Breaking Down Barriers to Mental Health Care
Mental Health Cooperative (MHC) is pioneering innovative approaches to address one of Tennessee’s most pressing challenges: ensuring rural communities have access to quality mental health services. As the state works to overcome significant disparities in care, MHC stands at the forefront of efforts to deliver comprehensive, trauma-informed behavioral health services where they’re needed most.
The Critical Need in Rural Tennessee
Tennessee faces a severe mental health crisis, particularly in rural areas. The state ranks 42nd nationally for mental health care access, with one mental health provider for every 560 people compared to the national average of one provider per 340 individuals (Tennessee Department of Mental Health and Substance Abuse Services). This shortage is even more pronounced in rural counties, where 95% of Tennessee counties have Health Professional Shortage Area designations for mental health (Tennessee’s Mental Health Workforce Shortage Report).
The statistics paint a sobering picture: rural suicide rates in Tennessee average 18.8 per 100,000 residents, significantly higher than the 14.4 per 100,000 reported in urban areas (WGNS Radio). Rural Tennesseans are four times more likely than their urban counterparts to die by suicide, with men experiencing rates of 32.0 per 100,000 compared to 7.2 per 100,000 for women.
“61% of Tennesseans reside in rural counties, and TDH data shows that people living in rural counties are more likely to die by suicide than those living in urban areas,” according to the Tennessee Department of Health (Rural Tennesseans and Suicide Infographic). The highest need is concentrated in rural counties with high poverty rates, where individuals may drive as far as 100 miles to access mental health services.
Tennessee’s Comprehensive Safety Net
Tennessee has developed a robust Behavioral Health Safety Net (BHSN) that serves as the foundation for MHC’s rural outreach efforts. This state-funded program provides essential outpatient mental health services to uninsured Tennessee adults and children who meet eligibility criteria through a network of 15 Community Mental Health Providers serving all 95 counties (TN.gov Behavioral Health Safety Net).
“If you’re in this state and you’re 133% of the federal poverty level or below, and you’re a kid or an adult, you can get the services you need through the Safety Net. That provides assessment, medication, therapy, group therapy, whatever that person needs, transportation to even get to the service,” explained Marie Williams, Commissioner for the Tennessee Department of Mental Health and Substance Abuse Services (NewsChannel 5).
The BHSN system served 34,325 adults and 1,855 children in FY24 across 149 physical locations statewide (TN.gov Behavioral Health Safety Net). Essential services include assessment and evaluation, individual and family therapy, psychiatric medication management, pharmacy assistance, peer support, and transportation.
MHC’s Strategic Expansion
MHC has demonstrated remarkable growth in addressing rural needs. Originally founded in Nashville in 1993, the organization has expanded to become Tennessee’s premier provider of behavioral health services for individuals with severe mental illness and substance use disorders. In 2023, MHC made a significant strategic move by opening its first West Tennessee location in Memphis, establishing a footprint that now spans twelve locations across the state.
“MHC’s top priority is making mental health resources both accessible and affordable for all,” says MHC CEO Michelle Schafer. This commitment is reflected in the organization’s comprehensive service model, which integrates behavioral health, physical health, and substance use services with a focus on those who might not otherwise afford such critical care.
The organization accepts all TennCare plans and has programs for uninsured individuals who meet financial guidelines, including those at or below the poverty line (High Ground News). This approach ensures that rural Tennesseans, who often face both geographic and economic barriers to care, can access needed services regardless of their ability to pay.
Innovative Service Delivery Models
Mobile Crisis Response
MHC operates as part of Tennessee’s comprehensive crisis services continuum, serving as the designated crisis response team for adults and children in Nashville-Davidson County. The organization’s mobile crisis teams comprise clinicians who provide assessments, brief interventions, and linkages to ongoing care for individuals experiencing mental health crises.
Our crisis services are available 24/7. Services are provided at no cost to you and walk-ins are always welcome. This approach is particularly crucial for rural areas where traditional office-based services may be hours away.
Telehealth Integration
Tennessee has embraced telehealth as a viable solution for rural access challenges. The Tennessee Department of Mental Health and Substance Abuse Services recognizes telehealth as “a viable option for access to behavioral health services and enhancing the efficiency of the crisis service delivery system” (Tennessee Telehealth Guidelines).
MHC has integrated telehealth services throughout its operations, enabling the organization to reach rural clients who might otherwise go without care. This technology-driven approach allows for live, interactive audio-video communication between individuals in need and healthcare practitioners, reducing transportation expenses and improving access to care .
Crisis Stabilization Expansion
A significant milestone in MHC’s rural outreach efforts is the upcoming opening of the Children & Youth Crisis Stabilization Unit (C&Y CSU) in Fall 2025. This new facility will provide short-term mental health support for children and teens ages 4-17, featuring:
- 15 beds for short-term stabilization care
- 2 observation beds
- No cost to families regardless of insurance coverage
- Services available to those with or without insurance
This development addresses a critical gap in youth mental health services, particularly important given that Tennessee ranks 50th in access to care for youth, with more than two-thirds of Tennessee youth with clinical depression going untreated (Tennessee’s Mental Health Workforce Shortage Report).
