May 12, 2023 - Health

The mental health crisis is costing local governments

Illustration: Sarah Grillo/Axios

The shortage of behavioral health workers is increasingly making courts and jails de facto providers of mental health services, straining local budgets nationwide, according to a new report from the National Association of Counties.

The big picture: The justice and public safety system was never designed for the task, and while the majority of incarcerated people in state prisons report a history of mental health problems, more than 70% have not received treatment since being jailed.

  • Americans suffering from mental illness are 10 times more likely to be put in jail than they are to be hospitalized, per a National Judicial Task Force report last fall on state courts' response to mental health.
  • This is likely due to a decrease in psychiatric bed capacity, per a 2021 study in the Journal of Psychiatric Practice.

By the numbers: As more and more residents with mental health issues stream into the legal system, 80% of respondents in Thursday's report said counties are incurring the most costs in providing treatment in courts and jails, followed by law enforcement and hospitals.

  • While 86% reported that more funding is needed to respond to the crisis, county officials also noted that even when there is money, they can’t retain workers.
  • In the last five years, nearly 90% of counties surveyed estimated an increase in behavioral health needs with about half reporting a "substantial increase" in the past year.

What's happening: In Barry County, Missouri, officials told NACO that the county jail is the only place available for residents in need of behavioral health services.

  • There's a lack of hospital beds to treat severe mental illness in Johnson County, Iowa.
  • Clinicians in Tulare County, California, are seeing more than 100 patients, stressing providers' ability to take on clients with milder behavioral health issues — which has implications for prevention.
  • Jefferson County, Nebraska, is seeing alcohol and methamphetamine drive up the need for mental health services, but waiting lists to get help are only getting longer.

What we're watching: Last month, the Biden administration released guidance encouraging states to apply for a waiver that would expand Medicaid coverage to incarcerated people to increase access to substance use and mental health treatment.

  • This is one policy recommendation NACO listed in its report, and California was the first state to be approved for it in January.
  • About 15 states have applications pending as of April 20, per KFF.
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