You walk into the clinic because your stomach hurts. Nobody blinks. That’s what a clinic is for.

Now picture walking in and saying you’ve been angry at everything for a month and you don’t know why. Most of us wouldn’t say it. Breanna Janovy has spent a lot of time thinking about that gap.

Janovy is a certified social worker in private or independent practice with Monument Health, based at the Sturgis clinic. She’s local, a Sturgis Brown grad who finished her degree at the University of South Dakota and later went back for her master’s in social work.

“It is an amazing journey to have someone be so vulnerable that they let you walk alongside them,” she said on Monument Health’s Doc Talk podcast.

Mental health is physical health

The phrase gets printed on posters. In practice, Janovy says, it’s mechanical. Sleep, food, movement, mood, all of it runs on the same system. Eat nothing but junk for a week and you’re running on empty.

“The more you move, even a little bit, the more feel-good hormones our brain releases,” she said. “And that helps us improve our outlook, improve our day, even if it’s just something very small.”

Not a gym membership. A walk.

What changed in Sturgis

Janovy has been with Monument Health more than five years, starting at the inpatient psychiatric unit, Monument Behavioral Health, before moving to outpatient work. She’s in the same building as the urgent care and primary care clinic in Sturgis. If somebody comes in for a physical complaint and the staff can see there’s more going on, they can call her over.

“If someone comes into the urgent care and they’re having a crisis, extremely down, extremely sad, tearful, and that’s not normal for them, the staff can call me,” she said. “‘Hey, Breanna, can you come and talk to them, please?'”

She also sees patients on scheduled appointments, same as any other provider in the building. She says the calls from staff are coming more often.

The vulnerability problem

Ask her why people can talk to a doctor about a stomach ache but freeze up about anxiety, and the answer is short. “I think it’s very hard for people to be vulnerable.”

She’s turned it over herself. “I can go in and talk to a doctor, and it’s fine. Why can’t I sit down and talk to you about how anxious I felt today? Where’s that line?”

Part of it is the fear that walking in means dumping everything on the table in hour one. It doesn’t work that way.

“It’s okay to take some time to build a connection with the therapist, the counselor,” she said. “It’s okay to figure out whether you think you can trust that person.”

There’s a name for that connection. Therapeutic relationship, or rapport. She wants people to hear the other half too.

“It’s okay to not like that person. It’s okay to go find someone else. It’s not personal.”

It doesn’t have to be forever

A lot of folks picture a standing appointment every Tuesday for a year. Plenty of her work is short-term. A divorce. The anniversary of a death. A rough stretch that needs a few sessions.

“Short-term therapy, it does not have to be forever,” she said. “Let’s get you feeling supported or connected. What do you need?”

For people who won’t open up, she uses motivational interviewing. What’s holding you back? What’s stopping you from wanting a change? Most of the time, she says, the wanting was already there. “Maybe there was something in them that was like, yep, I need to talk about it out loud, outside of my own head.”

Signs it’s worth a conversation

• You’re angry a lot, and it’s not like you
• You feel hopeless, down, or flat for stretches
• You’re going through something hard and not handling it your usual way
• You feel off or irritable and can’t point to a reason

“You have a broken arm, you might need a cast,” she said. “You might need to go see somebody if you’re not doing well.”

Janovy sees outpatient patients at the Monument Health clinic in Sturgis, scheduled like anything else there. The paperwork isn’t the hard part. Saying it out loud the first time is the wall, and getting over it is worth the trouble.

If you or someone you know is in crisis, the 988 Suicide and Crisis Lifeline is available 24 hours a day by call or text.