How Western North Carolina Providers Are Tackling Youth Mental Health Crisis After Hurricane Helene

Even as the 2026 Atlantic hurricane season begins, many counties in North Carolina are still recovering from the impacts of Hurricane Helene, which inundated communities far from any coastline in 2024.

The storm caused catastrophic flooding in the western portion of the state, killing more than 100 people. The storm has also had serious economic impacts, devastating much of the area's residential housing and critical infrastructure, making Helene currently the costliest natural disaster in state history.

One organization based in Asheville, a community severely impacted by the storm, began to provide mental health services to children and their families during the height of covid, and has since increased efforts in the wake of Helene.

The Mountain Area Health Education Center, or MAHEC, a nonprofit that provides health services and education in the region, operates a school-based therapy program. Within six years, the program has grown exponentially, reflecting the need for services. MAHEC began with 12 therapists in 13 schools in one county in 2020. Today, it employs 61 therapists at 83 schools across four counties.

MAHEC strives to increase access to care and ease the difficulty of getting students to appointments off campus throughout the school and work day.

Data on youth mental health has shown an upward trend of depression and anxiety over the past decade. Medical experts in North Carolina say that extreme events, like the impact of Hurricane Helene, have exacerbated the need for mental and behavioral health support.

The event was traumatic for some, and many families felt the weight of inconsistent housing, insecure employment, and unpredictable transportation in the year following the storm. MAHEC's school-based therapists responded to 1,280 children seeking help for trauma, anxiety, and depression through telehealth and phone check-ins.

Addressing Helene's Trauma Amid a Shortage of Child Therapists

The therapists were also available to school staff for trauma-informed support for the grieving process, given that so many experienced loss from the hurricane.

"It's a unique thing to be providing a service while you're also going through your own natural disaster," said Laura Hopkins, a school-based therapist at Oakley Elementary School in Asheville, North Carolina, and part of the MAHEC program.

According to a 2025 NC Child report, just three counties across the state have a sufficient supply of child and adolescent psychiatrists. Over half of North Carolina counties are without child and adolescent therapists at all. And for the children who do see a therapist, half of their parents say they have difficulty accessing care.

The MAHEC therapists began seeing students in the fall of 2020, at the height of the Covid-19 pandemic. At the time, students had transitioned from the classroom to virtual learning at home, and the school-based therapists said the switch from in-person learning was a dramatic change for kids of all ages and affected family life as some parents also had to navigate job losses, homeschooling, and fewer external community-led activities.

Hopkins, a licensed clinical mental health counselor supervisor, said the work often involves grief counseling.

"As a country, we have not processed the grief we all experienced from Covid and the amount of changes that happened," she said.

The MAHEC program requires parental consent for students to participate. The therapists typically involve play-based therapy for younger children and move into deeper conversations for teenagers for six weeks at a time. Hopkins said she encourages parents to meet with her and the child during the first session, then shares updates moving forward. She also asks parents about the resources and supports that they have outside of the school, to ensure that they have the knowledge to support their children.

Navigating the Post-Disaster Landscape

The therapists also consider the time of day for student sessions. Hopkins said she'd rather not do deep work in the morning, followed by math class with other students. Sometimes an afternoon therapy session is best so that a student can go home and rest, she said.

The therapists educate kids and parents on the different types of feelings that may come up following transitional events and how they can affect interpersonal relationships.

"Behaviors can come from feelings around grief or transition," Hopkins said. "So, if all of a sudden this child has been to two or three different schools, the family keeps moving around, or is briefly unhoused, or if there is [social services] involvement, that's a lot of change."

In younger children, the behavior can show up as tantrums, such as throwing furniture or chaotic behavior. Hopkins said middle and high school students can turn to self-harm. The therapists guide them to focus on impulse control, of waiting 90 seconds before making a decision, and to think about the things they enjoy and use those positive instances to lessen their distress.

Emily Roberts, licensed therapist and director of MAHEC's school-based behavioral health program, said they prioritize talking to families about their individual experiences. Roberts said that everyone hasn't been affected by the extreme events in the same ways. Some families have seen very little change, while others are living a new life.

"We know that kids in our community have experienced something hard, and we know that kids nationally have experienced something hard, between Helene and Covid and a culmination of other things."

Expanding Youth Mental Health Resources and Long-Term Disaster Recovery in Rural North Carolina

In the NC Child report "Staff Stories, Student Struggles: Insights from school support personnel on meeting rising youth mental health needs," researchers found that student suicide rates, the contemplation of suicide, and plans for suicide had all risen across the state.

NC Child is a state-based think tank whose mission is to advocate for improved outcomes for North Carolina's children.

According to the report, from 2016 to 2023, the percentage of North Carolina children diagnosed with anxiety or depression more than doubled and was higher than the national average. In 2023, NC Child shared that in 2023, 4 in 10 high school students across the state shared persistent feelings of sadness or hopelessness to the point that it disrupted their normal day-to-day life.

"Suicidal ideation among school-aged children was part of the impetus for this report, as was the increased rate of youth suicides in North Carolina over the past decade," the organization said in a statement to Direct Relief.

"This project was also motivated by worsening trends in other domains of youth mental health, such as higher rates of children with persistent feelings of sadness or hopelessness and diagnosed with anxiety or depression, and lower access to both community and school-based mental health services."

NC Child is conducting focus groups with high school students in western North Carolina about their mental health and plans to conduct additional focus groups with school district personnel for further information post-Helene this fall.

Roberts said MAHEC intends to continue expanding the school-based program. She said more therapists are needed to support the students and families in rural towns in Appalachia. The MAHEC director said she's working to continue building trusting relationships with schools so that the therapists can reach more students.

"With the right supports in place, kids can thrive and do well and can recover," Roberts said.

So far, the program has increased access, and Roberts said that parents are navigating resources to get their kids the help that they need.

"I think parents want to know that their kids are going to be okay," she said. "They (want to) have the support and the trusted relationships in their life that extend outside of them as parents."

Direct Relief continues to support North Carolina communities impacted by Hurricane Helene, and the organization has sent the Mountain Area Health Education Center with $1.9 million in medication assistance and medical supplies for safety-net services and disaster response.