Chapter 20: The Involvement of Clergymen in Community Mental Health Centers by Berkley C. Hathorne
Approximately one-fourth of the comprehensive community mental health centers that were operational in 1968 had clergymen on the staff; another 25 percent had a staff person designated to work with the churches and clergy within the catchment area being served; and the remaining half of the existing centers generally acknowledged that one of their goals was to relate in some helpful way to the churches and clergy, but had not yet formulated any plans for accomplishing this. In a limited study, conducted under the auspices of the Department of Ministry of the National Council of Churches, 18 community mental health centers were specifically evaluated for involvement of clergymen.(Berkley C. Hathorne, unpublished manuscript, "The Role of Churches and Clergy in Relation to Comprehensive Community Mental Health Centers," 1968. The centers selected for study either had existing programs relating to local churches and clergy or had clergymen functioning on the staff. Personal visits and interviews were undertaken at twelve centers while written reports and oral presentations at professional conferences gave sufficient information to include six additional programs.)
Among other aspects of the program of the centers that were evaluated was the nature of relationship and involvement of clergymen with the community mental health centers. There are five ways the clergy were observed being related to centers:
(1) in the planning, organization, and administration of centers;
(2) as ancillary mental health workers; (3) as consultants;
(4) as part-time staff persons; and (5) as full-time staff members.
1. It is apparent that in nearly every instance the clergy has been included in the planning of the community mental health program at the national, state, and local level. Many of the clergy selected for this responsibility were already giving leadership in mental health work through state mental health associations; a smaller number were selected because of their special training and experience in mental health ministries. However, the majority of those involved were ministers, priests, or rabbis who were well known as community leaders, usually in charge of a large influential congregation. Seldom were minority groups represented, and usually the clergy selected were not totally informed concerning current developments in the areas of pastoral care, counseling, or religion and mental health. As the centers themselves have come into being, fewer clergymen have been involved. The majority of the centers are related to existing institutions which already have a board of directors, some of which, of course, have clergymen on the board. Newly constituted centers, organizing a new board, usually include a local clergyman on the board of directors. Again, however, he is usually selected on the basis of community leadership, rather than expertise in matters of mental health, or how representative he is of the community being served.
A small percentage of the functioning comprehensive community mental health centers are sponsored by church-related institutions. In these cases, clergymen are often involved in the administration of the center. For example, the Mennonite Church has established several community mental health centers, and several are adjunctive services of institutions of the Roman Catholic Church. In both cases, professional church workers are largely responsible for the administration. Of course, in all such cases, the centers serve all people within the catchment area without regard to creed, and the professional and supporting staff of the center is representative of all faith groups.
2. The staff members of most community mental health centers view the local parish clergyman as an ancillary mental health worker. It is well established that many people go to their minister, priest, or rabbi with their personal and emotional concerns; therefore, the mental health professionals seek to relate to the clergyman as a "mental health gatekeeper" in order to reach people in need of mental health services. To accomplish this, about one-fourth of the centers have assigned a nonordained staff person to foster relationships with the clergy and the churches. In some cases the person is a psychiatrist (as is the case at the Temple University Mental Health Center in Philadelphia) or a psychologist, but most frequently he is a social worker. One of the major purposes of such a staff member is to relate to the local clergy in order to develop a referral net which makes it possible to reach the people the center is organized to serve.
Dr. Robert H. Felix has termed the parish clergyman "the first line of defense in mental health," and stated that he represents an untapped resource for the early detection, referral, and treatment of persons and families in community mental health. As the effort is made to push mental health back into the neighborhood and the family, the role of the clergyman takes on new importance. He is one of the few professional persons who relates to the individual in the context of his family and community. The staff members of the centers generally recognize the potential of the local clergy and the churches as community resources but express bewilderment as to how to relate to the various clergy and local congregations in a manner that will be mutually helpful.
This frustration is illustrated, for example, by the inability to understand the small number of referrals by clergymen to the mental health centers (approximately 3 percent) , whereas the expectation is that local clergy should be a primary source of referrals. The major reasons for this discrepancy is the fact that the local clergyman feels that (a) there is no one on the staff of the mental health center to whom he can personally relate, and (b) when he refers a parishioner he feels that his concerns are not adequately represented by anyone on the staff of the center, and (c) he feels that his role and relationship with the parishioner or the family is not recognized or utilized as an important part of the experience of therapy either during the treatment time or in the after-care period.
