State of the County Health Report 2025
A Community Health Needs Assessment (CHNA) is a continuous process that brings together a wide range of agencies, providers, and community members to identify local strengths, resources, and unmet needs. This collaborative effort is led by Healthy Carolinians of the Outer Banks. The following State of the County Health (SOTCH) Report provides an update on progress made in response to the findings of the 2024–2025 Community Health Needs Assessment. The 2025 Dare County SOTCH was submitted to the North Carolina Department of Health and Human Services (NCDHHS) on March 2, 2026.

This report focuses on the identified priority health issues of mental health and substance use. It also includes updated data on Dare County mortality and morbidity rates, along with information on emerging issues and new initiatives.

Ongoing communication with stakeholders and community members about identified health priorities and progress to date is essential to improving community health outcomes. After review by the Dare County Board of Health & Human Services and the Healthy Carolinians of the Outer Banks Executive Committee, the 2025 State of the County Health Report will be shared with partner organizations and the broader community. Printed copies will also be available in department lobbies.

About Dare County
Dare County is located in northeastern North Carolina and spans approximately 110 miles along the Atlantic coastline, an area widely known as the Outer Banks. The county seat, Manteo, is situated about 200 miles east of Raleigh. The nearby Virginia Beach area provides convenient access to additional dining, shopping, and air travel through Norfolk International Airport.

As home to the Outer Banks, Dare County is a well-known tourist destination. During the summer season, the population increases significantly, with more than 300,000 visitors arriving weekly. The county features several notable attractions, including Cape Hatteras National Seashore, Wright Brothers National Memorial, Fort Raleigh National Historic Site, Alligator River National Wildlife Refuge, Pea Island National Wildlife Refuge, Jockey's Ridge State Park, Elizabeth II State Historic Site, Roanoke Island Festival Park, North Carolina Aquarium on Roanoke Island, and Nags Head Woods Ecological Preserve.

The county includes six municipalities: Duck, Kill Devil Hills, Kitty Hawk, Manteo, Nags Head, and Southern Shores. Dare County operates under a Commissioner–Manager form of government. Its seven-member Board of Commissioners serves staggered four-year terms.

According to 2023 estimates from the U.S. Census Bureau, Dare County has a population of approximately 38,882, with a nearly equal distribution of males and females.

Substance Misuse

Opioid Settlement Funds
Dare County is part of North Carolina’s historic $26 billion settlement agreement that is bringing desperately needed financial relief to communities impacted by opioids. In Dare County, these funds are being used to support treatment, recovery, harm reduction resources, and other life-saving programs and services. 

Funds have been allocated for the following initiatives:

• Overdose Response and Linkage to Care

• Recovery Court

• Reentry initiatives and detention center support

• Tuition for inpatient treatment

• Social Determinants of Health

Dare Challenge
Facility Expansion
In 2025, expansion of the Outer Banks Dare Challenge residential recovery facility in Wanchese was still underway as part of a multi-year construction project begun in 2022 and broken ground in 2024. The roughly $6 million project—supported by state, county, and private funding—centers on a large multipurpose building and two new dormitories designed to triple the program’s capacity from about 15 residents to as many as 40–60 men receiving substance-abuse recovery services. County planning documents listed the project’s completion date as still to be determined in 2025, indicating construction and development activity continued at the Wanchese campus during that year.

Women’s Center
The Dare Challenge Women’s Center opened in Wanchese in early 2025 as the first residential recovery facility on the Outer Banks dedicated specifically to women struggling with addiction and other life-controlling issues. Located on a small farm property on Roanoke Island, the center was designed to house about six residents at a time and provide a faith-based recovery program modeled after the long-running Dare Challenge men’s program. The facility includes agricultural and animal-care activities—such as gardening, caring for horses, and farm work—as part of therapy and life-skills development in a peaceful residential setting. Plans for the project were completed in 2024 with a community grand opening targeted for January 2025, marking a major expansion of local substance-abuse recovery services for women in Dare County.

