Healthy Relationships and Mental Well-being

May 11, 2023

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

May 4, 2023

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

Bringing it to Life

June 7, 2022

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

Rooted in Community

May 18, 2022

*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

Planting Seeds for Healthy Relationships

May 12, 2022

*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 the perspective of an individual who is found in the future but who was a child. We invite you to meet Alex, who will begin their journey at age 18 and over the month of May Alex will reflect on the benefits gained from living in a system with preventive mental health policies.

*When we hear from Alex this week, they will have graduated from their undergraduate studies and been living in a medium size city after finding a job in their field. Alex has been in a serious relationship over the last six months and writes this journal entry reflecting on that relationship.

“What an amazing few months it has been! Meeting Frankie has really been a dream come true. I had no idea I could feel this way about a person. The first few months were of course our honeymoon stage, not the “I do” kind of honeymoon, but the most romantic and on cloud 9 I have ever felt. I may as well have said I do! I knew to expect those kinds of feelings though when it started. Sam, my therapist, talked to me over the years when I met with her for my annual appointments. I met with Sam a few more times when I was in some of my first relationships just a few years ago and she taught me a lot about what a healthy relationship looked like. What stood out the most in our conversations was the importance of being treated with respect and having a balance of yourself and your own interests plus the relationship in your life. In other words, when I felt myself getting pulled into a relationship too deep, she would remind me to stay involved in the parts of my life that make me who I am as an individual. For example, keeping up with my school work, my hobbies, and spending time with my family and other friends are all part of who I am as an individual. It is easy to get sucked into that one relationship and have it sort of become your entire world, but I think after our annual, and sometimes more, meetings I finally understand. I think those talks really helped me be a better partner from the start with Frankie too.

My relationship with my parents also really was stronger because of those meetings with Sam. Not only have I seen my parents have a strong relationship with each other, but our relationship changed as I got older and somehow though they were not as involved in every decision I made, our relationship seemed to grow stronger. Sometimes my parents would come to my appointments with Sam. She helped us navigate our relational boundaries so that they learned to trust my decisions more, and I also learned to stay open to their feedback without feeling defensive. I think even this lesson in boundaries has helped my relationship with Frankie have a healthy balance.

I just continue to be amazed how those meetings with Sam over the years have really had a lasting impact in my life. Knowing what to expect in a healthy relationship before you get into a relationship at all has been super helpful. Who knows, maybe Frankie will be the one, but I know I stand a better shot at making sure this relationship is healthy and strong thanks to those conversations with Sam and my strong relationship with my parents.” – Signed Alex

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

Mental Health Awareness: Meet Alex

May 3, 2022

*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 the perspective of an individual who is emerging into adulthood and received preventative mental health services as a child. We invite you to meet Alex, who will begin their journey at age 18 and over the month Alex will reflect on the benefits gained from living in a system with preventive mental health policies.

by Dr. Lisa Tyndall, LMFT, Dr. Amelia Muse, LMFT, and Mrs. Sara Herrity, MS, LMFT

*Alex recently graduated high school and is a first-generation college student at a University approximately two hours from home.

“Whew, the last few months have been an adjustment. Never having been away from my family longer than a week before, and not having them around at the end of the day has been hard sometimes. Not sure I quite fit in here with so many people around me having a lot more than me, at least cars and nicer clothes. I have met a few people who I like from towns and backgrounds like mine and that has been helpful.

I have to be honest though, there have been times I just want to hide out in my room scrolling on my phone or trying to study in the library. Sometimes things can feel so out of my control and I can feel really small. Studying or playing my video games or scrolling can seem like the only thing I know to do in order to feel okay. I knew getting my head in the books and in classes would help for a bit, but I was also glad to remember some of the things I learned over the years with my therapist and pediatrician.

Dr. Johnson and Sam were so helpful at my annual appointments each year. I honestly cannot remember a time that they were not in my life. One thing I remember is they said the same thing, but would talk about it differently. Dr. Johnson would talk to me about staying active for my health. Sam would talk to me about staying active too, and it seemed to reinforce what Dr. Johnson said, but would then add how it helped with my stress and mood. I learned that sometimes when I went through times that I felt anxious or down about life, a good workout was always something that helped, and I was able to really get out of my head. Sam would share with me how talking out the stress, like with her, my parents or my good friends, also helped. My check-ins with both of them gave me the coping tools and support to take charge of how I feel.

