Natural and manmade crises impact community-level behavioral health, including mental health and substance use. This article shares findings from a larger project about community behavioral health, relevant to the ongoing water crisis in Flint, Michigan, using data from a larger study, involving monthly surveys of a panel of key informants from Genesee County. The data come from open-response questions and are analyzed as qualitative data using grounded theory techniques. Although respondents were not asked about the water issues in Flint, participants commented that the water situation was increasing stress, anxiety, and depression among the city’s population. Participants thought these mental health issues would affect the entire community but would be worse among low-income, African American populations in the city. Mental health consequences were related not only to the water contamination but to distrust of public officials who are expected and have the authority to resolve the issues. The mental health effects of this public health crisis are significant and have received inadequate attention in the literature. Public health response to situations similar to the water issues in Flint should include sustained attention mental health.

Local incidence of behavioral health issues such as substance abuse or poor mental health are a topic of increasing concern, but the specific needs, issues, and priorities of cities can differ from those in rural areas. We illustrate how rural and urban perceptions and knowledge may differ with a survey about community behavioral health priorities in Clark County, Nevada. The survey had a 44% response rate and the sample was 77.3% urban. Rural leaders had different behavioral health concerns and received information from different sources than their urban counterparts. Alcohol abuse and illegal drug use were top behavioral health priorities for both groups. Rural leaders cited mental and physical abuse as priorities, while urban leaders prioritized depression and suicide. The findings demonstrate the importance of recognizing that geographic proximity does not equate to identical behavioral health concerns or priorities, which also impacts community use of data for decision-making.