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.