Introduction: The Community Mental Health Revolution — Challenge to and Temples
The phrase "community mental health movement" describes an exciting social revolution which is occurring in this period of history. It is a movement of profound human significance. Indeed, it is one of the most important social revolutions in the history of our country, perhaps of the world. Its influence will eventually be felt by every person in our land as a revolution of healing and/or of human fulfillment.
The revolution has two fronts. The first is a massive effort to win a battle that mankind has been losing through the centuries -- the provision of humane, effective treatment for the mentally and emotionally disturbed. A dramatic new strategy has brought the battle to the setting where it belongs and can be won -- the community. The movement is away from the futile pattern of warehouse care in isolated institutions and toward a broad continuum of early, intensive, and varied treatment in the local community.
The second front is to develop more effective ways of fostering positive mental health in all persons, to stimulate their growth and to help them release their unique potentialities for creative living and relating. Thus, the mental health revolution is good news both for the hundreds of thousands who are acutely burdened, and the millions who live half-lives (or less) of quiet or not-so-quiet desperation. Even the most mature persons among us have ample room to grow; therefore, the positive thrust of the mental health revolution should eventually benefit all persons in our society.
Here is a brief survey of how we got where we are. The whole thing began on a cold March day in 1841 when a remarkable woman, one of the great women of American history, Dorothea Lynn Dix, visited a house of correction in Massachusetts and found mentally ill people chained to the walls. That was a little over a hundred years ago in "enlightened" America. She began the one-woman crusade which led to the establishment of mental hospitals. The gradual progress which was made in the humane treatment of the mentally ill was mostly scuttled by World War I and the great depression. Snakepit-like conditions in mental hospitals were, to a considerable extent, the result of the tragic effects of these two social upheavals.
Since World War II, however, the tide has begun to turn. A surge of citizen and professional interest helped to produce, in 1946, the passage of the national Mental Health Act, establishing the National Institute of Mental Health. The federal government became involved in research and helping to fund training of much-needed personnel.
In 1955, in response to continued public interest, Congress enacted the Mental Health Study Act, under which the historic Joint Commission on Mental Illness and Health was appointed. In December 1960, the final report of this Commission was presented to the President and to Congress. This is now available in a book called Action for Mental Health.(New York: Basic Books, 1961.) For the first time in our history, a comprehensive strategy was available on a national level for meeting the gigantic unmet needs in the mental health field.
Then in 1963, under the influence of President Kennedy, Congress authorized grants to permit states to study their mental health needs and resources and prepare a long-range comprehensive plan, state by state, by which the Grand Canyon -- like chasm between needs and resources could gradually be bridged. The deadline for completing these state plans was September, 1965. It behooves each of us to learn what are the major provisions of the mental health plan in one’s own state.
February 5, 1963, was a great day for mental health in this country. On that date, President Kennedy sent to Congress the first presidential message dealing exclusively with mental health and mental retardation. In it he called for a bold new approach. He said there was no use putting new money into the outmoded approach based on the old concept of giant mental hospitals out in the country. Never before had the forgotten people of our society -- the mentally ill -- had a champion at this level. Congress began to move. The message included a challenge to develop a fundamentally new concept. That new concept, perhaps the most exciting in the field of psychiatry since Freud, is the comprehensive community mental health center or service. This is the image which is guiding what is happening in our local communities. Within a few years there will be hundreds of these centers in the United States.
The community mental health service is not a new name for an outpatient clinic or even for a regional unit of a state mental health program. It is not necessarily a new complex of buildings. Basically, a community mental health service is a program and a nerve center. Its goal is to coordinate and provide mental health services to meet the total mental health needs of the community.
What services are required? First, mental health education, to teach people the principles of mental hygiene and growth, and thus prevent mental illness. Second, special education to reach community leaders. Third, early help for persons with life crises and emotional disturbances to keep them from moving into major problems. Fourth, evaluation and research; this means continual looking at the needs of communities as they change in order to keep the program geared to these needs. Fifth, consultation for ministers and other helping professionals to enhance their ability to assist persons in crises. Sixth, a wide continuum of coordinated treatment programs, including day hospitals, night hospitals, foster care homes, halfway houses, alcoholism treatment programs, treatment for the chronically mentally crippled, and programs for the mentally retarded. There will be inpatient, outpatient, and emergency services, as well as partial hospitalization in the community. General hospitals will be encouraged to include psychiatric services to make them readily available for those in crises.
Crucial in all this is the concept of community organization. Those responsible for mental health planning in a region seek to identify the needs of the area, plan strategy, and then develop and coordinate resources for meeting the needs.
