Policy Brief

Enhance Counties' Ability to Prevent and Treat Mental Illness and Substance Abuse Disorders

Tags: Health


Urge your members of Congress to maintain at least consistent funding for substance abuse and mental health services provided through the Substance Abuse and Mental Health Services Administration (SAMHSA) and pass legislation that enhances counties’ abilities to provide local systems of care. Funding in future appropriations bill should be held to at least FY 2017 levels, especially the Community Mental Health Services (CMHS) and Substance Abuse Prevention and Treatment (SAPT) block grants.


America’s 3,069 counties are integral to America’s behavioral health system. Counties annually invest $83 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 abuse conditions. County-based behavioral health services exist in 23 states that represent 75 percent of the U.S. population. Counties help finance Medicaid, the largest source of funding for behavioral health services in the U.S., and serve as the local safety net, administering wrap-around human services supports.

SAMHSA, an agency of the U.S. Department of Health and Human Services (HHS), administers programs such as the Community Mental Health Services (CMHS) and Substance Abuse Prevention and Treatment (SAPT) block grants, which help make it possible for counties to provide direct behavioral services to those individuals in most need. Such services improve population health status, reducing counties’ health care and justice system costs and providing savings to local taxpayers.

One in five adults in the U.S. experience a mental illness, with less than half receiving treatment in the past year. One in 25 experience a serious mental illness, with only two-thirds receiving treatment. One in ten experience a substance abuse disorder, with only ten percent receiving treatment in the past year. It is estimated that 8.5 million adults have both a mental health and substance abuse disorder. As of 2013, 55 percent of counties reported not having a behavioral health worker.

In the 114th Congress, behavioral health reform provisions were included in the 21st Century Cures Act (H.R. 34) that reauthorized the CMHS and SAPT block grants, strengthened the behavioral health workforce and enhanced the implementation of mental health parity. However, new funding will continue to depend on appropriations. Other county priorities for behavioral health reform must still be addressed, including easing Medicaid’s Institute of Mental Disease (IMD) exclusion.


  • Congress should fund the Community and Mental Health Services (CMHS) Block Grant at no less than $541.5 million in future appropriations. The CMHS Block Grant is the principal federal discretionary program supporting community-based mental health services for adults and children. Counties may use block grant dollars to provide a range of services for adults with serious mental illnesses and children with serious emotional disturbances, including employment and housing assistance, case management (including Assertive Community Treatment), school-based support services, family and parenting education and peer support. The CMHS Block Grant received $541.5 million in the FY 2017 omnibus appropriations bill.
  • Congress should fund the Substance Abuse Prevention and Treatment (SAPT) Block Grant at no less than $1.9 billion in future appropriations. County behavioral health authorities use the SAPT Block Grant to serve vulnerable, low-income populations—those with HIV/AIDS, pregnant and parenting women, youth and others—by ensuring access to substance abuse services. An independent 2009 study of the SAPT Block Grant found the program to produce positive outcomes, including increased abstinence from alcohol and other drugs, increased employment and decreased criminal justice involvement. The SAPT Block Grant received $1.9 billion in the FY 2017 omnibus appropriations bill.

For further information, contact: Brian Bowden at 202.942.4275 or bbowden@naco.org


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