The biggest barrier to teen mental health isn’t treatment. 

Across North Carolina, more than one-third of high school students report feeling persistently sad or hopeless. At the same time, 94 of the state’s 100 counties face shortages of mental health professionals, and 43 counties have no child psychiatrist at all. The need is clear. The question is how we respond.

For years, much of the public conversation around youth mental health has focused on access to treatment. Treatment is critically important, but experience has taught us that another challenge often comes first: ensuring young people are identified, supported and connected to care before a situation becomes a crisis.

In our work with schools, county governments, healthcare providers and community organizations across North Carolina, we’ve learned that the biggest barrier is rarely a lack of caring or commitment. Parents care. Teachers care. Counselors care. Providers care.

The challenge is that the people and systems responsible for supporting young people are not always connected in the moments that matter most — and that lack of connection has serious unintended consequences.

Schools may recognize warning signs but lack immediate access to behavioral health resources. Families may know their child needs help but struggle to navigate a complicated system or pay for care. Providers may have expertise but no direct connection to the students who need it most. When those gaps exist, young people fall through the cracks.

That’s why conversations about youth mental health should focus not only on treatment, but also on identification and intervention.

Identifying a student who may be struggling is often more difficult than people realize. Warning signs are not always obvious, and no single teacher, counselor, parent or provider sees the full picture. The students most in need of support are often the easiest to miss.

Schools play a vital role because they are often the first place those warning signs emerge. But schools cannot be expected to carry this responsibility alone. Neither can families, providers or local governments.

The most effective approaches bring those partners together before a crisis occurs.

Across North Carolina, communities are pursuing that goal in different ways, but the strongest efforts share a common characteristic: they create clearer pathways between schools, families and behavioral health providers.

In Wake County, Alliance Health’s innovative school-based partnership model served more than 600 students in a single school year. Among students experiencing a behavioral health crisis, 93% were successfully connected to needed treatment. And students returning from psychiatric residential treatment also saw positive results, with 100% successfully transitioning back to school with coordinated support designed to help them continue their recovery and remain engaged in the classroom. Alliance recently expanded a similar initiative to schools in Durham County as well.

The lesson is not that one program can solve every challenge facing young people. It is that better outcomes occur when the right partners are aligned around a student’s needs and support is available before a crisis deepens.

This is where North Carolina has an opportunity.

Rather than asking any one institution to shoulder more responsibility, we should continue strengthening the partnerships that help educators, families, healthcare providers and community organizations work together. We should continue investing in approaches that make behavioral health services easier to access, easier to navigate and easier to coordinate.

After a tragedy, communities often ask what could have been done differently. A better question is what we can do sooner.

We cannot prevent every crisis. But we can build stronger pathways to identify struggling young people, connect them to support and ensure help is available before a moment of crisis becomes a lifelong tragedy.

That is a goal every North Carolinian should be able to support.

Ann Oshel is Senior Vice President of Community Innovation and Impact at Alliance Health. She oversees programs and partnerships that connect schools, healthcare providers, local governments and community organizations to improve access to behavioral health services and support healthier communities across North Carolina. She is based in Apex, North Carolina.