Brianna Lombardi, PhD, MSW, and Erin Fraher, PhD, MPP, served as lead investigators on a major new statewide report assessing the need, supply, and distribution of North Carolina’s mental health and substance use (MH/SU) services workforce. Released by the Cecil G. Sheps Center for Health Services Research, the report, State of North Carolina’s Mental Health and Substance Use Services Workforce: Need, Supply, and Distribution Landscape Assessment, provides the most comprehensive analysis to date of who is delivering behavioral health care in the state and where critical gaps remain. The release announcement is available on the Sheps Center website.
This work comes at a crucial time. Demand for mental health and substance use services continues to climb, with one in five adults in North Carolina reporting a mental health condition and 16% reporting a substance use disorder. Youth and young adults experience even higher rates of depression, anxiety, and co-occurring mental health and substance use conditions.
A Comprehensive Look at a Strained System
The report synthesizes data from multiple sources—including licensure boards, Medicaid data, federal surveys, emergency department surveillance, and vital records—to give state leaders a full picture of how well North Carolina’s behavioral health workforce meets population needs.
Key findings include:
High and growing need for services
- 21.3% of NC adults reported a mental health condition, and 16% reported a substance use disorder.
- Youth mental health concerns are especially urgent—33.5% of high schoolers report poor mental health most or all of the time.
- Emergency departments continue to serve as a safety net: in 2024, anxiety accounted for 143.9 ED visits per 10,000 residents, and suicidal ideation for 53.8 per 10,000.
- Deaths related to suicide (1,593 in 2023) and overdose (4,442 in 2023) have risen across the state.
Workforce Shortages and Geographic Gaps
Despite growth in some provider groups, the MH/SU workforce falls far short of meeting statewide demand.
Prescriber workforce
North Carolina has 3,605 MH/SU prescribers—psychiatrists, psychiatric NPs, and PAs—equivalent to 3.28 providers per 10,000 residents.
- Growth over the last decade has been dramatic for NPs (+431%) and PAs (+483%) but modest for psychiatrists (+26%).
- Rural counties face the most significant shortages: 15 counties have no MH/SU prescribers of any type, and 25 counties have no psychiatrist.
Graduate‑level clinicians
North Carolina’s behavioral health workforce includes more than 30,800 master’s- and doctoral-level clinicians, including clinical social workers, psychologists, counselors, and marriage and family therapists.
- Licensed Clinical Social Workers and Clinical Mental Health Counselors make up nearly 85% of the graduate‑level workforce.
- Supply is uneven: metropolitan counties have nearly double the number of clinicians per capita compared to nonmetropolitan counties.
Addiction counselors and allied health professionals
The state’s addiction counseling workforce has grown but remains unevenly distributed, with high need regions often having the fewest providers able to bill Medicaid. Recommendations highlight the importance of expanding training pipelines and supporting credentialing access.
UNC Family Medicine Leadership
UNC Family Medicine’s long-standing commitment to strengthening North Carolina’s health workforce is deeply woven into this project. Lombardi, who directs the UNC Behavioral Health Workforce Research Center, leads statewide efforts to generate the robust evidence needed to build, sustain, and equitably deploy the behavioral health workforce. The department is nationally recognized for its leadership in Graduate Medical Education (GME) development, with two training pathways critical to expanding access to behavioral health and primary care in underserved communities across the country. Fraher’s workforce policy expertise and clinical and educational leadership, along with Emily Hawes, PharmD, Director of the Rural GME and Teaching Health Center GME programs, have made UNC Family Medicine a trusted voice in both the North Carolina General Assembly and U.S. Congress, where they advocate for sustainable funding, evidence‑based workforce policy, and expansion of rural and community‑based training models.
Why This Work Matters
Behavioral health needs in North Carolina continue to grow, yet many communities—especially rural counties—lack adequate access to timely and comprehensive care. This report provides a roadmap for:
- Expanding training programs
- Strengthening recruitment and retention
- Targeting investments to underserved counties
- Supporting innovative care models across the behavioral health continuum
Through this work, UNC Family Medicine faculty are directly shaping the future of mental health and substance use care in North Carolina.