Background: Mental health conditions are highly prevalent in the U.S. and are associated with physical health problems. Federal initiatives recognize mental health as a public health priority, and local health departments (LHDs) have been identified as partners to promote population mental health. Little is known, however, about the extent to which LHDs address mental health or how LHD officials perceive mental health as a public health concern.

Purpose: To describe the cumulative level of LHDs’ engagement in activities to address population mental health and explore how LHD officials perceive their roles in promoting it.

Methods: Module 2 of the 2013 National Profile of Local Health Departments Study (N=505) was used to develop a cumulative measure of LHD engagement in mental health activities. Univariate and bivariate analyses were performed to describe LHDs’ level of mental health activity and identify associated LHD characteristics. Semi-structured in-depth interviews were conducted with 30 LHD officials, audio-recorded, transcribed, and analyzed using thematic content analysis.

Results: Over half (55.8%) of LHDs performed ≥1 mental health activities, and 21.2% performed ≥4. LHDs that provided primary care services were most engaged in mental health activities, with 30.4% performing ≥4 and 18.2% performing ≥6. LHD officials perceived mental health as a public health issue and felt community pressure to address it, but encountered barriers related to resources and organizational boundaries.

Implications: LHDs might benefit from quality improvement and information sharing resources focused on population mental health promotion. Research should examine LHDs relationships with behavioral health departments and roles within broader social service systems.