Chapter 21: The Community Pastor and the Comprehensive Mental Health Center by Frank S. Moyer
The development of meaningful relationships between community clergy and mental health professionals is one of several important challenges confronting comprehensive community mental health centers. While the external forms and structures of these relationships vary with each center, all are being made possible by the "new" concepts which centers are bringing to bear upon "old" problems.(Lucy D. Ozarin, M.D., "The Community Mental Health Center: Concept and Commitment," Mental Hygiene, January, 1968, pp. 76-80) Among these new concepts are at least three which have opened new potentialities for the community clergyman.
First, the center views the prevention of illness and the fostering of health as of equal importance to treatment. While treatment facilities are important aspects of the organization, centers are more than super-clinics offering multiple services to the mentally ill and retarded. Staff time and professional resources are legitimately involved in assisting other community agents and agencies engaged in various public service programs.
Second, the concept of comprehensiveness has meant an interdisciplinary approach at all levels and in all facets of the center’s program. There has been a recognition of the resources and assets of many other helping professions and occupations, and a utilization of them in the operation of the center.
Third, the centers have recognized the importance of "community" to the success or failure of their development. They have reaffirmed that mental health and/or illness do not exist in a vacuum nor can they be treated in one. Center personnel are actively working in reciprocal relations with other community helpers so that the full potential of both may be realized. Since community clergy and religious groups are also interested in mental health there are many areas for fruitful collaboration. These areas are more easily discerned when seen in relation to the five "essential services" each center must offer.
Consultation and Education. The service of consultation and education is of key importance in the growth of comprehensive community mental health centers. It represents the means whereby the mental health resources of the center becomes linked to the mental health resources of the community in a complementary manner. Prior to the development of this service many community clergy performed their mental health functions in isolation from other concerned professionals. Referrals were usually from clergyman to mental health facility, and the information accompanying such referrals tended to flow one way, as if the clergymen bad little to offer of practical value to the mental health professional. As centers develop this service they are realizing it must be a two-way process. Because of their involvement in so many community functions, community clergymen possess a wealth of knowledge about the attitudes, feelings, and organizational structures present in the community. Some centers now include clergymen on their ongoing planning committee, which has as its task the responsibility to keep the center relevant.
Consultation also increases the potential value of the clergyman as a care-giver because it affords him professional support. In one center the consultative service was offered each time a clergyman referred a parishioner for treatment. The result was that 80 percent of these parishioners never became clients of the center but were maintained by their pastors.( Frank S. Moyer, ‘Shepherd Without a Fold," The Clergy and Psychiatry, Community Services Division, Nebraska Psychiatric Institute, 1967.)
Community clergy are also being contacted when their parishioners are accepted as clients. Usually these men are able to provide additional information about the client’s lieben sitz so that the treatment plan may be better geared to meet his needs.
Educational programs for clergy in areas of mental health and illness have involved thousands over the years. Some community pastors have spent whole summers in clinical pastoral education programs as well as graduate degree programs in counseling, sociology, and similar fields. Centers have learned that greater effectiveness is achieved when they involve these local clergy in planning local programs. Also, they are learning that many of these clergy may be of value to the center’s own in-service education programs. Few mental health professionals have had courses in theology, comparative religions, or ethics; nor have they had the opportunities to learn the intricacies of their communities as have clergymen.
If consultation and education are done on a reciprocal basis, then a mutuality of concern and involvement is established. In this way the uniqueness of both is respected, and neither runs the risk of being patronized or misused.
Emergency Service. The emergency service facility or unit should enjoy a close working relationship with community clergy. The pastors have long had to deal with emergency situations alone and usually welcome any who offer to relieve their burden.
Emotional crises among members of the community tend to be both fragmented and complicated. They seldom follow classic symtomatology or respond to traditional treatment. Yet many mental health personnel and clergymen are still being trained to deal with these crises by classical methods. Let me illustrate: One area pastor recently reported the situation of a female parishioner who became progressively more disturbed. She had been hospitalized previously for an emotional illness and the family had been told to get early treatment should it recur. Being new in the area, the husband called the community pastor for suggestions and referral resources.
