Adverse Childhood Experiences (ACEs), substance use, and mental and behavioral health challenges remain significant concerns in Onslow County. Indicators such as limited access to mental and behavioral health treatment, opioid-related harm, child maltreatment, and juvenile involvement with the justice system highlight the need for increased support—particularly prevention-focused services. In 2025, Onslow County DSS assessed 1,762 child protective cases, underscoring the continued demand for services that support children and families and address risk factors early.

Substance use continues to have a substantial impact on individuals and families in Onslow County. In 2025, there were 85 emergency department visits for drug overdoses per 100,000 residents, and the overdose death rate was 23 deaths per 100,000 residents. These figures demonstrate the ongoing burden of substance use and the importance of coordinated prevention, treatment, and harm-reduction efforts across the community.

Mental and behavioral health are critical priorities in Onslow County. The 2024 Community Health Needs Assessment (CHNA) identified behavioral and mental health as a top priority need—alongside chronic disease prevention—guiding Health Department efforts through 2027. The assessment confirmed a continued high need for mental health and substance use resources, and this prioritization directly informs Community Health Improvement Plans (CHIPs) to address service gaps. These findings reflect input from community surveys, data analysis, and collaboration among the Health Department, Onslow Memorial Hospital, and local stakeholders.