By: Allison Hackman
Assistant Manager, Marketing & Communications | Foundation for Health Leadership & Innovation

Creativity is a great way to practice self-care. But how exactly does creativity support mental health and well-being, and how do you incorporate it into your life?

Girija Kaimal, EdD, ATR-BC, a Drexel University professor and leading art therapy researcher, says engaging in the creative process can help reduce stress, lower anxiety, regulate the nervous system, deepen connection with self and others, and improve mood. It also enhances our sense of agency, strengthening our ability to imagine and solve problems.

Learn more below about the science of creativity and ways to practice it for self-care!

The Science Behind Creativity & Mental Well-Being

Creativity is a dynamic process involving skills, thinking, and surroundings to create something new. It can include various forms of expression, such as art, music, writing, innovative problem-solving, and more.

Research has shown that creative activities enhance overall well-being, particularly regarding emotional regulation, cognitive flexibility, and social connectedness. This concept is known as the Psychosocial Model of Creativity and Mental Health:

1. Emotional Regulation

Emotional regulation is what, how, and when people experience emotions and how they perceive and express them. Creativity:

• Enhances self-understanding and awareness by providing an outlet for externalizing emotions and creating space for introspection.
• Opens a “flow state,” which involves total immersion and focus, resulting in a sense of timelessness that reduces stress and elevates mood.

2. Cognitive Flexibility

Cognitive flexibility involves recognizing and considering alternative courses of action and making decisions while adapting as necessary. Creativity:

• Increases cognitive flexibility, boosts self-efficacy, and fosters a sense of control, contributing to resilience and positive mental health.
• Enhances stress management and fosters confidence in navigating life’s challenges.

3. Social Connectedness

Creativity can be an individual or collaborative endeavor, and both offer many benefits for mental well-being. While each person is on their own journey of self-discovery, there is a cross-pollination of energy, ideas, perspectives, and insights. Creativity:

• Builds connections and develops social skills such as communication, empathy, compassion, and awareness.
• Enhances social support networks, reduces feelings of loneliness and isolation, improving overall health.

Creativity is also connected to our nervous system. It helps our nervous system relax, and we can access our creativity more easily by supporting our nervous system through a positive feedback loop. Here are a few tips for supporting your nervous system and enhancing creativity:

• Take movement breaks: Stretch, walk, or do your favorite exercise.
• Engage your senses: Music, textures, nature, and art can all inspire creativity.
• Prioritize rest: Sleep and mindful breaks help integrate creative ideas.

Engaging in creative activities enhances connections and forms new neural pathways in our brains. When combined with self-compassion, this helps us navigate life with greater presence and ease.

Creativity for Self-Care: Ideas to Try

It may take time to discover what you enjoy, but part of the process is that you get to experiment and explore. Setting goals can be helpful, as with any new habit. It’s okay to start small, such as doing an intentional creative activity for five minutes a week, gradually building up to ten minutes a day. Another alternative is dedicating a couple of hours one day a week to care for yourself.

Start small, choose what feels fun or doable, and build from there. Consider activities such as the ones listed below:

• Visual arts: mandala drawing, process painting, sculpting, collaging, mixed media, photography, visual journaling, and Zentangle art
• Music: Playing instruments (whether solo or with others), creating mixes, and curating playlists
• Dance and movement: improvisation, choreography, free movement, miming, and body language acting
• Writing: free writing, journaling, poetry, memoir, novel writing, short stories, and letter writing
• Crafting: crocheting, knitting, jewelry-making, needlepoint, metalworking, embroidery, scrapbooking, woodworking, and candle-making

Whether you’d like to do these activities alone or with others, there are engagement options to fit your needs best. You can take community classes, join online groups, visit local centers, or set up space in your home. Engaging in both can enrich the other’s experience. Spending time alone is vital for inner connection and self-reflection while socializing with others offers opportunities for interaction and the exchange of ideas.

Unpacking Stories: What You’ve Been Told About Creativity

Even with this information and some ideas to help you get started, you might still hesitate to explore creativity for self-care.

