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Counties Are Key to Solving Our Nation’s Mental Health Crisis

Metropolitan Detention Center of Bernalillo County outside of Albuquerque, N.M.

Metropolitan Detention Center of Bernalillo County outside of Albuquerque, N.M. AP Photo/Russell Contreras

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COMMENTARY | A third of people with serious mental illness didn’t receive treatment in the past year. Local leaders are on the front lines of building the continuum of care these citizens lack.

Counties are on the front lines of the mental health crisis in our nation. For example, counties run 91 percent of local jails and invest $70 billion in community health systems like behavioral health services every year. Despite these investments, many counties struggle to provide adequate mental health and substance abuse treatment services to residents. The Substance Abuse and Mental Health Services Administration reports that a third of people with serious mental illness didn’t receive treatment in the past year.

In addition, an estimated two million jail admissions a year involve people with serious mental illnesses like bipolar disorder or schizophrenia. Three-quarters of these individuals have co-occurring substance use disorders. Many times, people are arrested for minor crimes like trespassing, public intoxication or other minor offenses that are typically associated more with symptoms of a person’s illness than intent to do harm. People with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population.

Without a continuum of care in place to serve people with these illnesses in the community, hospital emergency departments and jails are often the first response when a person is experiencing a mental health crisis. Due to the lack of funding and workforce for providing this care in the community, jails have become the de facto treatment providers for people suffering with mental illnesses.

County leaders are working hard to do better. The high number of people cycling in and out of county-run jails and emergency departments comes at a great financial cost to local taxpayers, but more importantly, at a personal and societal cost to families and individuals with mental illnesses, and communities.

This month marks four years since the launch of Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails. Stepping Up is the result of a collaboration between the National Association of Counties, The Council of State Governments Justice Center and the American Psychiatric Association Foundation.

Since the initiative launched in May 2015, nearly 500 counties in 43 states have passed Stepping Up resolutions committing to working with community partners to develop comprehensive plans for systems-level change.

Counties of all sizes and geographies—from less than 10,000 residents to more than 10 million, from the East Coast to the West, and everywhere in between—are making the effort to better respond to some of our most vulnerable residents.

County leaders are fostering partnerships between traditionally siloed systems like behavioral health, law enforcement, the courts, and housing systems to develop policies and programs to keep people out of jails in the first place and to help them transition back into the community after being in custody.

We are sharing and using data to identify gaps in these systems where individuals are falling through, and where better efforts can be made to connect people to health care, housing and treatment services. A better way to connect the unconnected.

We are hiring peer support specialists—people who have experienced mental illnesses and have been through the justice system themselves—to better engage those who need community-based services.

To commemorate four years of progress, Stepping Up is hosting a Month of Action in May, encouraging counties to highlight the progress and challenges happening in our communities related to this effort. May is also Mental Health Awareness Month, providing an opportunity for county leaders to elevate this issue at the national level and to partner with local stakeholders to help reduce stigma and find effective and fair solutions to addressing these challenges where they live.

We cannot—and shouldn’t attempt to—arrest our way out of this problem. County leaders across the country are finding innovative and sustainable solutions so that our communities are healthy, safe and vibrant and all our residents have opportunities to live well and thrive.

Join us in the Stepping Up Month of Action this May to create better futures for all county residents. Find out more at

Greg Cox is the president of the National Association of Counties and a San Diego County supervisor.

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