Magellan Health’s Dr. Caroline Carney On Raising Children Who Are Mentally & Emotionally Healthy

An Interview With Maria Angelova

Limit the amount of time on phone/technology: No phone at the dinner table. No phone while in conversation with parents. No phone at the bedside. Set limits on time and content. The research here is very clear, especially if there are other risk factors for the development of depression, anxiety, isolation and eating disorders. If you bought the phone and are paying for internet access, as the parent/guardian, you have not only the right, but also the obligation to manage it and when needed, to take it away.

Our children are facing challenges that didn’t exist just a short while ago. They are growing up with social media, constantly being connected, and the hurried pace of life today, as well as the pandemic, and the often frightening news. In short, our children are facing unprecedented mental health challenges. Anxiety, depression, and even suicide are on the rise. As parents and educators, what can we do to raise children who are mentally healthy? In this interview series, we are talking to authors, parenting experts and mental health professionals who can share their expertise and advice on Raising Children Who Are Mentally Healthy. As a part of this series, I had the distinct pleasure of interviewing Dr. Caroline Carney.

Dr. Caroline Carney, a board-certified internist and psychiatrist, serves as the president and chief medical officer for Magellan Health. She is a frequent advocate for behavioral health services, integrated and collaborative care, and the importance of living a balanced post-pandemic life. Dr. Carney is also a published author and co-author for over 100 peer and non-peer reviewed publications focusing on issues surrounding comorbid medical and behavioral health conditions.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to hear a little about you. Inspire us with your backstory!

My backstory began in rural Iowa where I grew up in a small town with approximately 650 residents. I spent a lot of time outside with my four brothers. I also loved to read and devoured books from the small library in town.

My parents both had gone to college and earned degrees. My dad was a teacher and coach and mom was a dietician and worked at a hospital. I loved visiting her at work because I was fascinated by the hospital and by my pediatrician, one of the first female doctors in the area.

Even though I felt comfortable in the medical setting, I wasn’t sure I wanted to be a doctor until much later. I pursued many interests and spent the years leading up to medical school interning with a congressman, editing my college’s literary journal and dedicating a lot of time to my love for creative writing. My course work was also varied and diverse. I earned my bachelor’s in general science with minors in political science, psychology and chemistry. My biggest academic regret is not having focused on learning another language.

Ultimately, I took the minimum course requirements to get into medical school, and it was only in the months leading up to it that I made the decision to be a doctor. It came down to the fact that a doctor could be a writer, but a writer could not practice medicine. I went to medical school at the University of Iowa Roy J. and Lucille A. Carver College of Medicine, completed a med/psych residency — a five-year training program during which I studied both specialties, and then completed a master’s degree focused on psychiatric epidemiology and health services research.

I worked in a diverse array of clinical environments, including ones in academia and in the public sector and policy, where I served as the chief medical officer of the Indiana Office of Medicaid Policy and Planning, and in the insurance and benefits industry, where I’ve focused intently on data-driven clinical programs and the delivery of mental and behavioral health services.

Throughout it all, my own family — especially my wonderful children — were the central element of my story. Today, I am grateful to be a doctor and truly love what I do.

What are some lessons you would share with your younger self if you had the opportunity?

One of the great things about life and the passage of time is that we are constantly learning. What are some of the lessons I would share with my younger self if I had the opportunity? There are so many!

I would stop the self-deprecation, not that which enables us to laugh at ourselves or realize our shortcomings — that of course is a valuable skill and quality — but rather the tendency that so many of us have to be overly critical of ourselves, the mistakes we make and the abilities we wish we had. It does absolutely no good to hate on yourself.

I would also accept at an earlier age that change is inevitable. If we welcome this reality into our lives, so many aspects of our daily experience become much more manageable and joyous. Change and growth in many ways are synonymous, whether it’s our children growing up or the changes we experience as we age. That’s not to say it’s easy — if you speak with older people they will tell you that aging has its challenges — but the physical changes that come with growing older are often accompanied by greater perspective and comfort in one’s own skin.

I would also tell my younger self to make time for sleep and exercise and to treat those as protected parts of life. Balancing family and professional life can be challenging, and all too often it is easy to let sleep and exercise slip. Those are both incredibly protective of our physical and mental health, but also in how we address the challenges that arise every day in our personal and professional lives. I am a different person after a workout!

