Viverette: This is the FaithHealth Morning Forum podcast, a podcast series designed to offer insights into the vision of FaithHealth, NC, a dynamic partnership between faith communities, Wake Forest Baptist Medical Center and other healthcare providers focused on improving health. I’m Emily Viverette, director of FaithHealth education. This particular series focuses on mining the wisdom of key leaders within the division of FaithHealth ministries at Wake Forest Baptist health. Today I’m talking with Brian Hatcher, president of CareNet counseling. CareNet is a statewide professional counseling organization and a part of the division of FaithHealth. Brian is an ordained minister and licensed clinical social worker. He’s currently pursuing a PhD in public health, something not all counseling professionals explore, but we’ll get to that in a little bit. Brian, thanks for being here.
Hatcher: It’s good to be here. Thanks for having me.
Viverette: Some folks listening might wonder why counseling is such an integral part of FaithHealth in our system. I wonder if you might share how you see this as connected to the work of FaithHealth.
Hatcher: FaithHealth is a grand idea that is being used around the state and through Wake Forest here, CareNet participates in that through our counseling ministry by… we consider ourselves an extension of local faith communities. There are hurting people all over the place and pastors and others in churches and other faith communities can’t do all the work that’s needed to be done there. So we partner with faith communities around the state to provide the counseling services beyond what they’re able to do locally. That’s one way we understand it. We also take it to a different professional level. All of our clinicians around the state are licensed mental health professionals and demonstrate their ability to integrate the faith and spirituality of our clients.
Viverette: I know CareNet was birthed out of the hospital. It had its origins in the hospital and was originally kind of the department of pastoral counseling. And now’s CareNet. And so the language that’s often used is spiritually-integrated counseling. Could you say a little bit more about what that means?
Hatcher: What is that? So you are absolutely correct. We were birthed in a pastoral counseling context, meaning we had clergy who were providing counseling services. And our mission at that point in the beginning really was to train clergy in that. Over the years, the world has evolved a bit. Pastoral counseling as a profession exists mostly inside congregations. And as a way to sustain our organization, we shifted more toward outpatient counseling so that we could bill insurance companies and managed care organizations. And in order to do that, we began hiring licensed mental health professionals, all of whom have a spiritual background and a professional health background. So the evolution really has been from that pastoral counseling birth to where we are currently, where we hold to our roots of faith and sort of a pastoral presence. But the primary criteria for those who work for us is to have the state licensure. The state requires that as well. So this is a way to honor both sides of who we are as connected to an academic medical facility like Wake Forest Baptist Health and also our faith traditions coming out of the pastoral counseling background.
Viverette: Great. And I’ve had the great pleasure of working with some of your CareNet residents. You do some training there and it’s just been great fun to enjoy their wisdom and see the gifts that are being attracted into this profession. I wanted to ask, so there is a little bit of lingo that I feel like we need to talk about the, so we talked about spiritually integrated counseling. The second piece that I hear you talking quite a bit about, and I think health systems around the country are talking about or integrated behavioral health. What is that and why is that important? And how’s that connected to FaithHealth?
Hatcher: So the easy answer to integrated behavioral health or integrated care is we try to get our CareNet counselors in the same space where primary care physicians are. So we integrate the two services. The primary reason for this is for easy access to folks who may find it difficult to go to multiple places. They go to one location, they see their physician for their annual physical. when they have the flu, whatever’s going on with them. They can also come to that very same location and see someone for their depression or anxiety or other mental health scenario. So the easy or the primary driver for this has been access for people to get to our services. Beyond that, what we have also began discovering is our counselors and these physicians more than just working in the same space, begin to consult with each other. And we’ve learned more and more that a person’s mental health, spiritual health and physical health are really not separate identities or issues. They all go together and when we can address them as one whole rather than separate scenarios, people tend to get better faster and stay healthier longer.
Viverette: Excellent. Well, the other piece that I’m curious about is this whole notion of public health. I mean there are not a lot of counselors that are thinking about public health. So say a little bit about that journey and your evolution and your own sense of counseling and what’s important.
Hatcher: Sure. So this is part of my own personal story, if you will. And I give Gary Gunderson credit for opening the public health world to me. I can say that for the 20 years I’ve been with CareNet and Wake Forest… my mission began much like a story I heard as a youngster, as a young boy who was walking on the beach after a storm and the storm had washed up tons of starfish and he picked up one starfish and threw it back in the ocean. He walked down the beach, picked up another starfish, threw it back in the ocean. This gentleman walked by and said, “Son, what are you doing?” He said, “I’m saving these starfish.” And he looked around and saw thousands of starfish sitting on the beach and said, “You’re not helping.” And the little boy picked up a starfish, threw it back in the ocean and said, “I helped that one.”
