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Mental Health and the Church: An Interview with Stephen Grcevich, MD

There is a big disconnect between the frequency pastors report talking about mental illness at church and what individuals with mental illness say they need.

An estimated 1 in 5 adults in America battle with mental illness every year. More than nine million people suffer from "Serious mental illness in a given year that substantially interferes with or limits one or more major life activities," according to the National Alliance on Mental Illness.

But where is the church in all this?

Stephen Grcevich, MD, a Psychiatrist in Ohio explains in Mental Health and the Church: A Ministry Handbook for Including Children and Adults with ADHD, Anxiety, Mood Disorders and Other Common Mental Health Conditions that the church can't serve people struggling with mental illness if they are not equipped. 

Why do we rarely hear of a sermon or a discussion from the pulpit regarding mental health?

I don't think it's fair to say that mental health-related topics are never discussed from the pulpit. That's certainly not the case at the church my family attends, but the research suggests a big disconnect between the frequency pastors report talking about mental illness at church and what individuals with mental illness and their families say they need.

LifeWay and Focus on the Family conducted a survey of Protestant pastors, adults with depression, bipolar disorder or schizophrenia and their family members around the impact of their conditions on church participation and spiritual development. When family members were asked what local churches should do to assist families supporting persons with mental illness, their number one response was "Talk about it openly so that the topic is not so taboo." In the very same survey, nearly half of all pastors reported they "rarely" or "never" speak of mental illness during worship services. Nearly two-thirds speak of mental illness once a year or less.

We talk about the news and politics, but mental health remains taboo.

The taboo, or stigma around mental illness exists on two levels. The first level represents the stigma associated with mental illness in our larger society. Our patients often fail to receive necessary support services because of their reluctance to self-identify or because parents are reluctant to disclose their child's mental health disability to others. One reason why a stand-alone mental health ministry is unlikely to be successful is the last thing most people with mental illness want to do is call attention to themselves. They'll flee anything that draws attention to their differences because what they most want is to fit in inconspicuously with everyone else.

The stigma is compounded in the church. In response to the widespread embrace of moral relativism by large swaths of the mental health professions in the 1960s, the Nouthetic Counseling movement emerged. Essentially, followers of the Nouthetic approach believe any mental health condition without a demonstrable organic or physical cause results from sin. This view gained great influence among prominent church leaders in denominations and traditions most committed to evangelism and outreach and persists in many churches to this day.

How do we start the dialogue?

The conversation has already started among key influencers in the church, even if it hasn't yet started to reshape what happens at the local church level. Ed Stetzer has done a wonderful job of using the platforms he's occupied at Lifeway Research, Christianity Today and Wheaton College to promote a dialogue in the church around mental illness. Rick and Kay Warren have done much to advance the dialogue through their advocacy following the tragic death of their son, Matthew. Amy Simpson was a prominent voice at Christianity Today when she wrote highly praised books describing her personal experiences growing up in a pastor's home with a mother with schizophrenia and the challenges experienced by Christians overwhelmed with anxiety.

We're trying to advance the dialogue by providing a model for churches that want to take the next step by developing a ministry strategy for serving persons with mental illness in the communities they serve and their families.

You talk about how the church is great in welcoming new people; they have classes, mentors and other tools for the transition. But we lack the understanding that many of these people are struggling to get out bed in the morning. Where is the church missing it?

Here's the challenge in a nutshell... People serving on staff in a church and folks who are actively involved with church are likely very comfortable with the "culture" of church. By culture, I'm referring to the types of activities we engage in at church, our expectations of one another and the rules, both written and unwritten, that guide our behavior.

What happens when someone experiences one or more mental health conditions is that certain traits or attributes associated with those conditions present challenges for someone seeking to enter into our church culture.

For example, churches are intensely social places. What challenges might someone experience if they have a mental health condition that affects their ability to pick up on verbal or non-verbal social cues, body language or facial expression? What if your brain is wired in a way that you overestimate the risk involved in entering new situations and assume that others are judging you much more harshly than they really are? How will that person handle the level of self-disclosure expected in a small group?

Churches have VERY clear expectations for behavior. What if someone has a condition that causes them to experience more difficulty controlling their impulses or emotions?

My hypothesis is if we can help church leaders better understand the ways in which people with common mental health conditions experience our church culture and ministry environments, they can go about creating culture and environments that are more welcoming for everyone.

Tell us about your inclusion strategy. What has been the biggest challenge in implementing this?

The inclusion strategy is built around the idea described above that there are certain traits or attributes associated with a wide range of mental health conditions that present challenges to someone entering into the culture and ministry environments of our churches. We identified seven common barriers to church involvement related to mental illness – stigma, anxiety, executive functioning or one's capacity for self-control, sensory processing, social communication, social isolation and past experiences of church. We then identify seven broad inclusion strategies that churches pursue across their different areas of ministry to help minimize or eliminate each of those barriers. The seven strategies are easily remembered by the acronym "TEACHER."

