State health officials back mental health first aid training at colleges, universities

By Skye Crawford

When she was growing up in rural southeastern North Carolina, Alicia Freeman saw people whose mental health and substance use concerns went untreated because her area had very few resources to help them.

Freeman, who’s been at UNC Chapel Hill since 2019, said watching her community members struggle is part of why she now works to help people cope with mental illness. 

She’s part of the UNC School of Social Work’s Mental Health First Aid Program, which started in 2015 as a pilot, organizes and leads training sessions that teach participants how to recognize and respond to signs of mental health and substance use challenges.

At the time, state officials were promoting the methodology as a cost-effective way to reach young people with mental health help. 

This year, UNC’s mental health first aid program will get funding from the N.C. Department of Health and Human Services; the money will allow it to expand to more college and university campuses.

In a Sept. 9 news release, the department said the North Carolina chapter of the National Alliance of Mental Illness would also be partnering with them to “market and promote the training opportunities on UNC system schools and state community college campuses.”

Educators, clinicians and state officials have overwhelmingly supported the expansion of the program, saying that mental health among college students and young adults has become an increasing concern in recent years.

Jennifer Rothman, senior manager for youth and young adult information, support and education at NAMI, said that 75 percent of all lifetime mental illness begins by age 24. Additionally, she said, 68 percent of students say mental health issues hurt their academic performance.

“Our rates of suicide for some populations in North Carolina continue to climb, and that’s a real concern for us,” said Kelly Crosbie, assistant secretary for mental health, developmental disabilities and substance use services at NCDHHS. “One high-risk group in particular is young people.”

Suicide is the third leading cause of death for youth ages 10-18 and the second leading cause for those ages 19-34, according to the N.C. Suicide Prevention Action Plan.

“Suicide is an epidemic,” Crosbie said. “It’s a public health emergency.”

Concern for college student mental health grows

In calendar years 2022 and 2023, 12 N.C. State University students died by suicide — seven in 2022 and five in 2023, according to public records obtained in 2024 by the student newspaper, Technician.

NC Health News submitted a public records request on Aug. 24 to N.C. State University requesting the number of student deaths by suicide in the calendar years 2024, 2025 and 2026 to date. Despite multiple follow-ups, the request has not yet been fulfilled.

Three students at UNC Chapel Hill died by suicide in one semester in 2021.

As previously reported by The News & Observer, neither UNC nor N.C. State tracks the exact number of students who die while at the institution in the public record.  

In response to the public attention on the campus suicides in 2022-23, both universities have invested in responding to mental health crises on campus.

In November 2022, N.C. State established a mental health task force to “make short- and long-term curricular and co-curricular recommendations to help improve student mental health at NC State,” then-Vice Chancellor Doneka Scott wrote in a letter to the student body.

Each semester since fall 2022, N.C. State has held at least one Wellness Day — a mental health care–oriented day off from classes in which no assignments are due and students are encouraged to participate in wellness events around campus. The administration also asks that instructors not schedule tests or assignments due the day after.

N.C. State spokesperson Lauren Barker said that temporary mental health task force recommended the university join the JED Campus network, a program of the Jed Foundation that focuses on mental health in high schools and colleges. JED Campus is a four-year program that guides and works with schools to improve mental health outcomes on campus. 

“We joined [JED Campus] in fall 2023, and the task force’s recommendations informed the strategic plan developed with JED, which now guides our work in areas such as identifying and responding to at-risk students, policies and procedures, social connectedness and prevention,” Barker said in an email to NC Health News.

The 2023 JED Campus Impact Report found that universities and colleges who participated in its program saw decreased suicide ideation, planning and attempts among students.

UNC also joined the JED Campus network in February 2022, and other North Carolina colleges and universities — including UNC Greensboro and UNC Pembroke — have since established strategic plans with the organization. Appalachian State University, Wake Forest University, Davidson College and Elon University were previously designated JED Campuses.

Learning to ask

Since 2022, UNC has trained more than 1,600 students, staff and faculty in mental health first aid, the National Council for Mental Wellbeing reports. Through their partnership with NCDHHS, UNC hopes to train at least 600 people in the next year.

Paul Lanier, a professor in the School of Social Work, is principal investigator of the mental health first aid program. He said the program’s success is reflected in its evolution from a pilot program within his school to an initiative visible across campus.

“I can walk around campus and see signs on people’s doors like ‘I’m a Mental Health First-Aider’ all over,” Lanier said. “It feels like we’re coming from a small pilot to a larger, campus-wide movement.”

Freeman said that some of the first participants in the training program were those working in library and facility services, as they were likely to see students in moments of distress.

“A lot of them work third shift and a lot of the time students [that are struggling] may just be randomly in different areas of campus,” Freeman said. 

UNC requires all bachelor of nursing students to participate in the training, which has an online and two-day in-person component. 

Mia Spencer, a graduate of UNC, is now pursuing an accelerated bachelor of nursing degree. She had gone through emergency medical technician training, but she said the mental health first aid course was more in-depth.

“Especially if I hadn’t done EMT training before this, I would have definitely found it helpful,” Spencer said. “I remember being surprised when I first learned that you’re supposed to specifically ask people [if they are contemplating suicide] and what their plan is.”

Spreading the word

Freeman said the training-based program is a site of the National Council for Mental Wellbeing’s Mental Health First Aid initiative, part of a behavioral health springboard initiative initially funded by a federal Substance Abuse and Mental Health Services Administration grant.

There’s also state money, but until this July, North Carolina had not passed a state budget since 2023. As a result, Lanier said institutions had to make difficult decisions about which programs to fund.

“The challenges with a state budget not being passed really impacted our program because our program is not required for graduation. It’s not curriculum credit,” Freeman said. “We got down to the bare bones, and we were able to hold on to [the program], but we did lose quite a few staff in the process.”

Now, Freeman said the program is able to hire more staff — including a part-time outreach specialist and a full-time training coordinator — to expand the program.

Sara Newhan, youth initiatives outreach coordinator for NAMI North Carolina, will work with UNC and schools that serve young adults across the state to bring mental health first aid training to campus.

Newhan and Rothman, director of youth initiatives at NAMI, said young adults today talk more openly about mental health struggles than they may have in the past.

“But that doesn’t always mean they’re getting the treatment or the help that they need,” Rothman said.

Newhan also works with universities, community colleges and high schools to establish student-led NAMI On Campus clubs.

Newhan said NAMI NC has struggled to reach students in middle and high schools, which is why training young adults in mental health first aid is important.

“It’s a great basic but really informative, to-the-point course that gives you a general idea of how to take care of your mental health, what signs to look out for, how to reach out and get help,” Newhan said. “I think those are just really important foundational things to teach the students so that they can become trained to become trainers themselves.”

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