That really has defined how I’ve been about this work for the years I’ve been around more recently though, I’ve had this drive that as just an inner voice telling me you can do more. Rather than one at a time there should be a way to impact thousands at a time, whole communities at a time. And I believe the blending of public health and behavioral health is the way to that much like we talked a moment ago about integrating behavioral health and physical health or primary care. So I also believe the blending behavioral health and public health will help us make a greater impact. One of my mantras now, and I may be asked not to say this in public again, but I go about my day each day with the mantra of wondering, is there anything I can do today that would help anyone or any group not need the counseling services that CareNet offers. If I’ve done that, I’ve done a good day’s work. May not be a good business model, but it is a good health model.
So more and more and more I believe behavioral health providers like CareNet can bring to public health what we understand about human behavior and help make impacts that prevent depression, anxiety, trauma, those kinds of things. Much like the FaithHealth paradigm, if we can’t prevent it, let’s intercede, intervene as quickly as we can. Like any other health scenario, the earlier the intervention, the greater the impact. And let’s go from there. So really the blending of behavioral health and public health for me is the culmination of internal drives. Which FaithHealth is a grand place for me to sit and live these out.
Viverette: I love the idea of thinking about what are the things I can do to prevent someone having to get counseling in the future. And so it does feel innovative to think about behavioral health and kind of preventative and wellness from a preventative and wellness focus. So I’m curious, what are some of the challenges in doing that? The way things are structured today. And what are some of the things you’re hoping to work towards and your kind of leadership of CareNet?
Hatcher: Thank you for that question. It’s a great question. The things that in, in the world of healthcare, including behavioral health, the things that often impede innovative services coming bout about are usually related to funding, policy, and leadership buy-in. And this idea of prevention wellness from a behavioral health perspective meets those same barriers, if you will. The good news is the leadership buy in is not an issue. All of the leaders I talk with in our organization think this is a great idea and provide good support to help figure out how to do it. Now those who pay for our services, convincing them that paying us before we have to do intensive psychotherapy may be a challenge, but we will get there. We’re not going to let that stop us from figuring out how to do the good work. It would be great if a psychotherapists suddenly became change agents in the world that changed their own profession. I just think that would be marvelous from sitting with people after the event that has brought catastrophe to their life and rather sitting with people that teaches them resilience ahead of time so that when the hard waves of life a flap over us, we can stand tall and strong and absorb the impact and be present for others.
Viverette: There isn’t a billing code for preventing depression or preventing anxiety, which is one of the challenges right now. So what do you see as some of the common or most challenging mental health issues CareNet is facing today? what are your counselors facing on a daily basis? What are medical centers trying to manage on a daily basis?
Hatcher: In my experience with CareNet over the years when I began in this work, the primary issues that we dealt with 15, 20 years ago were depression and anxiety. The story generally was a person not unlike those of us having this conversation or anyone who may be hearing sort of going down the road of life hitting a bump in that road. Having that being a challenge and those of us at CareNet would help sort of reset that scenario. We still do a good amount of that work. More recently, I’m going to say in the last 5 to 10 years anyway, we have seen more and more trauma being presented in our offices.
And when we think of trauma, often we think of significant things like a military veterans and what they may have seen in conflict, being in major car accidents. But trauma also can be just the little chinks in life. And enough of those can impact a body and a soul, not unlike one major explosion, if you will. I don’t know if there is more trauma in the world, but we certainly are more aware of it. And so all of our staff are becoming more and more focused on just understanding the impact of trauma, how that shifts a person’s ability to participate in the world. And then helping to refocus that in a way that is healthy and productive. And as we were discussing earlier, we want to be in the prevention of wellness and trauma as well in the prevention of trauma and just doing away with that. Again, if there were no victims of trauma, life would be much better and we could be about other things.
Viverette: Because of CareNet’s connection with faith communities, I’m curious about what role do you see faith communities playing in mental health and wellness and prevention and what thoughts or ideas or advice do you have for clergy who are really struggling as they see more congregants dealing with trauma?