The idea of the clergyman as a "gatekeeper" is, in some ways, not a very flattering concept. Though not intended, it is quite demeaning, for a gatekeeper is, first, one who is outside, and, second, one who screens who goes in and who comes out, and nothing more. Most clergymen want to be seen not simply as gatekeepers, but rather as partners in mental health development and treatment. They want to be more than part of a referral process for the center. Such clergy would suggest that they might be used not simply as gatekeepers, but in programs of primary prevention, in some types of treatment, and in supportive after-care. For example, such things as life adjustment counseling; community social action; marriage and family life education and counseling; social, religious, and therapeutic group experiences; and the after-care of patients by means of a supporting, redemptive fellowship contribute to positive mental health. The clergyman performs a historic and meaningful caring and curative role. His primary orientation is working with people through all the experiences of life. He often sees a spiritual dimension bound up in numerous cases of emotional problems, although it is recognized that "only about ten percent of the problems brought to ministers . . . pertain to religious questions. Marriage and family problems are the most frequent of the problems encountered; psychological stress problems are second in frequency; youth-behavior problems, third; alcoholism, fourth; and problems of aging, fifth." (Research project by Eugene F. Nameche, under the Harvard University Project on Religion and Mental Health, reported in The Ministry and Mental Health, Hans Hofmann, ed. [New York: Association Press, 1960] , p. 225.)
The local clergyman should be involved in mental health in a positive way. He represents a potential for being the first line of offense in mental health. The resources of religion and the religious community have not been utilized in an attempt to foster good mental health. The positive aspects of religion have been generally overlooked, the usual approach of mental health workers being that when some people get emotionally sick they often use religion as one of their many defenses. A shift in focus and due regard for the positive utilization of religious sentiment in mental hygiene can be beneficial and will further the goals of the community mental health program. A partnership between the community mental health center and the local clergy should include consultative services with the clergy to assist them with their own pastoral care and counseling ministry with their parishioners; education and training opportunities in mental health, including evaluative and referral procedures in relation to the local mental health center; and the development and supervision of an after-care ministry with patients originally referred to the center by the local minister, priest, or rabbi. Dr. Gordon Allport states for the clergy what many of them feel. "Instead of two major disciplines demanding teamwork in the interest of mental health, there are clearly three: Religion, psychiatry, and the social sciences. Their interrelations are only now being understood." (Gordon W. Allport, The Person in Psychology[Boston: Beacon Press, 1968] , p. 148.) Partnership, not an ancillary relationship, is what is suggested.
3. In some situations clergymen have been engaged as part-time or occasional consultants in relation to community mental health centers. This has not been a typical or common pattern, but it has much to recommend it. Before attempting to relate to the churches and clergy, or to develop a clergy staff position, a few hours of consultation with an objective but highly competent clergy-consultant should be considered. Such a consultation may simply confirm the program that has already been planned, but in other cases, it could lead to a critical examination, revision, and improvement of the proposal.
At least two states have appointed full-time clergy-consultants on the stall of the state department of community mental health. The pioneer, South Carolina, has provided the consultant to work with local communities and religious organizations in the planning, implementation, and evaluation of programs and projects involving the local center and the clergy and churches. A few individual centers have engaged the services of nationally known experts in religion and mental health, such as a theological professor of related subjects, or officers from national organizations such as the Academy of Religion and Mental Health, the American Association of Pastoral Counselors and the Association for Clinical Pastoral Education. The Department of Ministry of the National Council of Churches is now able to recommend to centers the names of such consultants. In most cases, there will be such an expert within a few hundred miles of the center. In addition, the National Council of Churches can provide direct consultation with national, state, and local church and mental health organizations concerning the involvement of churches and clergy in community mental health centers.
There are no known examples of non-staff clergy-consultants being engaged by a center on a permanent basis. Centers desiring some type of ongoing relationship with a clergyman normally provide for a part-time or a full-time staff position. But it is conceivable that a clergy-consultant might he retained, for example, to attend a weekly clinical staff conference, or to conduct occasional seminars or workshops for the clergy. In a rural setting, where clinically trained clergy are not generally available, such an arrangement has much to commend it.
4. Of the approximately 25 percent of centers that have clergy on the staff, about two-thirds of these are part-time. However, if we add to the one-third full-time the number of centers that have the equivalent of a full-time staff clergyman (having divided the position into two or more part-time positions) , we reverse these ratios. In other words, two-thirds of the centers with clergy staff members have either full-time or the equivalent of full-time staff clergymen. Nationally, this means that one center in every six has provided for a full-time clergy staff position.
Most centers with part-time, rather than full-time clergy staff, have purposely selected this arrangement. In many cases, they have employed two half-time clergymen, usually one Protestant and one Roman Catholic.
