Living through the COVID-19 Pandemic taught us a lot about our well-being – physically, socially, and especially mentally and emotionally. With unending days of isolation and distance, lack of routines, consistent uncertainty and fear, as well as grief and loss, the topic of conversation quickly highlighted the emotional suffering experienced by many. It emphasized that not only was living through this experience overwhelming, but the experience also exacerbated or contributed to the development of mental and emotional issues for many individuals. As the conversation continues to remain on the forefront on all systems levels, with increased community conversations and funding surrounding mental health, I offer a review of some of the effective, evidence-based approaches to a community response to mental health.

Question Persuade Refer (QPR)

From the QPR Institute https://qprinstitute.com/

The QPR mission is to “reduce suicidal behaviors and save lives by providing innovative, practical and proven suicide prevention training.” The institute highlights that quality education regarding the signs of crisis can make a positive difference in the life of those around them, regardless of backgrounds. Additionally, they stress that professionals particularly in health care do not receive adequate training in helping those at risk of suicide within their programs and that patients are unaware of this, thus more training for professionals is necessary.

QPR offers a variety of trainings based on your profession and need and one can easily determine which course is most appropriate for them here: Which Course is Right for Me?

This course covers how to question, persuade and refer someone who may be suicidal, how to get help for yourself, how to learn about preventing suicide, the common causes of suicidal behavior and the warning signs of suicide as well as how to get help for someone in crisis. Gatekeepers (Surgeon General’s National Strategy for Suicide Prevention, 2001) are those who are able to recognize a crisis and the warning signs that someone may be contemplating suicide and this can include first response, ministers and priests, teachers, neighbors, friends, parents, doctors, nurses, office supervisors, and more. Organization Trainings and Professional Training offerings are provided as well.

The QPR Individual Online Gatekeeper Training is a one-time cost of $29.95, takes only 60 minutes, and provides an active certificate for 1 year. As noted on their website, “both CPR and QPR are part of systems designed to increase the chance of survival in the event of a crisis.” QPR holds the belief that at least one person per family unit should be trained in QPR given that suicides often occur in families where these emergency interventions may be most readily needed.

Mental Health First Aid (MHFA)

From the National Council for Mental Wellbeing https://www.mentalhealthfirstaid.org/

Giving you the skills to provide initial help and support to an individual who may be developing a substance use or mental health issue or is experiencing a crisis, Mental Health First Aid is a day-long course that teaches anyone how to identify, understand and respond to signs of mental health and substance use concerns or challenges, just as a person may take a CPR class to assist in someone having a heart attack.

Challenges discussed include depression and mood disorders, anxiety disorders, trauma, psychosis, and substance use disorders, and one learns how to apply the MHFA Action plan in a variety of situations depending on what the person is experiencing via role plays, scenarios, and activities.

The foundation for the training is both that of recovery and resiliency in that individuals experiencing mental health or substance use challenges can get better and use their individual and social strengths to stay well. By the end of the course, participants will be able to assess for risk of suicide or harm, listen non-judgmentally, give reassurance and information, encourage appropriate professional health, and encourage self-help and other support strategies to another person experiencing a mental health or substance use challenge.

Versions of MHFA include: Youth, Youth MHFA for Tribal Communities and Indigenous Peoples, teenMHFA (10^th-12^th graders to assist peers and get help from trusted adult), Adult, MHFA at Work (supporting co-workers), Rural Communities, Older Adults, Higher Education (students, professors, faculty and staff to assist in those settings), Military Veterans and Their Families, Fire/EMS, Public Safety, Corrections Professionals. The course can be done both virtually (2 hours of pre-work and 6 hour live virtual course) or in-person (8-hours with physical handbook provided) with a max of 30 participants in a course.

Community Resilience Model (CRM) Training and Workshops

From the Trauma Resource Institute https://www.traumaresourceinstitute.com/crm

The Community Resiliency Model (CRM)® is a skills-based, stabilization program, training both adults and children how to track their own nervous system to bring the body, mind, and spirit back into balance and to share this knowledge with friends, family, and others in their communities. This evidence-based model has growing substantial evidence in reducing anxiety, depression, somatic symptoms and hostility indicators (State of California, Mental Health Act, CRM Innovation Project, 2013).

Communities and local organizations who are trained teachers of the model can host Community Resiliency Model (CRM)® Workshops help create “trauma-informed” and “resiliency-informed” individuals and communities with a shared understanding of how chronic stress and trauma impact the nervous system and how using this skills-based approach, resiliency and balance can be restored.  The workshops provide education on neuroscience, reactions from experiences such as poverty, racism and violence that can stress the nervous system, reducing human reactions to those types of experiences and highlighting that these common human reactions are biological rather than a mental weakness and encourage folks to integrate wellness skills daily into their lives. The iChill app is available for smartphones to promote this education as well.

Questions? Email Sara.Moscarelli@foundationhli.org

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

“A good therapist will meet you wherever you are in your journey and help you get closer to truly living your best life—however you define that.”  

Sara Herrity Moscarelli, MS, LMFT | COE Senior Project Manager

Finding a therapist can be confusing and challenging to navigate whether you have been to therapy before or are seeking it out for the first time. Our team is here to help with some tips on how to find a therapist who fits your needs. You can learn about distinct types of therapists, tips for finding the right fit, an overview of how mental health insurance works, and more. 

