Chapter 1: An Overview of the Church’s Roles in Community Mental Health, by E.Mansell Pattison
Following World War II the American public became aware of the long neglected needs of the mentally ill. Among the major studies that ensued from the enactment of the National Mental Health Study Act in 1955 was a comprehensive analysis of the role of clergy and the churches in mental health. The results demonstrated that the clergy were on the front line of contact with people in emotional distress. Further it was noted that the clergy and the churches were in a position to uniquely provide a number of major services relevant to both the care of the mentally ill and the promotion of mental health. Community mental health programs were planned that would be intimately involved in the structure and function of the community, including programs related to the clergy, who are a major professional group in the community, and programs related to the churches, which are major institutions of the community.
Among the key concepts of community mental health programming are those of primary, secondary, and tertiary prevention of mental illness. Primary prevention is concerned with the elimination of conditions that produce emotional illness and with the promotion of conditions that will foster mental health. Secondary prevention is concerned with the early and effective detection of emotional problems when they do exist, so that such problems can be resolved before producing serious disruption in a person’s life. Tertiary prevention is concerned with rehabilitation that will prevent the development of chronic disability in persons who sustain severe emotional difficulties. Community mental health programs are concerned not only with providing direct clinical services to the emotionally ill, but also with developing services in the community related to each of the above three levels of prevention. The clergy and the church are in a vital position to contribute to each level of prevention.
The Clergy and the Church in Primary Prevention
A major concern in primary prevention is for the social and cultural attitudes which determine behavior. The church has long been one of the major social institutions that has defined how people should see themselves and direct their behavior. Thus, the teachings of the church regarding human nature and human relationships may foster either mentally healthy attitudes or destructive, neurotic attitudes in its members. Inevitably a church teaches its members, either directly or indirectly, how to deal with aggression, anger, pride, sexuality, competition, social relations, child-rearing, and marital relations. The paramount current challenge to the church today is to re-examine its implicit and explicit teachings in these areas of human concern. The church can be a major constructive force for mental health in the community if its preaching, church school curricula, and formal and informal social gatherings provide a cohesive and coherent sense of healthy human relationships that will guide, sustain, and encourage healthy emotional attitudes in its members.
A second area of primary prevention where the church can participate is in the provision of group activities that offer intimacy, support, and relationship. No person is able to maintain his existence solely by himself. We maintain our integrity as humans through the emotional nurture we receive from family, friends, and associates. The church in its programming can provide opportunities for participation in a number of formal and informal groups that provide this normal and necessary human nurture.
In addition to these groups, the church can also provide group social relations to persons who are exposed to particular life stresses which make them emotionally vulnerable. Through participation in church-sponsored groups a vital contribution can be made to sustaining such persons. Examples would be groups for adolescents, old people, single middle-aged adults, divorcees, and servicemen. Such groups are intended not to be therapy experiences, but rather to provide opportunity for human contact and relationship to people who are relatively isolated and need structured means of participating in human relationships.
Still another area of primary prevention is the provision of both material and human assistance to people in the midst of life crises. It is not unexpected that people will experience emotional distress during times of crisis. That in itself is not psychopathological. Yet people do need help in living through and effectively coping with crisis. Here the pastor and the people of the church can be available to assist in a natural human way. For example, the family that moves to a strange city can find advice and assistance in the church during their relocation; or the family that has suffered a death can find support and comfort in their bereavement; or a family may find itself unemployed; or the house may have burned down. These may seem like simple, common predicaments. However it is in these common life crises that emotional distress may be either generated or averted, depending upon the human resources available to the family in crisis.
A final area of primary prevention has to do with social concerns. Here the church may lend its official public support; supply monies; provide clerical and lay leadership, volunteers, and facilities to programs aimed at redressing social problems in the community which are contributory factors in producing mental illness. For example, churches may participate in interracial dialogue programs, preschool education programs such as Head Start, nursery school programs for children of working mothers, alcoholism education programs, sex education programs, open housing programs, health and education programs for migrant workers.
In summary, all these areas of primary prevention have to do not with those who are mentally ill, but rather with the provision of relationships and assistance in dealing with common crises and stresses of our society. This area of primary prevention is one where the church must take the lead, for mental health services cannot provide this type of normal everyday nurturance which everyone needs and without which people will run into emotional distress.
The Clergy and the Church in Secondary Prevention
In the area of early identification of emotional distress the clergy are in the most strategic position in the community. The National Mental Health Act studies revealed that when people encounter emotional distress they are more likely to turn first to a clergyman for assistance than to a physician or mental health professional.(See Chapter 16 for a fuller report on this study.) Why do people turn to the clergy? Clergy are the most numerous of professionals (350,000 in the United States) , they are widely scattered into the most distant geographic areas where no other professionals may be, they are easy to contact at any time, they are less expensive, their role and function are usually well known so that people know what to expect when they seek help, and they often have had ongoing contacts already established so that in a time of emotional crisis it is natural to turn to them.
The function of the clergy here may be twofold. If a person presents serious emotional problems that require the skills of mental health services, the clergyman is in an advantageous position to help the person obtain needed professional help. However, if the clergy were to refer all such persons to already overburdened mental health facilities it would swamp and capsize our community mental health services. Rather, the clergyman may be the most effective care-giver in many situations of emotional crisis. In the early stages of emotional crisis a modest amount of emotional support and guidance may be sufficient to help a person work out an emotional problem. However the same problem, if unattended, may compound over time and then require prolonged and skilled professional care. Thus this does not suggest that the clergyman should play the role of preliminary psychotherapist, but rather that in his pastoral role of guiding, supporting, and responding, the pastor may afford sufficient help to alleviate many emotional problems brought to him. He can then be selective in referring those persons who require intensive and skilled mental health services.