This arrangement appears to be working well in such widely separated centers as Lowell, Massachusetts, and Grand Forks, North Dakota. In the first instance the two clergymen have local church responsibilities half-time, and in the latter situation, both are half-time chaplains at local hospitals. Centers that have been organized as a new thrust of existing institutions often share part of the time of the full-time chaplain of the parent hospital. Although these part-time programs were functioning well in most cases, it appeared that there was not as much happening or as many new and imaginative developments taking place as in centers with full-time clergy staff members. Generally speaking, two half-time clergy do not equal a full-time staff clergyman, assuming that they are comparable as far as training and ability is concerned. A director may feel he is getting more for his money this way, and he may in terms of hours of actual work. Also, the fact that he can have two major faith groups represented may appeal to him, although in this age of ecumenism this generally is not necessary. However, if only one clergyman is employed he must be able to relate to all the local clergy on an ecumenical interfaith basis. In actual practice, however, the two tend to duplicate each other’s work. They apparently see their task as serving the patients and relating to the clergy of their own faith group, and they lack the total involvement in the work of the center that is needed to be creative. Further, the part-time clergy tend to see their role in traditional, institutional chaplaincy terms and usually do not have the time to get very deeply involved outside the center. In other words, they are largely center and staff-oriented, rather than church, clergy, and community-oriented.
In a few centers financial considerations dictated a part-time rather than a full-time clergyman on the staff. Where this is the case, would it not be advantageous to explore possibilities of the churches helping with the support of the program? At least one center has a clergy staff person who is supported, in part, by the local Council of Churches. A few of the part-time clergy staff members were engaged to do a particular job -- for example, to do marriage and family counseling. Such a specialized role greatly limits the possibility of developing a comprehensive pastoral services and consultation program at that center.
5. The clergymen serving full-time on the staff on community mental health centers are generally well trained for their work, with a few exceptions, having had a minimum of a full year of special clinical and advanced academic preparation beyond graduate theological school. There is no uniformity of title or functional responsibilities. For example, typical titles are: pastoral services consultant, director of pastoral services, community chaplain, coordinator of pastoral consultation, and mental health specialist in religion.
The role of the clergyman on the staff of the center has not been clearly defined. This is seen in the confusion concerning the function of the pastoral specialist, both on the part of the administration and stall of the center, and on the part of the staff clergyman himself. None of the centers studied was utilizing what might be termed a comprehensive, functional approach. (Berkley C. Hathorne, "Critical Issues in Developing a Pastoral Services Program in the Community Mental Health Center," Pastoral Psychology. May, 1969.) The role is still to be defined and developed, but at this stage it is desirable to keep things flexible rather than prematurely structuring a role model. What can be observed is that the following functions are being performed (this is a composite of what now exists, although no one center is providing all functions) : (a) Pastoral services -- in the traditional sense of pastoral care and counseling, religious services, and religious education. (b) Consultation -- to both the center staff and to the clergy and churches in the community. (c) Administration and community organization -- to develop both the pastoral consultation department and the program of the center. (d) Education and Training -- in such areas as continuing education for local clergy, in-service staff training, clinical pastoral education by qualified supervisors, and educating of clergy and laymen in programs of positive mental health. (e) Therapy -- to provide a religiously oriented therapist on the staff of the center when he is qualified by professional preparation. (f) Research -- to evaluate and improve knowledge of the relation of religion and mental health.
The above functions demonstrate the diversity of roles being undertaken by clergymen on the staff of community mental health centers. For example, at one center, the staff clergyman organized the local clergy and churches in support of a county tax measure that gives permanent support to the mental health program; at another center, the clergy staff member is involved in regular, weekly consultation with local clergymen concerning their own pastoral care and counseling ministry with their parishioners; at another center an extensive training program for clergy has been developed; and at another, a program of therapeutic social action involving local clergy is planned.
Although there is no consensus of what the functions of a clergy staff person should be, what seems to be common is this: The clergyman on the staff of a community mental health center has a dual identity. He is both a clergyman and a mental health specialist, and he should have no confusion about maintaining this dual role. He should attempt to relate to the staff of the center as a mental health specialist in religion and to relate to the local clergy and community churches as a religious specialist in mental health. As long as he maintains this dual identity without negating either dimension he will be able to relate the two facets of his professional role. If the center is seeking to facilitate an interdisciplinary team approach to community mental health in which each professional functions within his own specialty and cooperatively relates to the other team members, then the contribution of the dual-trained, clergy-mental health specialist, should be welcomed.
The above is a report of the use of clergymen in eighteen comprehensive community mental health centers and some of the efforts of the centers and the clergy to relate to each other. An effective, relational bridge can best be provided by a clinically trained clergyman on the staff of the center charged with the responsibility of fostering this relationship. Such a program will be of mutual benefit to the local churches and the mental health center in a local community, for it will mobilize the clergy and the resources of the religious community in a creative partnership of community service and improved health.
For additional reading
Pastoral Psychology. Special issue on "Community Mental Health and the Pastor," May, 1969.
Pattison, E. Mansell, "Functions of the Clergy in Community Mental Health Centers," Pastoral Psychology, May, 1965, pp. 21-26.