How can a therapist help me?  

Therapists can help you navigate life transitions, develop healthy coping skills, identify and process your emotions, and gain greater insight into your experiences. Even if you aren’t 100% sure what you hope to gain from therapy at first, a compassionate therapist can help you figure that out as you work together. 

It’s common to experience a range of emotions, including some discomfort, as you begin your therapy journey. COE Senior Project Manager Sara Herrity Moscarelli, MS, LMFT, MS, LMFT, says, “Therapy might not feel good initially. Change, growth, and healing can be hard, but it is the good kind of hard. That hard work usually doesn’t only occur in a one-hour weekly session. We see the inner transformation as the work sinks in during the other 167 hours (about seven days) in the week between sessions. Therapy is a space to slow down, reflect, process, gain insight, and learn skills, but the time between sessions is where the practice of these skills is put to work and becomes part of ourselves.” 

What types of therapists are there? 

When you search for a therapist, you will see different licensures, such as Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and Licensed Mental Health Counselor (LMHC). All these licensed professions require a master’s degree, including fieldwork experience, a state license, and certification. You can look up a therapist’s state license to verify they have met the requirements to practice. 

Other types of mental health providers include Psychologists (PhDs or PsyDs) who have Doctor of Philosophy degrees and a licensure and Psychiatrists (MDs) who have Doctor of Medicine degrees and a license to practice medicine.  

Beyond earning their degree and maintaining their license, therapists often pursue additional training in specific therapeutic approaches and models. A few examples of these include Cognitive Behavioral Therapy (CBT), Internal Family Systems (IFS), and Acceptance and Commitment Therapy (ACT).  

All licensed mental health providers receive training in treating and diagnosing individuals struggling with mental health issues. However, each licensure has a unique lens or training background with which they understand mental health. Depending on your needs, one type of therapist may be better suited for you: 

Tip: You can see more than one type of mental health provider at once to get the support you need. For instance, seeing a therapist and a psychiatrist who can prescribe medication simultaneously could be helpful. 

Is a coach the same as a therapist? 

Therapy and coaching are distinct. Coaches (aka life coaches) and therapists provide different types of support. Therapists provide mental health counseling and help people heal and develop healthy coping skills. They must have at least a graduate degree and state licensure that they need to maintain through continuing education and training. Coaches, on the other hand, help people achieve personal and/or professional goals. They may have a certification, but no education, training, or credentials are required. 

How do I find a therapist? 

If you have friends or family members who work in mental health or have been to therapy, asking them for help is a wonderful place to start. They can contact their network, recommend counselors they’ve worked with, or ask around for referrals. 

You can also search online using databases like GoodTherapy, TherapistLocator, and Psychology Today. The Psychology Today therapist finder allows you to filter your search by state, zip code, telehealth, and:  

• Issues (anxiety, depression, grief, marriage counseling, etc.)  
• Insurance (Medicaid, Medicare, Aetna, BlueCross BlueShield, etc.)  
• Types of Therapy (cognitive behavioral, acceptance and commitment, family, etc.)  
• Price (individual range, couples’ range, and sliding scale)  

You can also search by gender, age, ethnicity served, sexuality, language, and faith. 

After using the filters to narrow your search, read the therapists’ bios to get an idea of their approach, focus areas, personality, and style. If they aren’t currently accepting new patients, they will also indicate that on their profile. 

Then, you can email, call, or text the therapists you want to work with. Most providers offer a free, 15-minute consultation, typically over a phone or video call. During this time, you can ask questions and get a sense of the therapist before deciding whether to schedule an appointment. 

How do I find the right therapist for me? 

Finding the right therapeutic fit is essential—and it takes time- like searching for a place to live. Most people shop around before finding a therapist they connect with and can open up to easily. Research shows that a healthy, positive client-therapist relationship is essential for treatment success.

On top of having therapeutic approaches, specialized training, and higher education, each therapist has their own style and personality. You may also want to consider other aspects, such as cultural alignment, shared identity, and personal experience. This overlap can help you feel seen and validated. 

Many people face challenges when it comes to accessing mental health care, such as stigma, language and cultural barriers, and more. The lack of workforce diversity in the field can also play a role, making finding a therapist with a shared experience challenging. 

The majority of mental health providers are white, and there is a history of structural racism in mental health care. These factors can impact how individuals and communities of color access culturally responsive care. 

Therapy resources for Black, Indigenous, and people of color (BIPOC) 

• 7 Tips for Finding a Culturally Competent Therapist – from Someone Who’s Been There  
• FreeBlackTherapy.org 
• Therapy for Black Girls  
• Therapy for Black Men 
• Latinx Therapy 
• WeRNative: For Native Youth, by Native Youth  
• The National Asian American Pacific Islander Mental Health Association  
• Inclusive Therapists: BIPOC, LGBTQIA2S+ intersections (QTBIPOC), and Neurodivergent and Disabled Communities of Color  

If the first therapist you find doesn’t feel like the right fit, learn what you can from the experience and let it guide your search as you continue looking. “The client’s relationship with the therapist is the number one predictor of therapy success. If you have a couple of sessions, or even just one, with a therapist and you feel like you will be unable to connect with the person, just let them know,” says COE Senior Project Manager Sara Herrity Moscarelli, MS, LMFT. Therapists want what’s best for you and won’t be offended if you end up seeking support from someone else. 

