About Wellness Alley
About Wellness Alley
This article was the feature article in the NAMI Advocate Winter 2018 edition: Putting the Pieces Together on Integrated Care.
“She’s just anxious, Allison,” said my mother’s physician.
I had called in desperation to report Mom’s intensifying symptoms: cold sweats, difficulty breathing, low-grade fever, no appetite. In return, I was dismissed. I reported her labored breathing and her inability to force herself to eat—how she wrinkled her nose to once-favorite foods, how sweat rolled down her face, even when our car’s air conditioning was turned up too high. Despite her physician’s lack of concern for all this, Dad rushed Mom to the ER one day anyway, where her excessive coughing delayed a necessary lung biopsy.
The next day, Mom’s physician (now involved in her care) met me outside her hospital room and quietly said, “I’m sorry, Allison. Your mom has lung cancer.” I slowly entered her room and sat down. The words continued: “Late stage … little hope … chemo immediately.”
Devastation. Anger. Disbelief. The physician left me with nothing to hang onto. As Mom gasped for breath, her anxiety showed; she finally knew what was growing inside her, what she tried to treat with antibiotics and antihistamines. It was like being trapped in a nightmare. Mom was only 45 years old, was never sick, had never smoked, never even had allergies—and she loved life.
When I returned the next day, I walked into an empty room. I ran to the nurse’s station. “We’re sorry… Your mom had a stroke and is unresponsive. She’s been taken to the ICU.” Within hours, my family gathered to make “the decision.” I watched as my dad struggled to make the final call. I was numb. I watched the doctor’s lips move, but I didn’t understand. We gathered around her bed as Mom took her last breath. It had only been two weeks since my phone call asking the doctor for help. Now she was gone.
I later found in Mom’s datebook that she tracked her temperature for months and scheduled appointments with specialists who gave her various medical diagnoses and prescriptions. However, the elephant in the room was always her diagnoses of depression and anxiety. Her mental health diagnoses somehow managed to overshadow the underlying cancer that had been quickly invading her body. “She’s just anxious, Allison.” No… my mother was simply never heard.
I was 23 when my mother died. I’ve never really gotten over her death, but over time, I’ve learned to move through grief and turn it into something else. At the time, I’d been unsure of my career path. But after her death, everything became crystal clear.
Stigma cost my mother her life. I never wanted to see that happen to anyone again.
So, I obtained my master’s degree in social work and swore that I would always listen to my clients. I worked with people who had mental illness and often observed their physical symptoms being neglected due to their predominant mental health diagnoses. They would frequently call their doctors with symptoms that could be related to anxiety or depression and would have their psychiatric medications increased before having possible physical conditions evaluated.
People coming in for mental health services often lack a proper education about how their physical conditions impacted their psychiatric symptoms. For instance, I once met with someone before she met with her psychiatrist. She stated she was going to request an increase in her antidepressants since she was experiencing low mood and decreased energy. But I observed that she was drinking a regular soda and eating chips. Knowing she was diabetic, I talked with her about the importance of letting her psychiatrist know about her eating habits and blood sugar levels before defaulting to an increase in antidepressants. She had no idea that her food choices might be impacting her mood and energy and her psychiatrist had never mentioned it, either. As a clinician, it was frustrating to see.
That’s why I was excited when the organization where I had been working for years decided to become part of Missouri’s Healthcare Home pilot program. This program spearheaded the path to integrated care for our most vulnerable populations: people diagnosed with mental illness and major physical health issues. Research from the program showed that people with mental health diagnoses die, on average, 25 years earlier than people without mental illness—due to things like lack of health care integration, health literacy, poor nutrition and other social factors that impact overall health and wellness. When this program was initiated, I worked on its treatment team and referred many clients to the program, so they could have the medical oversight needed as part of their overall care.