I am grateful though that I had the benefit of talking to Sam and Dr. Johnson both because I know it was not always this way. My parents have said that no one used to go to therapy unless things were really bad, then the pandemic of 2020 happened, and some things changed. I am grateful that there is not stigma any more around people talking to their therapist, that even my friends have talked about having to go to therapy sometimes, and that my insurance has made it possible for me to get that support before I technically needed it. Now, along with other tools that I learned over the years, I check in with the student counseling center on campus once a month or so just to get grounded again. My parents say that now it seems like finally the systems around us have acknowledged how important it is to take care of all the parts of our health. I’m glad I do not have to wonder what it would have been like to grow up without people like Dr. Johnson and Sam.

Thanks, Alex

Posted in Mental Health AwarenessTagged Mental Health, Telehealth, Teletherapy

From the Frontlines: Pandemic Suicide Awareness

September 13, 2021

From the frontlines: Thoughts from a therapist on Suicide Prevention Awareness Month during a pandemic

by Dr. Rebecca Levy, LMFTA

September is National Suicide Prevention Awareness Month. In the past year and a half, we have experienced a great deal of tragedy, especially when considering the impact of this pandemic on mental health. Prior to the pandemic, researchers reported that approximately 50% of people who attempted to kill themselves went to their primary care doctor a week before their suicide attempt. With the impact of this pandemic, there was about a 50% increase in the use of a suicide hotline. As demonstrated by recent studies, COVID-19 has had a profound impact on mental health due to our increased isolation, stress, and fear of illness.

As a mental health provider, I am left with many thoughts; but here is my take on some of the major considerations of dealing with mental health issues during an international health crisis.

Telehealth

Helping people who struggle with suicidal ideation has been different this year for many reasons. As a mental health provider, I have had to provide therapy to patients over the phone or over video more than in person. Teletherapy can feel different, disconnected, or even scary, especially with a high-safety-concern patient. What if they are in a different city or even a different state? Before the pandemic, this geographic difference was almost unheard of.

Managing my own stress in conjunction with the increase of patients presenting with suicidal ideation over telehealth has been challenging. This increase in mental health concerns, combined with the physical distance between patients and providers, has been a recipe for mental illness to rear its head. Yet, there are some positives to telehealth for patients struggling with suicidality. Having a virtual option for patients we might not have typically reached has allowed for more access to those populations in need. There is also something to be said about having an emotionally charged conversation with your therapist in the comfort of your own home.

The Secondary Pandemic

As a society, mental health is something we have struggled to address. There is stigma attached to each diagnosis, as well as barriers to getting care. Historically, the importance of mental health has not been viewed as on par with physical health; however, suicidality is the pinnacle of illness because it can result in death. Dare I say that this pandemic has a brought a necessary focus to addressing poor mental health as the crisis it is?

This pandemic may have caused great distress and loss, but maybe it brought us where we need to be in recognizing the importance of taking care of our mental health. The biggest question is, what we do in times like this to help ourselves and our loved ones?

What To Do

What has mattered to people in helping them through a tough time, such as struggling with suicidality?

Normalize. A lot of us do not talk about having thoughts about not wanting to be here, but they are more common than we think. Having that de-stigmatizing perspective, and reminding people that those thoughts and feelings are normal when we are feeling very low, is helpful when talking to people who are having thoughts of suicide.

Ask. As mental health providers, and as friends and family of loved ones, we are doing a disservice by not asking the hard question: Have you had thoughts of hurting yourself in some way? By asking this question, we are normalizing the fact that we can talk about suicide and allowing space for those who are in that place to talk about it.

Listen. During this tough time, it should be everyone’s responsibility to check in on each other and their loved ones. Go ahead and ask that tough question or the easy question, ”How are you?” But take the time to be patient and wait for a real answer, and then truly listen.

Acknowledge – This pandemic is life-changing. The COVID-19 pandemic is overwhelming. Our worlds have been turned upside down. I think one of the most invalidating things I have seen done to people who are struggling with suicidality is telling them that they “need to be grateful” in some form or another. It is more helpful to validate them in their pain (i.e., “It sounds like you are having some really scary thoughts”) or risk emotionally isolating them further.

