March 26, 2025
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As part of National Criminal Justice Month, NAMI CEO Daniel H. Gillison, Jr. is joined by Matthew D. Chase, CEO/Executive Director of the National Association of Counties (NACo). As long-time friends and colleagues, they will reflect on efforts to divert people with mental illness from the criminal justice system, including 10 years of the Stepping Up initiative, and where they see the work of and ways that local governments, like counties, have led the charge.
You can find additional episodes of this NAMI podcast and others at nami.org/podcast.
We hope this podcast encourages you, inspires you, helps you and brings you further into the collective to know: you are not alone.
Episodes will air every other Wednesday and will be available on most major directories and apps.
Matthew D. Chase has served as the CEO/Executive Director of the National Association of Counties (NACo) since September 2012. As the chief executive officer, he is responsible for the overall management of the association. NACo is the only national association representing America’s 3,069 county governments.
During his professional career, Matt has focused on promoting America’s economic competitiveness, strengthening the intergovernmental system of federal, state and local officials, and engaging local elected officials in the federal policymaking process. In addition, he is a regular presenter on the impact of federal budget and policy trends on local governments and communities.
Previously, Matt served nearly a decade as executive director of the National Association of Development Organizations (NADO), representing local government-based regional planning and development organizations. Prior to becoming NADO’s executive director, he was the organization’s deputy executive director and legislative affairs director. He began his career with the Professional Managers Association, serving as membership services director and chief operating officer.
He is a graduate of Hartwick College in Otsego County, New York, and holds a master’s degree in political management from The George Washington University in Washington, D.C. He currently serves on the board of advisors for GW’s Graduate School of Political Management and previously served as a founding board member for Vets’ Community Connections. He was recently selected as a new Fellow for the National Academy of Public Administration.
Matt was raised in Warren and Washington counties in Upstate New York. Matt was introduced to county government by his stepfather who held two elective offices in Washington County – district attorney and judge.
He resides in Arlington County, Virginia with his wife, Shana, where they are raising their two young sons: Nicholas and William.
Dan Gillison brings expertise in non-profit leadership and a passion for advocating for people with mental illness to NAMI. Before coming to NAMI, Dan led the American Psychiatric Association Foundation (APAF), where he was responsible for strategic planning, personnel management, board communications, oversight of APAF’s public education programs and outreach, and formulating strategic alliances and partnerships to further APAF’s mission. Prior to APAF, Gillison led County Solutions and Innovation for the National Association of Counties, where he was instrumental in repositioning the organization’s programs to provide expertise in health and human services, justice, and public safety.
Dan has more than 30 years of experience and has previously held leadership positions at Xerox, Nextel, and Sprint. Dan holds a B.A. from Southern University and A&M College. Dan spearheaded the creation of the CEO Alliance for Mental Health in 2020, which represents some of the most vulnerable and diverse populations affected by disparities in the mental health care system. The leadership collective has collaborated to identify and amplify their priorities for creating a future of quality mental health care for all who need it. Dan serves on lululemon’s Mental Wellbeing Global Advisory Board.
00:00:00:00 - 00:00:27:07
Matt
You all are so important at bringing real world people to the table and showing us that this isn't an academic exercise. We are talking about our family members, our neighbors, our friends, our youth, our future, and that's why I think it's so important that Naco, representing elected officials with Nami bringing those with lived experience together, is so powerful.
00:00:27:07 - 00:00:53:09
Dan
Welcome to Hope Starts With Us, a podcast by Nami, the National Alliance on Mental Illness. My name is Dan Gillis and I'm your host and I'm the CEO for Nami. Nami started this podcast because we believe that hope starts with all of us. Hope starts with us talking about mental health. Hope starts with us making information accessible. Hope starts with us providing resources and practical advice.
00:00:53:11 - 00:01:21:05
Dan
Hope starts with us sharing our stories, and hope starts with us breaking the stigma. If you or a loved one is struggling with a mental health condition and have been looking for hope. We made this podcast for you. Hope starts with all of us. Hope is a collective. We hope that each episode, with each conversation brings you into that collective so you know you are not alone and you know your family is not alone.
00:01:21:07 - 00:01:56:07
Dan
Our episode theme is National Criminal Justice Month, taking place during the month of March. Why do we care? Because people with mental illness are overrepresented in our nation's criminal justice system 4.2 million times each year. People with serious mental illness are booked into a local jail. Second, 65% of people who are incarcerated have a substance use disorder. Third, suicide is the leading cause of death for people held in local jails.
00:01:56:09 - 00:02:28:22
Dan
Fourth, less than half of people with a history of mental illness receive treatment while being held in local jails. Nami, along with our national partners, is leading the charge to change these numbers. Our guest today is here to talk about those, these efforts and more. And I'm really pleased to introduce our guest, Matthew Chase. Matt is the CEO and executive Director of the National Association of Counties Naco, and has been leading them in incredible ways over a number of years.