When practicing integrated health care, an ongoing challenge is to coordinate care across all providers to ensure treatment plans are focused on health, wellness and preventive care. There are many barriers, which often keep doctors treating patients in a silo-approach (focused on our own areas of expertise). But the benefits of integrated care are innumerable—including decreased trips to the emergency department, decreased hospitalizations and reduced cost of health care thanks to preventative care. Having a whole team of professionals across various disciplines improves outcomes through early detection, monitoring and care coordination.
Programs like Healthcare Home show these effective interdisciplinary teams in action. Doctors, nurses, dieticians, occupational therapists, therapists, social workers, etc. meet to consult with each other and coordinate care using knowledge from each area of specialization. That way, when someone with physical health symptoms and a history of mental illness or substance abuse is being treated, they are heard—without stigma or judgment.
In the 32 years since my mother’s passing, progress in medicine and psychiatry have drastically and positively influenced health care. Thankfully, advances have also been made in integrated care, but we have a lot of work to do. We must break down the silos that separate physical and mental health because everything is connected: Physical symptoms affect a person’s mental health and a mental health diagnosis may increase the risk for physical health-related issues. Listening to a patient’s every symptom will lead to proper treatment and better quality of life.
As doctors and mental health professionals, it’s our job to dig deeper, peel the layers of the onion and address the core issues that keep people from living life to their fullest. Whether that’s uncovering childhood trauma that hasn’t been addressed or substance abuse that helps numb overwhelming symptoms or pushing past a mental health diagnosis to see a possible physical health diagnosis, addressing “one side” of a person’s care is just the tip of the iceberg.
If my mom’s cancer had been caught earlier, she may have been cured, but just as important, she would have been heard. It was only when my mother was diagnosed with cancer that her health care professionals gathered to formulate an integrated treatment plan. But by that time, it was too late.
I will never forget those words: “She’s just anxious, Allison.” Losing my mother changed my life, but it also inspired me to make changes in health care, so everyone—regardless of mental health diagnosis—gets the whole-person, integrated care they deserve.
Allison White, ACSW, LCSW, CCDP-D is a licensed clinical social worker with over 25 years in the field. She works in a community mental health integrated health care program. An important part of her work is recognizing and addressing all aspects of a person’s life and working with other health care professionals to integrate and coordinate their care. Visit her website at www.wellnessalley.com.
It’s becoming more challenging trying to live a balanced life when there are so many obligations and so little time to get them all done. We plan for the future, while ruminating about the past. It’s easy to allow things to spiral out of control as we get caught up in the business of everyday life. But there is hope.
When thinking about my vision of calm within the storm, I remember the movie “A River Runs Through It,” which shows how the art of fly-fishing demands stillness, creativity, concentration and balance for one to be successful at it. A main character in the movie often struggled to control his emotions, except when he was practicing his skills at fly-fishing. He found solitude on the river, where he learned to regulate and calm himself through what we refer to as “mindfulness practice.” Through the rhythmic, intentional casting of the line, he retained balance while standing on the rocks in the midst of the raging river. The fishing line flew with wild abandon above the water, but the fisherman maintained control as he stood solidly on the ground, keeping his focus.
This is the extent of my fly-fishing knowledge, having never experienced it, but the movie left an impact on me because it mirrors what we experience in daily life. We allow our thoughts and emotions to lead us, like the fishing line whipping wildly above the current – up, down, sideways, back, forth – with nothing to guide them in the right direction. Our thoughts can hijack our ability to think clearly and with purpose. No guide, no focus leads to feeling out of control, and increases stress, anxiety and depression, making it difficult to enjoy life.
It’s easy to get trapped in the chaos – the raging river – which can easily sweep us downstream. I’ve experienced the drifting; it leads me further from my goal, while zapping my energy as I fight to regain control. I’ve also had to tread water while searching, sometimes blindly, for that rock to hang on to in the current. It’s during those times that I force myself to focus: There are ways to catch myself before being swept away.