Tip: Try three to five sessions to determine whether a therapist is the right fit. Trust your gut. Do you feel accepted and respected? Can you show up as your whole self? 

In-person & telehealth therapy 

Most therapists offer both in-person and virtual (telehealth) options. You should consider this when searching for a therapist, especially if you strongly prefer one over the other.  

Many people like to meet with their therapist in person, which can help build rapport and provide a safe, private space to talk. It also makes non-verbal communication easier to pick up on.  

If you have a private space where you can do your therapy sessions at home, don’t live near a therapist you want to work with, and find it difficult to travel to appointments, telehealth can be a great option. It can make therapy more accessible and allow you to be more flexible with your schedule.  

Rules and regulations for seeing a mental or behavioral health provider through telehealth vary by state. Usually, you will need to work with a therapist in your state. Depending on where you live, however, you can see a therapist in another place who is licensed to practice in your state. Check with the therapist to make sure they can see you virtually. 

In recent years, telehealth-only platforms have also become popular. Compare some popular online therapy options. 

Tip: Check with the therapist to see if you can alternate between in-person and virtual sessions. 

How much does therapy cost? 

The average price range for a 50-minute therapy session is $100 to $200. However, some therapists offer sliding scale spots. The Open Path Psychotherapy Collective has a directory of providers who provide affordable in-office and online services at rates between $40 and $70 based on income or $30 for sessions with students. You can begin by searching for therapists in your city or zip code. 

Therapy funds are also available, like the Loveland Foundation, which provides financial assistance to Black women and girls seeking therapy in the United States. 

Free, low-cost, and sliding-scale options 

Depending on the county you live in, you may be able to access free or low-cost therapy from your local mental health department, Mental Health America affiliates, or community mental health agencies if you have Medicaid, receive social security benefits for a disability, or do not have insurance. You can also search this directory using your zip code for free and low-cost options through federally funded health centers. 

Does insurance cover therapy? 

Insurance may cover therapy depending on the type you have and the therapist you work with. 

NC Medicaid therapy coverage 

North Carolina Medicaid covers therapy for in-network mental health providers. Not all therapists accept Medicaid. Search online through Psychology Today or a similar site to find therapists who accept NC Medicaid (or Medicare).  

Some therapists who don’t accept insurance may provide you with a “super bill” that you can submit to your insurance for out-of-network reimbursement. Ask about this option when considering a therapist. 

Mental health insurance benefits  

Whether you have personal or employer-paid insurance, your insurance provider’s online directory is the best place to search for in-network therapists. You may need to call your insurance provider to verify whether a therapist is in the network. 

Some employers offer an employee assistance program (EAP) that you can use to connect with a counselor at no cost to you. They can support you for a set period, generally five to six weeks and help address life challenges impacting your work performance. You can check your employee handbook or speak with a member of human resources to find out if you have access to an EAP. 

If your employer offers a cafeteria flex plan spending account, you may also be able to use your savings to pay for therapy just as you would any health care reimbursement. 

If you feel concerned about privacy regarding your employer-paid insurance and mental health services, ask your insurance provider or prospective therapist during your consultation. 

Resources

• So, You’re Thinking of Trying Therapy… 
• How to Find a Therapist: 8 Tips for the Right Fit 
• A step-by-step guide to finding a therapist 
• Understanding Intergenerational Trauma and Its Effects 
• How some therapists are helping patients heal by tackling structural racism 
• Tips for Talking About Mental Health from Mental Health America 

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

I am an elder millennial. I am part of the generation that knew what life was like before social media, but also went through middle school with the AIM screenname “saraobx”—leaving away messages with moody song lyrics and “brb ttyl lylas”. The generation who had to receive an invite to join Facebook when it was exclusive and cool, when Instagram was for photos only, when Twitter was called Twitter, and Vine was the original TikTok.

Fortunately for my parents, they had minimal knowledge about the usage and impact of social media, chat rooms, and the Internet—outside of Ask Jeeves—as it was just getting its hold on their children. Also, luckily for them, we only had one home computer with dial-up internet so our addiction to being online was kept somewhat at bay. Yet fast forward 20 years and I am a parent raising a daughter in the age of rampant social media. I am simply terrified about the impact it will have on her, while simultaneously concerned about the impact it is currently having on me.

As I have grown up amid both the creation and rise of social media, it makes me ponder if all of us were essentially making up how to deal with social media as we’ve been going along. With inaugural praise for its ability to help connect people from all over the world, we quickly realized that what appeared to be a source of closer connection and understanding was also contributing to increased feelings of isolation, anxiety, depression, and low self-worth. When looking for articles written about the impact of social media on mental health, I found no shortage of publications, both academic and otherwise, highlighting the concerns. Up until recently, the path to engaging with social media without the associated risks was murky at best. And while we cannot rely on the social media companies themselves to protect us from these risks, we can start to take some internal stock on what we are doing well and what we need to change to better manage how we consume social media, and its impact on our mental and emotional wellbeing.

Social Media Wellness Check
While these social media beasts try to figure out towing the line perfectly of feeding us the ideal algorithm that keeps us engaged—while not getting sued in the process—I’ve concluded that we must look out for ourselves and our loved ones. This leads me to the list of reflective questions I’ve been working on when doing a social media wellness check on myself.

1) Am I connecting more than I’m isolating?