00:02:29:00 - 00:02:45:09
Dan
And you heard me speak in those numbers about local. So that's why we wanted to talk with Matt, because the rubber hits the road at the national county level with counties. And excuse me, the National Association of Counties leads that effort. So Matt, welcome.
00:02:45:10 - 00:03:04:01
Matt
Dan thank you. It's just great to be here. And so pleased that you're leading the National Alliance for Mental Illness. Nami. Just a great organization. One of our favorite partners, both overall with your mission but you personally with our connection. Just great to be partnering with you.
00:03:04:01 - 00:03:25:06
Dan
Likewise. Likewise. And, you know, it's really cool to have this time because we're always running hard and fast and sometimes we see each other in airports or whatever. So for us to have this time is really cool. And thank you, Matt. And it's really appreciated that you would give the time to us today and also the partnership that we have formally and informally.
00:03:25:06 - 00:03:42:14
Dan
So, thank you. Yeah. Thank you. Really sincerely. So, Matt, can you share why counties have long been leading the charge to divert people with mental illness from the criminal justice system, and also, why does this matter to Naco and your members?
00:03:42:14 - 00:04:13:01
Matt
Yeah, Dan, I think we always start everything we do here with our why why do county governments in our 40,000 elected officials and our 3.6 million county employees, why do we care about behavioral health overall and specifically mental health? There's there's two key factors. Number one is just our moral obligation as local leaders to make our communities more vibrant, to make them safe, and to make them healthy.
00:04:13:03 - 00:04:36:04
Matt
And you can't do that without addressing mental health as a country, as a society. We've had mental health issues, probably going back to the beginning of time. But we know in recent decades that we can do better, that we are not going to accept the status quo. Status quo is not an option. We're either going backwards or forwards.
00:04:36:06 - 00:05:05:14
Matt
And when we worked with Nami over ten years ago to launch Stepping Up, and we'll talk about that probably a little bit later that was saying from a local perspective, this is a national crisis. We are not going to wait for the federal government or state government to take the lead that as county officials who do run local jails and the local court systems and run 750 behavioral health authorities, let's lead from the grassroots up.
00:05:05:15 - 00:05:35:02
Matt
Let's crowdsource our own expertise with those 40,000 elected officials, the sheriffs, the clerks, the public defenders, even the coroners understand this issue. And our county commissioners and executives, let's get together both inside the courthouse and with key partners like Nami. And let's start getting to work on system change and let's help improve lives. And you played an instrumental role in that.
00:05:35:04 - 00:06:05:16
Matt
And bringing both judges, like a judge Laufman from Miami-Dade, but also state chief justices, along with sheriffs and others together. But what was so key, having Nami at the table, is to not allow us to stick to theory and to get to practice. You all are so important at bringing real world people to the table and showing us that this isn't an academic exercise.
00:06:05:16 - 00:06:21:18
Matt
We are talking about our family members, our neighbors, our friends, our youth, our future. And that's why I think it's so important that Naco, representing elected officials with Nami bringing those with lived experience together, is so powerful.
00:06:21:18 - 00:06:52:05
Dan
You know, Matt, thank you very much. And as you mentioned from the grassroots up, and actually looking at the moral obligation of this work and also the collaboration, which is so critically important. So thanks for teeing that up. And you also teed up, Stepping Up, which this is the the 10th, ten year anniversary. So I wanted to ask you a little bit about that work and how it really began to change hearts and minds and, and then that dynamic of the local leadership.
00:06:52:09 - 00:06:56:15
Dan
So would you share a little bit about Stepping Up from its inception to now?
00:06:56:16 - 00:07:28:19
Matt
Yeah. So Stepping u=Up. Well, it wasn't easy to execute. The vision was what I said. When we talk about Stepping Up now, we we call it the initiative that launched a thousand state and local initiatives. We have over 600 counties that have adopted official board policy or county policy that this is a priority and that they are going to work across silos within a county, within a community to advance progress and to try and measure that progress.
00:07:28:19 - 00:07:54:00
Matt
But this started for me on a personal journey where I grew up with a stepfather who raised me during my formative years, was a district attorney, and he was a judge. He actually created some of the first drug courts in the United States decades ago. And my mother was a mental health nurse and still has a mental health private practice.
00:07:54:02 - 00:08:27:01
Matt
And my stepfather, again, who raised me, he was, he committed suicide, which, interestingly enough, judges have one of the highest suicide rates in the country. Maybe only dentist and and a couple others with higher rates. Unfortunately, and part of his suicide related back to his childhood trauma, but it also related to one of his roles as the judge was to oversee family court, and a particular incident happened in the family court that he just decided he couldn't live with.
