Preventing and reducing suffering

How could churches help reduce mental distress?

With clear pressures on mental health services, could the church help? It offers that rare beast called community, has volunteers who want to help and its buildings have space for meetings. It also offers a broader perspective than health services sometimes have – offering both earthly and eternal hope. As (I hope) the church is less stigmatising and more understanding about mental health, what are the positives that it can bring to the table?
 
This article looks at a range of evidence-based interventions that could be implemented by churches. Some are easier than others and they vary in their degree of impact. It's from an anonymous contributor who has a lot of experience in health promotion.
 
Clearly most church teams face low resources and a wide range of thoroughly good things they could do (the challenge is working out which to do). However some of the below are very low resource and could have a major impact in reducing suffering. Which could your church do?

LOW RESOURCE – HIGH IMPACT

Give open and accepting messages from leadership and peers on mental ill-health.Church leaders mentioning mental illness in open, positive, accepting and supporting ways - such as that mental illnesses are common, real and treatable[1]. This will (a) reduce stigma, which causes great distress in itself, and (b) ‘validate’ and ‘normalise’ people’s own experiences, which can be very important in enabling them to move forward.

This could include people sharing in services about their experience, and teaching on the humanity of people God has used (e.g. Elijah), with linkage to current personal experiences.
Personal narratives of ‘normal’ (e.g. paying taxes, having jobs, being married, parenting) people who are successfully managing and/or have overcome a mental illness are particularly powerful in reducing stigma.
 
Encourage people to recognise, and seek to improve, their wellbeing.80% of people with common mental disorders (e.g. depression, anxieties and substance abuse) and up to 50% of those with serious mental disorders (e.g. schizophrenia, bipolar) do not receive any treatment.[2] Stigma may prevent people seeking help, or they may not be aware or accepting of their condition.
 
Church pastoral and counselling teams, and peers, may be well positioned to spot and explore whether someone may be experiencing mental ill-health, and if so to encourage them to seek self-help or external help.[3]

Basic education on mental health may be appropriate for church leadership, pastoral and counselling teams.[4]
 
A particular point here is the value of early intervention. If a person (child or adult) is encouraged to seek help after their first mental illness episode (particularly psychosis), this can strongly improve their long-term outlook.
 
Help prevent future mental health suffering by teaching and modelling good self-management and parenting skills.Self-management[5]  and parenting attitudes[6] are ‘modelled’ by church leadership in everyday life.
 
Particular learning points here are
-- setting only reasonable expectations (some Christians set very high demands and expectations for themselves and/or their children), and
-- the value of early intervention (see later). 
Poor parenting is a major risk factor for future mental illness (e.g. http://en.wikipedia.org/wiki/Mental_Illness - Prevention). Some large churches offer parenting skills classes, and for many the community of young families offer an informal sharing of skills and knowledge.

LOW RESOURCE – POSSIBLY GOOD IMPACT

Enable people to easily find existing church mental health support, by making resources clear, coherent and visible on church websites and information.Some churches provide support and groups for mental illness, but on an informal basis. In lists of church activities or on websites these may not be mentioned, or only in an unstructured way. Thus many people may not be aware of them.

People may find it difficult to ask about services personally, and may be operating below their best in internet searching capability. Thus making information easy available could be very helpful. (Have you looked for “mental illness” or “anxiety” on your church website?)
 
Enable access to someone competent to assess whether the sufferer should seek external help.Gold Hill Baptist (Chalfont St Peter) have a professional therapist in the ‘first contact and assessment’ role in their counselling team, who would be able if appropriate to guide people to external mental health services. Some church may have counsellors or psychiatrists available to advise on particular cases.
 
(In my view we may need to enable sufferers to be passed from spiritual counsellors to medical ones and/or vice versa as appropriate on their journey. E.g. someone may approach a church counselling team because they feel ‘a long way from God’, but may transpire to have negative thinking biases (e.g. ‘life always goes badly for me’) that could be helped by e.g. CBT.)
 
Make Samaritans visible. Have a Samaritans poster on prominent display, (and maybe have a member of the congregation who speaks for Samaritans in services); so any who are suicidal are able and ‘validated’ to call Samaritans. This may sound extreme, but I know two well-established Christians who have lost their lives in the last few months.

HIGH RESOURCE – POSSIBLY HIGH IMPACT

Provide places of support and peer contact, both a) for mentally-unwell people and b)for their families. Such groups can be very successful, providing a supportive environment where people can receive compassion, and feel unique and valued in an environment of freedom, mercy and patience, with an expectation that God loves to heal and restore, working with whatever works, on an holistic basis.
 
Encourage those with experience in this area to reach out to other sufferers. People benefit from having purpose and roles. Some mentally unwell people would find attending a support group very difficult. It might be a win-win for some others who have walked similar paths to reach out (visit, bring to support group) to others, perhaps in a structured way within the support group.
 