Get help. There is help if you, or a loved one, is struggling with mental health. Therapy, it can do wonders! A lot of therapy offices have walk-in hours to help patients in crisis. There are also a lot of medication options (e.g., antidepressants) you can discuss with your primary care provider that can bring relief from symptoms of feeling down or hopeless. If you are worried about a loved one, there are options available to help them. Your area may have a Mobile Crisis group that will go to a person’s home and assess for safety, or work collaboratively with the police department to complete a welfare check (which can be requested anonymously if you are nervous to do so!). In addition, you can research your local behavioral health crisis centers to see what services are available. And finally, the Emergency Department of your local hospital is available in cases of severe crises.

It has been a difficult, but enlightening time, supporting patients, providers, and families with mental health and substance use needs throughout the pandemic. When it comes to awareness about suicide prevention, please remember that it is okay to directly ask the hard questions, and there is help available.

If you or someone you know needs help, call: 1-800-273-8255 or Text HOME to 741741

Please call 911 if you sense immediate danger.

Dr. Rebecca Levy is a Medical Family Therapist and the Director of Behavioral Medicine at Cone Family Medicine. She holds a bachelor’s degree in Psychology, a master’s degree in Couple and Family Therapy, a doctorate in Medical Family Therapy, and an associate license in Couple and Family Therapy (LMFTA). Her areas of expertise are suicide assessment, integrated behavioral health care, cultural humility, and family medicine resident wellness. She sees her role in clinical practice, research, and education to advocate for underserved populations and health equality.

Posted in Mental Health AwarenessTagged Mental Health, Telehealth, Teletherapy

Press Release – July 2021

July 30, 2021

FOR IMMEDIATE RELEASE
JULY 30, 2021

The Foundation for Health Leadership & Innovation Secures Funding to Improve and Advocate for Behavioral Health Needs of North Carolina’s Children and Adolescents

The new program, funded by The Duke Endowment, will be led by FHLI’s
Center for Excellence for Integrated Care team

CARY— The Center of Excellence for Integrated Care (COE) — a program of the Foundation for Health Leadership & Innovation (FHLI) — has received a grant from The Duke Endowment to lead a three-year program focused on child and adolescent behavioral health. The emphasis of the project is on advocacy for mental health check-ups for children, as well as on training for behavioral health professionals to provide pediatric and family assessments and interventions.

“North Carolina’s health care workforce is doing amazing work every day with well-child exams and preventative services for children and adolescents,” said Dr. Amelia Muse, COE’s Program Director. “However, after the hardships of the past year, it’s time to answer the call for more support for providers, families, and communities on preventative and interventive behavioral health care.”

With a dual emphasis on advocacy and workforce development, The Duke Endowment has provided support for this program that will include partners from the i2i Center for Integrative Health and the North Carolina Area Health Education Center (AHEC) Program.

The COE team will partner with i2i to convene a workgroup of family members, advocates in children’s welfare, and representatives of practitioners to develop a sustainability plan to embed annual behavioral health well-child checks into medical protocols and practices, with a focus on the need for insurance coverage. This additional focus on behavioral health during or in conjunction with the well-child check will bring North Carolina alongside other leadership states, who have worked to support pediatricians, children, and families with additional behavioral health emphasis.

“With our more than 34 years of collaboration and advocacy experience addressing behavioral, I-DD, SUD, and primary healthcare, i2i is well-suited to lead this advocacy effort,” said i2i Executive Director Ann Rodriguez. “We are thrilled to partner with FHLI, COE, and NC AHEC on this critical initiative. The pandemic and North Carolina’s Medicaid transformation efforts have created an opportunity to ramp up integrated, preventative care practices across the state and strengthen whole-child care.”

Simultaneously, the COE team will partner with North Carolina AHEC to address workforce development issues by offering a continuing education opportunity for a cohort of 45 licensed behavioral health providers and ten graduate student interns currently working with youth and families. The one-year specialized training program will focus on mental health and substance use prevention, assessment, and intervention for children and adolescents and their families.

