Rising Concerns: Youth Mental Health and Suicide Rates in North Carolina

Youth mental health in North Carolina reveals a complex picture of progress and persistent challenges. After several difficult years marked by pandemic stress and social isolation, data now point to modest improvement. Yet suicide remains a devastating threat to young lives across the state.

The Numbers Behind the Crisis

In 2023, seventy-two North Carolinians aged ten to eighteen died by suicide, up from sixty-five in 2022, representing 4.5 percent of all suicides statewide. Most victims were male, with boys dying by suicide at nearly twice the rate of girls.

Suicide is now the second leading cause of death for youth ages ten to eighteen and the third for young adults ages nineteen to thirty-four. Most concerning, among children aged ten to fourteen, suicide has become the leading cause of death in North Carolina.

Shifting Mental Health Trends

The 2023 North Carolina Youth Risk Behavior Survey provides a more nuanced picture. Fewer students reported persistent sadness or suicidal thoughts compared with 2021, suggesting gradual recovery from the pandemic’s mental health toll. Increased physical activity, social connection, and school-based mental health efforts have contributed to this rebound.

However, disparities persist. Girls and LGBTQ youth continue to report significantly higher levels of distress, echoing national patterns identified by the Centers for Disease Control and Prevention. These groups remain particularly vulnerable and in need of focused support.

Context Across Generations

North Carolina’s overall suicide rate of 14.4 per 100,000 people in 2022 reflects a slow, long-term increase across all age groups. While not youth specific, it highlights the broader social and emotional strain facing families and communities statewide.

North Carolina faces a defining moment in its response to youth mental health. There are clear signs of hope, with fewer students reporting suicidal thoughts and more open conversations about mental health, but the loss of young lives continues at an unacceptable rate. Sustained investment in prevention, access to care, and community connection will be essential to turn progress into lasting change.

The Growing Pressures on Adolescent Mental Health

Multiple forces interact during adolescence: neurodevelopmental change, academic pressures, identity formation, and social comparison, often intensified by digital life. The CDC’s 2023 survey analyses document elevated risk for girls and LGBTQ students and highlight how school climate, unfair discipline, racism, and lack of belonging worsen mental health.

Access to Lethal Means, Especially Firearms

Access to highly lethal methods is a major, modifiable driver of youth suicide fatalities. North Carolina’s child safety leaders note that among older teens ages fifteen to seventeen, firearms are involved in nearly half of suicides, a stark reminder that safe storage saves lives. National research underscores the lethality of firearms in suicide attempts and the outsized risk when guns are present but unsecured.

Rural North Carolina faces distinct challenges, including higher gun suicide rates and geographic isolation that can delay help. Analyses of rural gun violence in the state highlight firearm suicides accounting for a large share of gun deaths and higher rates in rural counties.

Structural Inequities and Social Determinants

The CDC emphasizes that suicide risk is shaped by social and economic conditions such as poverty, racism and discrimination, unstable housing, and fragmented access to care. In North Carolina, these determinants intersect with rurality, provider shortages, and transportation barriers, amplifying risk for some communities, especially Black youth who face rising firearm suicides nationally and lower relative use of 988 services in the state. This has prompted a new Black Youth Suicide Prevention Action Plan.

Pandemic Aftereffects and Early Signs of Recovery

Youth distress spiked nationally during the pandemic. North Carolina’s 2023 Youth Risk Behavior Survey suggests a partial mental health rebound, possibly supported by more school attention to well-being and physical activity. Still, vulnerability remains, and improvements are not uniform across groups or regions.

Youth deaths edged higher in 2023, with seventy-two deaths among ages ten to eighteen compared with sixty-five in 2022. Males accounted for roughly two-thirds of youth suicides.

School Climate and Prevention Protocols Matter: North Carolina requires each K–12 unit to implement a school-based mental health plan with staff training and suicide risk referral protocols, strengthening the system’s early warning and response.

988 Usage Is Growing but Gaps Persist: The state operates a 988 Performance Dashboard, added a Peer Warmline in 2024, and reports the highest 988 contact rate among ages thirteen to seventeen. However, Black residents use 988 at lower rates, signaling the need for targeted outreach and culturally competent care.

Medicaid Expansion Is a Structural Game Changer: Launched December 1, 2023, the expansion extends coverage to many low-income adults, including young adults and caregivers, while the 2023 state budget added hundreds of millions for behavioral health. For youth, insured caregivers and stronger provider networks can improve access and continuity of family-centered mental health care.