Collaborative Partnerships and Support
Tennessee Voices for Children
MHC works closely with Tennessee Voices for Children, a statewide advocacy organization that has become a “statewide and national source of referral, support, and advocacy for families and the systems that serve them” (TN Voices About). Tennessee Voices serves thousands of children, parents, and adults across all 95 counties with services that prevent crisis, heal trauma, and build long-term stability.
“One of the very first services we offered, thanks to the Department of Mental Health and Substance Abuse Services, is for parents who have children in schools that need mental health services, so we work as advocates in the school to help families ensure that the services they need are provided, and that the child has the education they deserve,” explained Rikki Harris, CEO of Tennessee Voices (NewsChannel 5).
Centerstone Partnership
MHC collaborates with Centerstone, another key participant in Tennessee’s BHSN network. Centerstone provides services through 146 locations statewide and emphasizes the unique needs of rural communities.
“We are lucky enough to have school-based behavior health liaisons that are supported by the department,” noted Beth Hail, Centerstone’s regional vice president (NewsChannel 5). This school-based approach is particularly valuable in rural areas where schools often serve as community hubs.
Project Rural Recovery: A Model for Innovation
Tennessee’s Project Rural Recovery represents an innovative approach that complements MHC’s efforts. This program uses four mobile clinics to deliver integrated behavioral and physical health services in 20 rural counties, offering walk-in services and scheduled appointments free of charge.
The mobile units are staffed by dual-certified nurse practitioners who can provide both physical and mental health services, including onsite counseling and referrals to treatment. Each unit includes a behavioral health therapist, medical assistant, and case manager.
Key findings from Project Rural Recovery’s evaluation demonstrate the critical need these services address:
- 1 in 5 clients had not seen a primary care physician in the last 5 years
- 1 in 3 clients said they would not have received any care if the mobile clinic was not available
- 1 in 4 clients said it would have taken them over 30 minutes to travel if not for the mobile unit (RHIhub Mental Health Toolkit)
Addressing Systemic Challenges
Workforce Development
Tennessee has invested significantly in expanding its behavioral health workforce. The state has funded tuition assistance to increase the number of behavioral health professionals and expanded the types of mental health providers licensed in other states that can practice in Tennessee under multi-state compacts.
Recent legislative initiatives include a $50 million allocation from the TennCare Shared Savings program toward healthcare resiliency, demonstrating the state’s commitment to addressing rural health disparities.
Housing and Support Services
MHC recognizes that mental health care extends beyond clinical services. The organization provides comprehensive community-based care management that includes assistance with:
- Housing and budgeting support
- Medical and dental care coordination
- Vocational and educational services
- Social support and transportation resources
The Tennessee Department of Mental Health and Substance Abuse Services recently awarded $5.2 million through the Creating Homes Initiative to create 101 new beds of safe, quality, affordable housing for people living with mental illness (TN Tribune).
Looking Forward: Sustainable Solutions
Data-Driven Approach
Tennessee’s 2025 Needs Assessment identifies key priorities for rural mental health expansion. The assessment emphasizes the need to “increase the proportion of mental health providers per population” and expand crisis services continuum to include innovative alternatives to inpatient psychiatric hospitalization (Tennessee Department of Mental Health and Substance Abuse Services).
Technology and Innovation
MHC continues to explore innovative delivery methods, including the development of mobile applications and enhanced telehealth platforms. Tennessee Voices has launched MyHealthCoach, a free mental health and wellness app that provides 1-on-1 chats, video telehealth consults, and coaching by certified health coaches (TN Voices).
Community Integration
The success of rural mental health initiatives depends on deep community integration. MHC’s approach emphasizes building relationships within rural communities, recognizing that “relationships matter and are the most important part of our services” (Mental Health Cooperative).
Measuring Impact and Success
MHC’s expansion into rural Tennessee communities represents more than geographic growth—it embodies a comprehensive strategy to address systemic barriers to mental health care. The organization’s integrated approach combines clinical excellence with community-based support, ensuring that rural Tennesseans receive not just treatment, but comprehensive care that addresses the social determinants of mental health.
As “When folks don’t know where to go or what to do, they don’t really have to think about it. They can literally just come to us, walk right in, and get the help they need,” explained Michelle Schafer, CEO of the Mental Health Cooperative (NewsChannel 5).
Through strategic partnerships, innovative service delivery models, and unwavering commitment to accessibility, MHC is helping to transform the landscape of rural mental health care in Tennessee. The organization’s work demonstrates that with proper planning, adequate resources, and community commitment, it is possible to bridge the gap between urban and rural mental health services, ensuring that all Tennesseans have access to the care they deserve.
The path forward requires continued investment in workforce development, technology infrastructure, and community partnerships. But with organizations like MHC leading the charge, Tennessee is positioning itself as a model for rural mental health innovation, proving that geographic barriers need not be insurmountable obstacles to mental wellness and recovery.