00:08:27:03 - 00:08:57:02
Matt
And so for me, I saw this repeat itself across the country and talking to our county officials where they had their own personal journey. And what we decided was working with the American Psychiatric Foundation and with the council, state governments, with Naco, with Nami. We said again, status quo was not an option. Mental health trends are getting worse, not better.
00:08:57:04 - 00:09:26:22
Matt
We keep throwing money at the problem that we have a system design problem, we have policy problems and we have the wrong incentives for the wrong outcomes. And when we get into things like mental health parity, when we get into things like the 988 suicide prevention hotline and other things, and how we can get community based treatment and not using our jails as the default treatment facilities, we can do better.
00:09:27:00 - 00:09:53:12
Matt
And so what we said is, if state government comes together with the counties, with anybody else that wants to partner and including those with lived experiences, we can do better. And so how do we change the incentives for people's behavior? And again, helping run campaigns for my stepfather again, who's a district attorney and a judge, your incentive as a judge is make no errors.
00:09:53:13 - 00:10:24:03
Matt
Make sure that you don't have an attack out against you, of you either didn't prosecute somebody or you didn't incarcerate somebody who could be a threat in the community. And so the incentives for the prosecutors and the judges are let's over incarcerate. That reduces their risks as political elected officials. And we want to change that narrative, to say, those with living with mental health conditions are often the victim.
00:10:24:05 - 00:11:01:00
Matt
They're overwhelmingly those being abused, those being pushed aside. They're not the ones harming others, typically. Certainly there are those cases, but those are really in the minority. So let's figure out what are the outcomes that we want as a society. We want folks with mental health conditions, whether they're severe to more moderate to improve their lives. And you're not going to do that by being incarcerated in a jail setting.
00:11:01:02 - 00:11:30:15
Matt
That's not what jails are built to do. And so we are pleased to work together. And, you know, I'll pause there and let you make some comments on it, because there's a lot to say about it. And after ten years, we're at a pivot point. And but we think we made so much progress. And what we'll talk about here more is there's also risks now that we're going to go backwards based on some potential federal policy.
00:11:30:17 - 00:11:52:03
Dan
Yeah, there is there is that risk. And I want to pause for a second, Matt. And first of all is is we talked about lived experience. And, you know, that's who we are, as an organization. Nami. You've shared your lived experience and your family's experience. And as I was at a conference this past week, every time someone shares their story, it helps so many others.
00:11:52:03 - 00:12:16:11
Dan
So thank you for doing that. And, as you mentioned, your, your, your stepfather and his is, is role scope and mission and, some, childhood trauma. You know, we that makes me think about aces adverse childhood experiences and how that leads up to substance use disorders, how that leads up to the other diagnosis that, end up not being treated.
00:12:16:11 - 00:12:25:19
Dan
And we then end up someone, getting handcuffs versus help. So we, we look to see how we can change that. And this partnership has been so critical that and then.
00:12:25:22 - 00:12:28:20
Matt
On that and just before you pivot off of it.
00:12:28:22 - 00:12:29:10
Dan
Yeah.
00:12:29:12 - 00:13:00:23
Matt
One of the formative experiences of my life was at his funeral where when a prominent member of the community commits suicide, the family can either hide or they can embrace it and use it as a leadership moment to help others. And that's what our family decided to do. And quite honestly, I'm not sure we had a choice because the graduates of the drug court demanded to speak at his funeral.
00:13:00:23 - 00:13:01:13
Dan
Wow.
00:13:01:14 - 00:13:29:21
Matt
Because he had given them a new lease on life. He had put his own political career and we got to remember when he was doing this was the late 80s, early 90s. It was not politically popular to do. And those graduates of the drug court who had gone on to raise their family to to keep their jobs to live, quote, a middle class life, said, we could have gone the other way. Under the old system,
00:13:30:03 - 00:13:51:10
Matt
we would still be incarcerated. We would still be paying fines and fees in the court. We would still be losing our job because we had we were on probation and had to meet certain obligations. And so that experience to me when I came to Naco said, we can make change. We can make change one county at a time.
00:13:51:12 - 00:14:37:07
Matt
And if we wrap it in a national initiative, hopefully we can reduce the political risk of our sheriffs, of our judges, of our DA's that are elected in even our commissioners to say, look, we're getting really poor outcomes. Let's do better. And as we pivot into the conversation on federal policy, what has really been incredible is because of our joint work with Naco and Nami and others, that ten years of workshops, webinars, peer exchanges, congressional briefings, all this stuff. When Covid hit and Congress invested in the American Rescue Plan.
00:14:37:09 - 00:15:08:09
Matt
Yep. Counties got a significant direct allocation from the US Treasury and the number one use outside of public health. Our members invested in behavioral health. And because of Stepping Up in our partnership, they were ready to make strategic investments, especially in short term crisis intervention strategies and facilities. And what has been interesting is for years we had the workforce but not the facilities.