None of us are able to experience success without support along the way. Is there a particular person for whom you are grateful because of the support he/ she gave you to get where you are today? Can you share that story and why you are grateful for that person?

I am so fortunate to have had so many wonderful mentors over the years, but there is one I think of, and gives thanks for, at least once each week. Russell Noyes, M.D. — emeritus professor of psychiatry at the Carver College of Medicine at the University of Iowa — is an incredibly gifted and amazing psychiatrist and researcher. While a student, I learned a tremendous amount in his consults with medically ill patients who also exhibited mental health symptoms. He was also always a great sounding board for any number of questions, whether they related to administrative issues or patient care.

After I left the University of Iowa, I served as a professor of internal medicine and psychiatry at Indiana University’s School of Medicine. During that time, I was also the director of an effort to build and operate a psychosocial oncology program.

The need for the program was without question, but as you can imagine it is challenging and heartbreaking to care for patients who in many cases are in the final stages of their battle with cancer. By the time most patients needed our care it was usually because their story and experience had become too sad or upsetting for the oncologist or hematologist to treat.

My goal and that of my colleagues was of course to help bring solace, and evidence-based care, to our patients and their families. For years I did this effectively and felt a level of comfort in knowing I was helping to assuage their pain, if even in small ways.

Everything changed for me one day when I met a patient who was incredibly similar to myself. We were the same age. The patient was in a family with four brothers just like I am. The patient had two little kids who were the same age as my children. A third child was on the way when one day they experienced difficulty breathing while coaching little league.

It was found that the patient had stage four metastatic lung cancer despite having no risk factors. By the time chemotherapy began, the cancer spread and the patient progressed rapidly in the face of such a horrific disease.

I was bedside with the patient and their family when they passed away and for the first time in my career I had to leave the hospital. Something was different. All of the suffering I had seen over the years came to bear and I cried for three straight days.

When I reached out to Dr. Noyes, he gently shared with me that I identified too closely with that patient and others. He said I couldn’t be effective in the psychosocial oncology environment, at least for a time. Just as importantly, he consoled me that it was ok to acknowledge that I had reached a point where I needed to step away.

His understanding and counsel was more than sage advice, it was a gift that helped me to accept my situation and it freed me to take my career in new direction that would prove incredibly fulfilling and provide an opportunity to help hundreds of thousands of children and adults in different ways.

Going back to my earlier point about accepting that change is inevitable and welcome, Dr. Noyes helped me to see that wisdom. In some way, it also freed me to truly celebrate those rare and incredible individuals who have the amazing ability to work in such difficult environments day-after-day, month-after-month, and year-after-year.

Are you working on any exciting new projects now? How do you think it might help people?

We are working on many new and impactful projects at Magellan Health, but two are particularly exciting for me. The first is a new collaborative care effort that will extend evidence-based mental health services to patients in other points of care, including primary care and specialty care. I find this particularly rewarding, because it represents a way to increase access to evidence-based care, and the new appreciation of the direct correlation between physical and mental health.

The second is that we are continuing to expand and hone our suicide prevention programs. Suicide is a leading cause of death and the source of incredible grief for far too many families and their loved ones. In 2021, the last full year we currently have national statistics on, there were 47,646 deaths by suicide.

Notably, as a nation we are making gains. The 988 Suicide and Crisis Lifeline reflects the progress that is being made to educate the public and in eliminating the stigma that regrettably prevents far too many people from getting the mental healthcare they need.

Ok, thank you. Let’s talk about raising emotionally and mentally healthy children. In the Western world, humans typically have their physical needs met. But what has led to the tremendous downgrade in emotional and mental health that we are seeing today, especially for children? What is lacking in the mental health arena? Why are so many of our children struggling today?

First, I would stress that while children in the Western world do not face many of the same macro-economic challenges as those in other regions, it can’t be assumed that the physical needs of children in the United States are being met.

Food insecurity is a real challenge in many communities, with the U.S. Department of Agriculture estimating that 12.5% of households with children were food insecure in 2021. For these children, school meals are often one constant source of food they can rely on. For many families, housing and basic healthcare is likewise lacking. This is a tragic reality that must be addressed. One in five children and adolescents are obese, creating a myriad of health and emotional challenges. Overall, 42% of births are financed by Medicaid programs, with some states at 50% or above.