The second year of the program will train a second cohort of behavioral health professionals, with the first cohort of graduates acting as peer supervisors to assist with oversight and case consultation. The training curriculum will be informed by evidence-based literature, as well as by information collected from regularly held workgroup meetings of child and family advocates, youth, family members and providers advising on policy to support child and adolescent behavioral health wellness.

“At the Foundation for Health Leadership & Innovation, we are committed to cultivating a culture of innovation, experimentation, and risk-taking,” said Kelly Calabria, FHLI’s President and Chief Executive Officer. “Given how COVID-19 has exacerbated an already-dire need for behavioral health services for all North Carolinians, we believe this work — led by our team behavioral health experts — is the type of innovative thinking that is needed. We thank the Duke Endowment for recognizing this need and for trusting FHLI to drive a solution.”

About FHLI’s Center of Excellence for Integrated Care
The Center of Excellence for Integrated Care (COE) — a program of the Foundation for Health Leadership & Innovation — supports the clinical, operational, and financial transformation of health systems to provide whole-person care. COE’s integrated care experts support communities in providing whole-person care and reducing the stigma of behavioral health for patients and providers. Learn more at www.coeintegratedcare.org.

About the Foundation for Health Leadership & Innovation
The Foundation for Health Leadership & Innovation (FHLI) is a nonprofit organization that envisions healthy communities across North Carolina where everyone can flourish. FHLI develops and supports innovative partnerships that build a healthier North Carolina through collaboration and respect. With a long history in the state — and a deep understanding of its health care needs — FHLI scales solutions that benefit the entire state. FHLI staff are thought leaders and experts who bring communities together for a better, healthier North Carolina. Learn more at www.foundationhli.org.

About i2i Center for Integrative Health
The i2i Center for Integrative Health is a non-profit 501(c)3 organization whose mission it is to foster collaborative and evidence-based initiatives for improving the quality and efficacy of the behavioral health, intellectual and developmental disabilities, and substance use care and support service systems within a comprehensive system of whole-person care. Learn more at https://i2icenter.org.

About North Carolina AHEC
The North Carolina AHEC Program provides and supports educational activities and services with a focus on primary care in rural communities and those with less access to resources to recruit, train, and retain the workforce needed to create a healthy North Carolina. Learn more at https://www.ncahec.net.

About The Duke Endowment
Based in Charlotte and established in 1924 by industrialist and philanthropist James B. Duke, The Duke Endowment is a private foundation that strengthens communities in North Carolina and South Carolina by nurturing children, promoting health, educating minds and enriching spirits. Since its founding, it has distributed more than $4 billion in grants. The Endowment shares a name with Duke University and Duke Energy, but all are separate organizations.

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For more information, contact:
Marni Schribman, Director of Communications & Public Relations
Foundation for Health Leadership & Innovation (FHLI)
Marni.schribman@foundationhli.org
919-259-4547

Posted in Mental Health Awareness, Press Releases, UncategorizedTagged #covid-19, #mentalhealth, behavioral, behavioral health, integrated care

So, You’re Thinking of Trying Therapy…

May 12, 2021

Seven helpful tips from a therapist (who has been to therapy herself!) on navigating the decision to start the therapy journey.

by Sara Herrity, MS, LMFT

If the last 15 months have taught us anything, it is that:

Social media is the best and worst thing ever (hello Tiktok dances, but also political debates)
Banana bread has finally been recognized for the ultimate comfort food we never knew we needed, and
Our mental and emotional health matters.

In the beginning of the pandemic, we all were there with feelings of hope and optimism. The thoughts that crossed our mind were along the lines of, “This will just be two weeks, four weeks tops.” These thoughts were soon invaded by feelings of confusion, frustration, isolation, anger, and so much fear of the unknown, and of the virus itself. Gratitude floated in and out depending on the moment. And, for many, survival mode kicked in – just put one foot in front of the other, do what you need to do this minute, and worry about tomorrow… well… tomorrow. And just as we were concerned with our physical health and contracting COVID-19, we were increasingly noticing the toll the pandemic was taking on our mental and emotional health. Added onto all of this was a highly contentious election cycle and an increased discourse surrounding the racial injustices present throughout our systems as a nation.

For myself, I was making every effort to be cautious to protect and care for my physical health while maintaining my mental health. Despite two years in graduate school to become a Marriage and Family Therapist, having worked in behavioral health for more than nine years, having many close friends who were also therapists, and having just wrapped up my own personal course of therapy two weeks before the pandemic hit, I found myself still struggling as this last year moved on.

