Your (Unofficial) Guide to State-Sponsored Therapy in North Carolina

There’s a way to get affordable mental health care that you might not know about. That’s North Carolina’s mental health system.

If you qualify, you can get mental health care for a small co-pay or a low sliding-scale fee. But even if you don’t qualify for services at a state-funded provider, North Carolina’s system can still give you information, local referrals to affordable providers, and other essential help for free.

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If you’re in a hurry and want to get the most important information about what’s available in the North Carolina mental health system and who it’s for, you can read our quick start guide below.

To learn more about public mental health services in North Carolina, keep reading. We’ve done the research to uncover essential facts about who’s eligible, what services you can get, when to go, where to call, and how it works so you can decide if North Carolina’s mental health system might be right for you.

Who Is Eligible?

The North Carolina mental health system can meet many people’s needs, but you should especially consider looking into it if you (or a loved one) are having a mental health crisis, have a severe mental health condition, have Medicaid, or have a limited income.

Everyone in North Carolina can use the state-funded mental health emergency response system. If you or someone you love is in crisis, you can call a state or local crisis line to get the help you need, quickly.

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Public mental health services are usually the best option if you’re having a mental health crisis and need help right away.

State mental health programs are required to provide mental health crisis response services and are one of the fastest ways to get care when you’re having a mental health emergency.

The people who answer state and local crisis lines can provide caring attention and support as they help you determine the best response to a crisis, whether it’s inpatient treatment or an appointment with a counselor.

Even if you’re not in crisis, you can call your local mental health hotline for information about affordable mental health services in your area. When you call, you can find out whether you might qualify for state-funded mental health services, schedule an assessment, or get free information about other affordable local providers.

In North Carolina, public outpatient mental health services are provided by a network of independent programs that contract with and are overseen by state managed care organizations called “Local Management Entities” (LME-MCOs).

Because there are no statewide clinical eligibility criteria for publicly-funded outpatient mental health services in North Carolina, each program can set its own eligibility criteria, and many programs in the public system serve people with a wide range of mental health needs.

So, whether you have a severe mental illness (SMI) and need specialty services or are just looking for counseling to help you adjust to a life change, there is probably a program in the public mental health system that can meet your needs.

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Public mental health programs in North Carolina are great places to find specialized and intensive mental health services like case management and day treatment that can be hard to find anywhere else. These specialty programs can give you extra help when you’re dealing with severe symptoms.

While many agencies in North Carolina restrict admission to specialized or high-intensity programs to people with serious mental illness, you usually don’t have to have SMI to get therapy, medication, and other basic outpatient services.

However, it depends on the program and depends on their staffing and funding at the time. When there are limited resources or a long waitlist, community mental health programs may prioritize services for people with SMI or who can’t use insurance to get therapy anywhere else.

If the agency doesn’t have a waitlist, they are less likely to restrict who they admit. If you’re eligible, you’ll have to decide if the program is the right fit. Whether a publicly-funded provider is right for you will depend on whether they offer what you’re looking for and whether they accept your insurance or have better rates than other local providers.

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You generally don’t have to have a serious mental illness (SMI) to get public outpatient mental health care in North Carolina, but you may need to have SMI to qualify for specialty services. Also, at times of high demand, publicly-funded programs may prioritize admission for people with SMI.

Serious mental illness is usually defined as a condition that causes you severe distress, limits your ability to function, makes it hard for you to live independently without support, or puts you at risk of hospitalization. Conditions that can qualify as SMI include schizophrenia, bipolar disorder, and major depression.

To qualify for state financial assistance to help you pay for mental health services in North Carolina, you have to have SMI or a limited income.

One way to get state funding for mental health care is to qualify for Medicaid. There are also special state funds and programs that can help if you don’t qualify for Medicaid but have SMI and meet other criteria. Your mental health history and income may determine whether you can get financial aid.

One of the advantages of North Carolina’s partially privatized mental health system is that if you don’t qualify for state funding, you can still get services from state-funded providers. Programs that contract with the state can choose to admit clients who do not receive public funding but who have insurance they accept or who can pay out of pocket for mental health care.

