Nurture Your Whole-Person Health

May 25, 2023

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 ,

The Spirit of Mental Well-being

May 18, 2023

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.


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 ,

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 (, 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.

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 ,

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 painBack PainFatiguePoor hygiene
Stomach upsetHeadachesWeight changesRepetitive tics
Sore/tense musclesInsomniaHyperactivityRestlessness

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?


               “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.”


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.


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.


CDC Mental Health Toolbox

NC Therapy Directory

Find a Therapist

Posted in Mental Health AwarenessTagged ,

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.

Posted in Mental Health AwarenessTagged ,

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 ,

Planting Seeds for Healthy Relationships

May 12, 2022
Image courtesy of Pixabay

*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 ,

Press Release – July 2021

July 30, 2021

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

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

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

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

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.


For more information, contact:
Marni Schribman, Director of Communications & Public Relations
Foundation for Health Leadership & Innovation (FHLI)

Posted in Mental Health Awareness, Press Releases, UncategorizedTagged , , , ,

Maintaining Mental Health During a Pandemic

May 28, 2020

Maintaining Mental Health During a Pandemic by Brady Blackburn, MA

COE was pleased to collaborate on this blog post with the North Carolina Oral Health Collaborative (NCOHC), one of our partner programs at the Foundation for Health Leadership & Innovation, on a discussion of the intersection of mental health, the oral health care world, provider well-being, and COVID-19.

“This pandemic is a perfect storm,” said Dr. Lisa Tyndall, an integration specialist with the Center of Excellence for Integrated Care, a program of the Foundation for Health Leadership & Innovation (FHLI).

As North Carolinians navigate COVID-19 and its various impacts, NCOHC decided to sit down with our partner program at FHLI to discuss how the pandemic poses significant mental health concerns, for patients and providers alike.

Tyndall, a licensed marriage and family therapist, said that the wide range of impacts caused by COVID-19 — from financial stress to anxiety and isolation — are serious stressors that negatively impact mental health.

“The fact that we can’t be with each other absolutely negatively impacts the coping mechanisms most people use of reaching out and spending time with friends and loved ones,” said Tyndall. “We are wired to connect, and right now we are limited in those personal, face-to-face relationships.”

For the provider community specifically, Tyndall worries that we tend to forget that they are humans, too.

“I think that we forget that the frontline providers are facing a lot of the same uncertainty that the rest of us are,” said Tyndall. “Especially for those providers who live alone or are caregivers in their personal lives. If a provider doesn’t have a support system, or if their support system is already stretched thin, it is an especially difficult time. There’s a physical as well as an emotional toll to the stress, and it builds up. Providers manage the stress of patient caregiving every day, and then still go home to manage their own households, potentially adding an additional layer of stress.”

“As doctors, we are trained to be the rock,” said Dr. Zachary Brian, NCOHC’s director. “We’re trained to be the provider, there to serve the community, sometimes at the expense of our own physical and mental health.”

Both Tyndall and Brian described a juggling act for providers, balancing service to their communities, personal and family safety, as well as financial well-being.

“It can feel as though you are navigating a sea of conflicting resources, literature, and research to determine the safest way to move forward with your practice,” said Brian. “Given that this is a novel virus, it is not uncommon to see this type of response. The issue arises in that there’s no one clear authority to look to for guidance, which makes informed decisions on behalf of your patients and staff ever more challenging.”

As health experts learned more about the novel COVID-19 virus in recent months, guidance from the American Dental Association, the Centers for Disease Control and Prevention, and other state and national regulatory bodies were released, but were not always in exact agreement with one another.

“The resources for providers that we have seen, although very helpful, have not necessarily always been in parallel,” said Brian. “This has created a surge in confusion.”

What can you do about the uncertainty?

Dr. Brian says, “While the provider community as a whole may be very isolated during this time, forced to make decisions with so many unknowns, there is support within your regional communities. Don’t be afraid to reach out to your colleagues. People need to be very open and transparent, so we don’t have to navigate this crisis in a vacuum.”  

Dr. Tyndall says, “We have to lift ourselves up and we have to lift each other up. We don’t have to talk about it all the time, but we also should give a voice to it and not minimize the stress. It is important to have outlets to express uncertainties, fears, and concerns.”  

Dr. Tyndall also shared a couple of resources for providers who need help managing their own mental health needs during this time.  

The Hope for NC Helpline is a free helpline for people who need assistance coping and maintaining resilience during COVID-19. The number for the 24-hour helpline is 855-587-3463.  

