Mental health and the ministry

Ministering to people with mental health issues

by Wendy Kittlitz

By its very nature, ministry is people-intensive work. Some of the people we encounter, occasionally or regularly, will be dealing with significant mental health issues. Sometimes we will encounter these individuals in our own homes, and sometimes they will be us! Since most pastors are not professional counsellors, it might be helpful to know a few things about some of the common or stressful mental health conditions you may find yourself dealing with.

It has been estimated that one in five people suffer from some type of mental illness at some point in their life. Studies have noted that a pastor is often the first person consulted about issues of this nature. However, as LiveScience reported, “In a study of Christian church members who approached their church for help with a personal or family member’s diagnosed mental illness, researchers found that more than 32 per cent were told by their pastor that they or their loved one did not really have a mental illness.” Some pastors unfortunately still tell people that their problems are purely spiritual in nature.

Though spirituality and its impact should never be ignored or discounted, significant numbers of individuals, including clergy, suffer from identifiable forms of mental illness. When we understand something about these conditions, we can be more effective in recommending remedies to help people manage them.

Let’s talk about three categories of mental health: mood disorders, anxiety disorders and personality disorders.

Mood disorders include depression (which can be just one episode or a continuing condition), dysthymia (low mood over at least two years) and bipolar disorder. These conditions may have physiological causes and genetics can also play a part. In such cases, medication can be very helpful in correcting or managing the conditions. Counselling also helps with the distorted thinking that can be a feature of these disorders. I appreciate the Scriptural admonition to “take captive every thought to make it obedient to Christ.” (2 Corinthians 10:5) It’s helpful to people dealing with one of these conditions to learn as much as you can about it, thoughtfully evaluate the treatment options and then try the treatment that seems the best fit for the individual involved. Combining treatment options with prayer and other spiritual disciplines may be very helpful, but the combination is likely to be more effective than trying either without the other.

Anxiety disorders are a class of mental health conditions that involve varying levels of severity. These range from general anxiety to phobias to panic disorders to obsessive-compulsive disorder to post-traumatic stress disorder. Each of these has clear diagnostic criteria. The causes of these disorders vary; again there are sometimes biological, genetic factors, along with responses to traumatic events (either in the present or in the past). It is important to validate that people who suffer from these conditions are experiencing symptoms very real and sometimes quite debilitating to them, even if it appears to observers that there’s no “reason” for their distress (e.g. the person who is afraid of spiders, or has flashbacks to something that happened many years ago but is no danger to them in the present). Medications and counselling are also helpful resources in many of these cases. Scriptural reminders of God’s ongoing care and presence should convey comfort rather than communicate a failure to adequately trust God with their circumstances. A favourite verse is “do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God.” (Philippians 4:6)

Finally, people who display chronic unhealthy patterns of relating to others that show up in multiple areas of their life (home, school, work, church, friendships) may be suffering from a personality disorder. Rigid patterns of behaviour might include such features as frequent mood swings, angry outbursts, difficulty in relationships, need for instant gratification and poor impulse control. There are three clusters of personality disorders that each have distinct features:

cluster A types display odd or eccentric thoughts and behaviours;
cluster B types have unusually dramatic, emotional thoughts and behaviours;
cluster C types focus on anxious and fearful thinking and behaviours.

The key to recognizing this kind of mental health issue is that people are chronically struggling and don’t seem to get better without some kind of intervention. These disorders seem to be caused by a combination of genetic predisposition and life events. Counselling is the most common treatment option, provided the person with the condition is willing to engage in treatment. Medications can be helpful to treat symptoms and related conditions (anxiety and depression being commonly associated) and sometimes hospitalization is needed, especially if people reach a stage of being dangerous to themselves or others. If you think you or someone you know may be dealing with these issues, a book called Behind the Masks is a helpful resource.

How is this relevant to you, as a pastor? At some time, if you haven’t already, you will encounter someone in your church or family – or perhaps even yourself – who is dealing with one or more of these mental health issues. When that happens, you may be among the first to know there is a problem. As a counsellor, I encourage you to be part of the healing solution.

The minister’s role is to give important and often ignored spiritual support to a person with a mental disorder. The minister, as adjunct to professional mental health care, can impart:

A calm reassuring presence
Knowledge that the person is loved and accepted
Hope – which is necessary for the beginning of recovery
Visits when in the psychiatric ward, just as you would visit any other hospitalized congregant
Encouragement to continue on the road to recovery, especially when a person has had previous failures, maybe even harmful failures
Help in addressing any spiritual dimension of the person’s illness
Use of spiritual practices consistent with the person’s beliefs that you think might be helpful and comforting. For example: prayer, meditation, communion and other rituals
Confrontation when needed – when the person is in denial or is disruptive to church life
A safe place in a church that does not tolerate cruelty, exclusion or jokes at their expense
Sermons, classes or literature to educate the congregation and/or lay pastoral care workers about mental illness
Referrals to appropriate professional treatment, including handling of psychiatric emergencies. A rule of thumb: if a person needs more than three counselling sessions, a referral should be given.

Wendy Kittlitz is a registered counsellor and vice president of counselling and care ministires for Focus on the Family Canada.

Previously published under the title Mental Health in the Ministry