Building and Sustaining a Statewide Telepsychiatry Network: Lessons Learned from the North Carolina Statewide Telepsychiatry Program (NC-STeP)

BACKGROUND: North Carolina faces persistent shortages of psychiatric professionals, particularly in rural and underserved regions, resulting in prolonged emergency department (ED) boarding, avoidable psychiatric hospitalizations, and inequitable access to behavioral health services. The North Carolina Statewide Telepsychiatry Program (NC-STeP), launched in 2013, is one of the nation's longest-running statewide telepsychiatry programs. OBJECTIVE: To summarize the development, implementation, outcomes, and lessons learned from NC-STeP across ED, community, maternal, pediatric, and university settings. METHODS: Data were synthesized from NC-STeP operations, service data, and peer-reviewed publications (2013-2025). RESULTS: NC-STeP completed 67,543 ED psychiatric assessments, prevented 11,802 hospitalizations, and generated $63.7 million in cost savings. Telepsychiatry increased safe discharges, reduced ED boarding, improved access, and revealed persistent equity gaps. CONCLUSIONS: NC-STeP demonstrates a scalable statewide telepsychiatry model improving throughput, reducing avoidable admissions, and expanding equitable behavioral health access.