Most publicly-funded providers in North Carolina accept Medicare, Medicaid, and many private and commercial insurance plans. If you don’t have insurance they accept, they usually offer services for a sliding-scale fee (regardless of whether you qualify for public financial assistance).

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Medicaid is a great way to access affordable mental health care in North Carolina. Most providers who participate in the public system accept it, and it can be hard to find other providers who do.

North Carolina accepted federal Medicaid expansion in 2023, so you’re eligible for Medicaid in North Carolina if your income is 138 percent of the federal poverty level or less. You may also qualify based on a combination of your income, your medical history, and your mental health condition.

If you’re not sure whether you’re eligible, it’s worth looking into. You can apply for Medicaid in person, by phone, or online. To learn more, you can go to your local Social Services office or fill out an online application on ePASS or Healthcare.gov.

You can find contact information for programs in your area in the directory below. You can call to learn more about what’s available, whether you’re eligible, and whether there’s a waitlist. Even if you’re not eligible, or if the program doesn’t offer the service you want, they can probably still help you.

The people who work at community mental health programs are knowledgeable about local resources and will often give you free information or even referrals to other affordable providers nearby, including local non-profits that provide free or low-cost counseling.

Where Do You Call to Get Started?

The easiest way to learn more about state mental health services in North Carolina is to call the program you’re interested in directly. You can find contact information for mental health agencies in your region, as well as local mental health hotlines, in the directory in the next section.

There are also many numbers you can call for help no matter where you are in North Carolina. You can find the numbers for statewide helplines and hotlines in the information box directly below.

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The statewide North Carolina mental health crisis hotline is 988.

The Crisis Text Line for the state of North Carolina is 741741.

You can get crisis support from the North Carolina HopeLine by calling (919) 231-4525 or (877) 235-4525.

You can get emotional support and help finding mental health care by calling the Hope4NC Helpline at (855) 587-3463.

If you live in Mecklenburg County, you can get support from a peer by calling the Promise Resource Network’s 24/7 peer support hotline at (833) 390-7728.

You can reach the National Alliance on Mental Illness (NAMI) Helpline by calling 1-800-950-NAMI (6264).

If you need support, information, or just need to talk to someone, you can call (800) 451-9682 to connect with the non-emergency NAMI North Carolina Helpline.

You can connect with the North Carolina Mental Health Division’s Customer Services and Community Rights team by calling (984) 236-5300 or (855) 262-1946.

Public mental health services in North Carolina are managed on the state level by the Mental Health, Developmental Disabilities and Substance Use Services Division of the North Carolina Department of Health and Human Services. For general information about North Carolina’s mental health system, you can contact the MHDDSUS Customer Services team at (984) 236-5300 or (855) 262-1946.

However, you’ll probably get the best results by calling your LME-MCO or calling the program you’re interested in directly. You can find the number for your LME-MCO and programs in your area in the directory below.

North Carolina Mental Health Directory

Public outpatient mental health services in North Carolina are provided by private programs that contract with regional managed care organizations called Local Management Entities (LME-MCOs).

Over the last two decades, North Carolina has consolidated its system and reduced the number of LME-MCOs. There are currently four LME-MCOs serving North Carolina’s 100 counties.

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One of the responsibilities of LME-MCOs is to ensure that residents of the counties they serve can access same-day crisis services close to where they live.

They do that by managing a network of crisis walk-in-centers. At crisis walk-in centers, you can be seen without an appointment. You can also call for help, information, and referrals.

You can find the location and contact information for your local crisis walk-in center below, as well as numbers for the affiliated agency’s local outpatient programs.

Each LME-MCO has a crisis line you can call to receive support, information, and referrals to local mental health services. Calling crisis and information lines is free. Depending on the reason for your call, the person who answers may help you set up an appointment or encourage you to go to a local walk-in center for a face-to-face assessment. If you’re in crisis, they can help you find an inpatient facility, emergency room, or mobile crisis team in your area.

