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’ ability to provide local systems of care. Future appropriations bills should meet or exceed FY 2020 funding levels, particularly the Community Mental Health Services (CMHS) and Substance Abuse Prevention and Treatment (SAPT) block grants, which allow counties to direct resources to those with the most need.


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, and county-based behavioral health services exist in 23 states that represent 75 percent of the U.S. population. 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. 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 counties provide direct behavioral services to those individuals in most need. Such services improve community well-being, reduce counties’ health care and justice system costs and provide 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 nationwide – including 80 percent or rural counties – reported not having a behavioral health worker.

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 and created a new two-year State Targeted Response to the Opioid Crisis Grant program, which received $1.9 billion in FY 2020 appropriations. This figure builds on the $2 billion appropriated under the FY 2018 omnibus for states to address the crisis. In addition to new federal funding, NACo has worked closely with congressional legislators over the past few years to include key county priorities 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 meet or exceed FY 2020 funding levels for the Community and Mental Health Services (CMHS) Block Grant 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 and children with serious mental illnesses, 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 a total of $722 million in the FY 2020 appropriations bill passed by Congress in August 2019.

    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. SAPT received $1.9 billion in the FY 2020 appropriations bill approved by Congress in August 2019.

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

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