For first responders, the University of Minnesota, the Minnesota Department of Health, and the University of Minnesota College of Education and Human Development have released a First Responder Toolkit to help those deployed in emergency response maintain their own physical, emotional, and social well-being. The app can be accessed here (note: a login is required).  

Financial uncertainty is another stressor impacting many oral health care providers. This is especially salient in the private sector, where most dental practices are small businesses. On top of figuring out how to keep everyone safe and healthy, while still providing necessary care to the community, providers must also navigate out how to stay above water financially.

“Even though it seems like practices would be bustling during a health crisis, we also know that there is a side where providers aren’t seeing as many patients,” said Tyndall. “So that financial stress — especially for smaller practices, rural practices — is very real.”

Brian said that the oral health profession is on the low patient volume side of the equation. Largely due to the use of aerosolizing instrumentss, dentists, and hygienists in particular, are near the top of the list of most at-risk professions for COVID-19 transmission. In response to the elevated risk, most dental offices have only seen patients for urgent needs during the pandemic.

Brian said that in the oral health care space, safety net practices are facing profound and lasting financial impacts, as well. Practices that see patients regardless of their ability to pay, and who offer care on a sliding fee scale, have very thin to nonexistent margins to begin with. Nearly completely cutting off their revenue stream can be catastrophic.

What can you do to navigate financial uncertainty during COVID-19?

Dr. Brian points to the ADA’s resources for providers, especially the following the guidance:  

Return to Work Toolkit Financial Assistance for Dental Practices from Third Party Payers
COVID-19 Coding and Billing Interim Guidance: Virtual Visits
COVID-19 Coding and Billing Interim Guidance: PPE
Financial Obligations to Staff During COVID-19  

Additionally, the North Carolina Division Health Benefits has issued temporary modifications for telehealth billing, and NCOHC has launched a teledentistry fund with support from the Blue Cross and Blue Shield of North Carolina Foundation.  

If your practice is a safety net provider in need of teledentistry software, please reach out to for information on how to apply for funding through the NCOHC Teledentistry Fund.

Please note: The aforementioned guidance documents are only to serve as a resource, and are not necessarily founded in scientific evidence, or endorsed by NCOHC or COE.

According to Brian, it is important for providers to be aware of oral signs and symptoms that can alert them to potential mental health needs of their patients.

“You have parafunctional habits such as clenching and grinding that can develop as a result of stress, and from this you can see detrimental effects on teeth and other oral structures, such as extensive attrition and fractured teeth,” said Brian. “I saw that a lot with my patients when they were going through stressful events in their lives. They would come in with three or four fractures in their teeth, sometimes where the fractures extended past the gumline requiring surgical interventions.”

Brian also said that dietary changes due to stress and anxiety can negatively impact oral health. Increased sugary food and carbohydrate intake, as well as alcohol consumption, can both increase risk of tooth decay and gum disease.

“One thing that we’re not talking about enough is that we’re only seeing emergency patients right now,” said Brian. “There are people who are delaying appointments or not seeking care, and by the time they come in, what could have been a simple filling previously has now advanced to the point where it requires a root canal or an extraction. This is also particularly important for routine oral and pharyngeal cancer screenings.”

How can an oral health provider look out for mental health strains in patients?

Dr. Brian says, “Look for attrition patterns from clenching and grinding, fractured teeth, and TMJ pain.”  

“As an oral health professional, having a relationship with someone in the mental health space is vitally important, also. You need to have a sounding board to discuss mental health concerns of your patients, and a trusted referral source to help route that patient to proper care.”  

“It is crucially important that you have deeper conversations with your patients. Make sure that you take a whole-person care approach by including the mental health of your patients into the patient experience.”  

Both Tyndall and Brian agreed that taking time to reflect and take care of yourself is incredibly important for providers during this pandemic. Taking steps to interact with family, friends, and colleagues is an important way to cope with the isolation and stress we all are experiencing.

“Dig deep into your resource and faith buckets, and be kind to yourselves,” said Tyndall. “Take time to make sure that you’re taking care of yourself, too.”

“This too shall pass,” said Brian. “Dentistry remains a profession that allows us to impact our patients in direct ways, see immediate results, and change lives. That doesn’t change with the pandemic.”

Posted in Mental Health AwarenessTagged ,

Stress, or more?