How many times have you heard someone say, “I’m just not creative,” “I’m not artistic,” or “I’m bad at art”? We receive messages early on about who and what is ‘creative’ or ‘artistic,’ and that art is either “good” (e.g., visually appealing, realistic, monetizable, etc.) or “bad.”

Another dominant story in the United States is that kids draw and paint; they create and have fun. But, for most people, that free-flowing, spontaneous creativity ends in adulthood. Creativity is often considered a gift of skill and a luxury of time that few adults possess.

Stories are powerful. They profoundly influence our beliefs, and messages diminishing creativity can inhibit our growth from an early age. In this cultural and social context, it is common for people to become disconnected from their natural, creative processes as they “grow up.”

The truth is that creativity is innate; humans are wired for it. If you’re human, you’re creative. There is absolutely no ‘right’ or ‘wrong’ way to be creative. Creativity allows you to explore with curiosity, learn what ignites your imagination, provide comfort, and return you to that timeless flow state of childhood.

Tips for Engaging in Creative Self-Care

Expressing emotions through creative outlets—such as writing, drawing, or speaking—can alleviate tension and create space for insight and healing. There’s a saying, “Name it to tame it.” Sharing something, whether by writing down the painful words of our inner critic or discussing our feelings with a trusted friend, often leads to new insights and changes in perspective.

Expressing ourselves can feel vulnerable and scary. However, summoning our courage to express ourselves helps us step back and acknowledge those thoughts without completely believing them. This enables us to return to the present moment and keep moving forward.

If you notice your inner critic chattering away when engaging in a creative activity, write down your thoughts to externalize them. If you don’t feel comfortable keeping the paper, you can throw it away.

Be patient with yourself; It may take time to loosen up, especially if it’s been a while since you’ve prioritized rest and play. Although it may feel counterintuitive, being gentle with yourself is much more effective for achieving your goals than being hard on yourself.

When engaging in creative activities, as in life, things don’t always turn out as we hope or expect. Yet, we have options regarding the story we tell and how we respond to it, whatever ‘it’ happens to be right now.

There’s no wrong way to nurture a relationship with creativity—only opportunities to learn and explore. Remember:

• Treat yourself with the kindness, love, and compassion you would show your pet, child, or best friend.
• Stay curious.
• Prioritize play.
• Let laughter flow freely.

The more you care for yourself through creativity, the more ease, insight, and joy you’ll invite into your life.

Additional Reading

• Feeling Artsy? Here’s How Making Art Helps Your Brain
• Making art is good for your health. Here’s how to start a habit
• The intersection of art and health: How art can help promote well-being
• Creative expression and mental health

Resources

• Foundation for Art & Healing Creativity Hub
• 21 art therapy activities
• Art for Mental Health & Wellness book list
• Process painting

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Allison Hackman
Assistant Manager, Marketing & Communications | Foundation for Health Leadership & Innovation

Allison joined FHLI as the Assistant Program Coordinator for Marketing & Communications in September 2023. Previously, she worked as a copywriter at an agency and as a freelance writer-editor. She holds a Graduate Certificate in Science and Medical Writing from UNC Wilmington and a Bachelor of Arts in Spanish Literature with a minor in gender studies from Binghamton University in New York. She is passionate about supporting FHLI’s programs and advocating for a healthier North Carolina for all.

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

By: Austyn Holleman, MSW, MPH, LCSW
Director of Community Voice | Foundation for Health Leadership & Innovation

After years of graduate school and endless trainings on fancy treatment modalities, I find myself saying, “This feels hard because it is hard” more than anything else to the moms sitting across from me in a therapy session. I want them to hear and feel that their challenges managing their mental health during the perinatal period have nothing to do with personal failures or inadequacies, and everything to do with the systems that are failing them.

We live in an increasingly individualistic society, where families are left to raise children in dyads, or as single parents with little to no support. Our lack of affordable childcare, stagnant wages, and unrealistic expectations of a “good” parent are just a few of the endless factors coloring the experience of parents across the U.S. working hard every day to provide for their children.

