Funding local mental health and substance use disorder programs and services is an ongoing challenge. Although the federal government allocates money to support mental health care in the states, federal spending on public health has been eroded through funding cuts and budget caps. State governments haven’t done any better. However, over the past couple of decades, state legislatures have been empowering counties and municipalities to create their own revenue, whether through a local sales tax or property tax.
Sales tax in Washington State
Like many other counties in Washington State, Snohomish County adopted a 1/10th of 1% sales tax to support mental health and substance use disorders services. Since 2010, these funds have been used to support a range of direct and wrap-around services for six target populations: youth, families with children, veterans and their families, the aging population, the most vulnerable, and the most costly (i.e., high utilizers).
According to MJ Brell Vujovic, Director of Human Services, and Cammy Hart-Anderson, Division Manager – CD, MH, & Veterans Services, the sales tax has been a great way to fund county mental health services. “The sales tax has been a tremendously successful source of funding,” says Ms. Brell Vujovic. “It allows Snohomish County to address our most pressing social service needs.” In addition, by providing healthcare coverage through Medicaid, the Affordable Care Act and Medicaid expansion has freed up funds and allowed Snohomish County to fill in service gaps, according to Ms. Hart-Anderson. (See the “success story” in the following post.)
When asked what would be different if the County did not have this revenue source, Ms. Brell Vujovic and Ms. Hart-Anderson listed a number of consequences:
- There would be more homeless people with behavioral health issues
- The county jail would have more people with substance use disorders
- There would not be as many people getting into treatment
- The county would not have outreach to motivate people to get into treatment
- There would not be the level of therapeutic court services
- The county would not be able to serve young people in the schools and would not see the successes we’ve experienced.
In short, said Ms. Brell Vujovic, Snohomish County “would have many more crises.”
Other jurisdictions, other revenue sources
Scott County, Iowa, has a dedicated mental health and disability services fund for which the primary source of revenue is a property tax. However, the budget and operations have been adversely affected by withdrawal of state equalization funds, property reclassification, a tax cap for mental health services levies, and a mandatory Medicaid offset requirement. The FY16 budget plan expresses concern about significant mental health fund budget deficits in the near future.
The vast majority of counties in Ohio (all but 12 of 88) have adopted some form of property tax levy to support mental health services and the electorate has adopted all of the levy renewals in the past few years (though a few new or additional levies have failed). According to Cheri Walter, MA, LICDC, Chief Executive Officer of the Ohio Association of County Behavioral Health Authorities, the levies raise approximately $400 million per year primarily to fund mental health and addiction services. As in Snohomish County, WA, the Affordable Care Act and Medicaid expansion have allowed county mental health and addiction boards to increase programs and services. Although the opiate crisis has taken some attention and resources away from mental health services, it has helped some voters to better understand the need for the tax levy. As for strategy, Ms. Walter says that the local boards are familiar with local needs and, through local representatives, provide messaging that resonates with the voters. “The services funded by the levies help people reintegrate into the community and the voters support that.”
In Chicago, IL, 74% of voters approved an add-on property tax to fund community mental health services, supporting the opening and operations of the Kedzie Center, which provides counseling to local residents.
The Salt Lake County, UT, Behavioral Health Services anticipates new revenue attributable to changes in Medicaid (pp. 5.2.1-5.2.12).
There are ways beyond waiting for federal money to fund mental health programs and services in your community. Find out what is working – and not working – where you live and advocate for new ways to increase local revenue so we can increase access to mental health care.
- What funding sources does your local government use to fund mental health services?
- What actions can you take to increase funding for local mental health services?