Community Efforts Are Ramping Up: From safe-storage campaigns such as North Carolina S.A.F.E. to county-level coalitions, the state is investing in locally tailored prevention.

Certain populations of young people in North Carolina face significantly higher suicide risks due to a combination of social, environmental, and psychological factors.

• Older teens ages fifteen to eighteen have higher exposure to lethal means and developmental risk.
• Boys and young men have higher suicide death rates, though girls report more attempts nationally and have elevated distress in survey data.
• LGBTQ youth report markedly higher rates of depression and suicidal ideation nationwide.
• Black youth face rising firearm suicide nationally and lower 988 utilization in North Carolina, prompting the state’s new targeted plan.
• Rural youth experience higher gun suicide rates and thinner access to services.

Recognizing these patterns helps prioritize equitable, culturally responsive strategies.

Real progress begins when communities apply proven strategies that protect, connect, and empower young people.

Make Lethal Means Less Accessible During Risk Windows

Secure firearm storage, locked and unloaded with separate ammunition, is among the most immediately impactful preventive steps families can take. Health systems can normalize lethal means counseling in pediatric and primary care visits, especially after emergency visits, new diagnoses, or worsening depression or anxiety. Community campaigns that distribute free gun locks amplify impact.

Strengthen School-Based Mental Health Systems

North Carolina already requires district plans with staff training and suicide referral protocols. Next steps include:

• Universal mental health literacy for students, caregivers, and staff.
• Early screening within multi-tiered systems of support with trauma-informed pathways to care.
• Peer programs that build belonging, mentorship, and help-seeking norms.
• Physical activity and structured extracurriculars, which correlate with better mental health in the state’s 2023 survey snapshot.

Expand Access and Close Coverage and Capacity Gaps

Medicaid expansion and 2023 to 2025 investments can accelerate school-community clinical partnerships, grow youth crisis response, and stabilize inpatient and step-down capacity. Young adults who might otherwise lose coverage at nineteen now have a clearer path to continuity of care. Sustaining these gains requires workforce development, loan repayment programs, supervision capacity, lived-experience peer roles, and tele-behavioral health for rural areas.

Normalize 988 and Tailor Outreach

North Carolina’s data show strong 988 usage among thirteen to seventeen-year-olds, yet Black communities use it less. Partnerships with faith groups, barber shops, historically Black colleges, youth organizations, and Black media can create messages that build trust and relevance. Spanish-language and Deaf or Hard of Hearing access should also be well-publicized.

Invest in Upstream Protective Factors

The CDC stresses that social determinants such as economic stability, safe housing, and inclusive school culture can either buffer or compound risk. Strengthening after-school programs, mentorship, restorative school practices, and trauma-informed approaches builds connection and resilience.

Small actions from families, schools, and communities can make a big difference in preventing youth suicide.

For Families and Caregivers

Supporting youth mental health starts at home, where small, consistent actions can make a lasting difference.

Lock and Limit: Practice secure firearm storage and lock away medications. Dispose of unused prescriptions. This simple step can save lives if a young person experiences a suicidal crisis.

Ask Directly: Expressing concern openly and asking about suicidal thoughts can save lives. Studies confirm that asking the question does not introduce the idea but encourages honesty and connection.

Know the Signs: Watch for sudden mood shifts, giving away belongings, talk of hopelessness, sleeping or eating changes, withdrawal from friends, risky behavior, or a sudden improvement after long depression.

Map Quick Help: Save 988 in your phone and local crisis lines. Ask your child’s school about its suicide risk referral protocol and community partners.

Lean on Community: Teachers, coaches, youth leaders, and faith mentors can be trusted supporters. The more caring adults a young person has, the better their odds in difficult times.

Many young people experience sadness, but it’s important to recognize when those feelings signal something deeper. Read Depression vs. Sadness: Key Differences Explained to understand how to tell them apart.

For Schools and Campuses

Schools and colleges are on the front lines of youth mental health, where policies become meaningful only through consistent, compassionate daily actions.

Implement and Practice: Ensure every staff member knows the district’s suicide risk referral protocol and how to activate it. Regular drills and refreshers help.

Screen and Support: Use validated screening tools within multi-tiered systems of support, ensuring warm handoffs to school-based clinicians or community partners.

Belonging as Prevention: Feeling seen, safe, and valued protects against suicidal thoughts. Student-led clubs, affinity spaces, and inclusive advising reduce isolation, especially for LGBTQ and marginalized students.