Amidst all these challenges and the additional barriers that parents from historically disenfranchised communities face, it’s no surprise that mothers on a population level are unable to keep their heads above water.

What Are Perinatal Mood and Anxiety Disorders (PMADs)?

Perinatal mood and anxiety disorders (PMADs) are the leading complications of pregnancy and postpartum in the U.S. They are also the leading cause of maternal mortality, accounting for 23% of maternal deaths annually. Rates of PMADs and PMAD-related maternal deaths are significantly higher for Black/African American and Native American women, and lack of access to care in rural communities places those mothers at an even higher risk of severe morbidity or death.

Despite the significant risk that untreated mental health disorders pose to the perinatal population, data suggests that up to 75% of birthing people who experience a perinatal mood or anxiety disorder never receive treatment. 

Evidence-Based Practices to Support Perinatal Mental Health

As a professional who straddles the maternal and child health (MCH) and mental health spaces, I am continually surprised at how often perinatal mental health gets left out of conversations around the maternal health crisis in this country. It is increasingly becoming more widely understood how critical it is to address the disparities in maternal morbidity and mortality. Even though PMADs are the leading cause of maternal death, mental health is treated as a completely separate issue.

If we want to make meaningful strides toward a safer experience in pregnancy and postpartum, we have to view physical and mental health as inextricably linked.

Several evidence-based practices have proven effective in addressing perinatal mental health issues and supporting the overall well-being of moms and their new babies. A few of these include:

• Integrating screening for PMADs in OBGYN AND pediatric offices and creating referral pathways for patients that screen positively
• Increasing access to community-based doulas who can provide education, support, and advocacy for moms during birth and in the postpartum period and can notice early signs of mental health challenges
• Increasing the number of providers trained in screening and treating PMADs (through initiatives such as Postpartum Support International’s PMC-C certification program)
• Increasing awareness around resources such as the 24/7 National Maternal Mental Health hotline and the NC Mental Health Matters Hotline
• Increasing access to and decreasing stigma around substance use treatment in the pregnancy and postpartum periods

Additional policy changes are necessary on the state and federal levels to support systems-level improvements and increase positive maternal health and mental health outcomes.

Initiatives and Advocacy for Improving Perinatal Mental Health Outcomes

Postpartum Support International is a key organization that advocates for these changes through the Mind the Gap initiative. Mind the Gap seeks to raise awareness around the perinatal mental health crisis in this country, highlighting populations who experience disparate levels of poor outcomes and naming specific legislative changes that will help move the needle.

At the state level, the North Carolina Department of Health and Human Services Division of Public Health also recently released their 2024-2026 Perinatal Health Strategic Plan, which “…seeks to address both the challenges of structural racism and of the pandemic by focusing on drivers of health.”

Please visit the NC Mental Health Matters website for more information about NC-specific resources supporting perinatal mental health.

Supporting Perinatal Mental Health Through the Maternal and Child Health Equity Action Network

At FHLI, we are dedicated to advancing whole-family health across North Carolina and building a healthier state where everyone can access the care they need. As part of that commitment, we have proudly housed the Maternal and Child Health Equity Action Network (MCHEAN) for the past two years.

After conducting a statewide landscape analysis in 2022, FHLI facilitated the development of the MCHEAN, bringing together over 50 participants, about half of whom had lived experiences with maternal and child health equity challenges.

A diverse range of participants, including health providers, community organizations, advocacy groups, government agencies, policymakers, researchers, educators, and individuals with lived experiences, engaged in meaningful, nuanced conversations about the root causes of the maternal and child health crisis.

Centering community voices throughout the process, the MCHEAN co-created action plans to enhance our state’s maternal and child health outcomes. The second action plan includes integrating behavioral health and medical care as a key strategy for supporting maternal health and improving outcomes.

If you’re interested in learning more and getting involved in the next phases of this essential work, please complete this brief form, and we will be in touch!