Help mentally unwell people find and stay in ‘work’ roles if possible – including in church.Work (paid or unpaid) is very helpful for mental health recovery, offering social contact, social role, self-respect and regular activity. ‘Work’ may include volunteering roles in church – including helping run activities for the mentally ill. Church members may be able to act as mentors/coaches/friends to help  people to continue in their work.
 
Ask mentally-unwell people and their families what they would like/need. Potentially very valuable, not least because people gain significantly from being treated as valuable, capable and with something to contribute.
 
Care for the mental wellbeing of the church leaders (and missionaries and missionary children). Key factors may be not expecting leaders to be supermen/superwomen, and protecting them from endless non-critical parishioner concerns. Interhealth run a ‘Christian ministry medical’ that leaders can take every few years.
 
Have the church experience be positive, hopeful and uplifting! These factors support mental wellbeing.

Background

High prevalence: Research shows that mental ill-health prevalence is high, with 1 in 4 people experiencing this in every year (see appendix).
 
Reducing stigma leading to rising demand from congregations? In our view stigma may have reached a stage where people are still unwilling to be totally ‘public’ about their poor mental wellbeing, but do feel able to raise it with a particular person e.g. partner, house group leader, pastor. Sadly stigma remains a major issue in general, and in my view affects many church leaders. The best hope on this front seems to be to use personal narratives; if vicars can get involved with individual sufferers, they will soon realise these poor people are, indeed, human just like the rest...
 
What are churches doing? Most churches hope to provide counselling, prayer and support in some form to people in difficulty. Counselling is typically aimed at general life difficulties (e.g. unemployment, relationship issues, faith issues). In cases of mental ill-health, limits of competence are recognised (although the church team may work with mental health professionals such as community based mental health nurses.)[7]

Some larger churches offer support groups for various conditions: Saddleback, USA, have a Counseling Ministry is designed to assist individuals by providing biblical counsel in the following areas: marital and family relationships, communication and intimacy, parenting, grief and loss, anger and bitterness, inner personal struggles, and spiritual discouragement.
 
Are churches just being reactive? The vast majority of existing church activity appears to be reactive. However (a) there may be people in the congregation who are suffering but not telling anyone, and (b) there may be people nearby too ill to face coming to church, or even to leave their home.
 
Should Church leaders worried about doing more? - worried about a ‘deluge’, and/or a brand impact? Some church leaders seem to sense a high volume of hidden mental ill-health, but to be wary of offering more support very openly because they could be ‘buried’ by demand. In my view a key point is that churches could help significantly by setting attitudes and enabling referral. The church does not necessarily need to allocate great resources to this. There could be a significant and adverse impact on the church image if mental health work became significant (perhaps some large % of churchgoers for some fellowships see their church as part of their ‘perfect life’?).
 

References

[1] Possible messages; the 3 core messages of Shekhar Saxena, who leads mental health for the WHO, after a lifetime's experience; that mental disorders are (i) common (more common then realised), (ii) real (as real as physical diseases), and (iii) treatable. In addition; ‘we know many here are suffering - whether it's anxiety, depression, psychosis, bipolar, addiction; we’re all struggling – it’s normal – and it’s one thing Jesus came to sort out. We want to help. We want to offer compassion, fellowship and support. We understand stigma. We want to take a robust ‘straight into the issue’ attitude. We want to help people who are suffering meet together.’
 
[2] www.oecd-ilibrary.org/social-issues-migration-health/mental-health-and-work_9789264124523-en

[3] There may be a danger of encouraging imaginary problems, but this can be limited by maintaining a cultural balance between sympathetic counselling and positive ‘let’s fix this’ attitudes.

[4] e.g. spotting early signs, enquiring on genetic likelihood, separating stressful life from mental illness.
This article helps on this; http://www.mindandsoul.info/Articles/304271/Mind_and_Soul/Resources/Blogs/Wills_Blog/Responding_to_Emotional.aspx 

[5] Possible messages: Have non-excessive self-expectations, think about your physiology: beware drugs (caffeine, alcohol, etc) especially if you find you’re sensitive to them, sleep hygiene, exercise will probably help).

[6] Possible messages: Love (and hug) your children. Treat your children equally (no non-favourites). Do not load high expectations on them. No emotional, physical or sexual abuse. Beware cannabis or other drug (alcohol, caffeine (i.e. coke, coffee etc)) use.
 
[7] The Gold Hill Baptist (Chalfont St Peter) counselling team seeks to “support the work of church leaders, doctors and other caring professionals.”
http://www.goldhill.org/Articles/258663/Gold_Hill_Baptist/Church_Life/Pastoral_Care/Counselling_Service.aspx
 
[8] http://www.oecd-ilibrary.org/social-issues-migration-health/mental-health-and-work_9789264124523-en