In summary, the clergy are in a critical position in the community as the first contact for many persons in emotional distress. Appropriate pastoral care at this juncture may prevent the development of serious problems in many persons.
The Clergy and the Church in Tertiary Prevention
A major problem in the care of the mentally ill is that once a person has been defined as deviant (i.e., mentally ill) and to a large extent taken out of the community for treatment, that person will usually experience great difficulty in re-entry into the community. People are often suspicious of those who have received treatment for emotional disorders. The ex-patient may have difficulty finding a job, being received back into social circles, renewing friendships, and feeling comfortable in participating in the activities of his community. The church can assist here by affording an atmosphere of acceptance, receptivity, and interest. Church members can reach out to the ex-patient and draw him back into the human relationships of the church, and assist in vocational and social relocation. Some churches are supporting special ministries designed to provide specific help in social re-entry. Other churches support group activities designed specifically for ex-patients who can meet and share experiences and problems with others in like situations.
Finally, churches can develop liaison with community mental health programs where church people can establish contact with patients who are still in treatment programs, so that the abrupt transition back into the community is bridged by already established human relationships.
In summary, a crucial need exists for a community to which the patient can return after treatment and receive acceptance, support, and assistance. The church is a major institution that can provide just such a community of human relationships. Hence the church is in a position to contribute directly to tertiary prevention.
The Role of Clergymen in the Program of a Community Mental Health Center
Up to this point we have discussed the many instances where the clergy and the churches in the community can collaborate with community mental health programs in providing services related to prevention in mental health. It is assumed that community mental health programs will (and many do so now) actively work with the clergy and their churches in developing such community services. However, to successfully and effectively engage the churches and clergy in such preventive programs it is necessary to have specially trained clergy on the professional staff of community mental health programs. Such clergy will not only have had training in seminary, but will have acquired accredited training in pastoral care and pastoral counseling. Their function will lie not in the area of church-sponsored pastoral counseling programs, but rather in serving a particular professional role in a community mental health program. The pastoral specialist in a community mental health program may serve the following four functions:
1. Director of Pastoral Care. In this area the pastoral specialist would provide and coordinate religious activities for patients receiving inpatient or part-time hospital care. This would involve many of the usual religious activities that a pastor provides: religious worship services, administration of the sacraments, individual pastoral calls, religious study, and discussion groups. When patients are hospitalized they often feel estranged from their community life; thus, the provision of religious activities while they are hospitalized may serve to provide continuity, as well as the primary nurturance that persons may receive from their religious participation. Further, many patients may wish to maintain their relationships with their own pastor and congregation. Here the pastoral specialist may serve as a liaison, helping the patient to maintain such contacts, and helping the parish pastor and people to understand the needs and problems of the patient. Finally, the specialist may coordinate special programs and services in which various churches may jointly participate.
2. Consultant in Treatment. Here the specialist will continue to function in his pastoral role, but now as a consultant with particular knowledge and skills that may assist in the treatment process. The specialist may counsel a patient regarding theological or spiritual questions. Very often during states of emotional distress religious issues may loom large for the patient, or the patient may seek religious answers as a defense against dealing with his human problems, or in cases of profound emotional disorganization may develop distorted and destructive religious ideas. In these circumstances, the pastoral specialist may be in a position to provide guidance and clarification to the patient. He may also offer support in periods of stress or anxiety during treatment, help the patient fit his religious background into his therapeutic experience, and participate in religious rituals that may therapeutically benefit the patient. In recent years more attention has been given to the role of religious values in psychotherapy. Here the specialist may serve as a consultant and interpreter to the professional psychotherapist in regard to the religious concerns and values of the patient.
3. Diagnostic Consultant. As more religious persons seek mental health services it has become apparent that the relevance of religious background, participation, and values requires attention in the diagnostic and evaluative process. Here the specialist may function as a member of the diagnostic team as an expert on religious matters. He may interview the patient and explore the patient’s religious life and attitudes as part of the diagnostic evaluation. As an expert on various religious cultures, and with a knowledge of the role of religion in personality structure and function, the specialist is in a position to offer relevant insight for psychodynamic diagnosis, for evaluation of the manner in which religious issues should be dealt with in treatment, and the means by which religious resources may be used in rehabilitation.
4. Liaison to the Religious Community. Here the pastoral specialist will function in a role which capitalizes upon his clerical identity, religious knowledge, and contact and identification with the religious community. He will carry on mental health education and consultation programs for the clergy and churches in the community. Similarly, he may conduct seminars on religious aspects of mental health for the staff of the community mental health program. In his liaison role, he will be a primary agent in developing and maintaining liaison between the community mental health program and the churches of its community. This will include the development of a referral network, and assisting in the arrangement of after-care and rehabilitation programs in the community in which the clergy and churches will participate.
In summary, to effectively implement the resources of the clergy and the churches in a community mental health program there is need for clinically trained clergymen who can fill a professional role on the staff of community mental health programs. Such a professional clergy specialist will be an expert in both mental health and religion and will be a major link between these two dimensions of community life.
The clergy and the churches can move toward effective involvement in these areas of preventive community mental health through the following:
a. development of committees in the church that will gather information and implement programs and services within the church relevant to mental health.
b. provide representatives from the church to local citizen mental health associations.
c. provide representatives to the boards and advisory committees of the local community mental health program.
d. support the participation of the pastor in mental health in-service training programs designed for parish clergymen.
e. support local and general denomination programs related to mental health, including exploration with leaders for the development of such programs.
f. recommend, encourage, and support the appointment of pastoral specialists to the professional staff of the local community mental health program.