I learned the power of finding balance while practicing mindfulness. Just as in fly-fishing, it takes skill, practice and patience. When our thoughts leap around aimlessly – media blasts, cell phone calls, to-do lists – just like the fisherman, we must remain still, notice where our thoughts are leading us, then gently guide them back to stable ground. Breathe deeply; then reel them back to center.
Mindfulness is the practice of paying attention to the moment, without judgment. It seems so easy until the first wave of emotion hits. This is why it’s called “practice.” When life happens, we react, turmoil ensues – and the cycle continues. Mindfulness is the stabilizing force to help guide us back to stable ground.
Distractions – “I should have …” “If only I had …” or “What if …” – keep us stuck, unable to move, frozen in time, stagnant. They set us up for anxiety and depression, and quickly deplete our energy. So, you ask: How do I stop being hijacked by my thoughts and emotions? The first step is to notice the signs of tension or stress in your body. Whether you feel tightness in your shoulders, body fatigue or headaches, your body stores your emotions before you attach meaning to them or are able to name what you’re feeling. Notice changes in sleep patterns, which are clues to your need for mindfulness. Listening to your body’s needs creates the base necessary for overall well-being. Then, you can work on mental health to maintain balance.
Practice mindfulness every day, until it becomes a habit. Focus on your five senses, breathe deeply, listen to music, play with your pets, guide your mind’s imagery, mindfully eat healthy food – all ways to refocus on the things that matter and the moments you can experience right now. These are things you can control that will help regulate your moods.
Your mind and body are interconnected, so caring for your body is essential for good mental health. During times of low mood, increased stress or anxiety, reflect on how your body is feeling, and listen to what it’s telling you through symptoms such as headaches, muscle aches, tension, fatigue. The easiest place to start when you’re struggling is to focus on just breathing; that will ground you while your next steps become clearer. This is practicing mindfulness. Through this practice will come peace, and with this peace comes the ability to handle anything that threatens to knock you off your feet. If you do get knocked down – and you will – return to the practice. Breathe deeply again. Focus again. Stay grounded, and ride out the storm. The storm will pass – again – and in its place will come renewed strength and a sense of mastery over life’s obstacles.
We don’t get stronger by avoiding our obstacles. We learn from our failures and our weaknesses, and we gain strength through our ability to overcome them. It’s only then that we are able to live life to its fullest and enjoy what it has to offer.
Allison White, ACSW, LCSW, CCDP-D
Wellness Alley, LLC
These situations can be devastating. This group will support you in a safe, non-judgmental environment to help you regain peace in your life.
Support groups will be held at:
Breath Of Life
7700 Clayton Rd, Suite 319
Richmond Heights, MO 63117
2nd Monday of month 6:30–8:00 p.m.
4th Sunday of month 1:00–2:30 p.m.
Cost: $20 per person for 1 1/2 hour group
Please call 314.899.7140 to RSVP and confirm the group will meet as scheduled. Individual counseling is available upon request. Some insurances accepted if appropriate.
Had a wonderful time at the Humane Society’s Bark in the Park. Funds went to a great cause. It was so much fun to see people enjoying the beautiful day with their pets. Lots of laughter and good times!
I’ve always been a pet lover. I remember when I was 7, my great-uncle Benji said to my parents, “Allison needs a dog.” It was at that time, my life changed. I was a very quiet, reserved kid, but dogs brought me out of my shell and taught me lessons as my life began to unfold. They were with me during good times, painful times and major life events, and loved me no matter how I reacted to these situations. They remained stable forces in my life, even during the darkest turmoil. For example, my dog Charity stayed with me during the final days of my grandmother’s life. Charity was a healthy dog, but as I sat by my grandmother’s bed, she became sick, which forced me out of my immediate pain and suffering to divert attention to taking care of her. She suddenly became “well” after my grandmother passed away. She seemed to know how I was feeling, even when I had trouble expressing it myself. Charity stayed by my side, giving love and attention that dogs are so good at providing.
