Drivers of County Engagement in Criminal Justice–Behavioral Health Initiatives

Several large, county-level initiatives are underway to improve behavioral health care for justice-involved clients. Unfortunately, only about a quarter of counties participate in these efforts, leaving justice-involved populations at risk of poor mental health, substance use, and judicial outcomes. This study examined characteristics of 2,922 U.S. counties and county equivalents by whether they participated in these initiatives and found that crime and socioeconomic characteristics were not associated with participation. Participating counties had significantly more robust mental health and substance use care delivery systems. Nonparticipating counties may lack the expertise and basic delivery system prerequisites needed for participation in most national initiatives, further driving geographic disparities.