You’ve probably seen the meme of the couple putting their kids to bed and sitting in silence on the couch scrolling on their phones for 45 minutes. My husband and I could easily recreate the image. That mindless scrolling some evenings is a blessing as we come down from the overstimulation of the day. And at other times, it prevents us from connecting. So, I have to ask myself:

Am I mindlessly scrolling? If so, for how long and do I know how and when to cut myself off? How often am I picking up my phone to open a social media app? Am I ignoring my husband or daughter to look on a social media app instead of being fully present? How does that impact their ability to connect with me and vice versa? Am I being purposeful in using the social media app to connect with loved ones, particularly those who I have few other ways to easily connect and communicate?

2) Am I comparing more than feeling comforted?

Anyone who says they’ve never felt a pang of jealousy when an old friend posts about their three-week vacation on the Amalfi Coast or sees a TikTok of an influencer’s beautiful home renovation is lying. There are times when I see images and videos on social media of people I know or total strangers and I can find myself comparing to that person, wanting what they have, and shaming myself for not having what they have. And other times, I see a 10 month-picture of my friend’s baby—who they struggled to have—and feel instant joy. This begs the questions:

When scrolling through my feed, what feelings am I most often experiencing? Am I engaging with things that bring me more giggles, joy, and comfort? Is this informative or helpful information? Or am I more often pulled into viewing profiles or videos that fill me with envy, frustration, guilt, sadness or anger? How am I keeping that balance in check?

3) Am I cleaning more than collecting?

If you’ve been on social media long enough, the number of accounts you follow only seems to grow. So much so, that you’re catching a life update of someone you met at summer camp when you were 16 years old and who you wouldn’t even recognize if you passed them on the street. This is especially true since the algorithms can populate your feed with accounts you may not even want to engage with. It’s important to ask yourself:

Do I WANT to be following this person? When was the last time I audited my list of followers, so that it includes only those friends, family, and content creators that fill my cup rather than empty my cup? Do I constantly disagree with this account or feel the need to leave a negative comment? Am I paying too much attention to how many likes, views, or comments I have rather than being authentic in this space?

4) Am I being a critical consumer more than taking at face value?

There’s a reason why if you get diagnosed with a disease, one of the first things your provider will tell you is “don’t Google”. One of my closest friends reached out recently to let me know that thanks to an Instagram Reel she saw, she took a 10-question test that by the end convinced her she could have Autism. Now, this friend does not have Autism, but it does highlight how quickly we can be convinced of something that we see, whether it has validity or not. When we feel like something is “off” or we need support or are vulnerable in any way, we may, intentionally or not, turn to those on social media for advice and solutions. However, for many reasons, we have to take the critical reading skills we learn in school and apply these same principles to the social media we are consuming: 1) identify the author’s ideas; 2) evaluate the evidence provided by the author that supports their idea; 3) form your own opinion. And that means asking the following questions:

Is this a trusted voice and if so, why? What is the purpose of what they are sharing and why am I being targeted? What is this voice possibly not considering or considering incorrectly?

There’s no doubt that social media is here to stay in some form or another, and what that will look like in another 15 year is yet to been seen—hopefully for the better and not for worse. But we do have control of what and how we consume our information. It’s up to us to take actions to set appropriate boundaries and find a personal (family) balance in efforts to reduce the negative impacts on our mental health.

Sara Moscarelli, MS, LMFT—Senior Project Manager, Center of Excellence for Integrated Care

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

Our bodies are made up of complex systems. Not being a physician, I cannot explain the intricacies of our neurological system, respiratory system, endocrine system, digestive system and so on. I can however tell you that when I experience a stressor, I have a thought and depending on that thought my breathing may change, my stomach may gurgle, and my body may secrete a variety of hormones in response as well. Come to think of it, maybe it is the thought that generates the emotion that propels those system dominoes to react? Maybe our bodies even know it before we can consciously give language to the experience….or maybe it is all of the above. One thing we know for sure is that it is complicated.

I have had many instances of experiencing the mind-body connection in my life. They began when I was very young. One summer that stands out to me was the summer before 7th grade. I was spending the summer with my Dad as I typically did since my parents’ divorce. I loved my time with my Dad. However, this summer was the summer before middle school. I would attend a new school with new kids as our elementary school life ended. I was also aware of one of my teacher’s younger sons dying of leukemia. There were also some friendship issues—being out of touch and out of the loop of the friendship happenings that summer was probably hard for the first time as my need for peer acceptance increased in the pre-teen years (author disclosure: this was in the 1980’s so there was no FaceTime, no social media etc. When you were gone, you were out of sight and out of mind except for the handwritten snail mail letter.) Suffice it to say, this summer I found myself with my Dad at multiple doctor’s appointments. Doctors tried to figure out vague and somewhat chronic symptoms, ultimately with no clinical diagnosis. It is clear to me now, that in all likelihood what I was experiencing was mild stress and anxiety that my body was trying to bring to my attention.

Fortunately, we have seen a shift in awareness towards the connection between our mind and body. We see providers of all types tuning in to all the parts of a person’s health AND their interactions. For example, learning how anxiety can make pain worse. Or how insufficient rest can create a craving for carbohydrates, leading to frustrating weight gain, leading to depression and the cycle just continues. We are making progress as a healthcare system in truly seeing and healing the whole person. May is Mental Health Awareness month, and we want to lift up the reality that our mental health has always been and will always be intimately connected to the whole.

