Why Rural Missouri Still Doesn’t Have Enough Therapists — and What Must Change
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By Lilly White, LCSW
As a licensed clinical social worker in Shelby County, Missouri, I regularly witness the heartbreak of our mental health crisis. Not long ago, I received a call from a family member searching for therapy for a teenager who had recently lost both parents. I had to tell them I was full — my waitlist had grown too long. All I could offer was a referral to a provider in a neighboring county, with no guarantee of faster care, and adding in the challenges of travel, additional time, and cost to do so.
This is not an isolated incident. Across rural Missouri, countless families face the same roadblock: there simply aren’t enough mental health professionals to meet the need.
A Widening Gap in Rural Mental Health Care
Missouri’s rural counties have some of the lowest provider-to-resident ratios in the nation, and many are designated as Mental Health Professional Shortage Areas (MHPSAs) by the federal government. Shelby County is one of them. We are not just underserved — we are in crisis.
Data from the Missouri Department of Mental Health’s Behavioral Health Profile shows troubling trends:
Rates of suicide and depression exceed state and national averages.
Firearm-related suicides remain high in our region.
Mental distress, juvenile court involvement, and substance-related hospitalizations are all on the rise.
These indicators paint a stark picture: rural Missourians are struggling with complex, ongoing trauma, and far too many are doing so without adequate professional support.
Why This Is Happening
Part of the problem is access. In many rural areas, broadband limitations restrict telehealth options. For those without internet access, even remote therapy becomes impossible.
We also face a recruitment and retention crisis. Young mental health professionals often leave rural areas due to low pay, professional isolation, and lack of training support. And providers who do stay are often stretched thin, managing overwhelming caseloads with few local resources.
Promising Policy Solutions
There are, however, concrete policy solutions being debated at the state level right now — and we need our communities to pay attention:
SB 94 – Telehealth Equality Act: Ensures that audio-only telehealth visits are covered just like in-person or video sessions. This is crucial in areas without strong internet access.
HB 1925 – Rural Healthcare Professional Grant Program: Offers financial incentives for providers to practice in rural communities.
Residency Slot Expansion: Adds training positions in psychiatry and primary care in underserved counties, helping “grow our own” future professionals.
CCBHC and CMHC Expansion: Increases the number of Certified Community Behavioral Health Clinics across Missouri, particularly in rural counties.
Protect Medicaid and Rural Hospitals Act: Shields rural hospitals from devastating funding cuts and helps preserve the infrastructure needed to support behavioral health services.
What You Can Do
This is a call to action.
If you live in our rural community, it’s time to get involved:
Learn about the issues facing your local mental health system.
Contact your legislators and urge them to support policies that improve access, training, and funding for rural providers.
Talk to your neighbors. Mental health is not just a private issue — it is a public one, with real consequences for schools, businesses, emergency services, and entire communities.
We cannot solve a shortage by hoping for more therapists to appear. We must build the systems, pass the laws, and fund the programs that make rural mental health care viable. The well-being of our children, families, and neighbors depends on it.
About the Author
Lilly White, LCSW, is a licensed clinical social worker based in Shelby County, Missouri. She is trained in EMDR (Eye Movement Desensitization and Reprocessing) and specializes in treating adverse childhood experiences (such as abuse or neglect), trauma, and PTSD. For further information or to discuss EMDR and behavioral health access in rural communities, she can be reached at [email protected].
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