Michigan’s rural residents face different challenges when accessing mental health care. Lack of transportation, loneliness, and limited group therapy options can compound mental health needs. To address these challenges, community mental health (CMH) agencies like Sanilac County Community Mental Health (CMH) innovate community-based solutions that meet their populations where they're at. 

MI Mental Health spoke with Will Morris, CEO, Sanilac County CMH, about how he and his staff tailor services to meet their communities’ needs. 

This interview has been condensed for length and clarity.

Q. Do the mental health care needs of Michigan's rural residents differ from those of urban residents?

A. The answer to that is yes and no. No in the regards that everybody's specific mental health needs are very individualized, based on each person’s own lived experiences and symptomology. There are a lot of similarities in both urban and rural settings as far as diagnoses, trauma, and those kinds of things. The needs are different in rural areas because transportation is a much larger issue. Loneliness is a much larger issue. 

If we were in Detroit, Grand Rapids, or Lansing, and we wanted to do a support group for people who have lost loved ones, we would probably have dozens of people interested. In a rural area, you might get one dozen people who are interested, but each one is available at a different day and time or in different corners of the county. So you can’t get more than one or two people together. Because groups are much harder to run, services, in general, are more individualized. 

We probably do a significantly higher volume of community-based care home visits than other areas do. And we have a harder time doing social recreational activities and providing in-home help because it's harder to find enough employees willing to do that kind of travel for the salaries that we're able to pay for those positions.

​​There are certain regulatory restrictions that make it really hard for rural communities. We are a CCBHC [certified community behavioral health clinic]. CCBHCs are required to have mobile crisis teams and crisis service after hours. When we read the application, I thought, “That’s not cost-effective to do a team like they do in the city.” They might not get called out once in an eight-hour shift. So, we do an after-hours on-call system. Two staff are there so when a call happens, they can go out. It’s much more cost-effective and allows us to tailor services to the needs of our community.  

Sanilac County CMH is very involved in community events, partnerships, and programming, even the annual Santa Claus parade.

Q. What strategies or programs have you developed to address the challenges of delivering rural care? 

A. We distributed iPads to all of our law enforcement and first responders across the county. When there's an individual with behavioral health concerns, they can divert them when appropriate, assessing them for hospitalization or for other types of treatment services.

Being very rural, Sanilac County doesn't have the best high-speed internet. In a lot of communities, they use video technology so people can see their therapist from home. We created video rooms, so our citizens could come into the building and see their psychiatrist here. They also get face-to-face contact with a CMH staff person that can make sure that their needs are met.

Q. Sanilac County CMH is very involved in community events, partnerships, and programming. How does that help deliver care to more of your rural residents?

A. In rural communities, historically, stigma related to mental health and substance use disorder issues is a lot higher than in urban communities. So the more involved I am and the more involved my agency is, the more we can get people to understand that we're here to support the community in general — not a specific subset, not a specific person, but the community.

Building culture in the communities is so important. When I got this position, I moved to the county. I'm actually on the village council of the village I live in. I'm very active in our local community. My wife's on the arts council and does lots of work with the library. We immersed ourselves in the community so we could hear what the community was saying, so that we can adjust the agency's presence to meet those needs when they come up. 

Sanilac County CMH is part of the community. We step up whenever it’s necessary. We have lots of community partners. If I picked up the phone right now and said we needed something, someone would come through for us because they know they could call us, and we would do the same.

Like all Michigan community mental health agencies, Sanilac County CMH cares for residents of all ages.

Q. What else is important to consider when delivering mental health services in rural areas?

A. It’s really important to look at the community experts. You need to sit down with the sheriff. You need to sit down with the county administrator, the local municipality leaders, the directors of the homeless shelter, and the health department. You need to talk about what the community needs are and look at it from a community perspective, not just a CMH perspective. Then, tailor the CMH services to meet those specific needs in the most cost-effective way possible.

That's one of the strengths that we have in the Michigan system. Even though we have set rules, set services, and set things that we have to do, there is a level of flexibility. I don't have to spend $250,000 on a crisis van. I can take that $250,000 and invest it into smaller vehicles so 12 people can get out to help individuals in any corner of the county versus having one big van sitting in a parking lot. That flexibility and really understanding the pulse of your community is the biggest key.

Estelle Slootmaker spends most workdays as a journalist and book editor. She is also the author of a fun, new children's picture book, Places Where the Sun Don't Shine. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz. 

Photos, in order of appearance, Colin Westbrook, Liz Fredendall, and courtesy Sanilac County Community Mental Health.

The MI Mental Health series highlights the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, LifeWays, Michigan Health and Hospital Association, Northern Lakes Community Mental Health Authority, OnPoint, Sanilac County Community Mental Health, St. Clair County Community Mental Health, Summit Pointe, and Washtenaw County Community Mental Health and Public Safety Preservation Millage.