‘It’s like a family, a very large family’: A rural LGBTQ+ center in North Carolina fights the youth mental health crisis

With LGBTQ+ youth facing startlingly high rates of mental illness, especially in rural communities, we talked with mental health professionals and local activists about how to make change. They say anti-LGBTQ+ policymakers at the state and local level are contributing to the problem. 

[Editor’s Note: This story discusses topics such as suicidality and self-harm. If you or someone you know needs help, it is available. Consider reaching out to the Hope4NC Helpline at 1-855-587-3463. It’s free of charge for people in all 100 NC counties. Also, look into the 988 national mental health hotline.) 

It was Southern Pines’ annual AutumnFest. Bri Hersh, a volunteer with Sandhills Pride, a local LGBTQ+ pride organization, was setting up the group’s rainbow tent. 

She was carrying a rainbow “Pride” flag across a green space in downtown Southern Pines that’s used for the local farmers market, and no one said anything to her. No taunts. No sneers. Nothing. 

“I looked around and never imagined that I would be standing in the same spot as I was as a child—on the same playground that I played on as a child—holding a Pride flag,” she remembers.

Sometimes, the small things can feel very big. 

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Hersh is a Moore County native. She identifies as queer. So does her daughter. They’re living in the midst of a verifiable youth mental health crisis, especially for LGBTQ+ kids, who are more likely to experience symptoms of depression and anxiety, and more likely to think about or attempt suicide. 

Bri Hersh volunteers to lead a regular LGBTQ+ youth group for Sandhills Pride.

It’s not because queer people are naturally inclined to grapple with their mental health. It’s because of the bullying and the harassment—and the politics.

Hersh grew up in the rural South. People didn’t talk much about identity. It’s not that her family wasn’t supportive. It’s just that things like that aren’t table talk. It’s the kind of silence that can feel loud. 

In 2024, people might be more visibly supportive of LGBTQ+ people than they were when Hersh was growing up, but the hate’s more visible too. 

In North Carolina, Mark Robinson is running for governor behind one of the most anti-LGBTQ+ campaigns in modern times. He’s backed by a Republican-controlled legislature that’s passed a raft of anti-LGBTQ laws. They’ve banned trans youth from school sports, forbid LGBTQ+ supportive information in schools, and outlawed gender-affirming health care. 

In Moore County, it’s bad at the local level too. In May, two local groups filed civil rights complaints with the US Department of Education over anti-LGBTQ+ policies passed by the conservative local school board. 

Four months before the state legislature’s anti-trans bill passed, the Moore County school board passed its own “Parents Bill of Rights” which, among other things, forbade public school systems from engaging with LGBTQ+ information—even though it’s in K-12 when many young people formulate their identity. 

Moore County’s policy and an accompanying “Principal Implementation Guide” ordered school leaders to pull any books from libraries that feature queer parents or kids questioning their gender, The Pilot in Southern Pines reported. 

These are trying times for LGBTQ+ people in North Carolina, again. Here, Hersh and her family are right in the thick of it. 

“We are actually having people move out that have been supported by (Sandhills Pride),” she says. “They’re currently moving to different states where it’s going to be easier for their children to grow up.”

But not Hersh. 

“Most of us cannot afford to do that,” she says. “And I will never be leaving until someone else can take my place that cares about this community and cares about civil rights that may not necessarily be storming the castle, but taking care of the people that will, and that is my youth group.”

A lighthouse in rural North Carolina

For decades, there have been LGBTQ+ pride organizations in North Carolina’s major cities. This year, Charlotte Pride, one of the state’s largest such groups, will celebrate its 24th year with a two-day festival and parade. Last year, the parade drew more than 260,000 people to Charlotte, and 2024 is expected to be even bigger. 

While Charlotte Pride has never been more prominent, the culture in rural North Carolina is more conservative. And while local organizations exist—like Sandhills Pride in central NC and Wilson Pride in eastern NC—they don’t always have the same support. Rural LGBTQ+ centers tend to have budgets in the thousands, not the millions. And they rely on dogged volunteers to keep them afloat. 

Sandhills Pride is based in Pinehurst. They’re like a lighthouse for local LGBTQ+ people, acting as a repository for area resources, youth-focused support groups, a listing of supportive local businesses, and more. They also work with local businesses to train them in how to be a “safe space” for LGBTQ+ people. The local school board’s policies have all but ended similar efforts in K-12 schools. 

Through Sandhills, Hersh—who sits on the organization’s board of directors—leads a youth support group that serves Moore County and the surrounding six counties. She says the group started with just one child. Anywhere from 10 to 22 kids come to their regularly scheduled meetings these days. 

“We are very visible,” Hersh says of Sandhills Pride. “And when people are starting to move into town, when they see our tent and they see a set of events, they were nervous when they got here but now they feel a little more assured that there is a network that supports them.” 

Hersh says her group works on something called “the Kindness Project.” The idea, she says, is to talk about acts of kindness in every meeting because they are sometimes surrounded by unkindness, either in politics or in their schools. 

“Our events are a beautiful thing,” says Hersh. “It’s like a family, a very large family.”

If the mental health trends are any indication, services like these are more needed than ever. 

A deeper look at the crisis among LGBTQ+ youth

According to The Trevor Project, a national organization that publishes an annual survey of LGBTQ+ youth mental health, about 41% of LGBTQ+ youth “seriously considered” suicide in the past year. Nearly two in three said that hearing about potential anti-LGBTQ+ laws and policies “made their mental health a lot worse.” 

