Across North Carolina, the need to strengthen support for children and young adults is becoming increasingly clear. We’re seeing mental health needs show up earlier, often in childhood, while too many families still struggle to get timely care. At the same time, something important is shifting. Communities, educators, health systems, and employers increasingly agree that investing earlier, before needs escalate, leads to better outcomes for young people and helps avoid the high costs of crisis-driven care.

Mental Health Awareness Month is an opportunity to recognize both the challenge and the progress underway. It’s also a reminder that prevention and early intervention are essential to improving access and affordability over the long term.

At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), our focus is on turning prevention into practical access to care. Alongside investments in early identification and community based support, we’ve expanded access by adding more than 10,000 mental health care providers since June 2022, a 20% increase, making it easier for families to find in network mental health care earlier, when support can have the greatest impact. 

Half of all mental health conditions begin by age 14, and nearly three quarters emerge by early adulthood. When concerns go unrecognized or unmet, young people are more likely to rely on emergency care, experience disruptions in school, and face long term challenges that are harder to address later in life. 

By integrating mental health support into trusted environments and focusing on prevention and early identification, these efforts reduce barriers to care, shorten the path to support, and help avoid more intensive and costly interventions down the line.

One example of this upstream approach is the expansion of the North Carolina Psychiatry Access Line (NC PAL): Pediatric Collaborative Care in Eastern North Carolina. Through a three year grant from the Blue Cross NC Foundation, Blue Cross NC is supporting the expansion of this evidence based model, led by Duke University.

NC PAL provides real time psychiatric consultation, provider training, and resource navigation at no cost to primary care providers, allowing pediatric practices to identify and manage mental health needs earlier within routine care. Since launching in 2017, the program has brought together partners across the North Carolina Department of Health and Human Services, Duke University, and the UNC Chapel Hill Schools of Medicine to build a sustainable statewide infrastructure for pediatric and perinatal behavioral health.

This investment will expand a collaborative care pilot into six pediatric primary care practices in Eastern North Carolina, a region facing persistent provider shortages and limited access to psychiatric services. By equipping pediatric teams to manage common conditions like depression and anxiety earlier, NC PAL helps prevent unnecessary emergency department visits and specialty referrals while easing strain on the health care system and improving access close to home. 

Mental health needs often intensify as students transition into young adulthood. College campuses across North Carolina are seeing increased demand for behavioral health services, often without the onsite capacity to meet that demand.

Through an investment from the Blue Cross NC Foundation, Blue Cross NC is expanding NC STeP to UNC Pembroke, helping bring an evidence based, collaborative care model to a rural campus with significant access challenges. Behavioral health has emerged as a significant cost driver for young people, fueled by high prevalence, rising needs, and uneven access to care. Across North Carolina, small and rural college campuses are especially affected due to limited nearby providers. 

NC STeP was designed to address these gaps by expanding access to care in mental health provider shortage areas, supporting measurement based care, and helping campuses intervene before students reach crisis levels that drive higher medical costs and academic disruption. 

Improving access to care is only part of the equation. 

Blue Cross NC continues to invest in Youth Mental Health First Aid, with a new goal of training 10,000 people statewide. 

The program equips adults who regularly interact with young people, including parents, educators, coaches, and community leaders, with practical tools to recognize warning signs, respond appropriately, and connect youth to support earlier. These prevention efforts strengthen the network around young people, reduce stigma, and help address mental health needs before they intensify into emergencies.

These prevention efforts are complemented by Teen Mental Health First Aid (tMHFA), a peer to peer training model that helps teens recognize and respond to signs and symptoms among their peers, promotes help seeking behaviors, and strengthens connections to trusted adults. Together, these efforts reduce stigma, strengthen the support network around young people, and help address mental health needs before they escalate into emergencies.

Beyond statewide programs, innovative efforts within pediatric practices continue to demonstrate how aligning care models and incentives can improve access and affordability. Work underway with Sandhills Pediatrics, for example, highlights how integrating mental health services into pediatric settings can expand access to high-quality care for children while avoiding downstream costs associated with delayed treatment.

These partnerships offer valuable lessons about how systems can collaborate to address mental health needs earlier, supporting better outcomes for families and more sustainable health care delivery overall.

By focusing on earlier access, coordinated support, and care delivered in the right setting, we help prevent mental health needs from escalating into crises that are harder on families and more costly for the health system. 

Through in-house programs and a growing network of specialized providers, we help ensure children and young adults receive timely, compassionate, and effective care. For urgent needs, Behavioral Health On Demand (BHOD) offers virtual support, helping families avoid costly emergency department visits while getting care when it matters most. 

For youth managing more complex or ongoing mental health challenges, Behavioral Health Total Care provides wraparound, team-based support. Our internal care teams work alongside families and providers to coordinate care, reduce barriers like transportation or food insecurity, and support continuity across settings such as schools and treatment facilities.

One recent example involved an adolescent and family navigating trauma and emotional distress. Over six months, one of our case managers, a licensed clinical social worker, coordinated multiple levels of care and advocated for clinically appropriate options, including out-of-network treatment when needed. With consistent support, the young person showed meaningful improvement, reengaged in school and activities, strengthened family relationships, and began looking ahead with renewed confidence.

Together, these efforts reflect a broader, comprehensive effort focused on prevention, early intervention, and coordinated care. By addressing mental health needs upstream and in settings young people already trust, partners across North Carolina are helping students and young people thrive while reducing reliance on high cost, crisis driven care.

Mental Health Awareness Month is a reminder that when we invest early, collaborate across sectors, and focus on prevention, we can improve outcomes for young people today while strengthening the long term health and economic vitality of the state.

By continuing to work together, North Carolina can move from awareness to action, creating a future where young people have the support they need, when and where it matters most.