Behavioral Health Clinic

The term “behavioral health” is used to emphasize the broad applicability of integrated health services in medical care. Behavioral health encompasses behavioral factors in chronic illness care, care of physical symptoms associated with stress rather than diseases, and health behaviors, as well as mental health and substance abuse conditions and diagnoses.

At Riverwood Healthcare, the need for integrating behavioral health into primary care has been recognized as a priority. Many patients present to primary care seeking relief for physical symptoms that are related to mental, behavioral, and/or psychosocial problems. Alternatively, illness can lead to depression, stress, or other behavioral health issues. Evidence has found physical, mental, and social challenges are often interrelated. Improving the communication between behavioral health and primary care providers will improve care coordination and patient outcomes. Good healthcare, at its best, should be inclusive of behavioral health.

Mental Illnesses are among the most common health conditions in the United States. More than 50 percent of the population will be diagnosed with a mental illness at some time in their lives. One in five Americans will experience a mental illness each year, according to Centers for Disease Control (CDC).

Meet our Behavioral Health team

As a team, we are committed to patient-centered collaborative care based upon medical necessity and best practices. To serve our behavioral health patients, we have in-depth knowledge in the treatment and etiology of serious and persistent mental illness, developmental and cognitive disorder, as well as substance abuse disorders.


At Riverwood, our behavioral health providers are dual-certified in both family practice and psychiatry and bring a combination of 30 years of experience. Using dual certification allows for provision of a holistic approach to patient care with consideration of symptomology, current and past mental and physical illnesses, and social situations with the neurochemistry affecting their mental health.

In the treatment of mental illness, our providers integrate assessment, pharmacological treatment, diagnostic testing and therapy with consideration of preconception, childhood, adulthood, as well as end of life. Treatment may often include referral to psychotherapy, neuropsychological testing, CD evaluations and treatment, physical therapy, care management, and /or connection to community resources and if/when needed emergency stabilization.

Janet Larson, PhD, CFNP, PMHNP
Janet received her master’s degree in Nursing/Family Practice at the College of St. Scholastica in Duluth and completed post-graduate psychiatric mental health training at the College of St. Scholastica. She obtained a doctorate degree in Nursing Education from the University of North Dakota. Her experience includes rural primary care, outpatient mental health, dual diagnosis, and acute inpatient psychiatry.

Liz Thompson, CFNP, PMHNP
Liz received her master’s degree in Nursing in Family Practice through the University of Cincinnati and completed a psychiatric mental health post-graduate program through the University of Winona. As a nurse practitioner, she brings a wide variety of experience including outpatient, internal medicine, and urgent care.


Kirstiane Bilyeu, LICSW
As a behavioral health therapist, Kirstiane assesses, diagnoses, and provides psychotherapy to individuals, ages 10 and older. Kirstiane uses a client-centered and strengths-based approach to help individuals achieve their goals. Kirstiane is trained in Dialectical Behavioral Therapy, Eye Movement Desensitization and Reprocessing Therapy, Cognitive Behavioral Therapy, and play techniques. She earned a master’s degree in Social Work at the University of Minnesota, Duluth, and a bachelor’s degree in Psychology and Social Work at the University of North Dakota.

Tim Markgraf, LICSW
As a behavioral health therapist, Tim assesses, diagnoses, and provides psychotherapy to individuals, ages 6 and older. Tim uses a client-centered and strengths-based approach to help individuals achieve their goals. Tim is trained in Dialectical Behavioral Therapy, Eye Movement Desensitization and Reprocessing Therapy, Cognitive Behavioral Therapy, and play techniques. He earned a master’s degree in Social Work at the University of St. Thomas/St. Catherine University.


Our behavioral health provider team is supported by Lacie Hietalati, medical assistant; Erin Manley, patient access; and Kari Carlson, registered nurse.

Lacie Hietalati handles patient phone calls, gives injections of medications to patients as directed and handles other duties related to patient visits.



Erin Manley answers the phone and is the first point of contact for scheduling an appointment with our behavioral health providers. She greets patients upon their arrival for an appointment. She also facilitates processing of new behavioral health referrals and provides needed information about our services offered.

Kari Carlson serves as the Behavioral Health Coordinator, assisting patients in care management of their mental health needs. She is a liaison between the patients and the healthcare system and enjoys a culture where patients come first, helping them become engaged in their care while educating and connecting them to resources. Kari has been a nurse for 20 years and brings a wide variety of experience to the behavioral health team.


Our Behavioral Health team provides care at its main location in Aitkin at 601 Bunker Hill Drive as well as at Riverwood Garrison and McGregor clinics. Appointments are available in person, via virtual video, between 8:00-4:30 PM. Other times are also available on a as needed basis. Call 218-394-2490 to schedule or cancel appointments.

