This May, the National Association of Counties (NACo) invites the nation's 3,069 counties, parishes, and boroughs to participate in Mental Health Awareness Month. By showcasing how county governments provide vital behavioral health services and resources and by advocating for key mental health reforms—including repealing harmful exclusionary Medicaid policies, bolstering local crisis response infrastructure, supporting the behavioral health workforce, and ensuring mental health parity—we can effect significant change.

America's counties are frontline providers of mental health promotion and services, acting as the nation's safety net for residents in need, first responders, and operators of essential facilities like crisis lines, public hospitals, and detention centers. Due to their extensive interactions with residents seeking care, counties are pivotal in local, state, and national efforts to fortify the mental health system.

Facing a nationwide crisis, an intergovernmental solution is imperative. Counties stand prepared to collaborate across public, private, and non-profit sectors to address this growing crisis through targeted federal policies, cross-sector partnerships, and the enforcement of mental health parity.

This May, the National Association of Counties (NACo) invites the nation's 3,069 counties, parishes, and boroughs to participate in Mental Health Awareness Month. By showcasing how county governments provide vital behavioral health services and resources and by advocating for key mental health reforms—including repealing harmful exclusionary Medicaid policies, bolstering local crisis response infrastructure, supporting the behavioral health workforce, and ensuring mental health parity—we can effect significant change.

To demonstrate support, counties can utilize this template to pass a resolution declaring May as Mental Health Awareness Month in their jurisdiction. 

Key Themes

Throughout May, we'll provide opportunities for engaging in federal advocacy on mental health policy reforms prioritized by counties, offering sample letters, op-eds, talking points, and tweets in this toolkit.

  • Week 1: Repealing Exclusionary Medicaid Policies
  • Week 2: Bolstering Local Crisis Response Infrastructure
  • Week 3: Supporting the Behavioral Health Workforce
  • Week 4: Ensuring Mental Health Parity

NACo Commission on Mental Health and Wellbeing

To recognize Mental Health Awareness Month, members of NACo's Commission on Mental Health and Wellbeing share their stories and perspectives on our nation's ongoing mental health crisis, highlighting the critical work of counties in addressing mental health in our communities.

Learn More About the Commission

Hon. Dow Constantine

Executive, King County, Wash. | Commission Co-Chair

Hon. Kathryn Barger

Supervisor, Los Angeles County, Calif. | Commission Co-Chair

Hon. Bryan Davis

Commissioner, Scioto County, Ohio

Hon. Adrian Garcia

Commissioner, Harris County, Texas

Dr. Gina Nikkel

Executive Director, Association of Oregon Counties

Hon. Helen Stone

​Commissioner, Chatham County, Ga.

Write Your Member of Congress

Use this template to ask your congressional delegation to pass bipartisan behavioral health policies that enhances the ability of localities to provide comprehensive mental health and substance use disorder services in all settings, strengthens the behavioral health workforce, bolsters crisis response systems and increases resident access to services. Download NACo's letter template and send a letter to Congress written on county letterhead, either through the U.S. Postal Service or via email. Information on office locations and contact numbers can be found on members’ websites. Links to U.S. House of Representatives and U.S. Senate websites can be found below.

Publish a Letter to the Editor

Connect with your local media outlets to highlight the importance of congressional action on mental health policy reform. Write and submit op-ed columns, letters to the editor or guest commentaries to local newspapers outlining the top mental health policy issues in your county and urging Congress to take action. Below are issue-specific talking points to consider. Remember, your ability to craft and tailor the message to fit your community is very important to publishing an op-ed. County-specific examples and other local information will significantly enhance your advocacy. NACo’s Media Relations Guide for Counties is also available to assist county officials with local media outreach.

  • Medicaid reform: Medicaid policy reform can improve access to essential care for individuals with mental illness and substance use disorders, enabling treatment in appropriate settings and fostering a healthier future.
  • Behavioral health workforce: Investing in programs to recruit, train, and place behavioral health providers addresses urgent care needs in local and under-resourced communities. 
  • Crisis response: Effective crisis response systems can prevent tragic outcomes in the escalating mental and behavioral health crisis. 
  • Mental health parity: Enforcing the Mental Health Parity and Addiction Equity Act of 2008 is essential to ensure equal coverage for mental health and addiction treatment, improve care integration, and meet broader community mental health needs.

Engage Your Members of Congress & Constituents on Social Media

Demonstrate how counties are providing important mental health care services to all residents in your county through pictures and stories to encourage Congress to pass critical policy reforms. Most Senators and Representatives are on Twitter and monitor their Twitter feeds regularly. The easiest way to find your members of Congress is to utilize the search function on Twitter or by visiting your members’ website. In addition to reaching out to your members of Congress on Twitter, consider targeting House and Senate leadership.

Sample Social Media Posts

Use our social media toolkit to find relevant tweets and graphics for each week’s advocacy theme and don’t forget to include both @NACoTweets and #SupportCountyMentalHealth in your posts, to keep us in the loop! 

We are excited to announce that [COUNTY] is joining our colleagues across the nation in recognizing #MentalHealthAwarenessMonth #SupportCountyMentalHealth

Join [COUNTY] and recognize May as #MentalHealthAwarenessMonth!