You can find contact information for the LME-MCO that serves your county in the directory below. We’ve also included listings for some of the largest public mental health providers in North Carolina, focusing on programs that provide crisis and specialty services as well as regular outpatient care.

If you need information after hours or aren’t sure whether you’re experiencing a mental health crisis, it’s okay to call a crisis line for help. The staff who answer are trained to quickly figure out what you need and can tell you what steps you need to take to connect with the right services.

If you’re not in crisis, or prefer to search online, you can use your LME-MCO’s online search page to explore services in your area. We’ve linked to each LME-MCO’s provider search page in the directory above. It’s worth exploring—there are more providers in North Carolina’s mental health system than we are able to include in our listings.

If you’re interested in a particular program, you can call them to find out if they’re taking new clients, if you’re in their catchment area, and whether they offer financial assistance. If you’re not sure which program to call, you can call your LME-MCO for more help and for personal recommendations.

Also Consider: Federally Qualified Health Centers

Federally qualified health centers (FQHCs) are another great way to get affordable publicly-funded mental health services in North Carolina.

These federally-funded programs provide cutting-edge care in places where good primary healthcare was once hard to find. Most provide integrated care so you can get primary medical and mental health services at the same location. Each FQHC accepts Medicaid and Medicare and offers low sliding-scale fees if you don’t have insurance.

You can search for FQHCs near you by using the online search tool on the U.S. Health Resources and Services Administration website.

Troubleshooting Guide

The state mental health system is complicated and can be confusing to navigate. If you’re having any issues, we’re here to help. Here are some of our solutions to common problems you might experience.

If you’ve run into a problem that we haven’t addressed, don’t give up. Call someone at the program (or a state or local mental health hotline) and tell them what’s going on.

You’re much more likely to get the help you need when you advocate for yourself and are persistent. Tell the person you talk to what you need or what problem you’re having.

If they don’t help the first time, call them back and tell them. If you keep calling and keep calm and focused, you should eventually get through to someone who can help you.

Deep Dive: How Does the System Work?

To understand North Carolina’s mental health system, it helps to understand how it started and how it’s changed since then.

Public mental health services have been around for a surprisingly long time. But for over a hundred years in America, the only way to get them was in a psychiatric hospital.

In the 1960s, Americans started thinking differently about mental health care. Conditions in psychiatric hospitals were getting worse and new medications made it possible to provide mental health treatment on an outpatient basis.

In response, new laws were passed that required state and local governments to establish community mental health programs as alternatives to institutionalization for people with serious mental illness. The most important was the Community Mental Health Act, which President John F. Kennedy signed into law in 1963.

DEEP DIVE

To learn more about what the public mental health system was like in the early days—and how psychiatric inpatient care has evolved since then—you can read our article “Do Insane Asylums Still Exist? The Surprising Past and Present.”

To learn more about what inpatient mental health treatment is like now, and the differences between how it works in general hospitals and specialized psychiatric facilities, you can read our article “How Inpatient Mental Health Treatment Works.”

Many state mental health programs trace their origins back to the 1960s when these important changes started to happen. North Carolina is no exception.

Soon after Congress passed the federal Community Mental Health Act, the North Carolina General Assembly authorized the construction of public mental health clinics across the state. By 1970, North Carolina had 42 community mental health programs where people could get publicly-funded outpatient mental health care.

In 1977, the North Carolina General Assembly passed a law requiring county governments to establish mental health departments called “area authorities.” From 1977 to 2001, North Carolina allowed area authorities to directly provide publicly-funded mental health services. The state maintained its network of government-run county mental health programs until 2001.

DEEP DIVE

The state mental health department oversees a network of organizations called “Local Management Entities.” In the past, these were county-based agencies that directly provided some mental health services. Starting in 2001, LMEs began to transition into managed care organizations (LME-MCOs) that did not provide services but oversaw a network of private mental health service providers.

In addition to overseeing a network of local mental health providers, each LME-MCO provides information services and a crisis hotline. They also oversee local mobile crisis programs and a network of crisis walk-in centers where people can be seen without an appointment. These services are provided by private mental health agencies that participate in the public system.