Access is a problem, too. Roughly 56% of those surveyed said they wanted mental health care in the last year, but they weren’t able to get it. 

In 2022, the organization broke down their survey by states, and North Carolina’s results were startling. Most of the LGBTQ+ youth surveyed, between 60-74%, said they experienced symptoms of depression and anxiety. Nearly half had considered suicide, and almost 60% wanted mental health care but couldn’t access it for various reasons. Survey respondents said they were afraid to talk to a therapist, that they couldn’t pay for it, or they couldn’t get permission from a parent or caregiver, among other reasons. 

Here’s another reason: Mental health care practitioners are often hard to find in rural communities, even if you don’t identify as LGBTQ+. If you do, finding a therapist who’s affirming or experienced in working with LGBTQ+ kids is challenging, although the expansion of telehealth services since the COVID-19 pandemic has helped bring opportunities.

There are affordability concerns, too. NC health leaders are hopeful that the state’s long-delayed expansion of Medicaid services, approved by the legislature and signed by Gov. Roy Cooper in 2023, will make a difference. Medicaid is especially significant in rural communities, where people are more likely to live close to or below the poverty line.

After expansion, hundreds of thousands of people who didn’t qualify for Medicaid benefits before now do in North Carolina, and additional state dollars budgeted by the legislature will allow the state to boost its stagnant Medicaid reimbursement rate for mental health services. Before, there was little incentive for mental health providers to offer care to Medicaid recipients because reimbursement from the state was so low.  

“We have individuals living in the state where they can have an entire county where there is maybe one mental health provider in-network with your insurance,” says Kelsey Marano, a licensed clinical social worker in the Wilmington region. “And they are very costly out of pocket.”

Marano specializes in working with LGBTQ+ youth and trauma. 

Kelsey Marano, a licensed clinical social worker in Wilmington, specializes in working with LGBTQ+ youth and trauma.

“We’re in desperate need of services, especially for youth,” she told Cardinal & Pine. And rural communities need affirming and supportive therapists that interact with school systems and families. 

“Too many people are falling through the cracks,” she says. 

Lora Pilcher has been a therapist in Moore County for 11 years. She specializes in working with LGBTQ+ identifying youth. She traces her interest to her time at an inpatient hospital in Illinois, where she completed her grad program. 

“I kind of observed how specifically female-identifying teenagers, if they had different gender identity or different sexual orientations than heterosexual, they were treated as attention seeking,” Pilcher says. 

“That really bothered me how they weren’t validating,” Pilcher says. “Their sexuality was seen as a symptom instead of their identity.”

Lora Pilcher is a licensed clinical mental health counselor who works with LGBTQ+ centers in central NC.

Now Pilcher works with organizations like Sandhills Pride and Out Raleigh to provide care in central NC. It’s more important than ever because she said LGBTQ+ youth, especially in rural communities, are living in unsupportive environments. They’re bullied and harassed, and local school boards made their lives harder with policies like the Parents’ Bill of Rights.

“All the things that made them feel safe are being dismantled,” Pilcher says. “And they hear the rhetoric that is on the news and social media. It’s awful.”

Pilcher says many of the people behind the anti-LGBTQ+ rhetoric aren’t affected by the policies they pass, so it’s easier for them. She said the tide of anti-LGBTQ+ sentiment is fueled by misinformation too, especially concerning trans youth. 

Before Republican lawmakers passed a ban on gender-affirming procedures for trans youth, anti-LGBTQ+ activists talked like it was commonplace for trans youth to receive gender-affirming surgeries, but it’s not. And when trans youth do receive those procedures, it’s preceded by years of care from doctors and therapists. 

“They have to have three different letters of why it’s medically necessary for that to happen before they’re 18,” Pilcher says. “And it’s usually because of high suicidality, poor mental health, and even then they have to have their symptoms managed before the surgeon will perform surgery.”

“A (cisgender) woman can go get breast augmentation cosmetically, and nobody questions that,” Pilcher added. “She doesn’t have to have a million letters from doctors and therapists saying that this is necessary.”

What LGBTQ+ youth need

Therapists and parents who spoke with Cardinal & Pine say what LGBTQ+ youth need is more support, inclusive communities, and informed, accessible health care. 

Healthcare providers need to be trained and informed on LGBTQ+ youth. They need inclusive-looking websites. Schools need to be open and inclusive as well. It’s in the schools, and on social media, where many LGBTQ+ youth are bullied.

“I don’t envy kids growing up in 2024,” says Marano. “It is the wild west out there on the internet.”

When talking with these youth, Pilcher says you can’t be dishonest about the world. 

“Those fears and what they’re hearing are so valid because we’ve seen in our own state that those (anti-LGBTQ+) people are getting elected and laws are being passed that are hurtful. And so I kind of encourage kids to get connected with community, especially those I work with in therapy, to combat the isolation piece and to let them know that there are loving, supporting people out there. And yes, the world is scary. What’s going on in politics is scary now. But there are ways to get support and community supports.”

“Start small,” says Marano. “Start in your own community and your own backyard. There are kids right now down the street from you, in your school sitting next to you in class, that need help and that need people to listen. I think it goes a very, very long way and allows us to make that kind of bigger seismic change over time.”

And, if all else fails, you can wave that rainbow flag, says Hersh, especially in the places you don’t often see it, like on the green in downtown Southern Pines. 

“When someone sees the flag, they feel a little bit better and a little bit less alone,” Hersh says.