May 19, 2020

Am I stressed, or do I have a mental health disorder?

by Ricky Caliendo, LMHC

It was 2014, a fresh box of tissues sat on the coffee table and steam dissipated into the air above a warm cup of coffee. A screech from the opening of the lobby door traveled into my office as a wave of anxiety set in. Immediately, I remembered a not-so-encouraging joke that my clinical psychology professor overused throughout one semester: “Every student should prepare a sorry card for their first patient.” Why was it that this poorly placed joke has found itself cornered into my thoughts as my first patient eagerly waits outside my office?

A professional, middle-aged man sat down across from me, looked at the box of tissues, and offered me a cunning grin. He understood that I was younger than him. Nonetheless, I sipped my coffee and started the session. After obtaining informed consent, and just about finished reviewing the laundry list of office policies, he stopped me with a distinct purpose. He said, “All I want to know is if I am just stressed out or actually going crazy?” I jokingly assured him that there is a thin line between the two. He gave a small chuckle as we both felt the ice in the room breaking. He eased back into the couch and began to disclose the recent detour his life had taken. Between a divorce, cancer diagnosis, and his mother’s deteriorating health, I thought to myself that he had a lot more resilience in him than he realized.

Through the years in practice, and navigating through diagnostic and treatment recommendations with colleagues, the answer to the question that my first patient had has changed. Although humor has sustained, with a more sincere explanation now, I would not jokingly hint toward this line between stress and mental health disorders as thin; on the contrary, the line is thick yet permeable.

Is stress common? Definitely. We all experience good stress, such as excitement, and then there is stress that challenges us. This is a normal part of life.

Do mental health disorders exist? Of course. Mental illness can mean many different symptoms and experiences, but we do have a way of capturing the range of mental illness through diagnoses.

Making a diagnosis is very important in guiding evidence-based interventions and psychopharmacology. However, the person, and their uniqueness, exists before the diagnosis. A diagnosis can blind the individual differences in patients. Understanding the person, their experience, unique stressors, and even more importantly, how they respond to those stressors, will always exceed the importance of a diagnosis.

Our body and mind have a fundamental response to uncomfortable internal or external conditions. Stress is the umbrella of responses that can occur in relation to this, although this experience is hardly uniform. And, while every human being on this earth has experienced stress, everyone has not experienced a mental health disorder. So, what is the real difference?

Rather than dissecting the 5th edition of the Diagnostic Statistical Manual of Mental Disorders and providing a quiz at the end of this blog, let’s look at this in a different way. The size of the stressor may influence the size of the response. For example, a global pandemic that creates media hysteria, economic crisis, broken routines, and social isolation is likely to create a more persistent and intensified stress response compared to running late for work and burning your toast. However, there are variables — such as genetics, traumatic occurrences, and biological influences — that can make these stress responses less predictable and proportional, and even alter the likelihood of developing a mental health condition.

Given that we have already established that everyone has experienced stress, one may imagine that there are some shared manifestations of stress. Trouble with sleep, concentration, appetite, drive and motivation toward pleasurable activities, and irritability are some common internalization responses to stress. The intermittent slam of the door or giving someone the silent treatment may be common externalized responses. These can also be signs of depression. But the severity — how it impacts your functioning — and other symptoms need to be considered before naming a mental illness. Some of the more concerning symptoms related to clinical depression may include hopelessness, trouble with memory, increased alcohol and substance use, and suicidal ideation, to just name a few more concerning experiences. Certain things like good self-care, support, and treatment, can impact the degree of permeability of the line between mental health disorders and stress.

Remember, if you’re having a bad day, or your environment is providing you with an extra stressful situation, it is normal to not be at your best. Allow yourself to have a stress response and remind yourself that this is uncomfortable, but it is normal, and there are coping techniques that can help reduce your stress. If persistent, disproportioned emotional or behavioral responses continue — with a negative influence on your quality of life, relationships, and functioning — it may be time to dig a little deeper to explore support for your mental health.

For Mental Health Awareness Month, we wanted to bring attention to this important distinction between stress and mental health disorders, and remind our partners and communities that there is help and support available for both. Connecting with a behavioral health professional — such as a counselor, psychologist, therapist, or psychiatrist — can help you determine if what you’re experiencing is stress or a mental health disorder. Additionally, your primary care provider will be able to support your whole-person health needs, including your mental health. Many primary care offices are homes to behavioral health professionals, and providers work together as a team to deliver whole-person health. You may be able to speak with a behavioral health clinician right at your primary care office!            

We hope you all are staying safe at home and in the community. Take time to care for yourself and your loved ones. Feel free to explore our resources and blog posts related to Mental Health Awareness month.

Posted in Mental Health Awareness, ResourcesTagged , , ,