00:15:08:11 - 00:15:24:05
Matt
Then we get the money to build the facilities and now we have a workforce shortage. So it's been interesting to see. But as we get into the specifics here, we're just seeing so much innovation at the local level, and we got to figure out how we're going to sustain it.
00:15:24:06 - 00:15:48:11
Dan
You know, Matt, you know, thanks for that overview. And as you talked about those that, from the drug court that spoke at your stepfather's funeral, that is that talks about nobility and that talks about how we began this about care. And it demonstrates that he cared. And and it's a part of your legacy in terms of what you what what that lived experience has brought in terms of what you're doing.
00:15:48:11 - 00:16:13:13
Dan
So thank you for that. I wanted to talk about the,Stepping Up initiative in terms of the justice and Mental Health Collaboration program, which was a is a program that was created by Congress and has been championed by both, Naco and Nami. Can you talk about the the program and how it's helped shape what counties are doing to support justice diversion for people with mental illness?
00:16:13:13 - 00:16:40:16
Matt
Yeah, I think the this program is is so important to have justice and mental health collaboration program. And I want to I do want to put that important caveat at the beginning, but you all say two is obviously, well, it's not always so obvious to people, but the vast majority of people experiencing mental illness don't enter the criminal justice system.
00:16:40:16 - 00:17:13:02
Matt
And what we are talking about is that smaller percentage that does interface with the criminal justice system, and we want to do better. And so programs like the Justice in Mental Health collaboration program help us focus on jail diversion programs. So counties like Travis County and Texas, where Austin is through Stepping Up through our collaboration, have trained their 911 operators.
00:17:13:02 - 00:17:51:01
Matt
They've now are using 988 to answer over 6000 phone calls a year. They're training their officers in crisis intervention training. They're digging into their data to see who is in our jail that shouldn't be. But they've moved more and more to the front end of the front end, to the front end of the system to say before they even enter the criminal justice system, how do we divert, how do we assess, how do we embed mental health professionals or behavioral health professionals with law enforcement?
00:17:51:03 - 00:18:22:23
Matt
How do we send behavioral health professionals to these neighborhoods before we even send law enforcement? And of course, we know it's both art and science. There's risk involved with this strategy, but we also know that incarcerating 2 million people a year who really shouldn't be in jail is expensive. It's poor outcomes. And quite honestly, at the end of the day, it makes our communities even more dangerous.
00:18:23:01 - 00:18:59:13
Matt
And so really focusing on diversion, mental health courts, community based treatment. And as I said earlier, what we're so proud of is so many counties worked both regionally, they worked with their cities, they worked with a ton of nonprofits. You're seeing hospital systems get more engaged. We're now able to execute more on community based treatment, and we're executing more on short term stabilization facilities that can help people up to 23, 24 hours.
00:18:59:15 - 00:19:22:19
Matt
And if we can ever fix the federal IMD exclusion, which is a law and an acronym for a federal policy that limits the number of beds in a facility where we don't want to go back to state psychiatric hospitals, but we want to have a little bit more flexibility, especially for these crisis intervention type facilities. We think we can just continue to improve our outcomes.
00:19:22:19 - 00:19:45:07
Dan
You know, and you have some proof points. Thanks, Matt. You have some proof points on that. And I want to go back in time and then we'll come back into the federal, situation a little bit back in time at the birth of Stepping Up. And as, as that started, it was also getting, a mindset change with some of our local leaders.
00:19:45:09 - 00:20:12:15
Dan
And it was so interesting to see the sheriffs, the sheriffs wanted a different outcome. And it was interesting from the standpoint of, how that began, because it wasn't really known to them how they could be a part of the solution, and now they've adopted it as it is the real thing to do, because they've looked at the metrics they looked at the recidivism, and they looked at their communities in a way that, wait a minute, that could be my brother.
00:20:12:15 - 00:20:33:10
Dan
That could be my sister. Right. And so can you speak to the the the kind of the, I guess the best way of putting it that that, transition of of one way of thinking to a new way of thinking. And now you've got that adoption. So you almost have that false force multiplication that you can build on if you get the money.
00:20:33:12 - 00:21:01:15
Matt
That's right. When we started Stepping Up again over a decade ago, pretrial justice was well, it had been around. It was really starting to scale up, just this whole concept of pretrial justice. And we went through a period of that battling the bail bondsman industry, if you will. And that was a relatively short battle, and I'm sure it's still out there somewhere.
00:21:01:17 - 00:21:46:02
Matt
But where I saw the change with the sheriff's was in their own work force, where not only did they have increased compassion for the residents, what they were seeing was increased mental health issues with their own workforce. Those that have to deal with murders with really tragic traffic accidents. One of the biggest burnouts for anybody, but definitely in the county workforce, are those dealing with domestic violence and really those really tough societal issues.
