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

Action Needed

Urge your members of Congress to maintain consistent funding for substance use 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 maintain or increase funding levels from Fiscal Year (FY) 2024, with a focus on the Substance Use Prevention, Treatment, and Recovery Services (SUBG) and Community Mental Health Services (MHBG) block grants. This funding should align with the growing demand for services, enabling counties to allocate resources to those most in need. 

Background

America’s 3,069 counties are integral to the nation’s behavioral health system. Counties annually invest more than $130 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 use 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 (MHBG) and Substance Use Prevention, Treatment and Recovery Services Block Grant (SUBG), 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 health condition, with less than half receiving treatment. One in seventeen experience a serious mental illness, with less than three-fourths receiving treatment. In 2023, over 48 million Americans ages 12 or older (17.1 percent) reported having a substance use disorder, with only 4.5 percent of people receiving treatment, and 18.6 percent of those needing both mental health and substance use disorder treatment received both services. As of January 2024, nearly 37 percent of the U.S. population, or 122 million Americans lived in areas experiencing mental health professional shortages, with nearly two-thirds of these shortages in rural or partially rural areas. 

The combined total of FY 2024 appropriations totaled $385 million for the Certified Community Behavioral Health Centers (CCBHCs) program, $2 billion in SUBG funding and $1.01 billion in MHBG funding—all three of which matched the FY 2023 funding levels. Congress should maintain at least this level of funding for these programs in FY 2025. 

Key Talking Points

• Congress should meet or exceed FY 2024 appropriation and supplemental levels for the Community and Mental Health Services (MHBG) Block Grant in FY 2025 appropriations. The MHBG 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 MHBG received a total of $1.01 billion in the FY 2024 appropriations bill passed by Congress in March 2024.
• Congress should meet or exceed FY 2024 appropriation and supplemental levels for the Substance Use Prevention, Treatment and Recovery Services Block Grant (SUBG) in FY 2025 appropriations. County behavioral health authorities use the SUBG 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 use disorder services. SUBG received $2 billion in the FY 2024 appropriations bill enacted by Congress in March 2024.