Now more than ever, we need to act to address the mental health crisis in the U.S., as 1 in four adults experience a mental illness. Join us in participating in #MentalHealthAwarenessMonth and #SupportCountyMentalHealth

As a part of #MentalHealthAwarenessMonth, [COUNTY] is [COUNTY ACTION/EVENT] and we encourage others to join! #SupportCountyMentalHealth 


Counties are calling on Congress to amend Section 1905(a)(A) of the Social Security Act to retain federal health benefits for individuals with a right to due process #MIEP

60% of the 11 million individuals that cycle through local jails each year are pre-trial detainees that unfairly lose access to federal health benefits due to #MIEP

11 million individuals cycle through 3,100 local jails each year and many lose access to federal health benefits while they still await trial due to the #MIEP

In #county jails across the country, #MIEP unfairly revokes pre-trial detainees’ federal health benefits such as Medicaid, Medicare, and the Children’s Health Insurance program

Congress can help #counties break the cycle of recidivism caused by untreated mental illness and substance use disorders by amending the #MIEP to allow access to federal health benefits for those awaiting trial

Innocent until proven guilty. Having access to federal health benefits while awaiting trial with presumed innocence is an individual’s constitutional right #AmendtheMIEP

Termination of health care coverage under #MIEP results in poorer health outcomes, increased recidivism and higher taxpayer costs to #counties

Uninterrupted health care helps those who enter the criminal justice system break the cycle of recidivism exacerbated by untreated physical and mental illnesses and substance use disorders. Congress must #AmendtheMIEP 


The IMD exclusionary policy hampers counties' healthcare capacity, perpetuating patient inequities by limiting access. #HealthEquity #IMDExclusion

Updating the IMD exclusion will break down barriers to comprehensive behavioral health treatment and boost access to short-term residential care when needed. #MentalHealth #PolicyChange

#Counties urge Congress to amend Section 1905(a)(30)(B) of Social Security to ensure continued federal health benefits for patients with behavioral health disorders in IMD.

Regulations on the IMD exclusion haven't been updated since 1988. Amending the Social Security Act to end this exclusion would empower #counties to link their community members with suitable treatment.

#counties support federal policy advancements that create clear entry pathways for behavioral health professions, especially in rural and underserved areas. Initiatives like loan forgiveness programs and streamlined licensure processes are crucial steps forward. 

75% of the U.S. population is reliant on #county-based behavioral health services through more than 750 #county-supported or operated behavioral health authorities.  

Over 30% of the U.S. population lives in a #county facing a shortage of mental health professionals.

Offering new financial incentives for integrated care can attract more professionals to the behavioral health field, enhancing access to these crucial services.

The absence of an effective and accessible mental and behavioral health crisis services system in our nation has led to tragic outcomes for individuals in crisis.

#Counties are actively crafting and bolstering innovative crisis service models tailored to meet the distinct needs of their communities.

The lack of a crisis services system not only harms #county residents but also strains county budgets, footing the bill for hospitalizations or incarcerations. It's time for comprehensive solutions.

#Counties nationwide are investing in programs to recruit, train, and place behavioral health providers in underserved communities, ensuring vital care reaches those who need it most.

In 40 states + DC, mental health facilities operated by regional/district authorities or #county governments are crucial. Yet nearly 60% of #counties, including 80% of rural ones, face severe shortages of behavioral health experts.

#County jails and other public safety services often serve as frontline treatment providers for our most vulnerable residents.

Half of the US population resides in #counties lacking mental health professionals. It's crucial to secure direct, flexible resources to recruit, train, and retain enough behavioral health experts.

#Counties require increased funding authorization for programs fostering workforce recruitment and retention in local areas.

Investing in mental health professionals is an investment in our #counties' future. Prioritizing training, support, and resources strengthens our commitment to mental health care for all. 

#County efforts in behavioral health crisis services need strong intergovernmental partnerships. Modernizing local crisis response systems is key for effective and accessible care.

Prioritize mental health. Serious mental illness impacts 5% of the population, yet 26% of those in #county jails are affected. Many are non-violent offenders who need treatment, not incarceration.

Enhanced federal coordination, with resources and technical assistance to #counties, can help address the overrepresentation of individuals with serious mental illness in our jails. Let's prioritize support over incarceration.

Help is overdue. Timely and effective support is vital for those in crisis. Expanding support for evidence-based crisis response models is crucial for #county well-being.

Prioritizing programs like CAHOOTS and Crisis Intervention Team (CIT) programs helps #counties provide compassionate and effective care for individuals in crisis.

#Counties support the authorization of Medicaid financing for local crisis call centers, stabilization facilities, and integrated care models like Community Behavioral Health Centers (CCBHC).  

Success requires collaboration at all levels of government. #Counties are innovating tailored crisis services, including 24/7 call centers and integrated care to modernize crisis response systems.  

Behavioral health parity protections are essential for integrating mental health care into #county healthcare systems.  

Strengthening parity protections bridges the gap between primary and behavioral care, meeting #county community needs effectively.

Advancing federal and state-level legislation is key to ensuring parity in mental health care and addiction treatment.  

Mental health and addiction treatment is a #county priority. Advancing legislation that incentivizes and enforces existing parity policies promotes equitable access to care for everyone.

#counties support legislation that enforces parity policy uniformly across all insurers. Everyone deserves equal access to mental health care.

Unlocking the potential of parity requires the key of enforcement. Strengthening parity protections improves coordination and address #county needs. 

Additional Outreach Resources

Below you will find additional materials to assist in your own grassroots advocacy efforts.

Share How Your County Is Participating

Counties are encouraged to share key advocacy talking points and participate in social media discussions using the hashtag #SupportCountyMentalHealth. Together, let's make a difference in promoting mental wellness and supporting those in need. Additionally, you can share what you are doing directly with NACo by clicking the button below.

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