To get to your core question though, there is no question that we are seeing a worsening of the mental and emotional health of children today. If you are looking for the “why”, I would argue that there are so many reasons our children are struggling today. On a population health level, it’s a multi-faceted issue.

First, the risk factors for serious mental illness, including recurrent abuse and neglect, domestic violence, parent/caregiver mental or substance abuse problems, poverty, and social disadvantage due to a variety of factors create the milieu in which mental illness develops. We also must be aware that there is a difference between serious mental illness and symptoms.

I’d like to focus on the other kinds of risk factors that have become universal to kids, and those I’ve observed as a mom. Digital media, social media, and screens have become foundational to our lives. Research bears out that for some kids, the influence of social media perpetuates loneliness, creates feelings of insecurity, and can even hasten conditions like eating disorders. In a time of higher food and fuel prices, stress on parents to maintain the basics is challenging and stressful. The dinner table filled with people who are all on their phone, stressed out, fatigued, and not connecting to one another further exacerbates a sense of isolation, even in a family.

As a society, we also subject children to unrealistic expectations. We see this in the form of parents who expect that their kid in little league will be a major leaguer or demand that their child not only participate in orchestra, but achieve first chair. We even see kids pressured to compete for marquee college spots at a young age.

Helicopter parenting has been shown to increase rates of anxiety and depression in kids and can prevent their development of resiliency. Their kids never do anything wrong and are never allowed to fail. There’s always someone who swoops in to save the day, to provide the guidance, to fight with the umpire or argue with the school. As a result, many children are later suddenly exposed to a world that presents them with real opportunities to fail without the tools needed to address that reality. They are then left with an inability to make decisions on their own.

Children can’t develop resiliency when parents prevent the consequences of normal life from occurring. To develop resiliency kids need to have success and failure.

It is also important to realize that children are living in a far more complex world. Some kids are worried about climate change to the point that they are voicing that they will never have children because they are fearful of bringing them into this world. They live in a world with new threats of nuclear war, and one with incredible political division. This can be very intimidating for a child, particularly if they have questions about different viewpoints than those in their own family. Finally, mass shootings are not uncommon, including those in schools.

The world is also much more unstable from the vantage point of kids. For example, we might see on the news that another shooting has occurred, but if you are a child your first reaction might be, “Is this going to happen to me or my mom or dad?”

How does technology play into the equation of mental and emotional well-being? What about social media?

To begin with, I think it’s important to address the sheer scale of the issue. Right now, 43% of kids aged 8 to 12 years of age have their own smartphone, while 88% percent of teens do according to a national survey. The same research found that screen media use increased 17% since the pandemic began. Tweens are now spending more than five and a half hours each day looking at screens on their devices, while teens are spending more than eight and a half hours.

Clearly, that’s a significant portion of their day. Social media use is also associated with those figures, although it’s worth pointing out that other forms of technology also compete for children’s attention, whether it’s video gaming, television, etc.

Before we delve into the challenges associated with social media, it’s also important to note that not all social media is bad. Having some form of social media is incredibly important to kids today because it is part of the fabric of their lives. There’s also no question that technology in general has benefits, for example enabling us to maintain relationships with distant family members and relatives we can’t see in person using video calls.

We’re also using mobile apps to help patients with their responses to stress or even to replace in-person appointments for those with moderate or mild symptoms. So, technology is important and valuable when used responsibly, and I would argue in moderation.

That said, the impact of social media on children’s mental health is significant. It impacts many aspects not only of their growth and development, but also their happiness.

For example, there is evidence that it impacts their attention span and concentration. If a child is playing a game where things are moving around quickly, or they flip through images quickly, it trains their brains to be quick to focus and then move on. When you put that same child into a classroom setting where they have to pay attention it can be harder for them to learn to focus and concentrate because of the kinds of neuro pathways getting laid down as the child is developing and growing.

I also see a real issue with children’s developing brains being able to develop social connectedness with people. When a child is so attuned to a smart phone or screen, it is difficult for them to practice the social skills that are needed. For example, when the family is sitting around the Thanksgiving table, and they are being asked to engage their relatives in conversation. I see this all the time and it’s very concerning to me.