Hatcher: Let me flip it around to my clergy colleagues and friends I would say the first responsibility that you have is to yourself. If you are not well, if you are not healthy, if you are not living in good boundaries, you will quickly run out of steam to care for others. Please care for yourself and all the ways that is appropriate and healthy for you to do. For congregations, what a great opportunity to make a real impact in the world. What we know about mental health, for all of us, is that folks who have good relational connections, they have, you know, family connections and/or good social connections, which can easily be achieved through congregations, tend to just do much better than others.
So our analogy earlier of the wave rolling over you… if I am isolated and alone in the world and the wave of life knocks me down, it is much more difficult, to get up and be about life again. But if I get hit by that wave and there is a community of people to help lift me up and hold me in that then moving forward as much easier and healthier. Congregations can be that support system. We help people identify patterns that they may maybe sending them down a bad way and help kind of bring them back before tragedy happens. And tragedy will always be part of our world. When it does happen congregations, better than any other resource in our culture, can around people and hold them through the tough time.
Viverette: That’s a great response and so true for so many folks. I think one of the great challenges, I’m curious how you’ve seen this change or if you’ve seen it change over the years, is the stigma of going to counseling and the stigma of mental health. Any advice or thoughts with clergy who are dealing with congregants struggling with that aspect?
Hatcher: Stigma is probably still our greatest challenge, although we have made wonderful strides in that area over the last decade or so. I certainly do hear people more easily talk about their own struggles then previously. And I haven’t checked, this would be a good research point for me, would be to look and see if people are actually seeking a counseling support during times of struggle or not. The real challenge is for all of us to be honest. Clergy particularly are in a great position to minimize and reduce the stigma of mental health. There is a long-standing idea that if one is simply healthy spiritually, they are automatically going to be healthy mentally. And that just may or may not be the case. While I certainly hold that our mental, physical and spiritual lives are very intertwined, I also know that a person can be very strong in two areas and still, life for whatever reason can be a challenge in another area.
There are biological chemical, neurological aspects of us that really aren’t just about if you live right, it will be okay, but they drive what’s going on internally. And so for clergy to be candid with themselves about their own challenges around depression, around anxiety… I am a pastor. If, if you are a pastor of a church, you’re going to have tough days. Tough days can leave to tough weeks, tough months, and can turn into clinical depression. I don’t know about you, but every time I step into the pulpit, I get anxious. It’s just a nervous moment. And there are many, many moments of anxiety again that can evolve into not just sequential moments but a way of being. So just being candid with ourselves around that. The church is already in a position of helping people celebrate the joys of life as well as mourning the losses in life. And I think holding that as an example of way to help people live as, as healthily as possible with their mental and behavioral wellbeing would be a good format.
Viverette: I want to go back a little bit to this FaithHealth model we’ve been talking about FaithHealth the whole time, but more specifically thinking about, are there things that CareNet counselors are doing as a result of kind of the FaithHealth community work that maybe other counselors across the country aren’t doing or it would be unusual for them to be facing into?
Hatcher: Well, the answer is yes. My hesitation is the counting through the number of things we could talk about here. Probably the biggest thing many of our counselors are beginning to do is to make this shift from just one person at a time to really thinking about whole communities. What can we do today to help this community do better? The probably the most straightforward response to that is developing the relationships that are in place so that when we are needed, we are called. And even this week that has happened with our good friends at the Baptist State Convention. They are hosting a women’s conference this coming weekend and called and asked if we could have a person present in case anyone who’s there might need some support during that conversation. So that is one scenario that didn’t come about because of my work. That came about because of a relationship one of our counselors in that area has with people at the Bap state convention.
We love that model. After the hurricanes in the eastern end of the state, we had several responses where teams of our counselors went to the communities that were most directly hit by that. In one case, by the end of the week of the hurricanes, by Friday afternoon, we had a counselor meeting with clergy in this very rural community to address first their own hurts and losses. Many of these clergy lost their home. Many of them had family they had evacuated but stayed behind to care for their communities. And our counselors just went. We in leadership didn’t know they were gone until they came back and told us what had happened. So we went to places like Bergaw, we went to New Bern, we went to Shallotte.
We passed NCDOT picking fish up off the highway because that’s where the waters had taken them. So that our counselors could drive through and get to the people in need. That’s just going and being where the need is probably the biggest thing I would need. Historically, counselors like ours have been very comfortable sitting in their own office waiting for people to come there and walk in and sit down and in the counselor’s office. And we still do lots of that. But more and more I see our counselors getting outside the office and going to where the people are. We not only are integrating in primary care offices but we’re integrating in homeless shelters. We integrating in emergency shelters. We have one counselor who goes to a children’s home, actually two different locations. We have counselors going to the children’s home to serve them right where they are. Go to the people. That’s probably the biggest shift I see today.
