Interview by Tom Peterson
Steve Scoggin has been president of CareNet president since 2002. He is an ordained minister and licensed professional counselor. Since 1972, CareNet, Wake Forest Baptist Health’s network of community-based faith-integrated counseling centers, has been developing across North Carolina. Its mission is to provide high quality, faith-integrated counseling and behavioral health services to clients and be a resource to the community that enhances mental/spiritual health. You can find more about CareNet here.
How did you get interested in mental health and counseling?
My interest in mental health has roots in my family experience. When I was eight my grandfather committed suicide, and during my late adolescence my father was severely depressed. These life experiences were an underground stream that influenced my attraction to study human behavior, suffering and hope. So, although not fully aware of this meandering stream when I began college, I majored in psychology. At the same time, I became interested in the role of faith in mental health. Later I would realize that these are not separate concepts. Even though I was not reared in the church I was raised in an environment where my mother modeled the importance of advocating for and caring for vulnerable people. For me, faith was a lived experience, not a set of beliefs.
Realizing I could not explore my continued curiosity between religion and psychology in a doctoral program at the University I was graduating a local pastor pointed me toward seminary. I knew I wanted to study the interplay of psychology and religion and was told seminary would be a good place to do so. The humorous thing is I had to ask what a seminary was. After serving as a minister of a congregation I returned to my curiosity of integrating psychology and religion. I became a certified pastoral counselor and eventually a licensed professional counselor. Later, I did a doctorate in psychology. This was all about my continued journey of making sense of my life.
How did CareNet get started?
CareNet has its roots in the pastoral care tradition at then North Carolina Baptist Hospital as an outgrowth of the intelligence of chaplains in their clinical counseling care. The Baptist State Convention of North Carolina birthed and aided in the expansion of what is now a statewide network. The Convention desired to establish counseling centers in communities across the state in order to follow patients who needed behavioral and spiritual support after they’d left the chaplain’s care at the hospital. So starting in the mid-seventies the Baptist State Convention of North Carolina helped fund a number of hospital-related counseling centers across the state. CareNet, Inc. a wholly- owned subsidiary of the hospital didn’t come into being until 1996 in order to enter the managed care arena. Today there are 35 CareNet locations that cover 80 of North Carolina’s 100 counties.
How is mental health an important part of the overall health picture?
Historically, behavioral health counseling has been separated from the delivery of medical care. This is not to say that medicine hasn’t acknowledged the importance of behavioral and spiritual health to overall wellbeing, but it has been removed from the direct delivery of physical care. Over time, the distance between the physical and mental has been narrowing as we learn more about the relationship of the brain and mind to the body. And it’s accelerated even more as the Affordable Care Act has encouraged a more integrated approach to health care. Some studies cite that over 60% of patients who visit their Primary Care physician for a medical complaint also have a corresponding behavioral health condition. So the relationship between physical care and behavioral care is finding a new partnership in tighter alliance whose aim is improved care for people.
People who suffer from chronic pain, for example, usually have a comorbid (existing with another medical condition) diagnosis of depression. We know that the relationship between the depression and its corresponding neurological and behavioral components can exacerbate the pain—or vice versa. When depression is treated, it can have a positive impact on managing chronic pain.
Another example, the high incidence of type 2 diabetes and the corresponding comorbid condition of depression. Depressed people with diabetes are less motivated to care for themselves. If we treat the depression, the management of diabetes is better. A key is exercise and adherence to medicines of which motivation and hope are critical.
Can you say more about behavioral health issues?
More than 60 percent of visitors to a primary care doctors have a comorbid behavioral health condition. Through behavioral health screening and assessments in the Primary Care office we discover everything from high stress to un-diagnosed mental health conditions such as depression, anxiety or a substance abuse disorder. When it comes to behavioral health conditions, a front line is the primary care office. This is one reason CareNet is moving clinical providers into Primary Care, Pediatric Clinics, diabetic and weight management clinics.
But the real front line is the community. One of the most powerful delivery systems of mental health in this country is the congregation. And I would equally say the worst delivery system for mental health is also the congregation. On the positive side, we know that people who are connected socially on a regular basis—who are touched, acknowledged, encouraged and loved—have better health outcomes and better manage chronic conditions.
Equally, in some congregations people are shamed, not connected and have no strong social connections which can actually worsen your health. Pathological guilt, shame, fear and social disconnection are invisible health hazards.
How do you bring mental health services to an entire state?
In North Carolina, the Department of Health and Human Services is responsible for the mental health care of its citizens. The incidence of mental illness, the lack of access and providers in rural areas are especially challenging. Leaving people untreated creates an enormous cost to the system. We have been trying to reform mental health in North Carolina for more than 20 years. Most recently, we chose not to be an expansion state. This political issue is a hot potato. Even though NC citizens have access through the federal exchanges, this has left many North Carolinians without health insurance because they don’t qualify or cannot afford the cost.
CareNet’s long-term strategy has been to place clinics in North Carolina’s rural areas where access to mental services is challenged. This arises from our commitment that to experience long-term health one needs access to high quality behavioral health services and treatment. Local congregations and the Baptist State Convention of North Carolina enable us to extend care to our most vulnerable citizens.
We’re interested in adapting our behavioral health knowledge into more community-based strategies that focus on health and not sickness. This parallels the move to more prevention/wellness strategies in our healthcare system. We’ll always need to care for the most troubled, but another part of the equation is to focus on life logic rather than pathology logic. At CareNet, we desire to balance our model of care from reactive care when a client is troubled to proactive attention that focuses on health.
The emphasis on wellbeing is best focused on those webs of relationships in the community which are natural places for care to be delivered. The obvious places in the community are those organizations and agencies that care for people like: congregations, Goodwill, Habitat for Humanity, Senior Services and our foster care system to name a few. The not so obvious are beauty parlors, barbers, the corner store, in short, any place were one finds community, a place of belonging.
Mental health is central to a fulfilling life. Moment-by-moment we’re making choices: how we speak, who we relate to, how we relate and what we put in our bodies. These mind-brain exercises can be influenced by physical issues. Our goal is to bring a different logic and mind to mental behavioral health that’s been well-versed in pathology and find a new way to talk about—and invite people into—a health-based logic, more of a life- or strength-based logic.
Some would say that I’m just talking about positive psychology. I would say yes, but it’s a deeper dive. It is the place where hope and meaning reside.
How does this work on a larger scale?
It’s about a community-based approach to behavior. It is a marriage between the social determinants of health and behavioral health that knows safe neighborhoods, education, access to nutritious food, green spaces, transportation options, clean water and so on are critical to improved mental health. All of these make up the ensemble of assets that must coalesce if we’re going to make progress in our health care system. The beautiful thing is that in our healthcare system today disciplines that never would have dated are forced into, at least, some hand holding if not kissing, because it’s a necessity for improved care and reduced cost. Integrating medical, mental, spiritual care and public health is not only good care but it’s the right thing to do.