder for two years.

Waukesha County, Wis. (Pop. 406,978) is using $1.15 million to upgrade the county’s mental health center to include a crisis stabilization unit.

Federal/State Funding

Funding Source

Summary

Potential Uses

County Example

Medicaid

Medicaid is a public health insurance program jointly funded by the federal government and states. It can support a broad range of crisis-related services.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Maricopa County, Ariz. (Pop. 4,420,568) braids funding from the Regional Behavioral Health Authority and Arizona Medicaid to deploy mobile crisis teams and a “no-wrong-door” approach at local crisis triage centers.

Doña Ana County, N.M. (Pop. 219,561) is using Medicaid funding to expand mobile crisis teams dispatched via 988.

State Funding

Funding Source

Summary

Potential Uses

County Example

State cell phone fees

The federal legislation that created 988 and extended the scope of the National Suicide Prevention Lifeline also allows for states to charge fees on phone bills to help fund these services.

Someone to Contact ✓

Kern County, Calif. (Pop. 909,235) is one of 13 call centers in California that will benefit from comprehensive state legislation that established an eight-cent surcharge for cell phone users.

State appropriations

As part of the annual budget process, states can allocate funding to specific programs that counties can leverage.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Charleston County, S.C. (Pop. 408,235) will be home to a new 988 backup center in 2023, funded by $2.6 million in grants and appropriations from the state legislature.

Missoula County, Mont. (Pop. 117,922) is using $113,000 from the state County and Tribal Matching Grant funds to begin planning and renovating a space for the Crisis Receiving Center.

State taxes

States can levy taxes on certain items or income brackets for services that counties may access.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Sonoma County, Calif. (Pop. 488,863) uses funding from the state Mental Health Services Act, a one percent income tax on personal income in excess of $1 million per year, to fund its mobile support team.

State bonds

A state bond represents the issuance of debt for a state to undertake long-term construction and development projects, which may enhance county services.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Multnomah County, Ore. (Pop. 815,428) Commissioners leveraged a state commitment of $10 million in lottery bonds to help develop the $26 million Behavioral Health Resource Center.

County Funding

Funding Source

Summary

Potential Uses

County Example

Millages

A millage is a tax levied based on the market value of a property.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Washtenaw County, Mich. (Pop. 372,258) dedicates a portion of the voter-approved, county Public Safety and Mental Health Preservation Millage to support the 24/7 CARES hotline.

East Baton Rouge Parish’s (La.) (Pop. 456,781) Bridge Center for Hope, a crisis stabilization center, is funded by a 2018 voter-supported property tax.

Sales tax

A sales tax is imposed on the sale of goods and services.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Kitsap County, Wash. (Pop. 275,611) dedicates a portion of the Treatment Sales Tax to support the Behavioral Health Outreach Program. It provides law enforcement officers an option to request a navigator to assist with behavioral health calls.

Larimer County, Colo. (Pop. 359,066) leaders are leveraging funding from the county’s 0.25 percent sales tax to fund a new behavioral health center.

Bonds

A county or municipal bond represents the issuance of debt to undertake long-term construction and development projects.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Dutchess County, N.Y. (Pop. 295,911) leaders, alongside local partners, funded the stabilization center with a $4.8 million bond in 2015. The center is anticipated to save taxpayers $950,000 in 2023.

General funds

As part of the annual budget process, counties can allocate funding to specific programs.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Johnson County, Kan. (Pop. 609,863) Commissioners allocated $170,000 to hire four full-time case managers to staff 988.

Wood County’s (Ohio) (Pop. 132,248) Addiction Response Collaborative Quick Response Team is funded through the Wood County ADAMS Board, County Health Department and Ohio Attorney General’s Office. The team supports people during an overdose.

Sheriff/police budgets

Sheriffs and police chiefs are investing funds from their own budgets in the behavioral health continuum of care to provide the treatment and services to people in need before they encounter law enforcement.

Someone to Respond ✓

Somewhere Safe to Go ✓

The St. Mary’s County’s (Md.) (Pop. 113,777) Sheriff’s Office hired a mental health liaison to support law enforcement officers responding to mental health calls.

Sebastian County, Ark. (Pop. 127,799) will establish and operate a sobering center by leveraging $100,000 from a local police department and $675,000 in ARPA Recovery Funds.

Non-Government Funding

Funding Source

Summary

Potential Uses

County Example

Opioid Settlement Funds

In February 2022, a $26 billion multi-district settlement resolved a manufacturer’s and three distributors’ liabilities in over 3,000 opioid crisis-related suits nationwide. Over the next two decades, local governments will receive settlement funds for prevention, treatment and recovery efforts to be used primarily for opioid remediation strategies.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Frederick County, Md. (Pop. 271,717) is opening a crisis stabilization center, using ARPA Recovery Funds and state grant funds, with ongoing operations funded through payments made from the opioid settlement.

Philanthropic organizations

Philanthropic organizations can help fund elements of the crisis continuum through direct gifts.

Someone to Contact ✓

Someone to Respond ✓

Somewhere Safe to Go ✓

Denver, Colo. (Pop. 715,522) received a $2.8 million grant from the Caring for Denver Foundation to add three mental health clinicians to the co-responder teams in the fire department and park rangers program.

Richland County, S.C. (Pop. 416,147) received $200,000 from the Sozosei Foundation to add another co-responder team to the Law Enforcement and Behavioral Health Partnership.

Pennington County, S.D. (Pop. 109,222) is leveraging a $4 million gift from the Helmsley Charitable Trust to fund operations at the crisis unit’s new facility for 36 months.

Grant Resources

Further Reading

Acknowledgements

Support for this resource was provided by the Sozosei Foundation. The views expressed here do not necessarily reflect the views of the Sozosei Foundation.

This resource was researched and written by Jonah C. Cunningham, President and CEO of the National Association of County Behavioral Health & Developmental Disability Directors with support and guidance from Chelsea Thomson, Senior Program Manager, Behavioral Health and Justice at the National Association of Counties, and Naomi Seiler and Katie Horton from George Washington University.

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