I have had the privilege of working within North Carolina’s mental health system since 2008. This work is not only professional for me—it is deeply personal. Like many families, mine has been shaped across generations by serious mental illness and trauma-related conditions. I have seen both the harm caused by stigma and silence, and the possibility that emerges when people are met with understanding, effective care, and dignity.

North Carolina’s mental health system, like much of the nation’s, has a complicated history. Earlier approaches were often rooted in institutionalization, limited understanding, and stigma that pushed people to the margins. At the same time, our state has been a place of meaningful innovation. Over the past two decades, there has been sustained work to build a system that is more community-based, more responsive, and more humane.

What feels different now is not just how we are improving services, but how we are redefining the work itself. We are moving beyond a narrow focus on serious mental illness and acknowledging a broader truth: mental health and mental wellness affect all of us. One in four individuals will experience a mental health condition in their lifetime. This is not rare, and it is part of being human—and in many cases, it is highly treatable.

This shift requires more than system improvement; it demands cultural change. We must actively replace stigma with understanding and challenge narratives that equate mental illness with danger or deficit. People with mental health conditions—including those with complex needs—can and should live full, connected, and productive lives in their communities.

At the same time, we are seeing national policy conversations that risk pulling us in the opposite direction. Efforts that lean toward criminalizing mental illness, prioritizing control over care, or reinforcing fear-based narratives are not new, and they are not effective. We have seen where those approaches lead: people pushed further into the shadows, families left without support, and systems that respond only in crisis rather than preventing it. If we repeat those patterns, we risk undoing decades of progress.

The path forward must be different. It must be grounded in evidence, centered on people, and focused on access to timely, appropriate care. It must reject stigma in both language and policy. And it must recognize that public safety and public health are not competing priorities; they are deeply interconnected and strengthened when communities have access to effective mental health care.

We also know that mental health needs are not one-size-fits-all. Young people, adults, and older adults experience different challenges, and those differences matter. At the same time, race, ethnicity, culture, and the social and economic conditions in which people live also shape how mental health is experienced and how care is accessed. Our approaches must reflect that full context.

The articles in this issue reflect both urgency and hope. They represent the work of a strong and determined community—professionals, policymakers, families, and individuals with lived experience—who are working every day to move us forward.

Authors explore mental health services and care across the lifespan, with attention to priority areas for children and youth, adults, and older adults. Across these perspectives, they examine the current system of care as it exists today and highlight opportunities to strengthen it, building approaches that are more resilient, trauma-informed, and responsive to the needs of diverse communities.

Victor Armstrong of the American Foundation for Suicide Prevention writes about increasing suicide rates among Black youth and important considerations for community-centered approaches to connect with and help young people who are struggling. UNC Chapel Hill’s Dr. Paul Lanier also dives into youth mental health, writing about ways to stabilize North Carolina’s system to improve care. Michael Welker with the ncIMPACT Initiative through the UNC School of Government offers insight into collaborative opportunities to prevent youth suicide.

Co-authors from the Durham-based nonprofit El Futuro, Dr. Luke Smith, Dr. Rosa Gonzalez-Guarda, and Dr. Gabriela Plasencia, write about immigrant mental health and the unique challenges this population faces, especially as immigration arrest rates increase and the “racialization of ‘illegality’” extends stigma and stereotype into law enforcement practices. UNC Chapel Hill professors Dr. Evan Ashkin, Dr. Theodore Zarzar, and Dr. David Rosen share their work in the criminal legal system, writing about the North Carolina Formerly Incarcerated Transition Program (NC FIT) and ongoing efforts to help people transition from prison with support for their health and well-being needs.

Throughout this issue, authors are sharing insight and models, like the NC FIT program, that offer more personalized, community-centered options for mental health care. Dr. Ashley Jarrett, Burke County’s interim health director, writes about the county’s innovative mobile crisis response team and how they are helping people at the intersection of homelessness, mental health, and disaster resilience.

In Eastern North Carolina, Erika Taylor and colleagues at the East Carolina University Brody School of Medicine write about school-based telehealth as an important way to bridge gaps in care for children in rural areas. In another perspective on school-based care, Dr. Heidi Austin of the North Carolina Department of Public Instruction’s Project AWARE and Dr. Cat Warner-Griffin of AnLar write about North Carolina’s Project AWARE/ACTIVATE as a tool to build coordinated school-based mental health infrastructure.

You can read about all of this and more in this issue of the NCMJ, with additional commentaries from:

  • Dr. Elizabeth Cuervo Tilson, former North Carolina State Health Director/Chief Medical Officer and current director of Nurture NC, on mental health need, our existing systems, and opportunities for expansion.

  • Sierra J. Kaplan and Dr. Nathan Boucher of the Duke Sanford School of Public Policy on loneliness as a public health imperative for aging North Carolinians.

  • Emiliano Enea, a combat veteran and board member for Brothers and Sisters Like These, on therapeutic group writing about military experiences.

  • Dr. Brett A. Loftis and Dr. Sarah Norris, who lead Crossnore Communities for Children, on their organization’s approach to child welfare.

  • Emma Miller from the Western Carolina University Department of Social Work on workforce education and training for professionals serving the Eastern Band of Cherokee Indians and rural Western North Carolina.

North Carolina has witnessed significant change since the NCMJ was founded in 1849. Over the past 177 years, the health care community, working in partnership with individuals with lived experience and their families, has developed a deeper understanding of the drivers of mental health needs, the treatments that improve health and well-being, and the community supports that help people thrive. As we look ahead, the challenge for North Carolina is to ensure that what we have learned is consistently applied in both policy and practice, shaping a future equipped to meet the needs of our population.