Policy Brief

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

Tags: Health


Urge your members of Congress to maintain 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 bills should be held to at least FY 2019 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 the nation’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 also 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 community well-being, reducing counties’ health care and justice system costs and providing savings to local taxpayers.

Mental and behavioral health disorders remain prevalent and largely untreated. 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 2017, 60 percent of counties reported not having a behavioral health worker, including 80 percent of rural counties.

The opioid epidemic has further heightened the need for additional federal resources and reforms to help counties prevent, treat and provide recovery services for individual with substance use disorders. Legislation passed in the 115th Congress reauthorized the CMHS and SAPT block grants along with a new two-year State Targeted Response to the Opioid Crisis Grant program, which received $1.5 billion in FY 2019 appropriations. This figure builds on the $2 billion in new funding appropriated under the FY 2018 omnibus for states to address the crisis. In addition to new federal funding, NACo worked closely with congressional legislators over the past year to include key county provisions in comprehensive opioid legislation, the SUPPORT for Patients and Community Act (P.L. 115-271), including increased flexibility in the Medicaid program and federal health and justice program reauthorizations.


  • Congress should fund the Community and Mental Health Services (CMHS) Block Grant at no less than $701.5 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 $701.5 million in the FY 2019 Defense-Labor-HHS 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, such as 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 that the program produces 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 2019 Defense-Labor-HHS appropriations bill

For further information, contact Blaire Bryant at 202.942.4246 or bbryant@naco.org.

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