I often ask myself whether I’m treating others and living my own life as my dogs do. Am I loving without conditions, judgments or expectations? Am I living in the moment, or do I let the past cast shadows on the present? Do I worry about future issues that may or may not happen? Living life through the eyes of a dog is a challenge, but trying to do so is slowly changing my life. When I find myself defaulting to old habits and patterns, I try to recognize them, which makes them easier to deal with. It brings an almost immediate sense of calm and appreciation that would have gotten lost in the turbulent thoughts that used to take me off course. I’m able to stay on my path without so many diversions. And I use the same skills from my toolbox to teach others who also want to gain more joy in their lives.
I saw amazing results when I took my two certified therapy dogs on visits to a children’s home. Charity seemed to use her sixth sense to identify which child needed extra attention. I watched as she “worked” the room, going to the child who was quiet and reserved, but who lit up when she sank her head into the child’s hands. I started becoming more aware of how she interacted with these kids, using an unassuming presence without expectation or reward. She just sat by them, until finally, their hands reached out to touch her. She let them initiate the first step before moving closer. Then, beside even the most resistant child, she would roll over to get her belly rubbed, to the glee of the child. She loved her visits with “her” kids and knew whenever it was time to visit, waiting patiently by the back door as I prepared her therapy vest and tags. The uniform turned her into a dog on a mission, and she took her job very seriously.
Chip, my golden retriever, takes his job very seriously too. He patiently watches leaves and twigs fall, then runs around gathering them into piles that he quickly shreds into small pieces. He spends a long time on this task, stopping only when I call him inside. He loves his sticks and could be satisfied spending every waking hour gathering them and shredding them. The day in the life of a dog … it doesn’t get any better!
I practiced enjoying the moment as I watched Chip sleep peacefully in a chair on this lazy Sunday morning. A ray of sunlight beamed onto his head as he snored. I stopped writing my grocery list to capture the feeling of serenity and happiness, while watching his legs move as he dreamed. How I love this dog. His mission in life is to bring me dirty socks, towels and sticks, and to roll in anything muddy. Oh, and to bring me his beloved tennis balls!
I finished my “to do” list with a different appreciation for the day and what was really important for me to accomplish. All is well for me … in this moment.
I work with clients who have chronic issues such as depression, anxiety and addictions, and they don’t always feel like there is hope. It’s hard for them to see there is light on the other side of the darkness, and peace seems so far away. As I use my dogs during pet therapy visits, I see that spending time with animals brightens up a person’s mood and brings joy, even if it’s for a short time. That moment allows a small trickle of light into that person’s heart, which may not have been there before. During one session, a client asked if she could get on the floor because she wanted to talk to my therapy dog about something “very important.” She buried her head into my dog’s fur and told her about the horrible week she had endured. As she stroked my dog’s fur, I could see a sense of calm overtake my client in a way I could not have accomplished by merely talking with her. No judgments, no expectations – just a furry hug.
When we’re facing despair, loneliness, chronic health issues, depression, addictions, or anything beyond our ability to cope, a pet may help ease the pain. He or she can give us a reason to get out of ourselves and our thoughts to focus on a sense of purpose, meaning. Even pictures of pets can warm our hearts and make us laugh. I keep cute animal pictures readily available for a quick pick-me-up. The relationship we have with our pets is real and symbiotic. What I give to my pets comes back to me in ways that can’t be measured. If you’re not able to own a pet, there are many ways to reap the benefits of a pet relationship. Volunteering at a local shelter or helping rescue groups or therapy dog organizations are ways to save pets’ lives, and possibly your own.
Wildlife photographer, author and television personality Roger Caras said it best when he stated, “Dogs are not our whole lives, but they make our lives whole.” Now, go enjoy a pet, and allow yourself to reap the benefits he or she will so generously give back to you.
