North Carolina faces a critical mental health crisis, with behavioral health disorders affecting one-fifth of adults and one-sixth of school-aged children statewide, according to the National Alliance on Mental Illness. One in 18 North Carolinians lives with a severe mental illness defined as a mental, behavioral, or emotional disorder that results in serious impairment and interferes with or limits major life activities.
A 2025 North Carolina Institute of Medicine study ranked the state last in the nation for access to behavioral health. All but six of the state’s 100 counties are designated as professional mental health shortage areas. Nearly a quarter of counties lack a single practicing psychiatrist, and more than a quarter lack a single practicing psychologist. Despite these shortages, per-capita public expenditures on mental health in North Carolina are higher than those of neighboring states and large states including Ohio, Florida, Texas, and Illinois, suggesting the issue is more complex than simple funding levels.
The consequences of untreated mental illness extend beyond individual suffering to broader social impacts. Untreated mental health conditions imperil public safety, lower student achievement, reduce labor force participation, and make it difficult for employers to fill key jobs. The shortage also undermines the state’s ability to attract and retain households, businesses, investment, and talent.
Recommended Reforms
Policymakers should pursue broader access to a spectrum of behavioral health providers rather than focusing solely on psychiatrists with M.D.s. Seven states allow specially trained psychologists to prescribe medications to treat mental illness, which researcher Jacqueline Marie Gallios described in Regulation magazine as “not only safe and evidence-based, but also a vital solution to America’s escalating mental health crisis.” Other states have expanded the capacity of nurse practitioners, social workers, counselors, and peer counselors. Telehealth represents another promising tool, with studies finding comparable treatment outcomes to in-office care at lower cost and greater accessibility.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.reflector.com/standard/opinion/editorial_columnists/john-hood-options-for-behavioral-health-care-must-be-expanded/article_9eda4ce9-0cdb-4afe-abb9-4afaf0d701c6.html