NACo report highlights ‘acute escalation’ of mental health crisis over the last several years

Limited in their ability to respond by financial constraints, an overwhelming majority of American county administrators say their constituents are facing an “acute escalation” in an ongoing mental health crisis. A new report from the National Association of Counties’ (NACo) Commission on Mental Health and Wellbeing, “Behavioral Health Conditions Reach Crisis Levels: Counties Urge Stronger Intergovernmental Partnerships and Outcomes,” outlines these challenges by drawing on data from 232 counties from across the U.S. of varying population sizes.

“If people do not have mental health, they do not have health,” said NACo President Denise Winfrey in a statement. “With our vast responsibilities in public health, safety, human services, emergency response and more, county governments see the full picture when it comes to mental health. This new data underscores the need for stronger intergovernmental partnerships and outcomes.”

The Commission on Mental Health and Wellbeing, which was created in February, is comprised of 14 county leaders from across the country and is tasked with leading the development of policy and programmatic recommendations at the federal, state, and local levels to address systemic issues contributing to the ever-growing mental health crisis, according to NACo. Along with the report, commission members discussed the findings recently with the White House State and Local Partners Forum on Mental Health and Wellbeing and met on Capitol Hill with the Bipartisan Mental Health Caucus and the Bipartisan Addiction Task Force.

Based on the latest report, 75% of counties reported an increase in poor behavioral health conditions over the last year. Eighty-nine percent reported the same in the last five years. The findings are particularly concerning given the corrolation between poor mental health and other social challenges like homelessness, substance abuse, and behavioral health.

“Along with substance use disorder, many respondents saw a strong connection between behavioral health and homelessness. In Whitfield County (Ga.), many of the county’s homeless residents are suffering from either mental health or substance use challenges, and the caseloads for both types of issues have ‘definitely increased,’” the report reads. “Harlan County (Ky.) reported that the behavioral health crisis is causing an increase in the county’s homeless population, causing a strain on the community food kitchen and shelter. St. Francois County (Mo.), too, has seen an increase of transient homelessness alongside an increase in crime.”

Of all demographics, youth are at the forefront of the crisis. Challenges with suicidal thoughts, depression and anxiety can lead to substance abuse, the report continues. Two-thirds (67%) of counties reported that youth behavioral health conditions are “definitely a problem” or “very prevalent and/or severe.” About a quarter of administrators surveyed said youth behavioral health is “somewhat” of a problem, and less than 10% said it’s “a minor issue” or “not an issue” in their county.

Exacerbating the problem, as the need expands, the number of mental health professionals working in counties has decreased. Among respondents, almost three-quarters (72%) said the shortage of behavioral health workers in their county is a major problem.

“Hunterdon County (N.J.) has seen an increased number of suicides and hospitalizations among young people, but lacks inpatient pediatric beds for behavioral health as well as providers for younger children under 12,” the report continues, highlighting the detrimental impact of COVID-19 response over the last few years on mental health. “Throughout the pandemic, Tulare County (Calif.) saw a 168% increase in the number of youth experiencing a behavioral health crisis. Thirty percent of those who were hospitalized had never had mental health treatment previously.”

The crisis is hitting the bottom line of county governments. Financial and human costs of behavioral health are compounding across all county systems, the statement says. Eighty percent of counties incurred associated costs in the legal system (courts and jails), 77% saw costs in law enforcement rise, and 54% noted increased costs in health systems and hospitals. 

In addressing the crisis, NACo’s commission noted the key position county governments are in, given their “integral role in local health, justice and human services systems,” reads a brief about the group. The federal government also has an important part to play.

The report outlines a number of policy changes that could alleviate the problem: Amend detrimental policies under Medicaid, like the Medicaid Inmate Exclusion Policy and the Institutions for Mental Diseases exclusion; obtain direct and flexible resources to support the recruitment, training and retention of a sufficient behavioral health workforce; enhance intergovernmental partnerships for the development and modernization of local crisis response systems and infrastructure; enforce policies that ensure equitable coverage for treatment of mental illness and addiction. 

For more information and to read the complete report, visit NACo’s website.