In 2001, North Carolina passed a law that barred area authorities from directly providing mental health services. The law reclassified state agencies as “Local Management Entities” (LMEs). Their updated role was to oversee, develop, and manage publicly-funded services provided by private programs.

Starting in 2005, the state began shifting to a managed care system and transforming county-based LMEs into regional managed care organizations (LME-MCOs). Before this process began, the state had already shrunk its public program from over 40 area authorities to 23 LMEs. By the late 2010s, there were only seven LME-MCOs, and there are now only four.

This multi-decade process of transitioning to a managed care model has caused gaps in access to mental health care. However, in recent years, North Carolina has taken steps to address these issues and improve access to care, including accepting Medicaid expansion in 2023.

DEEP DIVE

When America first shifted to a community-based mental health system, public outpatient mental health services were provided by community mental health centers that offered a wide range of services under the same roof. These were often public agencies that were directly run by the state or county government.

However, since partially privatizing its mental health system, North Carolina has moved away from this model. Publicly-funded outpatient mental health services are provided by a range of agencies, and some specialize in only one type of service. For example, some programs are primarily counseling agencies, while others focus on just one type of specialty care.

However, there are some agencies in North Carolina that still follow the old model. North Carolina’s mental health department designates them as Critical Access Behavioral Health Agencies (CABHAs). To qualify as a CABHA, an agency has to provide a full range of both basic and intensive services.

Most of the agencies listed in the directory in this article are CABHAs. You can find an updated list of all CABHAs currently operating in North Carolina here.

Medicaid expansion has not only increased the number of insured people in North Carolina, but it has also significantly increased the state’s mental health budget.

North Carolina plans to use the funds to build new crisis facilities and establish more mobile crisis teams, as well as invest in efforts to hire and retain more mental health workers in rural areas and expand integrated care programs.

Even before this budget increase, North Carolina had already expanded its local and regional crisis services by implementing the statewide 988 crisis line and by expanding facility-based and mobile crisis services.

If you’re in crisis and aren’t sure how to access these new services, you can get the help you need by calling a crisis line. The people who answer know how the system works and will help you get where you need to go.

Conclusion

According to the Substance Abuse and Mental Health Services Administration, only 45 percent of people in North Carolina who have mental health conditions get treatment for them. Many of them qualify for public mental health services but don’t know about them.

You can make a difference by reaching out and connecting with local mental health resources to get the care you need. If you’re not sure whether the North Carolina mental health system is right for you, call a local program or mental health hotline. You may find out you can get mental health services at a local state-funded program or that there’s another affordable option nearby.

The most important thing is to get started—the help you need may be only a call or click away.

Are You Thinking of Online Therapy? Start Here to Get Matched with a Licensed Therapist Right For You.

Therapy with No Waiting Rooms or Driving. Take a quick quiz about your preferences and needs and get matched to a therapist in as little as 48 hours.

Your (Unofficial) Guide to State-Sponsored Therapy in North Carolina

Are You Thinking of Online Therapy? Start Here to Get Matched with a Licensed Therapist Right For You.

Have you been in therapy before?

Quick Start Guide

Who Is Eligible?

PRO TIP

Use the State System When You're in Crisis

PRO TIP

Check Out the State System If You Need Specialized Services

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What Is Serious Mental Illness?

PRO TIP

Are You Eligible for Medicaid?

Where Do You Call to Get Started?

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Important Numbers in North Carolina

North Carolina Mental Health Directory

PRO TIP

Crisis Walk-In Centers

North Carolina Clinics and Crisis Lines

Vaya Health

Alliance Health

Partners Behavioral Health

Trillium Health Resources

Also Consider: Federally Qualified Health Centers

Troubleshooting Guide

Problems and Solutions

Deep Dive: How Does the System Work?

DEEP DIVE

For More Information

DEEP DIVE

What Is the Structure of the North Carolina Mental Health System?

DEEP DIVE

Critical Access Behavioral Health Agencies (CABHAs)

Conclusion

Are You Thinking of Online Therapy? Start Here to Get Matched with a Licensed Therapist Right For You.

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