Guided by Knoster's (1991) Model for Managing Complex Change, this qualitative study explored implementing mental health focused MTSS and addressing mental health support within schools. This study focused on the experiences and perspectives of five principals and six school counselors implementing mental health MTSS within a rural Central Southwest public school district. This study provides researchers, school administrators, and school counselors a deeper understanding of mental health MTSS implementation. Knoster's (1991) Model for Managing Complex Change highlights elements for effective implementation: vision, consensus, skills, incentives, resources, and action plan. Four themes that emerged from the data included: (1) targeted support for teachers; (2) improved school climate; (3) reduced mental health stigma; and (4) continued sustainability of MTSS. In addition, the findings lead to three conclusions. These were: (1) the need for shared vision; (2) the need for continuous improvement; and (3) the need for financial responsibility. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]