Editor’s Note: A staggering 20 million adults in the United States have a substance use disorder (SUD), yet 88% do not receive treatment for their conditions. Local communities are experiencing the human and economic costs of the opioid epidemic firsthand, especially rural communities, where the opioid-related death rate is 45% higher than in metro areas. Unable to wait for federal action, cities and counties are designing, funding and launching innovative local programs—almost all built and operated on a shoestring budget. In a new article for Modern Healthcare, summarized below, Manatt Health reveals the five key elements that successful programs share. Click here to read the full article.

The article highlights findings from a new Manatt Health report, supported by the Robert Wood Johnson Foundation, “Communities in Crisis: Local Responses to Behavioral Health Challenges.” Drawing from extensive research and interviews with local program leaders, the report provides detailed profiles of 13 local initiatives, as well as a comprehensive taxonomy categorizing program elements and features. Click here to download the report and taxonomy.


President Trump’s declaration of a public health emergency to address the opioid epidemic brought renewed attention to a crisis that claimed more lives last year than annual deaths from car crashes and gun violence combined. The lack of adequate treatment to address the SUD epidemic most acutely impacts local communities, often through rising rates of incarceration, homelessness, use of the criminal justice system, and utilization of emergency departments (EDs) and first responder services.

Cities and counties are responding to the opioid crisis by developing community-driven programs that connect individuals to treatment and social support services. Successful local programs share five key elements.

1. Collaboration and Alignment of Local Resources

Individuals with behavioral health conditions interact with a multitude of public and private institutions during the course of treatment or a crisis, often leading to a fragmented system of care that inhibits coordination across settings and providers. Successful programs overcome these challenges by identifying shared priorities and focusing on promoting collaboration and alignment of funding and resources, including through safe and secure information sharing among participating partners.

2. Establishment of a Holistic System of Care

Clinical treatment for behavioral health disorders is far less likely to be successful if it does not take into account the full spectrum of social service needs, such as housing, nutrition and employment assistance. Successful programs seek to connect individuals to Social Security, Medicaid and housing benefits to enable access to services during and after treatment to support recovery.

3. Navigation Across Settings

Accessing and navigating behavioral healthcare across myriad public and private settings can be challenging for individuals with SUDs. Successful programs invest in case workers and coordinators who create care plans and help clients navigate across settings to access the services they need.

4. Community Engagement and Advocacy

The social stigma associated with behavioral health disorders can be a barrier to accessing care and affordable housing, resulting in many individuals becoming homeless, cycling through the justice system and ending up in EDs. Strong community engagement is necessary to overcome this stigma in order to build support for community-based treatment as an alternative to incarceration and repeated emergency responses to behavioral health crises.

5. Leveraging Both Public and Private Financing

Many cities and counties are challenged to secure sufficient funding to respond to the crisis in their communities. Some localities are overcoming this obstacle by weaving together a patchwork of public and private funding streams, including state and local general funds, targeted assessments of taxes, grants from local health system community benefit programs and philanthropies, and federal programs.

Although Medicaid is the single largest funder of behavioral health services, most local initiatives have not leveraged the full complement of Medicaid-reimbursable services. This gap suggests a need for better communication and coordination among local program leaders and state Medicaid agencies.

Looking Ahead

The SUD crisis is not abating and continues to devastate communities across the country. Local initiatives are making a difference, but the challenge is evaluating them and spreading those that show promise by tapping into funding and expertise across public and private stakeholders.