Austyn Holleman, MSW, MPH, LCSW
Director of Community Voice | Foundation for Health Leadership & Innovation

Austyn is a licensed clinical social worker with her Master of Social Work and Master of Public Health from UNC-Chapel Hill. Most recently, she served as a consultant for the National Network to End Domestic Violence in Washington D.C. while also serving as a perinatal mental health therapist and a doula.

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

One of my first clients as an outpatient therapist 12 years ago involved a woman who was living in a hotel with her daughter and grandchildren, limited food, no reliable transportation unless she had money for public transit, unable to work due to multiple health conditions, and uninsured—all while experiencing significant mood disturbances. I was able to see her in her hotel room at most once a week for 53 minutes for a therapy session (travel expenses paid for by me, mind you) for up to 8 sessions, and she currently qualified for minimal social services, of which I would also need to seek out on my own time as care coordination was not reimbursed.

I came back from that session and cried in my supervisor’s office, I cried to my mom, I cried in my car. 1) I had no idea where to begin, 2) She had SO many challenges and each influenced the other, making providing her with support seem impossible, and 3) In Maslow’s Hierarchy of Needs, we know that unless your basic physiological needs are met, you can’t even begin to truly meet your additional needs of safety, needs for love and belong, or self-esteem—all of which were my area of expertise, as opposed to helping with physiological needs. I became a licensed Marriage and Family Therapist to help people feel better who were struggling with mental health conditions, and my role seemed inconsequential to what my client was experiencing and needing. But there were no other options for her.

I would have many more of these experiences after this that can only be described as moral injury—witnessing how our health care system and the business of health care can do a disservice to us as providers and the quality of care available to our clients or patients.

What is Moral Injury?

Moral Injury was often used to conceptualize the experience of soldier in war, “battling the mental, emotional, and spiritual distress people feel after ‘perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations,” (Litz et al., 2009). This concept for soldiers was then increasingly compared to being a health care worker in the United States which “…occurs when clinicians are repeatedly expected, in the course of providing care, to make choices that transgress their longstanding, deeply held commitment to healing” (Dean & Talbot, 2019).

Those who serve as health care providers, while often trained to expect and manage instances of distress, can be faced with consistent and difficult work experiences that make them battle what needs to be done and their values or beliefs. For example, health care workers during COVID were battling caring for their patients while faced with an under-resourced system and the knowledge that caring for their patients was putting their own family members at risk of infection.

The experience of placing competing priorities such as administrative burdens and financial concern over patient care can be increasingly taxing. Health care workers may feel burned out, including feelings of guilt, shame, or anger can persist as a result of the moral injury not being addressed. Symptoms of PTSD can be present including avoidance of certain people or places, withdrawal, self-blame, intrusive thoughts or memories, mood disturbances, or differences in how one sees the world. On a larger systems level without proper support, a person may feel betrayal, anger, resentment, and a lack of confidence in their leaders, organization or systems in which they work.

“All of us who work in health care share, at least in the abstract, a single mission: to promote health and take care of the ill and injured…But the business of health care—the gigantic system of administrative machinery in which health care is delivered, documented, and reimbursed—keeps us from pursuing that mission without anguish or conflict. We do our best to put patients first but constantly,” (Dean & Talbot, 2019).

An interesting parallel came in 2023 from Wendy Dean, co-founder of the non-profit Moral Injury of Healthcare, to work on clinician distress. Comparing physicians to high-performance automobiles, Dean shared that “the fault lies much less in them than in the bumpy road they are asked to navigate. We need to get about fixing those potholes.”

How to Tackle Moral Injury

On an individual level, self-care is critically important in addressing moral injury, particularly via connection. This can look like reaching out to others to get feedback and support in navigating difficult choices or in situations that lead to moral distress. This can allow for helpful alternatives to managing these experiences along with validation and emotional support.

