Messaging to Support A Behavioral Health Continuum of Care: Elected County Officials

Counties play a critical role in supporting community members living with behavioral health conditions or experiencing a behavioral health crisis. Annually, counties allocate $100 billion to community health systems – including behavioral health – and provide services through 750 behavioral health authorities and community providers.¹ This funding supports prevention, treatment and recovery services as well as the elements of a continuum of care – someone to contact, someone to respond and somewhere safe to go – when people are experiencing a behavioral health crisis.

County leaders have been successful investing in and supporting a behavioral health continuum of care through communicating that provision of necessary services improves community mental health, saves taxpayer money, allows law enforcement to focus efforts on public safety responsibilities, reduces the overuse and misuse of the criminal legal system and decreases the reliance on emergency rooms.

NACo and NACBHDD are collaborating on a series of messaging briefs that will provide examples of how local leaders are leveraging their unique roles to advance behavioral health care and effectively communicate the importance of these efforts. The briefs will provide members of these groups’ insight into the work of peers. For community members, staff and advocates, they offer a framework for understanding and engaging with their own local leaders. The following stakeholders will be highlighted in this series:

• County elected officials
• Law enforcement
• Behavioral health directors
• Rural and frontier county leaders
• Intellectual and developmental disability directors, and
• Judges.

The following is the first in the series.

County elected officials serve as key leaders in developing and enhancing local behavioral health treatment to best serve all community members. As primary policy and funding decision-makers, elected officials may be responsible for identifying gaps in services, driving solutions and building stakeholder consensus, in addition to other roles. From passing resolutions to eliminate stigma, putting behavioral health levies on the ballot, supporting crisis triage centers and dedicating resources to community-based care, elected officials can cultivate support and funding for a robust, integrated, accessible and sustainable behavioral health continuum of care.

Population: 461,860

In 2021, Burlington County commissioners passed a resolution designating the county as stigma-free to combat misperceptions about behavioral health and increase awareness of local resources. The commissioners also created a Stigma-Free Task Force to develop actions the county can consider taking to engage and educate residents.

"By designating the county as stigma-free, we are declaring that there can be no health without mental health, and we will break down barriers our residents may face either before seeking treatment or in recovery."

– Commissioner Linda Hynes, Burlington County, N.J.²

Population: 584,526

To seek guidance and input from the community, Douglas County commissioners hosted a series of town halls to discuss if and how ARPA Recovery Funds should be spent on a mental health facility.

"There's a void, a gap. We're serving those individuals in our jail, and that's not appropriate. It is not something that we should continue to do."

– Commissioner Mary Ann Borgeson, Douglas County, Neb.³

Population: 54,303

Saline County leaders allocated nearly $200,000 from the county’s ARPA Recovery Funds to develop a co-responder program to partner a mental health clinician with law enforcement to deescalate and triage mental health related calls. The co-responder program provides community-based care and connections to services, while avoiding unnecessary police response. In a 14-month period in 2021 and 2022, the program serviced 830 calls, amounting to 600 hours of time.

"Normally, you’re trying to weigh one side against the other, but in this case, there is no other side. We’ve been working on figuring out ways to do the compassionate thing and stop the revolving door of mentally ill patients coming to jail, getting out and coming back two days later. This isn’t being soft on crime. This is just trying to get folks to the right place where they can get help."

– Commissioner Monte Shadwick, Saline County, Kan.⁴

Population: 8,072

After learning that one in five San Miguel County residents reported eight or more days of poor mental health in the past 30 days, commissioners passed a ballot resolution, later approved by 66 percent of voters, to create a behavioral health mill levy to fund local services. Elected officials are developing partnerships across the continuum of care to improve access to behavioral health services, including funding a Behavioral Health Care Coordinator to act as a systems navigator for higher needs clients.

"That's a priority for me to get the behavioral health, and especially substance use disorder continuum of care, as formal of a partnership as possible, with our criminal justice system."

– Commissioner Hilary Cooper, San Miguel County, Colo.⁵

1. National Association of Counties, “Behavioral Health Matters to Counties,” (March 4, 2021)

2. Burlington County Times, “Burlington designated as ‘stigma-free county’ by Commissioners, “ (September 28, 2021)

3. KETV 7 Omaha, “’There’s a void, a gap’: Douglas County commissioners propose mental health facility”

4. The Pratt Tribune, “Co-responders to offer mental health help ‘on the street,’” (September 20, 2022)

5. The Norwood Post, “Commissioners hear behavioral health year-end update,” (December 1, 2022)