Then of course there is the issue of content. Technology and social media have the potential to expose children to things they are not old enough to process, or worse that is designed to draw them in. On the most basic level, kids are going to websites they should absolutely not see under any circumstances.

And in the case of social media, there is of course cyber-bullying and algorithms often feed information to children that is harmful. For example, a child might be teased for their weight on a social platform and search for information on eating disorders — an act that causes the algorithms to send the same child even more information on weight loss and body shaming. Perhaps not surprisingly, it is found that social media is particularly detrimental to young girls — a point made painfully clear by researchers within Instagram who reported that “Thirty-two percent of teen girls said that when they felt bad about their bodies, Instagram made them feel worse,” as reported by The Wall Street Journal.

There are other issues as well, all of which contribute to mental health. The posture of children is impacted by technology use and social media, as is their sleep, which can be disrupted by blue light. So now we have kids that must self-stimulate to stay awake in the classroom, with the subsequent pencil tapping or leg movements regrettably leading many to be misdiagnosed with attention deficit hyperactivity disorder (ADHD).

All of these factors can contribute to depression and anxiety among children that must be addressed. It is of course a huge issue.

Obviously, this is a huge issue, and it seems to be growing. What are some small, practical tips, or tweaks, that parents and educators can easily implement to help their children who are struggling?

First, I would say to trust your instincts. If you suspect something is going on with your kids or students, stay engaged and address it. Secondly, set limits on technology and social media use. It’s important to set perimeters, such as no phone at the dinner table or during family activities.

It is also imperative to monitor your child’s phone and to remember that you are in control. Know what sites they are visiting, set screen time limits, and be prepared to take the nuclear option — taking the phone away — if needed. Never forget that having a phone is a privilege for children and that as a parent, you own and pay for it. You control the situation.

In addition, it’s always important that we model the behaviors we want to see. That means addressing and controlling our own use of technology and social media, as well as our own approach to mental health. That means being present, not face down in our own phones when with the kids and being open and proactive in acknowledging the importance of mental health and emotional well-being. One of the most effective things we can do is model to our children that a mental health issue is no different than a physical health issue. In both cases we must acknowledge and treat the issue.

Most importantly, always be on the lookout for any expression of suicidal ideation. If it arises, address it immediately, keep trying and get assistance from a primary care provider or mental health professional.

In your professional opinion, what are certain triggers or signs that the state of a child’s mental and emotional health is not at its best? What is the best way to be proactive and address these signs from the get-go?

There are many triggers and signs that reveal that a child’s mental health is not at its best. This includes any outward signs of depression and anxiety, loss of interest in normal activities, any changes in behavior, and of course any mention or interest in suicidal ideation, which must be addressed immediately.

Do you think we can do a better job of educating our children about their emotional and mental health? What would that look like?

We absolutely must begin teaching kids when they are young about recognizing their emotions and their reactions to situations. We must also teach them that it’s alright to fail, and that with failure other doors open. As kids get older, we also need to engage them in an ongoing conversation that equips them to address the realities of depression and anxiety, as well as substance abuse. At a higher level, this includes addressing and breaking down the stigma that surrounds mental health.

Okay, fantastic. Here is the main question of our interview: Can you share with our readers your “5 things parents can do to raise children who are emotionally and mentally healthy”?

1 . Teach your kids that it is ok to not win, to not be the best, to not succeed at everything they do: The worst thing we can teach our kids is that they must be the best or win every game or get cast in the lead role, be first chair, or get a grade point above 4.0. We aren’t perfect, nor should we expect our kids to reach that standard every time. My kids are all actors and competed in speech and debate teams. During their early years of acting, there were often times that they didn’t get a role, only to have another audition open later and create a new opportunity. If we try to prevent our kids from “failing”, they don’t learn resiliency — they will never learn there will be another at-bat. Life is a series of wins and losses.

Tied into this is teaching gratitude, to never lead kids to having a sense of entitlement. What we earn for ourselves matters, what we work toward, how we reach goals. Be grateful for what you have, or the life that you are living. Work for what you want, and who you want to be.

2. Encourage exercise and movement: My own life experience first taught me this. The world always feels better with that runner’s high, and I can problem solve and work through issues while taking a long swim. Today there is ample research to show the importance of exercise for kids on both mind and body. Even if your child isn’t cut out for sports, they need to stay physically active in some way every day. Find the thing they like to do and encourage it. I support bringing back recess and physical education classes. Kids need an opportunity to move their bodies.

