Putting School-Based Mental Health Services in Place: Evidence from Rural Tennessee

• In Event: Suicide and Mental Health Inequities in the U.S.: Evidence from Policy, Place, and Practice

Abstract

While the prevalence of mental health conditions is similar among rural and urban Americans,rural Americans are significantly less likely to receive mental health treatment (Morales et al.,2020) . Students in rural districts thus face particular challenges in accessing needed mentalhealth care, and schools are often important access points to care for rural youth (Angold et al.,2002) . Tennessee districts have worked hard to expand access to school mental health care inschools, yet districts continue to face hurdles in delivering services. These hurdles are oftenunique and particularly salient in rural communities. There is a small but growing literature thatinvestigates the barriers to providing school-based mental health care in rural schools. A majorlimitation of this research is that many studies focus on single counties or small case studies. Ourstudy conducts a cross case analysis of semi-structured interviews with Coordinated SchoolHealth Directors from nearly 50 counties across the entire state of Tennessee and seeks tounderstand the ecology of school-based mental health services in rural Tennessee. We ask:

1. How do Tennessee coordinators of school health perceive the location of rural schooldistricts to shape the mental health needs of their students?

2. How do they perceive the location of rural districts to position them within externalfactors that contribute to the provision of student mental health?3. How does their perception of student needs and external factors relate to their strategicapproach?

Analysis for this study is ongoing. Initial evidence highlights the interplay between districtfunding for SBMH, local labor markets, and community partnerships. Rural districts frequentlyidentify recruiting certified mental health staff as a reoccurring challenge. In some cases, districtsconnected staffing challenges with their limited SBMH funding, noting that they are unable topay staff as much as elsewhere in the state. In contrast, other districts emphasized that even whenthey have funding for a position, it can be hard to recruit highly trained individuals to live in thearea. Further, the time-limited nature of much SBMH funding can further increase staff turnoverwhen positions may be eliminated or created on a year-to-year basis. While staff recruitment canbe a challenge, districts engage in a number of strategies to build personnel capacity. Districtstaff work closely with external providers to retain experienced staff who are personallycommitted to the local area by shifting individuals between grants and employers as fundingstreams come and go.

Author

• Liliane Nienstedt, Vanderbilt University
  Presenting Author