Frequently Asked Questions

Therapy is working cooperatively with a therapist to find a way(s) to deal with unhealthy or troubling behaviors, beliefs, feelings or issues. Therapy is healing, life altering, challenging, and rewarding. Therapy is not magic though at times it can feel that way. It does take hard work, dedication, honesty, letting go of old and current ways we react, behave or think, and risk opening up and being challenged. Therapy can lead to having a sense of hope, feeling empowered, and being effective in everyday life.
Eye Movement Desensitization and Reprocessing Therapy, or EMDR, is a type of psychotherapy used for thoughts, feelings, and body sensations that bother you. When an event occurs, it seems to get locked into the nervous system with the original picture, sounds, thoughts, feelings and sensations. EMDR uses eye or body movements to allow the brain to use its natural healing process. EMDR helps the brain unlock and reprocess these mixed-up feelings, thoughts, and body sensations. Allowing you to not experience negative thoughts as you had before, instead remembering what you learned from these difficult experiences. For further information, go to emdr.com or emdria.org
It’s OK to have a mental illness; many of us do. People of all age, races, genders, careers and socioeconomic backgrounds experience mental illnesses. One in four people will experience a mental illness at some point in their life. About 1 in 10 people will experience a more serious mental illness, such as schizophrenia or bipolar disorder. We are all an incident away from experiencing a mental illness. It’s OK to ask for help to feel better!
Bipolar disorder is a serious brain disorder that may severely disrupt a person’s life and may cause severe emotional pain and result in social difficulties. Bipolar was once referred to as “manic-depressive” disorder because It causes extreme mood swings. At times, the person may feel almost too happy, then may feel great despair. In some cases, both extremes may occur at once. More often, moods shift back and forth. These mood swings may only occur occasionally, but they can also occur more frequently. Without treatment, they will likely recur throughout life. Bipolar disorder includes manic and depressive episodes. During manic episodes of bipolar disorder, a person feels on top of the world. Even the worst news cannot bring them down. They can feel like they can do anything and may even try. One may take great risks, not thinking about getting hurt. They may participate in activities or behaviors they would not generally do. They may talk too fast and have racing thoughts. One may go for days without sleeping and be very active doing many things in a short time. Manic episodes often end in a depression. In depressive episodes, there are intense feelings of sadness and depression. It may include feelings of worthless, fatigue, and helpless. Even their most valuable items will not give them pleasure. At times they are suicidal. The exact causes of bipolar disorder are unknown. But we do know that it runs in families. Over 5 million adults in this country have bipolar disorder, which most often starts in young adults, and includes both men and women in all races, cultures and income levels. There may be a time when one experiences no symptoms. But it is a chronic illness that requires lifetime care. Like heart diseases or diabetes, bipolar symptoms can return, or treatments may need to be changed. Ongoing professional support is key to effective long-term management. Much research is being done on bipolar disorder and may lead to improved treatments. (2000-2019 The StayWell Company, LLC, 800 Township Line Road, Yardley, PA 19069) See the mood questionnaire used to help diagnose bipolar disorder.
In the United States, depression is a common and serious mood disorder that more commonly affects adults but can also affect children. It can result in severe symptoms that affect how a person feels, thinks, handles, day-to-day activities. Depression is caused by a combination of genetic, biological, environmental, and psychological factors. It can occur with other serious medical illnesses, such as diabetes, cancer, and heart disease. Depression is a treatable disease with medication and/or therapy. The earlier that treatment starts, the more effective it is. There are other alternative treatments to explore with your provider as well. (National Institute of Mental Health, 2020)
A diagnosis of major depressive disorder includes at least five of the following symptoms for at least two consecutive weeks occurring nearly every day or one more either depressed mood or loss of interest or pleasure. 1. Persistent sadness, emptiness, anxiety. 2. No interest or pleasure in usual hobbies and activities. 3. Sleeping too much or not being able to sleep. 4. Significantly noticeable appetite or weight changes. 5. Slowed movements or irritation that others notice. 6. Fatigue or low energy. 7. Difficulty concentrating, thinking, or making decisions. 8. Thoughts of worthlessness or excessive or inappropriate guilt. 9. Repeated thoughts of death or hurting yourself, or a suicide attempt. 10. Aches or pains, headache, cramps, or digestive problems, that do not have a clear physical cause and/or improve, even with treatment. A screening tool is a checklist or questionnaire used by professionals such as a nurse, teacher, medical professionals in assessing symptoms, which may be related to a mental health diagnosis. Screening tools do not provide conclusive evidence of a mental health diagnosis, rather a diagnosis is provided by a licensed professional. (CDC, 2017) See Patient Health Questionnaire - 9 (PHQ9) used to help diagnose depression.