3. Limit the amount of time on phone/technology: No phone at the dinner table. No phone while in conversation with parents. No phone at the bedside. Set limits on time and content. The research here is very clear, especially if there are other risk factors for the development of depression, anxiety, isolation and eating disorders. If you bought the phone and are paying for internet access, as the parent/guardian, you have not only the right, but also the obligation to manage it and when needed, to take it away.

4. Expect and hold kids to be responsible and accountable: This is critical. Each of my kids worked while in high school. They had to be accountable to a boss. They had to balance that with school and extracurricular activities. Was it hard? Yep. But they learned to navigate the world better by working with groups of people who weren’t necessarily their school friends. They earned money which they then had to manage. If your child is too young for a job, hold them accountable for work at home. I think that the best example is with a pet. From the first day, the child must be accountable for their role in caring for the pet. That job, whether it is feeding or picking up the dog poo, needs to be built into their schedules so that they can learn accountability.

5. Communicate openly and without judgment: This one is very hard, especially when working parents are exhausted and it’s easy to fall into patterns of non-communication and monochromatic thinking. Create the space for this, whether during meal prep, or at dinner, or scheduled time alone. I’ve found that some of the very best conversations with my kids started in the car, while driving to/from school or activities. We’ve spent a lot of time sitting in the garage in the car and continuing a conversation. There really is no right place or time. We can and should challenge our children’s perspectives, especially to protect them from real harm. But we need to listen first and not judge that their desires or perspectives are wrong. When we see nuance, we help them learn that the world is full of different perspectives that must be considered.

Do you have any favorite books, podcasts, or resources you recommend to our audience reading this interview?

I would have to admit that I rarely read self-help books or listen to podcasts — I did that more when I was a full-time clinician providing both medication and psychotherapy. I try to listen and pay attention to the topics that my kids are interested in, whether that’s football or the latest music artist or streaming show. Not only have my interests expanded because of this, but I also get a clear line of sight into my kid’s interests and can engage with them in a way that shows I truly pay attention and care. I also try to stay aware of what is happening in the community and world around us. Like it or not, our kids live in the same environments we do, and are sponges absorbing everything.

As a parent I want to know how they have digested the news and if it is affecting them.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

If I could wave a magic wand and start a movement, it would be to encourage daily exercise, and to get people of all ages to avoid highly processed foods. There is a lot of truth in the adage that you are what you eat and highly processed foods are directly associated with a number of comorbidities, among them obesity, heart disease and hyper-tension. We also feel better when we eat well, which impacts our physical and mental state.

We also know that exercise is beneficial and necessary to live healthy lives, but the importance of movement cannot be overstressed, particularly given how much time so many of us, children and adults, spend sitting. Sitting is increasingly acknowledged as its own risk factor and precursor to a wide range of health challenges. Movement and exercise that gets our heart rate up is one way we can address this.

What is the best way for our readers to continue to follow your work online?

To learn more about mental and behavioral health, check out some of my blogs here.

For more information about Magellan Healthcare, visit MagellanHealthcare.com or follow us on Twitter, LinkedIn, and Facebook.

Thank you for these fantastic insights. We wish you only continued success in your great work!

About The Interviewer: Maria Angelova, MBA is a disruptor, author, motivational speaker, body-mind expert, Pilates teacher, and founder and CEO of Rebellious Intl. As a disruptor, Maria is on a mission to change the face of the wellness industry by shifting the self-care mindset for consumers and providers alike. As a mind-body coach, Maria’s superpower is alignment which helps clients create a strong body and a calm mind so they can live a life of freedom, happiness, and fulfillment. Prior to founding Rebellious Intl, Maria was a Finance Director and a professional with 17+ years of progressive corporate experience in the Telecommunications, Finance, and Insurance industries. Born in Bulgaria, Maria moved to the United States in 1992. She graduated summa cum laude from both Georgia State University (MBA, Finance) and the University of Georgia (BBA, Finance). Maria’s favorite job is being a mom. Maria enjoys learning, coaching, creating authentic connections, working out, Latin dancing, traveling, and spending time with her tribe. To contact Maria, email her at angelova@rebellious-intl.com. To schedule a free consultation, click here.