Leadership can be helpful in both prevention of moral injury or in managing the impact of these types of experiences. Increased communication, extended patience with one another, and checking-in with staff are all important. Reminding employees that they are doing the best they can despite the challenges they are unable to change, or that what they did was not preventable, or that it is okay to seek professional support if needed. Praise and gratitude can have an impact. Larger organizational approaches and changes can be critical as well in prevention and mitigation of moral injuries. On a smaller scale, treating these incidents as occupational hazards and allowing health care workers to process with their peers (Rabin et. al, 2023). Additionally, and on a much larger scale, improving the health care and insurance infrastructure as well as organizations’ infrastructure will have lasting improvements on the well-being of healthcare worker’s mental health (Rabin et. al, 2023). Improved pay, appropriate working conditions, paid time off, increased access to equitable health care services and insurance coverage for all, and addressing moral injury within systems are all critical for the lasting careers and overall well-being of those working in health care. This allows us to fulfill the mission we had when joining the field: to help care for others.

Resources

• Cynda Rushton, Ph.D., M.S.N., R.N.Professor of clinical ethics and nursing, Johns Hopkins Berman Institute of Bioethics and the School of Nursing
• https://www.aamc.org/news/moral-injury-harms-providers-and-patients; Weiner 2023
• Rabin S, Kika N, Lamb D, Murphy D, Am Stevelink S, Williamson V, Wessely S, Greenberg N. Moral Injuries in Healthcare Workers: What Causes Them and What to Do About Them? J Healthc Leadersh. 2023 Aug 16;15:153-160. doi: 10.2147/JHL.S396659. PMID: 37605753; PMCID: PMC10440078.
• https://pmc.ncbi.nlm.nih.gov/articles/PMC10440078/

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

Medical providers talk with us about preventing high blood pressure, high cholesterol, weight gain, low bone density, diabetes…shall I go on? Each year I visit my primary care provider to have these conversations and as I have gotten older, some conversations have trickled in around perimenopause and menopause as well. But the same emphasis has not been given to my mental health. There have not been conversations about my family’s well-being, how I am handling the launch of my first-born to college, or simply how I manage my day-to-day stress. And yet…it is no longer a secret how stress impacts our body. Why do we not close the loop on our health recognizing the relationship between the body and the mind? Why do we not give the same degree of attention, importance, and infrastructure to maintaining our mental wellness and preventing mental illness?

For our children, prevention in mental health seems to have typically been left up to school programs. Unfortunately, many children have come to tune out those messages, even my children have admitted to blatantly dozing off during those lessons. While universal prevention and health promotion programs such as these remain valuable to many, I have come to wonder if they allow students to have that thought of “it won’t happen to me” or simply “this doesn’t apply to me.”  I wonder if it also sends the message, that for most kids this group lesson will be enough…but for the “really troubled ones…” well then you are really “messed up and you need a therapist”. Does this perpetuate the stigma around mental health? Why is this one area of our health not given the same individual attention as our physical health?

Part of me thinks it is because mental health is one of the most amoeba-like parts of who we are as human beings. While we have figured out a lot about mental health, thank goodness, there is still a lot that is unknown. Personally, I believe it will always be unknown. I don’t think we are meant to be able to calculate and control all the elements and devise all the solutions. But what we do know is that things are not getting any better for our children and youth, and we must begin to do things differently.

At the Center of Excellence for Integrated Care, we have been talking with stakeholders, clinicians, and other states to best understand how to build the infrastructure that would support individualized conversations with children, youth, and families around mental and relational health. Insurance coverage of a mental health well-child check, especially (but not only) provided alongside the well-child visit already received by families, would provide a sustainable opportunity for providers to have these conversations around mental health and wellness. It would likely also create a more sustainable environment for integrated behavioral healthcare in primary care offices, which would increase accessibility to behavioral health services for many of the mild to moderate needs. It would be a chance to get upstream, to begin to turn the tides and shift the paradigm of waiting until a crisis occurs before therapeutic help is sought. Think of the many individuals, couples, and families who might benefit coming in early if that stigma of seeking this type of healthcare was eliminated. While we are right to continue resourcing the intervention and crisis needs of our children and youth, it is clear we must dig deeper to simultaneously discover how we can perhaps begin to live in a world where we are able to focus on thriving and not barely surviving.

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

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