Allison White, ACSW, LCSW, CCDP-D
Wellness Alley, LLC
I love the change in seasons, but with it comes the busy holidays and the desire to gorge myself with artery-clogging treats. I can feel my body drifting into hibernation mode, enjoying the fire pit, roasted marshmallows and lazy evenings at home. It gets harder and harder to make it to spin class. Interaction with friends and family often involves food, which offers gratification – until I step on the scale the next morning. Succumbed to temptation, yet again! But why?
For many reasons, we disregard rational thought for that heavenly slice of cheesecake. Habits, patterns, cravings and pleasure all play major parts in the cycle that takes us away from our wellness goals. It’s challenging to change old habits, and it seems to take forever to develop new routines. We have cravings, are tempted and seek relief to satisfy our bodies and minds. It’s a vicious cycle. But how satisfying is succumbing to immediate gratification? What do we say to ourselves to justify this behavior? These questions play a part in the creation of habits.
You’ve likely heard that almost anything in moderation is okay, but that’s not true for everyone. Understanding what impacts craving, motivation and behavior – and setting goals – will help you break bad habits and make positive changes in your life. The effort requires making incremental changes, while learning why changing the behaviors is hard, and why it’s important to practice self-compassion during the process. Be as kind to yourself as you would a friend who needs support during a challenging situation. In her book on self-compassion, Kristin Neff, Ph.D., author and associate professor of Human Development at the University of Texas in Austin, states that when we try to “beat ourselves into shape,” we become overly emotional, anxious, depressed and impulsive in our behaviors. We react, rather than respond rationally. She states that self-compassion changes our way of dealing with situations and can counteract the stress.
Many experts discuss motivation, change and habits – it’s important to find the message that resonates for you. Kelly McGonigal, Ph.D., health psychologist and lecturer at Stanford University, offers many YouTube videos on “willpower,” motivation and the neuroscience of change. Deepak Chopra, in his book What Are You Hungry For? discusses how underlying emotions lead to unhealthy eating. This expert in mind-body healing says that understanding why we reach for food helps us deal with the underlying issues directly. Dr. Wayne Scott Andersen, in Discover Your Optimal Health, states that setting primary goals and developing strategies to resist temptation are important. You have a choice to eat that piece of cheesecake, but that decision should be intentional, not impulsive. Keep your eye on your main goal (losing weight, feeling healthy). The question “Why?” will help guide your behavior: Why do you want what you want – be it good for you or bad for you?
Reporter for The New York Times, Charles Duhigg talks in his book, The Power of Habit, about the “habit loop” – consisting of cue, routine and reward. Once you recognize a habit loop, and the reward (pleasure) you seek, you can work backward to identify how it contributes to the unhealthy patterns – you can change the loop. For example, if you crave soda, what pleasure do you derive from it? Is there a substitute for that pleasure? By analyzing the reward (sugar, energy boost, stress reduction) that’s driving the behavior, you can create substitutes that will give you that boost without the undesired consequences. Then, work backward to change your routine to fill that need, which will lead to a different, healthier reward. Duhigg states: “If you identify the cues and rewards, you can change the routine.” It’s actually a very simple concept when broken down and analyzed.
It’s also important to identify what needs changing in your life and the obstacles to that end. How can you support yourself when making the change? For example, if you know that you eat poorly when you are stressed, take a route that avoids your favorite fast-food restaurant after a hard day. Try to identify the stress leading to the craving, and deal with that stress. It doesn’t have to be complicated.
By identifying the underlying trigger (stress) and the familiar behavior (eating fast food for relief), then practicing stress-reduction techniques while supporting yourself (taking a different route to avoid temptation), you will feel a sense of accomplishment. When you succeed even once, you will realize you are stronger than your urges. It’s all about choice in the moment, and identifying your triggers. Then, if you choose to eat that cheesecake knowing it’s not because of negative emotions, you can enjoy it. You regain control by making conscious choices, rather than reacting based on emotion. This power will lead to more positive changes in other areas of your life!
(published in 12/2015 Spirit Seeker Magazine)
St. Louis, Missouri