A good friend told me recently that in tech engineering they say, “If you do not schedule system maintenance, the system will schedule it for you.” The same thing goes for our bodily systems – if we do not schedule time to take care of all parts of ourselves, it will force us to schedule it. This last year has served as a wake-up call for some, and a reminder for others, that our mental and emotional health matters as much as our physical health. We must take time to nurture and care for our bodies, minds, and relationships.

As vaccine distribution increases and restrictions slowly begin to lift, we are preparing to re-engage into our new normal. Despite the feelings of relief and joy this brings, many of us will find ourselves still struggling with feelings of depression, anxiety, fear, confusion, and so forth. If that is the case, and you’ve started to wonder what to do, might I suggest therapy? Here are some helpful tips that can hopefully make navigating the decision to engage in therapy a bit easier:

THINGS DON’T HAVE TO GET “THAT BAD” – I cannot explain to you the number of times I have heard, “Well, I don’t think it’s bad enough that I have to go to therapy.” But that is the point. You can go to therapy when things are going well to process changes, build emotional or relational skills, or get support. Or, you can go to therapy when you feel utterly distressed. 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.

FIND A FIT – Once you have made the decision to go to therapy, the next step is finding a therapist. Psychologytoday.com is a great resource to find therapists in your area (or online) while allowing you to filter searches and be as particular as you would like – many people prefer a therapist who is a certain gender or race, or of a certain faith background, or offers teletherapy appointments or in-person, only takes sliding fee scale, or perhaps will bill through insurance. Clinicians provide a picture, short bio, and information regarding their services on the site to ease in selecting a therapist that could be a good fit. If you have insurance, you can also contact your insurance company via phone or their website to find a list of credentialed providers. Finding a clinician who is a licensed provider helps ensure that you are seeing a professional who has been through appropriate training and supervision . Lastly, one thing to keep in mind is to ask about any additional training or certifications the therapist may have earned. For example, if you are seeking therapy to address your experience of childhood abuse, it is important to ask the therapist you are considering about any additional training and/or experience working with this issue. The same way you would not want to go to a cardiologist for an ankle sprain, you would not want to go to child psychologist for coping with your adult complex trauma concerns.

I REPEAT, FIND A FIT – The number one predictor of success in therapy is the relationship the client has with the therapist. 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! I promise, the therapist will not be offended if you tell them it is not a good fit. Therapists know the importance of the relationship and fit and they are ethically obligated to provide you with referrals. Of course, you are welcome to find a new therapist on your own. My friend and colleague Lisa says, “You don’t stop ever getting your hair cut because the last hairstylist gave you a bad cut – you find someone you like better.”

DON’T GET HUNG UP ON DIAGNOSES – In the first session, therapists often complete what is called a “comprehensive clinical assessment.” This generally is comprised of an overview of your mental health, substance use, family and medical history, understanding your strengths and supports, and beginning to understand what your goals are for therapy, and most likely providing a provisional diagnosis. While a diagnosis is typically required if therapy is being billed through your insurance company, it is also a category that helps provide a directive to the therapist for the most effective, evidence-based treatment and approaches for your care. Though not every reason to attend therapy results in a diagnosis such as depression or anxiety, receiving a diagnosis can be an extremely validating experience and your therapist can talk through your diagnosis with you.

RELATIONAL WORK IS POWERFUL – If you are seeking individual therapy and find that it would be beneficial to include a partner, friend, or family member, let your therapist know. Most therapists will encourage relational work if they recognize the need, but you can always ask for a support person to be involved in your treatment, whether for just one session or several. We are relational beings, not independent but interdependent, and thus having the skilled support of our loved ones who are learning some of the tools you are learning in therapy can make a world of a difference. For example, my fiancé knows to start deep breathing when he sees me in distress, often before I have realized I am even in distress. Because of his cue (thank you mirror neurons!), it is a reminder to myself to take a pause and focus on my breathing to calm my system before I proceed to problem-solve. He learned this through me teaching him and also from joining me in therapy.