Viverette: I’m so glad you responded to that question so we could hear those great stories. Because I do think so much about FaithHealth is building relationships and innovative partnerships. So are there other partnerships that you see across the state or within the network or kind of surprising partnerships that are happening out of this work?
Hatcher: That is a great question. There are many, many faith partnerships. CareNet’s structure is that CareNet, Inc., is a 501-C-3 nonprofit separate from Wake Forest Baptist Medical Center. So in many ways we operate on our own, but we have a great partnership with the Medical Center. So that’s the first one I would name. All of our staff were employees of the medical center, get the benefits and supportive that we get lots of in kind support from the medical center. So I start there. And then across the state we are divided into regions. Each of those regions covers multiple counties and each of those regions has a separate nonprofit status with a local board of directors. All of those members of those boards of directors are connected to faith communities locally, to businesses, to the academy, both university college as well as primary and high school kinds of scenarios, businesses, local entities. And when we start culling through those relationships, always there are partnerships. One, that we didn’t even know we had and two, that just offer the opportunity for remarkable connections. So just in the last month, I have had the opportunity to visit two residential programs. One for people with severe and chronic mental health issues. The other people dealing with addiction issues. They both have very different business models, but they are just staffed with people who care for people in the world.
And CareNet is partnering with groups like this so that we offer a whole continuum of care, from prevention to all of the things necessary when a person is struggling either immediately or for life. And we can care for them and all the different stages whether they need inpatient, whether they need residential, whether they need intensive in home or they need the outpatient counseling that CareNet provides.
We want to have partnerships so that we can just plug people in when they needed as they need it. So that would be a scenario. I was also introduced to a liaison with the Roman Catholic church here in North Carolina this week to begin having a conversation with them about how CareNet services can be of support to their staff and their congregants. Our Baptist roots run deep and long and we are very proud of those. And we go well beyond that to serve all people across the state.
Viverette: Wow. Those are pretty remarkable partnerships. One of the things because of the seat I sit in, I’m seeing how CareNet counselors and chaplains and community engagement people are working so closely together. And I wonder if there’s anything you have to say about that.
Hatcher: Well, for CareNet that has been a beautiful development. We know sitting in our office, a person can walk in and we can discover multiple needs that are well beyond our scope to be able to manage. What we’ve learned in the last few years with the development of FaithHealth is that now all we need to do is pick up the phone and call any of these resources that you’ve just named. And usually, often we can have a person resourced with what they need within a matter of hours. So we’ve helped people obtain housing. We’ve helped people obtain necessary food or transportation as is needed. And those are critical. But again, CareNet alone is not positioned to be able to care for that. But now we can do it almost immediately.
Viverette: So what’s next for CareNet? Where are you headed or where are you hoping to head?
Hatcher: Oh, now we get to open the vision. Imagine. What CareNet is committed to is staying true to our roots. We are an outpatient behavioral health provider and our primary service is spiritually integrated counseling and psychotherapy as we have named. Beyond that, there’s a whole world out there where I believe people like CareNet counselors are the best resource to help slow a community infection, if you will, to reduce the trauma that’s going on in the world, to prevent scenarios that are happening, to help build resilience as others in our FaithHealth program or helping to do and get there. So CareNet will be an outpatient behavioral health provider. We will continue to vision with each other and all of our partners about how do we, how do we get into the world of behavioral health before people hit the brake and we can help them be healthy through a difficult moment versus letting the difficult moment really take the air out of them so to speak. So that’s the world we will be in.
There is opportunity for growth, of course, just new sites around. Almost immediately, probably within the next couple of years, we will have formal programs and tele-behavioral health where our counselors can be accessed by phone or by the Internet and provide services that way. We will more and more be able to offer Employee Assistance Programs, through insurance companies or employers or other paradigms, those kinds of things. That’s the low hanging fruit that automatically we’ll be involved in.
Viverette: Brian, is anything you’d hadn’t had a chance to say that you’d hope to?
Hatcher: You know, I think your questions covered it well.
Viverette: Okay. Well, thanks so much for being with us today. I appreciate it.
Hatch: Thank you for having me.