T: Assemble your inclusion TEAM.

E: Create welcoming ministry ENVIRONMENTS

A: Focus on ministry ACTIVITIES most essential for spiritual growth.

C: COMMUNICATE effectively

H: HELP families with their most heartfelt needs.

E: Offer EDUCATION and support.

R: Empower your people to assume RESPONSIBILITY for ministry.

I think the biggest challenge involves all of the needs and demands that compete for the time and attention of church leaders. There are always more worthy ministry ideas and opportunities than there are time, money and manpower.

This model doesn't demand that church leaders establish a new program that will take resources away from other important priorities. We're talking about a mindset as opposed to a program. A good strategy involves coming to a better understanding of the challenges that 20-25 percent of the population experience in being part of church and thinking of ways to make it easier for them to participate in the activities your church offers to promote spiritual growth.

What did you find in your research?

I can't say that I've personally conducted research in this area. With that said, one of the drivers for starting Key Ministry was the observation that the kids and families we were serving in my child and adolescent psychiatry practice appeared to be significantly less likely than families in our broader community to be actively involved in a local church.

The available research from LifeWay suggests that nearly a quarter of adults with serious mental illnesses who regularly attended church at one point either stopped attending church, changed churches or couldn't find a church because of the ways people in the church responded to their mental illness. Investigators from Baylor University report that 30 percent of persons who reach out to their churches for help with mental illness report negative experiences, 15 percent report a weakening of their faith and 13 percent leave the church entirely in response to their experiences. The numbers are shocking.

What trends are you seeing in your practice and ministry?

One of the most exciting trends is that God seems to be raising up many different leaders and ministries called to help the church minister more effectively with individuals with mental illness and their families. Fresh Hope and Mental Health Grace Alliance represent two outstanding ministries that offer Christian-based education and support models. Outside In Ministries has an innovative model for equipping church leaders and volunteers to serve as mental health liaisons in their congregations. We're in a similar place as the special needs and disability ministry community was 10-15 years ago just prior to experiencing explosive growth.

You mention in your book about creating a new way of how we address people with disabilities. Can you share more about this?

Over the last 15 years in the church, we've made remarkable progress in ministry with persons with physical disabilities, due in large part to the leadership of Joni Eareckson Tada and the ministry organization she founded. More recently, a number of outstanding ministries have blossomed to help churches serve children and adults with intellectual disabilities and more severe presentations of autism spectrum disorders. We do well in the church in serving persons with more profound disabilities where there's general agreement that the person afflicted bears no moral responsibility for their condition.

Mental health-related disabilities are different in that persons with those conditions are often disabled some, but not all of the time, and in some, but not all environments and activities. Mental health disability is often episodic. Someone with recurrent depression may be a regular attender at church or Bible study but disappear for weeks or months at a time during a mood episode. The disability is often hidden. Someone with agoraphobia may turn around and leave church shortly after arriving if there are no open seats near a door allowing for a discrete exit if labored breathing or palpitations occur during the worship service. The man with a mental health condition associated with sensory processing difficulties may be fine at a small group, but unable to handle a contemporary worship service when the band turns their amplifiers on high. Mental health disability may be situation-specific. Someone with social anxiety may be quite successful in their work or studies but find themselves incapacitated by fear at the prospect of visiting a church for the first time. The middle schooler with separation anxiety may sit with his parents at worship every Sunday, but overnight retreats or mission trips are out of the question.

What are the key barriers that face the church and Christian culture?

If were talking about barriers facing the church in developing an outreach and inclusion strategy for persons with mental illness, there are several. One of the most alarming findings from the LifeWay study I referenced earlier is that 55 percent of U.S. adults who don't regularly attend worship services perceive that churches are unwelcoming to individuals with mental illness. We have to radically shift perceptions of the church in a part of our culture where we have little influence. Because persons with mental illness are often socially isolated, they're less likely to know church members and attendees who'll invite them to worship services and other activities. We'll need to be very intentional and strategic in pursuing relationships with persons with mental illness. Finally, in a culture that highly values individual autonomy, self-determination and sexual liberty, attending a church and publicly identifying as a Christian increasingly has less and less appeal to many, including persons with mental illness.

How do we finally overcome the stigma of mental illness?

We're winning the battle against stigma. As more and more high-profile Christians who have led lives of unquestionable spiritual fruitfulness disclose their own personal experiences of mental illness, the view that sin is the cause of all mental illness becomes less and less defensible. Combine their witness with our rapidly expanding base of scientific knowledge demonstrating the biological basis of common mental health conditions and I find myself very hopeful that subsequent generations of church leaders and attendees will have radically different attitudes toward persons with mental illness.

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