Movement Matters: The 2023 state survey links more physical activity with better mental health. Protect physical education, recess, and extracurricular activities.

Postvention Plans: Prepare compassionate, non-romanticized responses to a student death to reduce contagion and provide care for peers and staff.

For Health Systems and Payers

Health systems and insurers play a critical role in ensuring that mental health care remains accessible, coordinated, and sustainable for every young person in need.

Primary Care Integration: Expand integrated behavioral health in pediatric and family practices. Routine suicide risk screening and safety planning save lives.

Crisis Continuum: Grow mobile crisis teams, crisis stabilization units, and step-down options aligned with state priorities to reduce emergency department boarding and improve capacity.

Means Safety Standard Work: Normalize lethal means counseling during every high-risk encounter and after emergency visits for self-harm.

Equity Dashboards: Track 988 awareness and use by race, geography, and age, and partner with communities to close identified gaps.

Early recognition saves lives. Visit our post on Recognizing Depression in Friends and Family: Early Signs & Support to discover how to spot warning signs and offer meaningful support.

North Carolina has laid important groundwork.

School Mental Health Requirements: Session Law 2020 mandates district mental health plans with training and referral protocols. Implementation quality now matters as much as the law itself.

988 Infrastructure: The state launched a performance dashboard in December 2023 and a Peer Warmline in February 2024 to complement 988, shortening the distance between crisis and care.

Medicaid Expansion: Enacted in December 2023 with major behavioral-health investments, expansion is reshaping access, with hundreds of thousands newly eligible and funding directed toward system transformation.

At the same time, policymakers, districts, and communities must monitor workforce capacity, telehealth parity, data-driven equity strategies, and sustained safe-storage campaigns to curb firearm suicides among teens.

Progress in youth mental health can be tracked through data, outcomes, and lived experiences that reflect real improvement across the state.

• Fewer deaths and fewer emergency visits for self-harm among ages ten to twenty-four.
• Improved survey trends for sadness, hopelessness, and suicidal ideation across all subgroups.
• Higher 988 awareness and utilization in underserved communities, alongside faster response times and strong follow-up care.
• Greater adoption of secure storage in households with youth and a decline in firearm-involved youth suicides.
• Shorter wait times for therapy and psychiatry and more collaborative school-community care supported by Medicaid expansion.

Recent coverage has featured both promising and troubling developments. Reporting in mid-2024 highlighted North Carolina among states showing post-pandemic mental health rebounds in student survey metrics. Yet 2024 and 2025 also brought tragic youth deaths and program failures that show how fragile systems can be when supervision, staffing, and culture fall short. The message is clear: data is trending in the right direction for many students, but the mission to prevent every preventable death remains urgent.

1. Youth suicide is preventable. Most young people who survive a suicide attempt do not go on to die by suicide. Reducing access to lethal means, particularly firearms, dramatically improves the odds in a crisis.
2. North Carolina has momentum but no mission accomplished. A small rebound in survey indicators coexists with persistent disparities and a rising count of youth deaths in 2023. The state must continue pressing for equity, access, and means of safety.
3. Connection is medicine. Belonging at school, supportive adults, mentorship, and culturally grounded care are powerful protectors. The more these supports are woven into everyday life, the fewer families will face tragedy.

Help is always available. The following resources offer free, confidential support for anyone in crisis or concerned about a loved one.

988 Suicide and Crisis Lifeline: Call or text 988, or chat via 988lifeline.org. Available 24 hours a day, free and confidential, with Spanish and ASL access. In North Carolina, teens ages thirteen to seventeen contact 988 at the highest rate of any age group.

NC 988 Peer Warmline: Offers support from trained peers with lived experience, operating in tandem with 988.

Emergency: If someone is in immediate danger, call 911 and state clearly that it is a mental health emergency.

School Resources: Ask your district about its suicide risk referral protocol and school-based mental health providers.

Secure Storage Help: Local law enforcement, health departments, and community coalitions can connect families with free gun locks and safe-storage education such as North Carolina S.A.F.E.

Every young life matters. Protecting the mental health of North Carolina’s youth requires all of us, including families, educators, health providers, and policymakers, to work together with compassion and urgency. Every small action contributes to a stronger, safer future.

At NuTrans Health, we remain committed to advancing accessible, evidence-based mental health counseling and care that empower young people to heal, grow, and thrive.