After 40 years of managing an anxiety disorder, Gussie Belisario knows when she needs professional help.
Last fall, she did. Belisario, 60, had relocated to Elizabeth City, North Carolina, in 2022 to help care for her mother, who has memory loss. She also was struggling to maintain her speech-language pathology practice with virtual appointments and spotty internet service.
“I told my doctor, ‘My anxiety is way out of the norm,’” she said. “And he told me, ‘Well, we have a therapist right down the hall.’ About three weeks later, I had an appointment — which is nothing compared to if I’d had to look around for someone myself.”
Belisario is among the local patients benefiting from a Sentara initiative to embed therapists within primary care practices. The concept aims to ease access for patients and promote the idea that mental and physical wellness are equally important to overall health.
Since 2020, Sentara has added five mental health professionals in practices in Norfolk, Suffolk, Virginia Beach, Elizabeth City and Northern Virginia. This June, a licensed clinical social worker will join Sentara Family & Internal Medicine Physicians in York County; two others will be hired soon at Southside practices, including a pediatric specialist.
“It normalizes therapy as part of routine medical care,” said William Morrison, a physician assistant at Sentara Internal Medicine Physicians in Suffolk. “A lot of times, it’s hard to find a provider out in the community with availability and who takes your insurance. And someone with PTSD doesn’t want to hear, ‘My first available appointment is in four months.’”
Morrison has referred patients with depression, anxiety, grief, bipolar disorder and other challenges to Linda Lewter, a licensed professional counselor in his practice. Some are lower income and don’t have reliable transportation to travel outside the area.
Sentara’s initiative is one of multiple efforts to meet a rising demand for mental health services, which intensified nationwide during the COVID-19 pandemic.
Riverside Health System, for example, added integrated telepsychiatry services to its primary care practices in 2020. Patients can schedule appointments with a behavioral health professional through their primary care office and attend virtual visits in that office or at home.
Children’s Hospital of The King’s Daughters also has expanded services for children and teenagers in recent years, including opening a new Norfolk-based pediatric mental health hospital and outpatient center in 2022.
For patients who are unfamiliar with counseling, an in-house therapist can help reduce the fear and stigma of seeking care, Sentara team members say. Although embedded therapists can take referrals from outside doctors, providers within a practice also are able to flag their patients as high priority to line up services more quickly.
Rebecca Cohen, a licensed professional counselor embedded at a Sentara Internal Medicine Physicians practice in Virginia Beach since 2023, sees patients in the office three days a week and schedules virtual appointments for the other two.
“We still have a wait list because there’s such high need, but we definitely are getting people in faster,” Cohen said. “It’s different and has taken some adjustment, but I think it’s a really unique option — a great option — to bring providers under one roof.”
Many patients also like being able to access their medical documents and appointment notes on a single online site, Cohen added: “I’m excited to see how we grow. When our mental health is better, we have more capacity to do better in other areas.”
In Elizabeth City, Amelia Walker, a licensed clinical social worker, sees patients three days a week at a Sentara medical practice and works virtually the other two. Common issues include anxiety, depression and attention-deficit hyperactivity disorder, or ADHD.
“If patients are nervous or have never sought counseling services, the doctor or advanced practice provider can literally walk them to my office,” Walker noted. “It’s also been really helpful for me to communicate with the primary care providers.”
Belisario is one of Walker’s patients. Diagnosed with generalized anxiety disorder, she began suffering crippling panic attacks in her senior year of high school. At times, she struggled to breathe and was terrified of breaking down during public outings.
Occasional therapy has been a lifeline for Belisario since age 18, and last year, her stress level grew overwhelming as she juggled several moves, caregiving responsibilities and part-time work trying to help autistic children with communication challenges over a computer.
“I didn’t feel like I was providing services to them well, which was really hard,” she said. “It was all a tough transition.”
Connecting with Walker has kept Belisario from having to search for another provider or drive to an office that is farther from home, especially on days that her mother needs her. Over the past eight months, she said, her anxiety has “drastically reduced. It’s been such a blessing.”
An integrated mind-body approach has the same value for many patients, Morrison said: “I can prescribe medication, but talking to someone for longer periods of time is an extremely part of treatment. What I want people to understand is that mental health care is health care.”
Alison Johnson, ajohnsondp@yahoo.com
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