As of 2024, approximately 20% of adults in North Carolina experienced a mental health challenge and 16% had a substance use disorder. Thirty-one percent of young adults aged 18-25 reported having a mental illness and 19% of youth ages 12-17 reported having a major depressive episode in the last year. Youth females were twice as likely (46%) to report poor mental health than males (21%).
 
Despite the need for services, a third of the state’s behavioral health workforce positions remain unfilled. Further, about 25% of adults had unmet mental health needs in 2023 and that number has increased over time since 2012 as shown in the graphic below from the newly released report.[1]
 
Adults Age 18 and Older with Any Mental Illness Reporting Unmet Needs,
United States and North Carolina, 2012-2023
 


 The State of North Carolina’s Mental Health and Substance Use Service Workforce: Need, Supply, and Distribution Landscape Assessment was developed by the UNC Behavioral Health Workforce Research Center, the UNC Sheps Health Workforce NC team, and NC DHHS is a comprehensive reference document that compiles definitions, descriptions, and data on the state’s mental health and substance use (MH/SU) workforce. It also provides an in-depth analysis of the supply, distribution, characteristics, and capacity of the MH/SU workforce as well as information on the populations served and the need for MH/SU services. Main data sources for the report include: 1) NC licensure and certification boards, 2) Medicaid provider enrollment data, 3) Bureau of Labor Statistics (BLS) data, and 4) the American Community Survey.

Why is a MH/SU workforce assessment needed?

We know MH/SU services are important but often lack the common language and shared understanding into this complex landscape to meaningfully advance the conversation. No resource on these topics exists in a central location with so much detail. More than 40 professions are included in the report. Although the report is large, it includes diverse types of information such as narrative text, tables, and maps across multiple geographic levels for all MH/SU professions – ranging from paraprofessionals to doctoral-level providers.

With so many different professions detailed and assed in the report, coverage of professionals to recipients of services varies. But generally, behavioral health workers are not in large surplus anywhere in the state for any profession. Perhaps one of the greatest challenges related to the MH/SU workforce in the state is distribution. In many instances, NC counties have less than one or no behavioral health workers in a given category available in a given county. For example, 59 of the state’s 100 counties have less than 1 psychologist per 10,000 people. Of those counties, 29 have no psychologists and 30 counties have less than 0.6 licensed psychologists (less than one full time position) per 10,000 people.

The report helps quantify and map the need for services, availability of providers, and the difference between the two per profession by various geographic categories.

How is the report organized?
Broadly, the report is divided into data related to service recipients and data related to the MH/SU workforce service providers. As such, it aids any individual trying to understand or make the case for the need for MH/SU services or the workforce that provides them.

Service recipient data including counts, demographic data, and geographic information on:

• Rates of mental health and substance use disorders
• Treatment data including: 1) unmet needs, 2) emergency department visits, and 3) crisis calls
• Death by suicide and drug overdose

MH/SU workforce data are organized into six categories:

1. Prescribers
2. Graduate-level clinicians
3. Addiction counselors
4. Health and allied health professionals
5. Certified paraprofessionals
6. Mental health and substance use service support specialists

For each occupation within these categories, the report provides details on:

• Credentialing or licensing authority
• Educational requirements
• Supervised practice requirements
• Scope of practice
• Independent practice authority
• Medicaid billing authority

The report also includes information on workforce demographics, trends over time, and geographic distribution, presented through tables and maps.

Who should use this report and how?

This report is a valuable resource for anyone engaged in discussions about the supply and distribution of the mental health and substance use (MH/SU) workforce. It provides insight into educational pathways, training and supervision requirements, geographic distribution (county, AHEC regions, Tailor Plan Catchment Areas, and Metro/Non-Metro), and whether professionals are trained in- or out-of-state.

• Employers: Assess workforce supply, distribution, and overall availability of professionals
• Legislators and decision-makers: Understand workforce pipeline timelines, geographic distribution, training origins, oversight structures, and Medicaid billing eligibility
• Educators and training leaders: Compare professions and align curriculum with credentialing and training requirements
• Public health professionals and providers: Identify available provider types and their geographic locations
• Students and career seekers: Explore roles, responsibilities, and education and training pathways across MH/SU professions.

More detail on report structure, use, and suggested high-level reference pages
Among the six categories the report organizes professionals into, there are extensive but varying
levels of information. Below is a list of high-level tables or summaries per category. However,
many professions are broken out specifically with detailed information. For example, licensed
psychologists, which are a type of graduate-level clinician, have an additional summary,
dedicated tables and maps including primary area of practice over time, demographic
characteristics by region, race/ethnicity and age by specialty, supply, training location by year
and degree, practice setting by specialty, years active and in-state licensure by degree type,
among other information.

Six MH/SU categories with main summative tables

1.           Prescribers

Professions included: physicians, physician assistants, and nurse practitioners

• Page 26              Description and overview
• Page 27              Table 18 – Licensure Requirements and Practice Authority in NC
• Page 37              Table 23 – Workforce Summary of Findings
• Page 39              Table 24 – Current Workforce by Geographic Region
• Page 61              Table 42 – Supply and Geographic Distribution

2.           Graduate-Level Clinicians

Professions include: psychologists, psychological associates, marriage and family therapists, mental health counselors, social workers, and fee-based pastoral counselors.

• Page 28-29       Description and overview
• Page 30              Table 19 – Licensure Requirements and Practice Authority in NC
• Page 63              Table 43 – Workforce Summary of Findings
• Page 65              Table 44 – Supply and Geographic Distribution

3.           Addiction Counselors

Professions included: licensed clinical addiction specialists, licensed clinical addiction specialist associates, certified alcohol and drug counselors, certified prevention specialists, certified criminal justice addiction professionals, certified clinical supervisors

• Page 31             Description and overview
• Page 32            Table 20 – Credentialing Requirements and Practice Authority in NC
• Page 119           Table 81 – Workforce Summary of Findings (current counts)

4.           Health and Allied Health

Professions included: registered nurses, licensed practical nurses, speech language pathologists, occupational therapists in MH settings, occupational therapy assistants in MH, licensed recreational therapists, behavioral analysts, assistant behavioral analysts

• Page 31              Description and overview
• Page 32              Table 20 – Credentialing Requirements and Practice Authority in NC
• Page 119           Table 81 – Workforce Summary of Findings (current counts)

5.           Certified Paraprofessionals

Professions included: certified peer support specialists, community health workers

• Page 35              Description and overview
• Page 36              Table 22 – Credentialing Requirements and Practice Authority
• Page 171           Tables and maps per profession start here – no overarching table

6.           Mental Health and Substance Use Service Support Specialists

Professions included: qualified professionals, associate professionals, certified mental health technicians, certified psychiatric technicians, and behavior technicians who provide direct care and support services under varying levels of supervision

• Page 23              Professions included
• Page 36              Table 22 – Credentialing Requirements and Practice Authority as applicable

To read the report click:  The State of North Carolina’s Mental Health and Substance Use Service Workforce: Need, Supply, and Distribution Landscape Assessment