This pastor visited the woman, recognized an acute fulminating psychosis, and called the local center. A "team" was convened to meet with the patient, her family, and her pastor to evaluate what treatment was indicated. This team, which did not have present either a psychiatrist or psychologist, decided she should remain at home under medication and with supportive help from the pastor. The decision was made in the erroneous belief that home would be similar to the institution, which had nurses to supply medication and other staff members to help set limits. This woman became worse, refused to take her medicine, and had the whole neighborhood upset because she went from door to door. Whom did they call? The community pastor, wondering what he was going to do about it! When he called the center they still wanted to continue the first plan. Fortunately, this trained community pastor demanded that more competent help be obtained or he would camp on the doorstep with the patient.
The reasons for describing this are to emphasize the many roles the community pastor plays and why collaborative efforts must be made. Collaboration in planning treatment programs helps to avoid many emergency situations and minimize the trauma in others.
We now recognize that immediate assistance for persons facing emotional emergencies increases the prospects for a healthy resolution. Communities have a long tradition of calling clergymen in such crises. Many centers have recognized this and have joined with clergymen in the development of creative programs for emergency needs. These include twenty-four hour telephone service, suicide prevention programs, after-care programs for released patients, and home visit programs.
Partial Hospitalization. The opportunities for more direct service for the community pastor in the partial hospitalization program are manifold. If this service is to be either a bridge between inpatient service and his home or to provide treatment without leaving the community, the pastor should be invited to participate if the patient indicates a church preference.
In addition to visitation, many community pastors could conduct groups at the day care center or other partial hospitalization programs. These should be not group therapy sessions, but discussions. As a pastoral function he could introduce studies of the religions, or of current situation ethics. If it is conducted as pastoral act, it will be therapeutic.
Some church groups may also wish to operate a partial hospitalization unit as part of the center. This might be a day care facility such as The Threshold in Champaign, Illinois.
Outpatient. The outpatient service is one area where cooperative efforts often have failed. Once the patient is referred for treatment, many pastors are not sure what role to assume. Yet, in between visits the patient-parishioner sees the pastor at worship services and in other areas of activity. Often the pastor is called for little emergencies which need band-aids. Some pastors are told to maintain only a superficially supportive role during this period. This, allegedly, protects the patient from having two therapists who may work at cross-purposes. Others, the majority, are given the green light to continue in whatever manner desired. Here the implication is that the minister’s therapy will be of no consequence either for good or for had.
Neither approach is valid. The hands-off system fails to grasp the pastor’s role as a pastor. It does not understand that to offer only superficial support means he is not able to involve the patient in the strengths of faith -- for faith, to be strong, cannot be superficial. The opposite, or "it’s-of-no-account," approach represents a conceit inappropriate to any community mental health professional.
Any community pastor who makes a referral to the outpatient service should be given the opportunity to join the therapeutic effort in whatever role is effective. Some few may be therapists using the center staff as consultants. Most will be able to contribute to the social history. All will continue to serve the patient as pastor, and that role may be used therapeutically.
Inpatient. The opportunities for the pastor to be involved should continue once the patient enters the residential treatment program. This is assumed because of the short-term nature of treatment and the community involvement concept. Pastors should do the major share of pastoral visitation, conducting worship, and similar functions. Chaplains, if employed, should be used only where their expertise is required. This helps to insure continuity with the community for the patient.
The future of comprehensive centers depends on our ability to grasp the significance of the community and its resources. Centers must learn how to accept the various care-givers in their natural roles. They must let them treat those they traditionally have been treating -- rather than becoming screening agents for them. If they attempt the latter, the manpower needs will never be satisfied.
The community pastor works most effectively when there is open communication, encouragement, mutual trust, respect, and cooperation. If centers will approach the community pastor in that atmosphere, a relationship may develop in which both grow toward more effective service in their community.
Local ministerial associations should initiate communications with their centers offering to serve as professional resource personnel. They should assume responsibility for planning and implementing their own educational programs and use the center’s resources where applicable. The most urgent need, however, is to develop creative means of working together with centers in the areas of prevention. This working together in preventive education not only lightens the burdens for both groups, it establishes that close sense of community that is a powerful resource for health and against illness.
For additional reading
Consultation and Education, Public Health Service Publication No. 1478, N.I.M.H., Washington, D.C.
Moyer, Frank S., "Consultation as a Pastoral Function," Occasional Paper, #681, Lutheran Social Welfare Services of Illinois, January 1968.
Schofield, William, "In Sickness and in Health," Community Mental Health Journal, Fall 1966.