00:21:46:04 - 00:22:26:15
Matt
And we had so many great sheriffs. Sheriff Katujan up in Massachusetts and many, many others. A former sheriff, where in Dane County in Wisconsin say we need to do this for our residents and we need to do this to protect our own workforce where we need them trained on how to deal with this. And a lot of the conflict between law enforcement residents, a lot of it comes from law enforcement's own fear going into perceived dangerous situations or really dangerous situations.
00:22:26:15 - 00:22:51:10
Matt
And the more they were taught crisis intervention skills, the lower you could lower the anxiety level going into a situation. And I and I had a personal experience with my neighbor. I came home, you know, it was a day we actually had after decades, we got the previous white House administration to hold a summit on mental health, and I was at the white House till about six at night.
00:22:51:12 - 00:23:16:21
Matt
I drove home and literally on my front yard were six sheriff cop cars, a big fire truck and an ambulance with one of my neighbor's children has severe mental illness combined with with substance abuse. And, you know, law enforcement was having to wrestle with this young man and they didn't want to do it, but they were all CIT trained.
00:23:16:21 - 00:23:39:11
Matt
And the way they handled that situation where he had abused his mother, he had threatened his father and other things. And and because of his co-occurring mental health and substance abuse, it was a dangerous situation. But to watch how those officers handled him with dignity at a time when 20 years ago, they wouldn't have they would have cuffed him and stuffed him in the car.
00:23:39:15 - 00:23:49:10
Matt
And that comes through all of the work of Nami, of educating elected officials and law enforcement and judges and educating Naco members about. We can do it a better way.
00:23:49:15 - 00:24:10:07
Dan
You know that that that is really the theme of our podcast. Hope starts with us and we do have hope for better outcomes. And you're seeing it. And, Matt, something that our audience doesn't know is that during our time together, we traveled to many county jails, from LA County to Cook County to Shelby County, to a few other counties.
00:24:10:07 - 00:24:41:16
Dan
And no, you don't have to share the story about L.A. County. But what I want to say about that is that, you know, our audience, and our and our listeners and watchers, and Matt believes in this work, through his bones and believes in leading by showing and went into the jails and we went into many of these jails together to see what we were hearing, and then to look at what was the operational model that we we needed to put in place.
00:24:41:18 - 00:24:52:01
Dan
So I just wanted to mention that because as you hear, Matt, Matt has been in many of these jails and yes, I've been to a few with him. That's right.
00:24:52:03 - 00:24:55:01
Matt
So, we've and we've left him thankfully.
00:24:55:03 - 00:25:17:02
Dan
Yes, yes. So, you know, Medicaid, you were kind of going there. Medicaid is a vital program, Matt, to the people that we represent, we both represent and I know it is vital to counties, and especially in efforts to help people who are justice system involved. Can you talk about would you talk about the importance of Medicaid to the future of diversion efforts?
00:25:17:04 - 00:25:20:06
Matt
Yeah, so this is let me frame this real quick.
00:25:20:08 - 00:25:21:12
Dan
Yeah. If you would.
00:25:21:14 - 00:25:48:22
Matt
There's a lot of attacks on Medicaid and what when we go up to Capitol Hill or talk to the administration about health care insurance, because that's what we're talking about is who's paying. What we always say is counties come at this out of self-interest, as well as our moral obligation. For counties, county governments either own or support over a thousand public hospitals.
00:25:49:00 - 00:26:14:13
Matt
We have over 800 long term care facilities like nursing homes or skilled nursing. We have over 25 states where county governments have to help match the state portion of Medicaid. So if you're in New York State, the counties are spending over $2 billion a year on a taxpayer property taxpayer money to support Medicaid. And if our residents don't have health insurance,
00:26:14:15 - 00:26:44:05
Matt
then counties often have what's called indigent care, where we end up footing 100% of the bill. So out of self-interest, I just tell people, look, we would love for the federal, state, local partnership to help cover the cost of uninsured together. But as a country, let's start with what happened to private insurance. What happened post-World War two is we had a model where you got your health insurance through your employer.
00:26:44:07 - 00:27:11:15
Matt
And obviously in the 80s and 90s and 2000, that model started to break down because of cost, the nature of our jobs moving from manufacturing to service economy. And I won't go too far into it. But right now, we're not having discussion in this country about, if not Medicaid, then what? So if we're going to cut Medicaid, where are we going?
00:27:11:17 - 00:27:44:05
Matt
What's the alternative? And right now the only alternative is you probably go off of insurance and you become uninsured. Now you're using the ER, which is the most expensive form of care, or even worse, you're not getting any care at all. And we move into long term chronic health when we're not doing preventative health. So we like to start the conversation with, okay, if you're going to cut $800 billion from Medicaid, what is the alternative?