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

Have you ever had a day, a month, or, heck, maybe even a whole year or YEARS that really tested your resolve? A time that really pushed you mentally, physically, socially, spiritually to the edge? Maybe your sleep was troubled and you ate what you could when you could. Perhaps you forgot to call and text your family and friends back despite thinking of it a few times a day. Or you re-scheduled that dentist appointment for the fourth time because there just aren’t enough hours in the day. You were just going, going, going until BOOM – you crashed.

That was my year this past year. It started when my father-in-law passed away after a decades-long battle with multiple sclerosis. Soon after, I got pregnant with my first child, then quickly realized that my “morning” sickness would be all-day, everyday sickness, making basic daily life tasks and work nearly unmanageable. When my water broke at 26 weeks and 1 day, I was hospitalized with the intention of delivering at 34 weeks. That changed as my baby girl decided on New Years’ Eve that she was ready to party and I delivered her at 29 weeks and 6 days. She was in the NICU for nine weeks, the first six of which I spent desperately willing my body to comply with my diligent attempts at pumping and breastfeeding. 

Now, some of these challenges were of the “life’s tough, get a helmet” variety, and some of them were the “life’s tough, a helmet won’t help because you’re getting thrown in a life-sized dryer that’s set on 400 degrees while you’re constantly poked and ‘it’s a small world’ is being played on a loop for an unknown period of time.” We’ve all been there, I’m sure.

I quickly started to recognize how all of my systems were tested. I was physically drained; unable to eat when pregnant, then unable to eat enough while breastfeeding, weak from lack of movement for months of sickness and hospitalization, and exhausted from lack of sleep. I was emotionally depleted, a true roller coaster of emotions– going up high as I stared at my beautiful girl in her incubator and then plummeting into the darkness, enraged that she had to be in an incubator and blaming my body for not nurturing her longer in utero or producing enough breast milk to nurture her after delivery. Socially, I was a robot, reaching out to my support system when I could with updates and knowing I needed help but often not knowing where to begin. My faith oscillated between being upset with God and wondering why this was happening and pouring my faith out, asking for our baby to grow and thrive. Everything was at its breaking point.

In integrated care, we talk about having a whole-person, biopsychosocial-spiritual approach where we must assess and care for each of these systems and their intersection. And we see stories like mine often, in which all of the issues within our systems are exacerbated by one another. For instance, an older woman caring for her two grandchildren while dealing with depression and diabetes is unable to take the time to manage her diabetes because she is pulled in so many directions, leading to her struggling emotionally as her blood sugar irregularities impairs her mood and her depressed mood contributing to a lack of care for her diabetes. Or a farmer who is working sixteen hours a day at the cusp of a new season, terrified to see how much damage his crops experienced from the most recent freeze while also experiencing high blood pressure, ulcers, chronic back pain, and significant anxiety and depression. This, of course, all goes unmanaged because he must focus on ensuring that he feeds not only his family this year, but many others, and his social circle consists of those whose livelihoods depend on him. At times, it is a change-making conversation with a provider that can really turn things around, as was the case with me.

My lactation consultant, therapist, and my OB all let me know that I could stop pumping and trying to breastfeed, and to put my own health first. My daughter’s providers consistently asked about my well-being during rounds each day. And then there were the (frequently unanswered) texts and emails I received from friends, family, and colleagues, letting me know that they were there if I needed anything. So, slowly, I started looking at the different parts of my life that were suffering at my own hands. The internal and societal pressure I felt to breastfeed that was no longer serving me. The lack of sleep that was clouding my emotions and decision-making abilities. The very real postpartum anxiety I faced that rendered me a shell of the person I recognized, just going through the motions to survive each day. And with the support of others and some real action steps that tested me in new ways, I have made significant progress.

I have a healthy and beautiful four-and-a-half-month-old daughter and a partner who supports us in every way. I’m spending time with my family and friends, finally introducing them to our little JoJoBean. I’m able to move my body again when I want and where I want (and not just in the confines of WakeMed hospitals!) despite losing so much of my muscle mass. I am able to eat more than cereal and bananas and my appetite has returned in full force. My family and friends have finally gotten to meet and love on my daughter like I imagined they would one day during those months in the hospital. I utilize my faith to express my gratitude for the positive outcomes of this past year as well as for comfort when I have flashbacks to the darkness of that time. And I’m in therapy to work through the trauma of the past year and to ensure that I continue to nurture all of these parts of my being. I have a renewed drive to make sure that all of me, especially the parts of my life that I am in control of, are cared for. When we’re able to apply this same nurturing approach to all parts of ourselves, we can start to feel some peace and joy again within ourselves and our relationships– and we can wear our “life’s tough” helmet and feel safe to avoid a crash.

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

In the behavioral and mental health space, we talk often about the biopsychosocial (BPS) model that was developed in the 70’s by psychiatrist Dr. George Engel. As we move in to 2023, some might reference the BPS model when talking about whole person care, a phrase that is firmly taking hold in healthcare overall. Our healthcare systems are acknowledging that there are elements beyond the physical domain that need to be taken care of if we are going to see improvements in a person’s overall health and well-being. However, we all seem to still be working on incorporating one more component of truly whole person care, and that is spirituality. In 1996, quite some time after Dr. George Engel wrote about this new BPS framework, a group of clinicians (Wright, Watson, & Bell, 1996) emphasized the importance of beliefs and of making meaning around illness and health, adding in effect, the spiritual component to the biopsychosocial-spiritual framework. It is time we embrace this idea of spirituality even more and see the benefits it can add to our mental health.