Recovery Court
In 2025, Recovery Court experienced significant growth and transformation. Following the retirement of Judge Jerry Tillett, Judge Robert Trivette has taken on leadership of the program.

The program transitioned from a two-phase structure to a more comprehensive five-phase program to better support participants throughout their recovery journey. In addition, a formal Policies and Procedures Manual and a Participant Handbook were developed to provide clear guidance and structure.

A new case management system, Drug Court Information Management System, was implemented which enhances the program’s ability to track participant progress, promote accountability, and provide timely reminders of upcoming court dates and requirements.

To further strengthen the team, members received specialized training aimed at improving processes and collaboration. Recovery Court’s support network was expanded by adding a primary care physician and a counselor who prioritize Recovery Court participants. This coordinated approach allows one physician to oversee and monitor prescriptions, ensuring safe and consistent medical care.

A nonprofit organization was established to provide community members with the opportunity to support the Recovery Court. Donations will help fund participant treatment services and ongoing training for staff and team members, ensuring the continued growth and effectiveness of the program.

Recovery & Ongoing Support Services
The program continued its upward momentum in 2025, with two additional staff members beginning the required coursework to become North Carolina Certified Peer Support Specialists, scheduled for completion in summer 2026. This expansion supports continued operation of the Mobile Recovery Services Unit—known in the community as the Recovery Bus—which provides weekly mobile support and harm-reduction resources across Dare County. In addition to more centrally located townships, services include regular visits to Hatteras Island, Stumpy Point, and Manns Harbor. The mobile unit also continued offering free, confidential HIV and Hepatitis C screening and referrals, as appropriate. A sustained partnership with Beach Food Pantry enabled distribution of more than 3,000 pounds of non-perishable food during 2025 site visits. The addition of Peer Support Specialists also strengthened Post Overdose Response Team (PORT) activities in collaboration with Dare County EMS, increasing peer-support services and linkage to care throughout the community.

Management of the Dare County Syringe Services Program (SSP) fully transitioned from Community Care Clinic of Dare to the mobile unit. This allowed continued service to existing participants while expanding access through a by-appointment SSP option, particularly benefiting residents in rural areas with transportation barriers. The program also received a state grant from the North Carolina Harm Reduction Coalition that provided a full year of free syringes and related SSP supplies, including alcohol swabs and wound-care kits. In December 2025, the first round of a new eight-part class began at the Dare County Detention Center: InsideOut, a SMART Recovery–based correctional program. Developed by the SMART organization in partnership with the Arizona Department of Corrections, the curriculum delivers a cognitive-behavioral therapy–based substance-use-disorder program for both female and male incarcerated individuals.

Mental Health

Mental Health First Aid
The Dare County Department of Health & Human Services Youth Mental Health First Aid instructor expanded their certification to teach the Adult Mental Health First Aid course. Another staff member also earned certification as a Youth Mental Health First Aid instructor. These new certifications expand capacity to offer Mental Health First Aid programs to the community.

Mental Health & Addictions Counselors Roundtable Meetings
The Breaking Through Task Force hosted four Mental Health & Addictions Counselor Roundtable events in partnership with the Dare County Department of Health & Human Services. Approximately 10 counselors attended these events, which included a continuing education component. The group is now exploring the opportunity to establish a community response team of counselors who could be available to provide support during distressing events that have a far-reaching impact on our community.

Sound Minds Grant
In 2025, Dare County continued supporting the Sound Minds mental-health grant program, a collaborative initiative that connects uninsured and underinsured residents with counseling and treatment services. The program, which is operated through partnerships among Interfaith Community Outreach, Outer Banks Relief Foundation, and the Dare County Department of Health & Human Services, provides financial assistance so residents can access therapy, substance-abuse treatment, and other behavioral-health care regardless of ability to pay. In 2025, the county allocated additional local funding to the program, building on earlier foundation grants and private donations that helped establish Sound Minds as an ongoing community resource addressing Dare County’s behavioral-health needs.

