From Intern Elena's Desk: Embedding Responder Wellness Across North Carolina

“Grief feels so overwhelming and so dark and so personal, but it doesn’t have to be… You can bond with another person around something that’s so familiar and so hard. Do it together. You’re not alone.” –Rae Powers, public health nurse, at our First Responder Event in Asheville

Last month in Asheville, the Grieve Leave team hosted something different. In a taproom usually reserved for casual Sunday conversations, firefighters, officers, nurses, therapists, and advocates gathered to talk about the thing few ever do: grief. What we witnessed wasn’t just a community event; it was a powerful moment of connection, vulnerability, and validation.

We heard stories of burnout and recovery, loneliness and resilience. What stood out most was the impact of Responder Support Services, a Western North Carolina initiative that embeds trained mental health professionals directly into first responder agencies across 22 counties. These clinicians are available 24/7: offering trauma-informed, culturally fluent support that doesn’t just wait on the other end of a crisis line but meets responders exactly where they are.

Research shows that first responders experience PTSD, depression, substance misuse, and suicide risk at significantly higher rates than the general population. Yet stigma and logistical barriers keep too many from seeking care. The solution is simple in theory but challenging in practice: bring care to them.

Embedded clinicians normalize wellness. They build trust, show up regularly, and become part of the department family. Programs like those in Western NC prove that this model works, but access to these supports is uneven across North Carolina.

Geography should not determine who gets to heal.

What we saw in Asheville affirmed what we already knew: supporting North Carolina’s first responders means embedding care into their everyday environments, not just reacting in moments of crisis, but building systems that support them before, during, and long after the call

The Statewide Backbone: RAI

At the center of North Carolina’s responder wellness infrastructure is the Responder Assistance Initiative (RAI): a vital, free, and confidential service offering telehealth counseling, peer support, crisis response coordination, and wellness coaching to first responders across the state. RAI represents a critical baseline, especially for rural counties or smaller agencies that may lack local infrastructure. The RAI hotline (866-731-6901) operates 24/7 and can often be the first step toward accessing care.

Despite its importance, RAI is not designed to embed responders within local departments or to maintain physical wellness offices. The model works in parallel with on-the-ground support, but cannot replace the value of consistent, localized, face-to-face mental health services.

Across North Carolina, counties and municipalities have begun stepping in to fill that gap. Often operating independently of RAI, these local programs reflect creativity, urgency, and a recognition that statewide coverage must be built from the ground up.

Local Innovations

Cabarrus County: Crisis Collaborative Assistance Program (CCAP)

In Cabarrus County, the CCAP integrates mental health and public safety through collaboration between EMS, the Sheriff’s Office, and local public health agencies. The program offers trauma-informed response teams to assist individuals in crisis, including those experiencing mental health emergencies, substance use challenges, or homelessness. While not exclusive to responder wellness, the program relieves pressure from front-line workers and provides immediate behavioral health interventions that benefit both residents and first responders.

City of Davidson (Mecklenburg County): Co-Response Model

Davidson, a municipality in Mecklenburg County, has adopted a co-response model that pairs law enforcement officers with licensed clinical social workers to respond to 911 calls involving mental health or substance use issues. The program does not just support the individuals in crisis, it also functions as an embedded support system for the responders involved in those calls. This model provides real-time clinical assistance, de-escalation expertise, and aftercare referrals, all of which help mitigate the long-term psychological toll on first responders.

Learn more: Davidson Co-Response Program

Mecklenburg County: Crisis Intervention Team (CIT) Training

The CIT program in Mecklenburg County focuses on building responder capacity through specialized training in mental health crisis response. While the program does not embed clinicians within agencies, it helps police and EMS professionals identify signs of psychiatric distress, de-escalate confrontations, and direct individuals to appropriate care. The model is a training-based intervention, enhancing responder awareness and skills, but still lacks ongoing mental health presence within departments.

Learn more: Charlotte CIT Program

Wake County: Emerging Peer and Wellness Support

In Wake County, reports indicate that peer wellness and mental health initiatives are being piloted within fire departments and emergency response units. Though details are not yet fully public, these efforts include the development of peer-led responder wellness teams, embedded support liaisons, and confidential counseling referrals. These local supports complement statewide tools like RAI but offer the kind of personalized attention that comes from knowing a department’s culture, routines, and stressors.

Learn more: Wake County Fire Services

Western North Carolina: Responder Support Services

Since 2017, Responder Support Services has delivered comprehensive behavioral health care to responder agencies across 22 western counties. This includes:

• Embedded mental health clinicians, trained in grief, trauma, and law enforcement culture

• 24/7 telehealth and in-person care

• Crisis response during line-of-duty incidents

• Post-call debriefing and burnout prevention

Despite its success, the program is entirely locally funded and managed, with no formal state sponsorship. It is one of the only regional systems in the state offering fully embedded, in-agency clinical care.

Next Steps: How to Bring This to Your County

1. Start the Conversation
   Talk with local fire, EMS, and law enforcement leaders about the need for embedded mental health support. Share examples from Western NC, Davidson, and Cabarrus County to show what’s possible.

2. Find Public Health Partners
   Reach out to your county’s public health department or health provider networks to explore collaboration and funding opportunities.

3. Use RAI as a Backbone
   While RAI doesn’t offer embedded clinicians, its 24/7 hotline and statewide resources can complement local programs and provide essential crisis support.

4. Advocate for Funding
   Attend county commission meetings, apply for state wellness grants, or partner with nonprofit organizations to secure sustainable funding.

5. Stay Connected
   Contact Responder Support Services to learn more about building trauma-informed, responder-specific care models in your region.