00:27:44:06 - 00:28:14:01
Matt
Is it just state and locals are going to pay more? Well, that's just a government shift from one tax payer to another tax payer. Why aren't we looking at system design and improving outcomes like we were doing through Stepping Up of, let's look at folks who are going from the ER to the jail to the homeless shelter. Let's look at folks who are on nutrition assistance and other public assistance, as well as behavioral health issues.
00:28:14:01 - 00:28:51:06
Matt
And if we focus on outcomes, I think we could all either reduce costs or redirect some of the money to workforce education, to housing stability, to other job skills that would be more positive or long term treatment. So long winded. Way to say where we're at is the House budget resolution basically looks at cutting over 800, 830, $860 billion in Medicaid over a ten year window, and there's debates on whether that's true or not.
00:28:51:06 - 00:29:20:07
Matt
But the Congressional Budget Office said the House Energy Committee basically only has so many programs on its jurisdiction Medicare and Medicaid and a couple of smaller ones. And the only way that committee can read it reach its budget targets is to reduce Medicaid. Now, there are 101 different ways they can achieve it. They're looking at things like work requirements, which
00:29:20:08 - 00:29:44:02
Matt
we understand. But when you look at the Medicaid population, the vast majority of people on Medicaid are either elderly and this is really helping their nursing home. So that population is not going to go get a job. And 40% of kids are on Medicaid. So unless we're going to force our kids to work, the work requirements typically won't apply to them.
00:29:44:04 - 00:30:13:07
Matt
So it's a fairly smaller population, not insignificant that that we're looking at for workforce requirements. And that will reduce the savings. Obviously, if it's a smaller population and then they get into things like provider tax of what states used to charge hospitals and other providers, and we're open to those conversations. But know any change is going to have consequences somewhere at the state and local level.
00:30:13:09 - 00:30:41:15
Dan
Yeah, it really is. And, you know, thank you because you've just given a real good overview, Matt. And as we bring bring this home, one of the things that I want to go back, to something you said very early on, workforce. The workforce within the counties is critically important as we look at workforce, what is your focus in terms of the National Association of Counties, in terms of helping to develop and maintain a workforce and grow a workforce?
00:30:41:15 - 00:31:08:11
Matt
Yeah. So, Dan, let me start with this. Last year, the National Association of Counties launched a National Commission on Mental Health and Well-Being of county officials to take the year to study what have we learned in the last decade? What are we anticipating in the next decade? What did we learn during Covid around behavioral health and loss, learning with kids and other things?
00:31:08:11 - 00:31:39:01
Matt
And what are our federal policy priorities? And we ended up with four policy priorities. One was to amend some of the exclusionary policies that we talked about. The IMD exclusion, like the Medicaid inmate exclusion, where you lose your Medicaid and your VA benefits and your Chip benefits at arrest, not post adjudication. So that's a constitutional issue. Number two was enhance our local crisis response.
00:31:39:03 - 00:32:06:08
Matt
We had to look at those first 48 hours. How do we really enhance treatment facilities and programs around that? Third was mental health parity on the insurance side, and fourth was workforce. And as I said, we we really didn't come up with... Workforce i's going to be tough because that's a multi-decade you're not going to turn the workforce over time.
00:32:06:09 - 00:32:32:10
Matt
But we talked about things like what we kept hearing from entry level county employees was I would have joined the behavioral health workforce if I could have lived while I was getting educated. Meaning, hey, loan forgiveness is great, but what about the 2 to 4 years that I'm in school when I can't pay childcare or transportation or my rent?
00:32:32:10 - 00:33:04:22
Matt
If we could figure out some front end assistance to help people through their workforce journey and through their education and training journey, they would have gone to market faster. And so that requires resources upfront versus loan forgiveness on the back end. And of course, we know loan forgiveness has become a hot button political issue. But what we wanted to do is shine a spotlight on there is a workforce gap.
00:33:05:00 - 00:33:21:09
Matt
As I mentioned earlier, we had county after county, so proud to build facilities. And then they said, wow, we can only operate at 60% or 70% or 40% because we don't have the workforce to staff that 24 seven.
00:33:21:11 - 00:33:48:01
Dan
Yeah, yeah. Got it, got it. Matt, I wanted to ask something else. We always assume sometimes that people know about our organizations, and this is more of a setup. And we will have something with the podcast that that prescriptive says and writing who Naco is. But I would love to give you a moment or two to speak to who is Naco, what does Naco do and what is the size, the scope of the National Association of Counties?
00:33:48:06 - 00:34:15:23
Matt
Well, thank you, Dan. So the National Association of Counties is part of our nation's inter-governmental system of federal, state, local and tribal officials. We're not a special interest group. We are a public officials organization that is tasked with working government to government, as I said, federal, state, local, tribal. And we're supposed to be looking out for the greater public good.