School Behavioral Health Program
In response to increasing mental health needs among students and in an effort to reduce barriers to accessing care, Dare County DHHS partnered with Dare County Schools to launch the School-Based Behavioral Health Program during the 2025–2026 school year. With strong support from community stakeholders, the initiative experienced early engagement and broad community support.

The program is staffed by 3.5 full-time equivalent positions, including a combination of contract and permanent employees. The team consists of two licensed mental health therapists and two licensed clinical social workers who provide services to students across all 10 schools in the district.

The program began with the start of the 2025-2026 school year.  With a current caseload of more than 80 students, and additional students referred for outside services each week, the program reflects both its meaningful impact on the youth in our community and the clear need for future expansion.

DCDHHS Behavioral Health Services
The Behavioral Health Program offers counseling services to individuals and families through Dare County Department of Health & Human Services (DCDHHS). Emphasizing interagency collaboration, most referrals come from in-house healthcare providers and social services staff.

The program employs two full-time Licensed Clinical Mental Health Counselors who provide services across three locations in Dare County: Manteo, Nags Head, and Frisco. Clients range from school-aged children and adolescents to adults and older adults. One counselor is bilingual, allowing services to be delivered in both English and Spanish.

In addition to counseling services, a clinical psychiatrist provides monthly medication evaluation and management for adult clients currently enrolled in the program, based on referrals from the program’s counselors.

In 2025, 97 referrals were made to the DCDHHS Behavioral Health Program. An average of 89 visits per month were conducted, and each counselor maintains a caseload of approximately 24-30 clients.

Access to Healthcare

The Access to Healthcare Task Force reviewed both quantitative and qualitative data from the most recent Community Health Needs Assessment and identified its primary priority as improving awareness of available healthcare services in Dare County. While the group recognizes that many medical services are available locally, it also understands that residents may need assistance identifying and navigating these resources.

The Task Force further acknowledges that some healthcare services are not available within Dare County. As part of its efforts, the committee aims to help residents understand why certain services must be accessed outside the county and provide guidance on how to obtain them.

To advance this work, the committee is partnering with the Dare County Department of Health and Human Services (DCDHHS) on a pilot artificial intelligence initiative designed to support residents in locating, understanding, and accessing healthcare services.

Changes in Mortality

Mortality Data (2012-2016, 2013-2017, 2014-2018, 2015-2019, 2016-2020, 2017-2021, 2018-2022, 2019-2023)

(Chart Source: NC State Center for Health Statistics, County Health Data Book (2018, 2019, 2020, 2021, 2022, 2023, 2024) Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; https://schs.dph.ncdhhs.gov/data/databook/)

The chart shows that heart disease and cancer have consistently remained the leading causes of death over the period, with heart disease declining through 2016–2020 and then rising again to 148.4 in the most recent column (2019–2023). Cancer shows an overall gradual decline compared with earlier periods, despite a small uptick in the latest column. Several causes—especially pneumonia & influenza and chronic lower respiratory disease—have decreased steadily over time, reaching their lowest levels in the most recent period. In contrast, unintentional non-motor-vehicle injuries rose sharply over the decade, peaking in 2018–2022 before easing slightly in the latest column, indicating a major emerging contributor to mortality.

Changes in Morbidity

Adults with Diabetes & Obesity

Diabetes & Obesity Prevalence (2014, 2015, 2016, 2017, 2019, 2020, 2021, 2022)

(Chart source: County Health Rankings, Dare County Profiles (2024, 2023, 2022, 2021, 2020, 2019, 2018)

The chart shows that the share of adults 20+ with diabetes has declined modestly over time, from about 10–11% in 2014–2017 to 8% in the most recent years, with no change between 2020 and 2022. In contrast, adult obesity has risen overall since 2014, increasing from the mid-20% range to around 30% by 2022, despite some year-to-year fluctuation. In the latest column, obesity decreased slightly from 32% in 2021 to 30% in 2022, while diabetes remained steady at 8%, indicating stabilization for diabetes but persistently high obesity prevalence.

