WILMINGTON, N.C. (WECT) – North Carolina is facing a mental health crisis as the state struggles with a severe shortage of professionals willing to work in rural communities.
The state is the second most rural in the nation, behind only Texas, according to Victoria Browder, hiring coordinator for Youth Villages in Western and Central North Carolina. The shortage has persisted for at least five years and continues to worsen.
“North Carolina is the second most rural state in all of the United States, only second to Texas,” says Browder. “And so over the years, we’ve just continued to see a decrease in the service providers that are in the rural states.”
The numbers are staggering. According to recent data, 40% of the U.S. population lives in a mental health professional shortage area. In North Carolina, the crisis is even more acute. A 2024 study found that in some rural areas, the patient-to-mental-health-provider ratio is as high as 5,000 to 1.
Yet this isn’t a new problem. The shortage has persisted for at least five years, and it’s getting worse.
Med North Health Care in Wilmington specializes in providing health care for those with and without insurance. However, that widespread coverage brings challenges.
“We all can serve with social justice, compassion, and care to our whole community without putting all of it on these individuals trying to serve too many people with too many different needs,” said Med North Health Care Integrated Health Director Evie Nicklas.
Another problem with a shortage of providers is that the wait list for patients grows. Med North says they’re booking Spanish-speaking patients and patients under 10 years of age a month or two out.
For some, that’s too long to wait.
“Without mental health support, our patients go into crisis. They’re more unhealthy, they utilize the emergency room more for care, and overall, it puts our community at risk. When people don’t feel well, they don’t act well,” said Nicklas.
Officials with Med North say retaining clinicians for multiple years is their issue.
“It’s staying for longer than five years, which is really difficult. I think partly because of the acuity of the patients. I think it’s also because the pay is higher in obviously a private practice environment, and so is the flexibility of scheduling,” said Nicklas.
The shortage isn’t random. It’s the result of several interconnected barriers that make it difficult for both providers and patients to access care in rural areas.
One of the biggest obstacles is insurance. Many mental health professionals simply won’t accept Medicaid or Medicare, the primary insurance types for rural populations. This forces patients to either seek care with primary care providers or go without treatment altogether.
“A lot of people that can get services through places like Youth Villages or nonprofits that do accept Medicaid, we end up having to refer out to primary care providers rather than more behavioral health specialists because they won’t accept the different insurances outside of private pay insurance,” explains Miranda Knight, Internship Coordinator for Youth Villages statewide.
Another barrier is education. Most mental health positions require at least a bachelor’s degree, and many require a master’s degree or licensure. This limits the pool of people who can fill these roles.
Even more challenging is accessibility. Rural patients often have to travel 40 to 50 miles just to access any mental health services. This pushes both patients and providers toward urban centers, where services are more concentrated and financially viable.
“When you couple those things together, we kind of see this shortage in the areas that really have a higher need because we’re moving to areas that are going to have just more availability for people to be able to work in and to be able to make money in,” Browder explains.
There’s another often-overlooked barrier: stigma. Mental health stigma in rural communities can be more pronounced, and when combined with the perception that services aren’t even available, people simply don’t seek help.
“When there’s that created barrier of, ‘oh, I don’t even know if I can get these services,’ then we see people that just won’t access them,” Browder notes.
The consequences of this shortage are serious and far-reaching.
According to officials with Youth Villages, rural populations experience higher rates of mental illness, including:
- Depression and anxiety
- Post-traumatic stress disorder (PTSD)
- Suicide
These aren’t just statistics; they represent real people struggling without access to the help they need.
Consider the demand: 1 in 5 adults will experience a behavioral health disorder. 1 in 6 youth between ages six and seventeen will too. Yet North Carolina can currently only meet about 13% of that need with its existing workforce.
“Everybody deserves to have a good quality of life,” says Knight. “And if you can’t have your basic needs met, whether it’s health care or mental health care, then your quality of life is not where it should be. It’s like a disservice to those that need it.”
Despite the challenges, there is hope. Organizations and policymakers are taking action to address the shortage.
Some universities in Western North Carolina are beginning to shift how they educate future mental health professionals. They’re offering scholarships to students dedicated to staying in rural areas and teaching them about the critical need for providers in underserved communities.
“There are some universities that are starting to give scholarships to students that are dedicated to staying in rural areas,” Knight says. “Because they’re actually being taught about the why behind, and even though you might want to live in Durham, that doesn’t mean that you can’t serve the outside rural communities and the importance of that.”
A significant breakthrough came this past year: a $20 million grant program that allows licensed mental health professionals working in qualifying rural areas to receive loan forgiveness of up to $50,000.
“There are a lot of things out there to be able to get people in to serve these populations,” Browder says. “I think we just got to get it out there so that people know.”
The ideal solution, according to those on the front lines, would be to require all mental health professionals to accept Medicaid and Medicare. While that may seem unrealistic, even incremental progress could help.
“If we can increase the number of people who can accept different forms of insurance, and we can kind of switch over from private pay, then we can get more people in the door,” Browder explains. “We’re able to kind of solve that problem cohesively.”
Perhaps the most promising development is the growing use of telemedicine and community-based services to bridge the gap until more physical locations can be established in rural areas.
“Thinking about how we can utilize how advanced technology has gotten now with telemedicine, and encouraging providers that have the opportunity to do that,” Knight suggests. “And also the other side of removing barriers with community-based services, too. Bringing the care to someone, if at all possible.”
Rural areas lack public transit, which adds another layer of difficulty. But telemedicine and mobile services could help overcome this challenge.
For Victoria Browder and Miranda Knight, who have dedicated their careers to addressing this crisis, the impact of their work speaks for itself.
“To see the impact that you’re able to make in people’s lives, to be able to help them with things that they didn’t even know they could get,” Browder reflects. “It’s incredible. And to be able to change those lives.”
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