00:34:16:01 - 00:34:51:11
Matt
We represent 3069 county governments as institutions. Our members invest about $750 billion a year across the country into local communities. We're led by 40,000 elected officials, and we have a combined workforce of about 3.6 million Americans, about 2% of the adult workforce are employed by county governments, and we are probably one of the most misunderstood levels of government, but an essential level of government.
00:34:51:13 - 00:35:36:21
Matt
And, you know, we're proud to work on things like justice and public safety and public health, but we're also incredibly proud to work on behavioral health. And as we've just talked about through this whole podcast, our biggest concern is we've made all this progress. But the trends of the world and the trends of our society are working against us as we have more economic stress, as we have more technology present in our life and screen time and our political discourse, it's eroding our hope and our optimism and our trust in one another, which is causing more behavioral health conditions.
00:35:36:23 - 00:36:05:05
Matt
And so we already had a tough battle. And what we're concerned is we're going to have fewer resources to deal with a growing problem. And that's where collaboration with Nami, both nationally and your local chapters are so important. And we know that policy alone isn't going to fix this. But we also, as I said at the very beginning, we just can't accept status quo.
00:36:05:09 - 00:36:38:04
Matt
We've got to keep working together, to innovate, to try new things, to measure those. Fail fast, fail often, but keep moving just like they do in industry and to scale up what works. And not to say there's any one model, and that's one of the most frustrating parts, is policymakers like to replicate the same exact model. And we like to have flexibility for local cultures, for local conditions, for local governance.
00:36:38:06 - 00:36:46:20
Matt
But the key is how do we create the right incentives for our elected officials to stay engaged in this journey?
00:36:46:20 - 00:37:11:17
Dan
Very important. This is a good overview and thank you because we want to bring understanding for what is misunderstood about, the county government, element, Matt So if we can be and use this platform to help educate and inform, and share who Naco is and why Naco is so important and how Naco works. Yeah. With your 40,000 members and, 40,000 elected officials.
00:37:11:17 - 00:37:15:08
Dan
Excuse me, is is is very important. And then we're I want.
00:37:15:08 - 00:37:48:05
Matt
To applaud Nami nationally is you understand the difference between progress and perfection. If we are holding ourselves to a standard of perfection, and we expect every policy and every initiative to be perfect, we won't move forward. And not that we want micro, incremental progress. We want to scale up. We want to get better faster. But in today's society, you know, all the political parties will become risk averse.
00:37:48:08 - 00:37:49:00
Dan
Yes.
00:37:49:02 - 00:37:57:11
Matt
Yeah. You know, when we work together, we always used to say in the private sector, you word innovation in the public sector you investigate it.
00:37:57:13 - 00:37:58:16
Dan
Yeah.
00:37:58:18 - 00:38:13:18
Matt
And so we've got to get over that. And groups like Nami help us innovate. They help us take some some educated risks. But you help us again, I'm saying it over and over, not accept the status quo.
00:38:13:20 - 00:38:32:18
Dan
Yeah. If you if you do what you've always done, you're going to get what you've always got. And that is not accepting the status quo. And that's why our partnership, is so symbiotic. And it works so well because we understand that and we're willing to look at, the opportunities to innovate, and scale. And that’s going to take time.
00:38:32:22 - 00:38:57:21
Matt
And unfortunately, you know, we're both parents where how we grew up is so different than today. You throw in Covid, you throw in social media, you throw in peer pressure, you throw in economics. And we're just concerned it's going to get worse before it gets better. So we better get prepared. We better get to work.
00:38:57:21 - 00:39:18:06
Dan
And that's that's going to continue to, to, to keep us, engaged as leaders to, to continue to help, look to make a difference in this, Matt. So appreciate this. And is there anything you would like the audience to know I haven't asked you. I have one last question. But before I go to my question, I wanted to give you the opportunity.
00:39:18:08 - 00:39:25:09
Dan
Is there anything that, as you've thought through this conversation, this podcast that you say, I want to leave the audience with this?
00:39:25:11 - 00:39:52:17
Matt
Yeah. I think what I tell folks is we're living through history. We're living through interesting times where we're battling as a country of what we stand for and what we are hoping to stand for is to help those. The role of government is to look out for the greater good of the population, and to really help those that are that are at risk.
00:39:52:19 - 00:40:25:15
Matt
And so we're going to stay committed to this. There will be a lot of federal battles, federal policy battles. They'll be state battles. Our members aren't perfect either. No level of government is. But through Naco, we know that there are literally thousands of locally elected officials that this is why they ran. And even if they didn't run for it at the beginning, once they got in that courthouse and realized what counties do, this jumped to the top of their list.