Cancer Incidence Rates

Cancer Incidence Rates (2010- 2014, 2013-2017, 2015-2019, 2016-2020, 2017-2021)

(Chart Source: https://www.statecancerprofiles.cancer.gov/incidencerates/)

The table shows cancer incidence rates across several cancer types from 2010–2014 through 2017–2021. Overall cancer incidence declined from 480.0 in 2013–2017 to 426.6 in 2017–2021 after a dip in 2016–2020, suggesting a generally stable recent trend. Breast and prostate cancers remain the most common, with breast cancer increasing steadily over time to 148.4 in 2017–2021. Lung and bronchus cancer incidence decreased markedly from 77.3 in 2013–2017 to 51.9 in 2017–2021, while colorectal cancer shows the clearest decline, falling from 37.3 to 24.6 over the same period. Most other cancer types display relatively stable incidence rates with minor fluctuations.

Measles
Measles remains an emerging health concern due to increasing outbreaks nationally and globally, despite the absence of confirmed cases in Dare County at this time. Given its high transmissibility and potential for serious complications, the DCDHHS is proactively strengthening surveillance, education, vaccination outreach, and response planning. These preparedness efforts are intended to ensure rapid identification, containment, and protection of vulnerable populations should cases occur locally.

Buxton Formerly Used Defense Site
In 2025, the main activity at the Buxton Formerly Used Defense Site was ongoing cleanup of petroleum contamination and storm-related damage along the shoreline in Cape Hatteras National Seashore. Early in the year, the U.S. Army Corps of Engineers formed and held meetings of a Restoration Advisory Board to involve the community and plan comprehensive soil and groundwater sampling. 

By August 2025, petroleum odors and sheen observed at the site led to another interim response action, closure of a stretch of beach, and excavation plans to remove contaminated soil. Hurricane Erin then worsened erosion and exposed additional contaminated material and debris, including asbestos pipe, prompting assessments and debris removal. Through September 2025, contracts and funding were awarded for Phase II cleanup, bringing heavy equipment to excavate and dispose of petroleum-impacted soil and groundwater; work continued at the active construction site with beach closures and safety advisories in place.

Collapse of Homes in Buxton
In 2025, 22 homes collapsed into the ocean due to erosion and shoreline retreat. To help monitor water quality and potential public health threats, Dare County Department of Health & Human Services initiated quarterly water and soil (sand) testing in collaboration with the National Park Service. This involves compromised septic systems that require additional response from and demand on DCDHHS’ Environmental Health Unit.

New Initiatives

UNC School of Social Work Behavioral Health Needs Assessment
The University of North Carolina at Chapel Hill’s School of Social Work (Office of Community Engagement and Outreach) and the Dare County Department of Health & Human Services will collaborate to evaluate and enhance behavioral health services in Dare County. From January 1 through May 31, 2026, the partners will engage stakeholders, conduct a comprehensive behavioral health landscape analysis—including needs assessment and system mapping—identify service gaps and priority needs, particularly for uninsured and underinsured residents, and develop recommendations to inform future multi-year funding proposals. UNC will lead the study design, data collection and analysis, facilitation, and reporting, while Dare County DHHS will contribute local expertise, stakeholder access, data coordination, and community engagement support; both parties will provide in-kind resources and share governance through a steering committee and regular meetings. The study was scheduled to commence in January 2026.

School Behavioral Health Program
The program began with the start of the 2025-2026 school year.  With a current caseload of more than 80 students, and additional students referred for outside services each week, the program reflects both its meaningful impact on the youth in our community and the clear need for future expansion.

Hepatitis C Treatment Available at DCDHHS
The Dare County Department of Health & Human Services (DCDHHS) is now providing both screening and treatment for hepatitis C. 

Patients can now make appointments directly with the public health division or get a referral from their primary care physicians.  The new service eliminates the need for patients to obtain treatment outside of the county. 

Pre-Exposure Prophylaxis (PrEP) for HIV
PrEP for HIV is a highly effective HIV prevention strategy that is now available at DCDHHS.  Discussions about PrEP are a crucial part of comprehensive health and HIV prevention. Anyone can schedule an appointment with the public health division to meet with our providers to discuss.  No referral is necessary.