Given the recognition and action related to North Carolina’s youth mental health crisis, I continue to look for signs that the tide is finally turning. I caught a glimmer of one in May when I joined the president of the NC Chamber Foundation in a “fireside chat” as part of the North Carolina Chamber of Commerce Business Summit on Mental Health.

At very same time we were talking, the University of North Carolina System Office was hosting its annual Behavioral Health Convening in Boone, bringing together representatives from 17 institutions in the UNC System, community colleges, and independent colleges and universities across the state. 

Even in the moment, it struck me that these two events were happening simultaneously. A coincidence perhaps, but perhaps not. Important activity is unfolding across the state to help young people – across different age groups and in different social contexts – meet their mental health needs. During the month of May, when our nation promotes Mental Health Awareness Month, these events were powerful reminders to reflect on, share, and expand the work that happens year-round. 

The national youth mental health crisis is regularly reported and discussed. Still, I suspect that many adults don’t really grasp the scale of the problem, especially here in North Carolina. 

When 61 of our 100 counties have no psychiatrists who specialize in treating children and adolescents, as reported in the North Carolina Medical Journal, many families in North Carolina have few access points for support. When an untreated mental health challenge escalates into a crisis, often they have few choices but to turn to emergency rooms. That’s not a long-term solution for families or for their communities. Addressing a mental health crisis in an emergency department can exacerbate the anxiety and stress a young person is experiencing; it puts stress on an already overwhelmed system; and it drives up costs for everybody. For good reason, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has identified tackling the youth mental health crisis as a top priority in our commitment to improving the well-being and resiliency of our customers and communities. 

To state the obvious, expanding the mental health care workforce is essential. Building out telehealth capabilities can help meet patient needs and preferences, particularly in rural areas, but it also redistributes rather than adds to the workforce. Our collective response must also be guided by a comprehensive vision that builds a broad network of support – one that helps heal while also providing preventive resources that help address the root causes of the youth mental health crisis.   

Those supports can’t just exist in clinical spaces and provider offices. Resources should also be available where they’re easy to access and where, in many contexts, they’ll have the greatest impact: in schools and other community settings. Those school and community resources can’t be just limited to behavioral health professionals but also include trained faculty, staff, and even peers who are often the first to identify and intervene. 

One important reason why Blue Cross NC sponsored the UNC System’s Behavioral Health Convening is because young people are 6 times more likely to complete evidence-based treatment when it’s offered in schools compared to other community settings, according to the US Department of Education (PDF). 

The convening gave faculty, administrators, and staff the opportunity to learn about innovative strategies for proactively engaging students, promoting well-being, and steering them to resources that can help. When students have access to support on campus: 

• It increases the visibility of available options and reduces the stigma often associated with mental health care.
• It eliminates transportation as a barrier to care, according to the National Alliance on Mental Illness.
• It eases scheduling conflicts, which can be especially tricky for students who are busy during most of the hours when providers are seeing patients; students miss less instructional time when they have access to resources just down the hallway.
• It helps connect children and their families with serious needs to more robust resources in the community.

This kind of work isn’t just happening on college campuses – in some form or fashion, it’s reaching students at all grade levels. Here are a few of the activities we’ve been involved in over the past few weeks:

• On April 29, Healthy Blue (Blue Cross NC’s Medicaid managed care plan) collaborated with Charlotte Mecklenburg School District, Sanctuary Counseling Group, Shine a Light on Depression, Teen Health Connection, and others to host a Mental Health Day school event at Ridge Road Middle School.
• We’re partnering with UNC Behavioral Health Springboard and the UNC System to expand Teen Mental Health First Aid (tMHFA) training across North Carolina. The program embraces a peer-to-peer approach to support, training adolescents and teens to recognize and respond to the signs and symptoms of mental health need. Our goal is to train more than 2,700 teens, and to certify an additional 50 tMHFA instructors. 
• At Blue Cross NC’s own annual Health Care Symposium, attendees took time out of the busy conference schedule to assemble 275 Hope Bags for students at Owen Middle School in Buncombe County, an area of the state hit particularly hard by Hurricane Helene. These bags of hope included critical information on the 988 mental crisis helpline, motivational stickers, a safety plan for dealing with a mental health emergency, and plenty of kid-friendly (and fun) resources to help manage stress, promote mindfulness, and offer comfort during challenging times.
• The University of North Carolina at Chapel Hill’s Carolina Across 100 initiative, with support from Blue Cross NC and the UNC Child and Adolescent Anxiety and Mood Disorders Program (CHAAMP), has launched a program that will harness collaborative community partnerships to address youth mental health needs. CARE4Youth (Community-driven Approaches for Resilient and Empowered Youth) will support young people across 18 counties. By embracing strategic approaches and developing systems of care designed for – and with the participation of – young people in North Carolina, CARE4Youth puts young people’s voices front and center.

Any effort to meet students “where they are” is critically important. Given that the age of onset for half of all mental health conditions is 14 years or younger – 75% appear by the age of 24 – schools provide an ideal setting for prevention, early detection, and intervention.

Discussion throughout the NC Chamber Summit on Mental Health made it clear that the work to support youth mental health has expanded well beyond clinicians’ offices and posters on school walls. Business leaders recognize that they too have unique opportunities to reach young people, in different contexts; that creates opportunities to help in different ways.

The discussion highlighted how unaddressed mental health need doesn’t just hurt the individual child and their families – it impacts today’s workforce (cutting into parent productivity) and tomorrow’s talent (undermining academic success and long-term prospects). As health tolls tally up, so do business costs. Altogether, the additional business and reputational risks that this widespread health care need can generate will weaken our state’s competitiveness if we don’t take action now.

Even if you don’t have children of your own, every North Carolinian has a vested interest in making sure young people have better access to high quality resources to support their health and mental well-being. Each of us has a role to play. 

Far from being trivial, it’s pretty remarkable that not one, but two conversations (both with statewide impact) around youth mental health unfolded in Boone and in Raleigh on the same day. This kind of dialogue wasn’t always so easy in the past. 

When I started practice as a family physician in the late ‘90s, mental health remained highly stigmatized, and many could not access affordable care because the federal law to cover mental health services on par with medical/surgical services hadn’t been passed yet. 

We have made great strides as a society since then, first by recognizing the problem and then addressing it head on. I’m optimistic we can continue to learn from the journey we’re on, accelerate the pace of change, and improve the resilience and treatment of youth mental health.

Let’s work together to turn signs of hope into signs of progress.