Congressional briefing: Behavioral health matters to counties

Where do you turn for behavioral healthcare if you lack necessary health insurance coverage or you can’t access a provider, or you are homeless? Clearly, you turn to your local county, the safety net of last resort when all other systems fail you.

America’s 3,069 counties invest more than $70 billion per year in healthcare, including county behavioral health services. These counties operate more than 750 behavioral health authorities. Such authorities exist in 23 states and cover more than 75% of the US population. Many counties help finance Medicaid, a principal source of funding for county behavioral health services.

County behavioral health authorities confront a very large and continuing problem: about 1 in 5 adults experience a mental disorder each year, and 1 in 25 have a serious mental illness; about 1 in 10 adults experience a substance use disorder each year; co-occurring illnesses are very common in these populations. Yet, more than half of those with a mental illness did not receive any care, and, astonishingly, almost 90% of those with substance use disorders did not receive any needed care last year.

All of these facts were presented in a very important Congressional Briefing held today, October 28, and sponsored jointly by the National Association of Counties (NACo) and the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD).

Three members of the House joined the briefing and offered remarks. They included Rep. Paul Tonko of New York, Rep. Doris Matsui from California, and Rep. Tim Murphy from Pennsylvania.

County is the safety net

Sallie Clark, the new NACo president, led a panel of presenters. After documenting the very important role that counties have in delivering health and behavioral health services, she noted that counties are the primary health safety net in the United States and that counties also administer wrap around human services, such as housing, food assistance, and transportation supports.

Cherryl Ramirez, NACBHDD Board President and the Executive Director, Association of Oregon Community Mental Health Programs, eloquently described how county behavioral healthcare programs serve those most in need, and provide not just treatment services, but also prevention and rehabilitation. A major challenge confronted by every county, in her view, is lack of adequate service funding—from the SAMHSA block grants to Medicaid. Clearly, counties could do a much better job if the SAMHSA block grants were funded fully, the Institution for Mental Disease (IMD) restrictions on Medicaid funding were modernized, and Medicaid payments were extended to pre-adjudicated detainees in county and city jails.

Robert Sheehan, the new executive director of the Michigan Association of Community Mental Health Boards and recent Executive Director of the Community Mental Health Authority of Clinton, Eaton, and Ingham Counties in Michigan, recounted the dramatic progress being made in Michigan under the Affordable Care Act, especially the new Medicaid expansion. From his perspective, local authorities are responding to the needs of the newly-insured populations, while, at the same time, seeking to increase their emergency response capacity to mitigate the need for long-term intensive care and to reduce the incarceration of persons with mental health and substance use conditions in county and city jails. As a result, counties have a major need for resources and technical assistance to build their emergency response capacity.

Harvey Rosenthal, the executive director of the New York Association of Psychiatric Rehabilitation Services, is a nationally-recognized mental health advocate. In his comments, he emphasized the essential role of SAMHSA in fostering trauma-informed care and the fundamental goal of recovery. He also noted a growing disparity between the increasing number of persons seeking care and the static number of providers available to serve them. In his view, peer support is a major and fundamental tool for addressing this disparity. If we are to access this tool effectively, resources will be required for short-term training.

A large number of congressional staff and community representatives attended this briefing in person, and a large number also linked in to the simulcast. NACo Executive Director Matthew Chase concluded, "As Congress considers legislation to address challenges in behavioral health systems, counties can play a critical role in shaping effective policy solutions. We look forward to continuing to work with Congress to improve responses to behavioral health needs in communities across the country.”

You can access an infographic from the briefing here. This infographic also contains a succinct list of some major actions NACo and NACBHDD would like the Congress to address in the short term.