Shared Problems, Local Solutions: Understanding Suicide and Prevention in North Carolina

Michael Welker, ncIMPACT Initiative Community Engagement Director

July 19, 2023

Carolina Acros 100 aims to partner with communities as they respond to complex policy challenges created or exacerbated by COVID-19. As we looked for our next program, mental health and suicide quickly emerged as the right issues to address in this moment. 

Worsening mental health was one of the most common challenges North Carolinians cited in our initial listening survey at the outset of Carolina Across 100. As we have extended our work across the state, we have continued to hear stories from our community partners about the impacts of mental and behavioral health challenges on North Carolinians and their communities. We have read countless headlines and seen statistics pointing to alarming trends in suicidality and mental health crises. And sadly, the Carolina community has directly experienced the grief and pain that come from lives lost to suicide. 

People don’t really understand who dies by suicide. This is anybody. Anybody can find themselves in a mental health crisis or in a life crisis where they feel like they can’t go on.”  Licensed psychologist 

Our State, Our Wellbeing: Partnering to Prevent Suicide in NC will bring together communities across the state with the aim to improve mental and behavioral health supports and ultimately reduce suicides. UNC’s Suicide Prevention Institute will bring their expert knowledge of suicide and mental health as the lead partner in this endeavor. 

Before launching Our State, Our Wellbeing, the Carolina Across 100 team spoke to more than a dozen experts from across the state to understand the current landscape and efforts already underway to prevent suicide and improve mental and behavioral health supports in North Carolina. Here’s what we learned. 

A Worsening Problem

Many of the experts we spoke to emphasized that suicidality and related issues have been on the rise since before the COVID-19 pandemic. Since the pandemic began, however, rates of suicidality have begun to increase more rapidly. 

 Across race, age, geography, and other categories, there is no community in North Carolina unaffected by suicide. Many racial and ethnic minorities have seen fast-rising rates of suicidality in recent years. Older people have some of the highest rates of suicide, but many experts we spoke to expressed concern about rapidly worsening mental health and suicidality among youth. Certain populations that are highly concentrated in North Carolina—like people living in rural communities or veterans—have higher rates of suicidality than the broader population.  

While the data we have is cause enough for concern, available data may not capture the full scope of the challenge for a few reasons: 

  • Suicide deaths and attempts are sometimes classified under a different cause, such as an overdose, due to the additional due diligence required to prove that the death or attempt was intentional.  

  • Stigma may lead people to underreport suicidal ideation or mental and behavioral health problems.

This means that for every death or suicide attempt requiring medical care, there may be many more people attempting or thinking of suicide whose needs go undetected.  

Existing Statewide Efforts to Respond

Given the seriousness of this issue, policymakers and other leaders are taking steps to reduce suicide and address mental and behavioral health challenges in a variety of ways. Below are just a few examples. 

  • The 988 Suicide & Crisis Lifeline launched in July 2022. The new line replaces the previous 1-800 number and is meant to make it easier for people experiencing suicidal ideation or a mental health crisis to get care. As part of the 988 rollout, the state made new investments in capacity for call centers. 

  • North Carolina is one of 17 states funded through the CDC’s Comprehensive Suicide Program, which funds efforts to implement and evaluate public health approaches to suicide prevention. 

  • NC DHHS has recently updated its Suicide Prevention Action Plan and included a variety of action steps and targets around suicide and mental and behavioral health in its most recent State Health Improvement Plan. 

  • Earlier in 2023, Gov. Roy Cooper and legislative leaders issued proposals to invest $1 billion from Medicaid expansion funds to strengthen the state’s mental and behavioral health care system. As of this writing in late July 2023, the biennial state budget is still being negotiated, but signs point to new investments in this area of care. 

“We need to focus on community-informed practices, not just evidence-based. We need to acknowledge that we’ve missed the boat and not been as attentive to community needs as we should be.”  – Public health practitioner 

Engaging Trusted Partners is Key

Despite the importance and potential impact of state-level interventions to strengthen prevention efforts and improve mental and behavioral health supports, suicide is ultimately a deeply personal, human issue. Even the most proven strategies may have limited impact if the strategies do not reach the individuals who are most at risk. 

Making connections to those individuals can be challenging. Suicide and mental health issues often carry heavy stigma. There are frequently differences across race and ethnicity, age, gender, and other categories in how willing people are to talk about suicide and mental health, how they describe the challenges they face, and how likely they are to seek out help. Even those who do seek help may not be aware of resources or supports that are available in their community or know how to navigate complexities of the mental and behavioral health care system. 

Because of this, experts we spoke to emphasized the importance of finding trusted partners in each community beyond the healthcare system to connect people with information, resources, and supports.  

  • Churches were often cited as an excellent partner because they are already places where people come to connect and to deal with grief, loss, and other challenges in life. 

  • Schools are critical for reaching youth, but so are organizations like YMCAs, Boys and Girls Clubs, and youth sports leagues where children have trusting relationships with adults.  

  • Veterans of Foreign Wars or American Legion posts may be able to partner on outreach to veterans. 

  • Senior centers or programs like Meals on Wheels might help connect with the aging or elderly population. 

These are just a sampling of the ways communities can think creatively and holistically about connecting with those struggling with suicidality to the support they need.  

Look to Communities to Lead

Our conversations and research about this work led us to a few clear conclusions. First, the issues of suicide and mental health are shared across the state, but they affect every community differently. In turn, every community brings different assets, resources, and relationships to this challenge. To address this issue effectively, we need local-level input and context alongside coordinated efforts across state-level partners and systems.  

These findings both affirmed Carolina Across 100’s commitment to taking on the issue of suicide and shaped how we think about this work. Over the next year, Carolina Across 100 and SPI look forward to bringing stakeholders together around this collective problem and designing, implementing, and evaluating solutions—all within the unique local contexts of communities across North Carolina.  

We hope your community will join in this work. You can learn more about Our State, Our Wellbeing on this page or listen to our information session held on July 11If your community is ready to be a part of this effort, submit your application by July 28. 

Our State, Our Wellbeing is the second program of Carolina Across 100, a five-year initiative whose goal is to aid community-driven recovery and build sustainable efforts in all 100 counties by providing human resources, data insights, coaching, facilitation, coordination efforts, and program design.