00:40:25:17 - 00:41:04:06
Matt
And it's an incredibly decentralized, fragmented system. If we even have a national system for mental health. But I want to end with small wins like the 988 hotline .One we worked together to get it created, and we had to get private industry to work with us. But what was really important was when we figured out that we had a geo routing problem with where the phone calls were being routed, to which call centers, and we looked at what we had done
00:41:04:09 - 00:41:24:23
Matt
with 911 and you used to work in this industry and know the complications and the cost that a very short period of time by federal policy standards, we were able to get a fix. So now you can get a call, you can get a response and you get someone to go if necessary to help individuals in crisis.
00:41:25:01 - 00:41:52:18
Matt
And that shows when we have the will and the collaboration that we can move the needle. When I talked to counties about the number of inbound calls, it's in the thousands. So as I mentioned earlier, Travis County is getting 6000 calls a year, and they're diverting 86% of those calls away from law enforcement, 86% away from law enforcement.
00:41:52:19 - 00:42:01:22
Matt
Yeah, better outcomes, more safety for the law enforcement officials themselves, and certainly more safety for the residents.
00:42:02:00 - 00:42:15:02
Dan
You know, it's it's thinking differently, doing differently and knowing that to the point of nine, eight, eight, you know, that's that's that's something that shows that we can do it if we have the will, if we have the will.
00:42:15:04 - 00:42:16:20
Matt
It was bipartisan.
00:42:16:22 - 00:42:38:23
Dan
Yes. How about that? How about that? Oh yeah. So you know, to that point, Matt, we always ask our guests at the very end, with the last couple of minutes that sometimes with the world being a difficult place, and our environment being difficult, it can be hard to hold on to hope so. Matt, what has you holding on to?
00:42:38:23 - 00:42:46:20
Dan
Hope. You just shared an example of of how the federal government moved. Big picture Matt. What has you holding on to Hope?
00:42:46:21 - 00:43:19:14
Matt
Yeah, it's I have the pleasure of working with locally elected officials who don't get paid a lot of money. And so many of our county officials are facing death threats. They're facing social media harassment. It's the political environment, unfortunately, is very nasty. And yet they show up every day, whether they're elected or professional county employees, and start with the mindset, how are we going to make our community better?
00:43:19:16 - 00:43:53:18
Matt
Now, we’ll never have enough resources to fulfill all of our dreams and aspirations, but I'm working with people that just want to chip away every day. And so again, it takes community partners like the National Alliance for Mental Illness to keep us focused and aligned and keep us grounded. How does policy translate into the real world? How does policy impact your family, your neighbors, your friends?
00:43:53:20 - 00:44:16:00
Matt
And that's what gives me hope is when you go beyond the entertainment of national media and you get into the local level, you can't tell for the most part, many of our members who's a Republican, who's a Democrat, or if they're unaffiliated with a political party. For the most part, they just want to get things done.
00:44:16:06 - 00:44:34:15
Dan
Yeah, I totally agree with that because I've had the opportunity, and to our members, I used to work at the National Association of Counties and interact with many of the leaders that Matt is speaking of, and I will use one big word with that, and you've heard me use it within Nami care. People don't care how much you know until they know how much you care.
00:44:34:15 - 00:44:51:11
Dan
And there is not a local county leader that I met in my time at the National Association of Counties that didn't demonstrate their care, before their knowledge, it was all about and still is about how much they care. And, and and Matt just shared that.
00:44:51:17 - 00:45:24:02
Matt
Yeah and Dan I'll end with this if we're wrapping up is. Yeah. From an advocacy perspective. Give for your audience. These county officials have domestic policy A to Z on their plate. They're managing roads and bridges, libraries, parks, their airports, transit systems, you name it. They've got the responsibility for it. And so, so many times when they don't take action or they don't feel maybe you don't perceive that they care.
00:45:24:04 - 00:45:53:15
Matt
Keep working at it. Keep educating, keep the outreach. Because, again, they have so many priorities and so many responsibilities that it's not typically because they don't care. It's one they don't have enough resources or time or they there are just so many competing demands, whether it's natural disasters, whether it's elections, there's so many roles and responsible parties. So keep pushing.
00:45:53:17 - 00:46:13:05
Dan
Yeah. Thank you, Matt, thank you very much. We have, a really, great relationship with Naco and, and Matt and I just wanted to make sure that we, represented his body of work and Naco in the right way through this podcast. So this has been Hope Starts With Us, a podcast by Nami, the National Alliance on Mental Illness.
00:46:13:07 - 00:46:43:11
Dan
If you're looking for mental health resources, you are not alone. To connect with the Nami helpline and find local resources, visit nami.org/help text helpline to 62640 or dial 809 five zero Nami 6264 or if you are experiencing an immediate suicide, substance use or mental health crisis, please call or text 988 to speak with a trained support special or visit 988 lifeline.org.
00:46:43:13 - 00:46:47:15
Dan
I'm Dan Gillison, your host. Thank you for being with us today and be well.
NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264,
text “helpline” to 62640, or chat online. In a crisis, call or text 988 (24/7).