Spirituality is often confused with the idea of religion or religiosity. For most people religiosity represents a concept that is based in an organization, whereas spirituality sits more within the individual and the meaning that the person makes around their life. Spirituality, however a person defines it, can be incredibly important to consider when thinking about mental wellbeing. Most people are looking for a sense of connection, a sense of meaning and greater purpose and a sense of where they belong in the world. All of these types of questions and explorations often bring conversations back to a spiritual part of life.

Often when a person is suffering with a bout of depression or anxiety, they can have a deep sense that they are alone in that experience. It can indeed feel incredibly isolating when those symptoms appear. It is important that we talk about building a skill set or coping tools to use when they feel that sense of disconnection. It can be quite helpful and that tool kit can involve elements of spirituality. For example, thinking about getting connected through community service, especially one where you work with others on a shared project (ie: packing boxes for a food bank). Speaking from personal experience, when I have had the opportunity to work with complete strangers on doing something good for people I will never meet…well, it did a world of good for my mental wellbeing and my sense of connection to a greater purpose. If a person is not quite ready to engage with people, spending time with nature outside can be an incredibly soft entry point to stepping into our sense of interconnectedness. Spending time outside observing the activities of local birds and wildlife, looking for the many patterns, or fractals, that can be found in nature. Spending time self-reflecting and journaling, though I acknowledge writing is not enjoyable to everyone, spending time thinking about things a person is grateful for can also help them get in touch with their connection to others and the deeper meaning of their life.

Spirituality can seem really personal, even when you are amongst friends, but often times I find that people have more in common with their beliefs than they have different. If we can see these commonalities then it can help foster an even greater sense of connection and deeper meaning.

Resources

NAMI FaithNet

Harvard Study on Spirituality and Better Health Outcomes (2022)

Mental Health America – Tips on Taking Care of Your Spirit

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

Can you think of a person in your social circle who makes you laugh easily, helps you feel heard and understood, and feels energizing to be around? Relationships, and relational health, are instrumental in our mental well-being. As part of our Mental Health Awareness Month series, which we kicked off last week (https://bit.ly/3VzZslH), we will be exploring mental wellbeing from a biopsychosocial-spiritual framework. Last week, we focused on awareness and recognition of some psychological symptoms of mental distress and avenues for support. This week we are diving into our social health, or relationships.

Having supportive social connections is associated with better mental health, higher self-esteem, better recovery from illness and disease, and a longer lifespan. The longest standing relationship we will have in our lifetime is usually with our romantic partner, but if we are lucky, we experience extremely fulfilling relationships in all walks of life: parenthood, friendship, colleagues, community, and more. Investing in our social health can be challenging if you are very introverted, isolated, or maybe are struggling with mental health symptoms that make it difficult to give energy to your relationships. Relationships can also be a source of stress when there is conflict or unhealthy boundaries, which we will talk about in a moment. First, let’s explore – how do we get support for our wellbeing through relationships?

Soliciting Support

Bringing you back to the person you thought of in your life who gives you joy and energy, what type of effect have they had on you when you were struggling? We can derive a lot of healing from being around people who feed us emotionally, rather than feed from us. During times of struggle, these key support people provide a safe space to ask for support. How often do you ask people in your support system for a venting or processing session, or even advice?

Keeping your emotions bottled up can lead to an increase in cortisol levels. Over a long period of time this will likely impact your physical and mental wellbeing. Whether you like to communicate over the phone, video chat, texting, or journaling, talking it out can be a big relief to your nervous system. When asking for support, clarify whether you need someone to listen, or if you are asking for solutions. It can feel awkward asking other people to explicitly support you, so here are a few conversation starters to have in your toolbox for initiating that conversation:

• Can I talk through something with you? I just need someone to listen to me right now, I’m not ready to take action or think of solutions.
• I’m having a tough day and just needed to share that with someone.
• I’ve been feeling kind of lonely lately. Do you want to meet me at the park for some quiet time? I think it would be helpful for me to be around someone right now.

Giving Support

When someone approaches us for support, our instinct is to try to jump in and offer a quick fix, or solutions to solve a problem. That can often be overwhelming to the person needing support, so try to temper that initial reaction to offer solutions and make sure you are “listening to listen” first, rather than listening to react. Here are a few suggestions to keep in your toolbox for how to respond when someone needs support from you:

• I hear you, and I am here for you. Do you want to share a little more about what has been going on, or do you want to think of some action steps together?
• I’m sorry that you have been dealing with this. I understand how you feel. Is there anything I can do to help?
• Hey, I was just thinking about you. You don’t need to respond, but I wanted to let you know I’m here for you if you want to talk.
• I hate that this happened to you, it sounds really challenging. Thank you for opening up to me, I will do what I can to support you.

Setting Boundaries

Remember that person you were thinking about when prompted with “brings you joy” and “makes you feel understood”? Now, think of the opposite. Do you have someone in your life who feels draining to be around, like they emotionally feed from you, but you get nothing in return? Maybe someone who is overwhelmingly negative and critical, quick to stir up conflict? Yes… them.

First, take a deep breath. You are not alone! We all have relationships that challenge us.