FIND COMFORT IN THE DISCOMFORT – More often than not, therapy might not feel good at first. Change and growth and healing can be HARD, but it is the GOOD hard. Consider the beautiful butterfly and its humble beginnings of the caterpillar; we often forget the mucky, hard, process it takes for the caterpillar to turn into that butterfly. That hard work usually does not occur solely in the one-hour session you have once a week. To really see change sink in, that work happens mostly in the other 167 hours that occur in the week between sessions. Therapy is a space to slow down, reflect, process, gain insight, and learn skills, but the time in between sessions is where the practice of these skills are put to work and become part of ourselves. So give yourself and the process grace when it feels uncomfortable, angry, scary, or slow. Often times, it means the treatment is working.

GET THE BEST OF BOTH WORLDS – Just because you choose to see a therapist does not mean you cannot also engage in other types of therapies. In fact, many therapists can incorporate art, yoga, music, biofeedback, and more into their approaches. If these seem like approaches you would benefit from, talk to your therapist about this or you can find a licensed art therapist, Trauma-Sensitive Yoga therapist, and more. Additionally, medication for your mental health condition(s) has been a game-changer for many. We don’t bat an eye at providing insulin to people with diabetes when it is needed, so we must remove the stigma of asking for pharmacological help for mental health when it might be helpful. Please talk to your doctor and/or therapist if you are considering medication, and they can walk you through your concerns and needs to find the best medication for you.

The first time I decided to go to therapy, I was scared, but had the support to guide me through the process. I hope this information can provide some support and comfort to you, because taking this action step is worth it, as are you.

Posted in Mental Health AwarenessTagged Mental Health, Therapy

Essential Understanding: What is psychotherapy?

September 25, 2020

by Amelia Muse, PhD, LMFT

Friday, September 25th is recognized as “National Psychotherapy Day” in the United States. In healthcare, we have observed that some patients, clients, and providers seem to have an aversion to the idea of psychotherapy, probably due to the stigma associated with the term or related terms. As a team of therapists working to promote behavioral health integration and whole-person care, the Center of Excellence for Integrated Care staff wanted to use today as an opportunity to promote a better understanding of psychotherapy.

The term “psychotherapy” comes from the ancient Greek word roots of “Psyche” which means breath, spirit, or soul, and “Therapeia” which means healing or medical treatment. Those root meanings are a long way from the often stigmatized vernacular term of “psycho.” Additionally, the historically popularized image of therapy — during which clients lay on a couch while a therapist proclaims hypotheses about childhood experiences and current mental illness — have contributed to a misunderstanding about the expectations and outcomes regarding psychotherapy.

What is psychotherapy?

In the context of mental health treatment, psychotherapy is often used interchangeably with the terms “therapy” and “counseling.” Though some professionals in the mental health field have highlighted distinct differences between psychotherapy and counseling, psychotherapy remains the name of the service of providing talk therapy. At COE, we advocate that there should be a common understanding of the language used to describe any therapy services, outpatient or integrated. However, we think that whichever term feels most comfortable to clients/patients and their care team is appropriate. Most important is that the client is well aware of the service they are consenting to receive.

What happens in psychotherapy?

Therapy could be beneficial to most everyone; you do not have to have a serious and persistent mental illness to benefit from therapy. Many people participate in psychotherapy to work on challenging relationships, cope with stress, adjust to new life situations, and explore self-identity.

Once you identify a therapist with whom you feel comfortable working — see this page about identifying a behavioral health provider — you will work toward developing a safe and trusting working relationship with your therapist. The therapist’s role is to help you walk through your challenges, versus the commonly held assumption about offering direct advice or making decisions for you. You and your therapist will work collaboratively to set goals, and both you and your therapist will establish boundaries about the work you will do in therapy. Sometimes therapy will primarily involve talking. Other times your therapist may introduce various activities into therapy, such as creative expression or role-playing to help practice talking through relational issues.

The COE team hopes that this discussion has helped improve awareness and understanding about psychotherapy — and provided some normalization about the therapy process — in honor of National Psychotherapy Day.

If you would like to learn more about providing whole-person care involving psychotherapy, please reach out to us!

Other resources:

Psychology Today locate a therapist.

Therapist Locator.net

Emotion Focused Therapist Locator

Posted in Mental Health Awareness, ResourcesTagged Mental Health, psychology, psychotherapy