Mental Health Awareness Month: County Participation Toolkit

America's county governments are frontline providers of mental health programs and services, investing over $130 billion annually in community health systems. From operating crisis lines and focusing on early intervention to providing care through county-owned hospitals and behavioral health authorities, counties are committed to supporting the long-term well-being of residents.

Each year, 1 in 5 adults in the U.S. experience a mental health crisis, while 21.2 million adults report experiencing both a mental health and substance use disorder. Counties stand prepared to collaborate across public, private and non-profit sectors to address this growing crisis through targeted federal advocacy, cross-sector partnerships and support for the county behavioral health workforce.

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, counties can effect significant change.  

Enacted in 1965 an amendment to the Social Security Act (P.L.89-97), the IMD exclusion was designed to prevent the federal government from financing large psychiatric institutions when states were shifting toward deinstitutionalization.  

The exclusion prohibits Medicaid reimbursement for services provided to individuals ages 21–64 in residential mental health or substance use facilities with more than 16 beds.  

While the behavioral health system has evolved toward short-term, recovery-oriented and clinically-appropriate inpatient and subacute care, the IMD exclusion has remained largely unchanged for decades.  

Today, the IMD exclusion has become a barrier to care rather than a safeguard. Over the last year, 75% of counties report increased incidences of behavioral health conditions with 89% reporting an increase in the last five years.  

Due to the IMD exclusion, counties cannot respond to the mental health crisis by expanding treatment beds or operating appropriately sized facilities without losing Medicaid reimbursement, the nation’s primary funding source for behavioral health services.

The resulting lack of beds restricts access to care, with many residents in crisis being turned away or facing long wait times. Overflow often lands on county-run systems not designed for behavioral health treatment: emergency departments or jails. 

This Mental Health Awareness month, join NACo in urging Congress to pass the Michelle Alyssa Go Act, a bipartisan bill that aims to modernize the IMD exclusion and expand access to care.   

Learn more

Use NACo's template letter to ask your congressional delegation to pass the Michelle Alyssa Go Act.  

Counties are encouraged to download the template and send a letter to Congress on county letterhead, either through the U.S. Postal Service or via email. In addition, counties should consider reaching out to their congressional offices to request meetings during the month—either in Washington, D.C. or in-district—to reinforce this request. During these meetings, county leaders can leverage NACo’s accompanying talking points to highlight local impacts and strengthen their advocacy. 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.  

Template Letter Talking Points Contact Your Representative Contact Your Senator

Pass a Resolution

Use this template to pass a resolution recognizing May as Mental Health Awareness Month in your county. 

Resolution Template

Publish an Op-Ed

Connect with your local media outlets to highlight the importance of congressional action on mental health policy reform. Counties can write and submit op-eds to local newspapers outlining local mental health policy issues and urging Congress to take action on the Michelle Alyssa Go Act.  

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. 

Op-Ed Template