Second, can you find points of empathy for this person? If we can have empathy, it will help us be less reactive to the relationship dynamics that bother us. For example, understanding that your colleague is going through a difficult divorce may help you understand their bluntness during team check-ins. Knowing that your colleague has a high level of personal distress that has nothing to do with you can help you de-personalize their blunt comments in the team meetings.

Third, in all relationships, we need boundaries. Boundaries are perhaps the most uncomfortable, but most essential, function in relationships; especially to protect our mental wellbeing. Boundaries help us communicate our limits and teach people how we would like to be treated.

What does it look like to set a boundary? You decide for yourself what your boundaries are, and it is your responsibility to communicate them. Ideally, you communicate boundaries verbally and follow through with your behavior. Here are a few ways to clearly state your limit or expectation:

• I am not in a space where I can hear about that right now. I would appreciate it if you spoke to someone else about this.
• These conversations tend to turn into criticism about me, which makes me completely shut down. I can’t continue having these conversations unless you respond respectfully and listen, and I will offer you the same.
• I don’t let people talk to me that way. I think we should take a break from this conversation and revisit it in a few hours/days.
• I would love to help/attend, but I would be overcommitting myself. I am sorry.
• I am struggling myself right now and I don’t feel equipped to be your primary support.

Discomfort from setting boundaries often comes from other people’s reaction to them. But remember, in adult relationships, it is not your responsibility to manage the emotional experience of others. We are often guilty of not setting a boundary in fear of hurting the other person’s feelings. We should be respectful and kind, but we are each responsible for our own emotions. If you do not follow through on your boundary, the person it is most likely hurting is you. Also remember, the people who react most strongly to your boundary setting are likely the people who benefitted the most from your lack of a boundary.

While setting boundaries can sound like you are handing out restrictions left and right, it is usually very liberating. We invite you to actively partake in giving and receiving support this month in honor of Mental Health Awareness and explore boundaries for yourself that could benefit your mental and social health.

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Relational Harm

Reading about giving and receiving support and setting boundaries may have made you consider whether you’re in a healthy relationship. Please know that there are resources available for you if you suspect you are in a harmful relationship.

If someone you are in a close relationship with says hurtful and demeaning things to you, threatens physical harm, uses violence such as pushing, restraining, or throwing objects, demonstrates jealousy and controlling behavior – that is NOT okay.

National Domestic Violence Hotline: 800-799-7233, or text START to 88788

North Carolina Coalition Against Domestic Violence

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

May is Mental Health Awareness Month and it cannot be denied that mental health has become a focal point of many broader discussions in our state and country over the last few years. There is no question that the COVID-19 pandemic worsened the state of mental health in North Carolina and beyond. According to Mental Health America, approximately 1 in 5 adults in our state are experiencing a mental illness.

Mental illness used to be surrounded by significant stigma, as something that people had a tough time understanding. There was a misconception that mental health concerns or illness could happen to “others” but not you or your family. For better or worse, this lack of understanding is becoming a thing of the past. For many people, the COVID-19 pandemic exacerbated a myriad of issues and mental health was certainly one of them. Isolation, fear of sickness, actual sickness, and loss were universal reasons that people across the globe came to understand what it was like to feel anxious or depressed. For those not doing well with their mental health, their symptoms tended to worsen over the course of the pandemic. And for those who did not have mental health symptoms before the pandemic, many began to experience these symptoms. Now that the world has seemingly picked up where it left off, many are still left with a feeling that things are not quite how they used to be before the pandemic. Mental health exists on a continuum and depends on several factors including, but not limited to, life circumstances, genetics, zip code, trauma, and resilience. Today, you may find yourself at a point on the continuum of mental wellbeing that you did not anticipate.

Recognizing the Signs

It can be difficult to recognize the signs and symptoms of a mental health disorder. Research shows that it can take upwards of ten years from the onset of symptoms to beginning treatment (NAMI) This common delay in receiving treatment, for whatever reason, makes it critical that we begin to recognize in ourselves and in our loved ones when we might need a little extra support.

People often miss these symptoms because they manifest physically such that they land in their primary care office wondering why they have periods of racing heartbeats or daily headaches. Gastrointestinal upset and even difficulty breathing can be physical symptoms of moving towards the illness side of that mental health continuum. This is not to say that these symptoms are always indicative of mental health concerns, but to consider that possibility when taking in the bigger context of a person’s life.

Stomach pain	Back Pain	Fatigue	Poor hygiene
Stomach upset	Headaches	Weight changes	Repetitive tics
Sore/tense muscles	Insomnia	Hyperactivity	Restlessness

Other symptoms might be less surprising, such as feelings of sadness for two weeks or more, or an increase in drinking or using substances, often to self-medicate or escape the thoughts that might be upsetting. So, what does a person do when they notice these in themselves or a loved one?

Examples…

               “I knew I was struggling when I had several weeks when I would finish work for the day and just wanted to go straight to sleep to get the day over with and go to the next one. There was nothing that I looked forward to or found joy in, and I wanted time to pass me by.”

               “I was so fixated on my family’s safety, to an extreme level. I would panic when they would go to school and work and could not sleep at night thinking of all the ways I needed them to be safe. My body and mind were on edge 24/7.”

               “I could feel myself being reactive and irritable towards my friends, coworkers, and partner. I was so annoyed with everyone. I just wanted to be alone. Then I would feel terribly guilty and try to re-engage, only to find myself so irritable again with no emotional energy to give to my relationships.”

Connection

Conversations about coping and toolboxes are often found in a therapist’s office, but there is no reason those conversations cannot be had among your support system, including friends, family, and colleagues. True connection with others makes a difference in our lives.

What do you do when you start feeling not quite yourself? When you find yourself worrying about a bunch of stuff or feel like a lead balloon and can’t quite get out of bed? These are the conversations that can help you feel validated about your emotional experience and prevent the slide down the continuum towards more severe mental health challenges. Connection is one of the best protective factors for managing and mitigating mental health concerns.

Coping

What could some of those tools or coping strategies be to help you stay in the mental wellness part of the mental health continuum?

• Keeping with the idea of whole person health, often strategies that ground a person in their body can be very helpful. Research has shown that getting into nature and getting outside can really provide a myriad of cognitive and psychological benefits. Walking, stretching, simply moving our bodies can also be extremely helpful as a coping tool.
• Developing a sense of connection either through personal relationships or volunteering can be helpful.
• Setting very realistic and achievable goals can be the first step towards deciding how to find what works for you.

Of course, these are techniques for when you just notice a slide into worsening mental health. If symptoms become more serious then additional support like talk therapy and medication may be in order. Many people are caught off guard when their mental health takes a hit, and they find themselves in what we would call a clinical distress category. A clinical level of distress is when symptoms impair functioning, such as mental health symptoms disrupting your work or home life. Having that level of disruption in your life indicates that professional support is needed. However, we do not want to wait until we are feeling that bad to start taking steps to take care of our mental health.

In fact, as much as exercise and nutrition have become integrated into conversations about our overall health, mental wellbeing management should become a part of that conversation as well. Let’s start talking about how we take care of ourselves and when we need additional support and help reduce the prejudice and discrimination that often still exists if professional support, such as therapy and evaluation for medication, is still needed.

In celebration of mental health awareness month, as licensed therapists ourselves, we will be sharing our insights into the bits and pieces that can help support mental wellness for the rest of the month and hope you will join our conversation.

Resources:

CDC Mental Health Toolbox

NC Therapy Directory

Find a Therapist

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

While the month of May flew by, the idea of mental health awareness, is here to stay. Now more than ever, Americans are talking about their mental health in a way that is forcing the conversation around the unnecessary stigma of seeking support. No longer in the shadows of healthcare, mental health is slowly gaining parity in terms of the conception of when and how people can seek support. Prevention is no longer just for our physical health, but it should be for our mental health as well. This month’s blog entries focused on the development of a young adult who benefitted from systemic changes in our healthcare system that provided him access to preventive mental health services. The Foundation for Health Leadership and Innovation has brought these words to life in this cartoon sketch of Alex. Let’s all take a minute to envision a life where our children are able to live a life of intentional wellness rather than a life of reactivity.

https://www.youtube.com/watch?v=lDD2GqGBvgA

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

*For the month of May, honoring Mental Health Awareness, the Center of Excellence for Integrated Care, a program of the Foundation for Health Leadership and Innovation, will host a series of blogs following Alex. These weekly journal entries from Alex begin in 2032 when Alex is 18 years old. Over the month Alex will reflect on the benefits gained from living in a system with preventive mental health policies as they grew up.

*Week 3 flashes forward to Alex in their late 20’s and fully engaged in adult life in their community. Alex is employed and continues in a serious relationship considering future plans with that person.   

“Life is plugging along nicely. I haven’t gotten a chance to write in this journal as much as I would like.  Life is busy now that I have gotten the promotion I was hoping for and Frankie and I have been traveling so much. Things are getting serious with Frankie and I am excited. I feel like we have found our groove as a couple, and we have the support of those around us as well if we decide to move forward.

When I graduated college, I realized I had actually made quite a good space for me there. Leaving college felt like I was leaving another nest or family of people who understood me and who shared a common goal. I felt like I floundered a bit looking for work and then meeting Frankie helped me not feel so lost out in the adulting world. Also finding other community groups that I took an interest in helped a lot as well with my overall wellness. Long ago during my pediatric days, I remember talking to Sam about being involved with groups or events around me to help me not get stuck inside my own head or in sort of an anxious state. In high school she got me to be involved in some clubs even when I did not want to, and what I probably liked most about those clubs was the community service. Now I volunteer even as an adult with a community food bank. Being involved and being helpful in that way always makes me feel useful and connected to others and somehow life seems more manageable. Yet another tool in my mental health toolbox that really doesn’t seem like a “tool” anymore, just seems like a part of my life that I enjoy and that makes my life more enjoyable.

I also finally found a church that fits for me as well. It might be a little different than what I grew up with, but I had to find a church that I felt good about and that I wanted to be connected with. It just so happens this church does a lot in the community as well and even serves as a distribution site for the food bank I volunteer with. I have been involved with a young adult group through the church as well and might be considering leading a group, but I am just not quite sure I am there yet. We’ll see what the future holds. It feels so good to talk to my parents about where I am in life and how well things are going. I think they were worried about how I would do moving from such a small town to a bigger area in the state. We talk a lot about how grateful they are for Sam’s role and my pediatrician’s role in preparing me to launch out on my own.

Well, who knows when I will get time to sit down and write again – but life is good! “ Thanks, Alex

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health