The mental health revolution is a major challenge to churches and temples. The challenge is for them to become vigorously and creatively involved for two fundamental reasons: (1) The mental health revolution needs the churches and temples; it needs them on both major fronts -- treatment and prevention. Without maximum church participation in this remarkable social revolution, the struggle will be slower and less effective. (2) Churches and temples must be involved to be true to their mission and to be relevant to contemporary human needs! The revolution needs the churches and temples; the churches and temples need the revolution. Mental health is "an idea whose time has come." If religious groups and leaders miss the boat in this revolution, they cannot stay "where the action is" in ministering to human need and pain. Mental health centers would then become the de facto churches in that they would be doing more to meet the growth and healing needs of persons than the churches.
A strategy is needed for motivating rank-and-file churchmen, lay and ministerial, to become involved, committed, and enthused about the mental health potentialities of both their church programs and community programs. The key to motivation is to help religious leaders discover that this is their revolution, as well as the mental health leaders’ revolution. This discovery can be facilitated by confronting church leaders with these facts:
(1) Mental health deals with that which is of central importance to churches and temples, the wholeness and fulfillment of people. Churchmen who take the "ho-hum," "leave it to the psychiatrists," or "let’s get back to religion and stop fooling with psychology" attitudes toward community mental health, are ignoring two facts: the basic purpose of the churches and temples is the increase among men of the love of God and neighbor"( H. R. Niebuhr, et. al., The Purpose of the Church and Its Ministry[New York: Harper, 1956] , p. 31); and, as a teacher of psychiatry has stated, "a person is mentally healthy to the degree that he is able to live the two great commandments, to love God and neighbor fully." As churchmen we should rejoice that the mental health movement is a growing, concerted effort by person-serving agencies and professions to give human values greater priority. Churches have the chance to cooperate in this dynamic social movement. Churches and temples major in people. So does the mental health movement! We are natural and complementary allies.
(2) Mental and spiritual health are inseparable. The health of one’s relationships with self and others (mental health) , and with God, the universe, and ultimate values (spiritual health) , are deeply interdependent. No understanding of mental health is complete if it ignores spiritual health. (By spiritual health, I mean the adequacy and maturity of one’s relationships with the vertical dimension of existence.) No conception of spiritual health is complete if it ignores mental health. Positive mental health is synonymous with the biblical term, "wholeness." Both point to the fulfillment of human potentialities for living a constructive life in mutually satisfying, loving relationships. Mental health is a contemporary label for a century-spanning concern of the Hebrew-Christian tradition. This concern was reflected in the life style of one who said, "I have come that men may have life in all its fullness" (John 10:10 NEB) Every clergyman is deeply involved in mental health concerns whether he knows it or not. As members of one of the oldest counseling, caring professions, clergymen can affirm their heritage by increased involvement in mental-spiritual health ministries within both religious and wider communities.
(3) The enormous load of suffering and wasted creativity produced by an absence of mental health constitutes another reason why churches and temples have an inescapable responsibility. Behind the cold, familiar (perhaps too familiar) statistics of emotional illness are the warm bodies and live souls of human beings suffering the hell of brokenness. By moralism and immature religion, churches and temples have contributed to this suffering. Even where the religion that hurts has been absent, the religion that heals has not been generally available. If churches and temples pass by on the other side of the Jericho Road of mental illness and health, they do so at the cost of sacrificing their mission to help the troubled and heal the broken.
(4) Religious communities have unique and essential contributions to make to the mental health revolution. If the churches and temples don’t make them, they won’t be made! These contributions can enlarge and enrich the image of positive mental health by bringing an emphasis on values, meanings, and relatedness to the Spirit that permeates all of existence. Congregations can make their unique contribution to mental health best by being responsive to their reason for being. As such, they will "turn people on" to God, life, creativity, relationships, tragedy, loving, being real, and fighting evil in society. This ministry moves far beyond the important goal of helping the mentally ill. Its ultimate aim is life in all its fullness.
Theologically educated persons can help the mental health movement avoid narrow vision-limiting definitions of mental health. They can do so by a continuing emphasis (a) on a "height psychology" (Frankl) , which points to the eternal, the transcendent, the imago dei in man, which must be fulfilled if he is to be mentally healthy; (b) on a "breadth psychology," which sees man as essentially relational and his wholeness as the aliveness of his relationships with nature, God, his fellows, and himself; (c) on a "depth psychology" including both psychoanalytic awarenesses and a theological emphasis on the Ground of Being at man’s deep center.
This volume is one response to the challenge to the churches (The words "church" and "churches" are used in this volume to refer to the total religious community, including both churches and temples.) of the community mental health revolution. It is designed to serve as a practical resource for clergymen, mental health professionals, and lay leaders in churches and temples. It is for those who have a desire to increase the participation of religious leaders and their congregations in community mental health programs. It is hoped that it will be useful both as a stimulus and as a guide to creative involvement in the community mental health movement.
It may be helpful to the reader to know what specific purposes were in the minds of those who formulated the design of this book. They desired that it should accomplish these objectives:
Share the insights and experiences of clergymen who are involved in the community mental health movement.
Give guidelines and practical suggestions to churches and temples which wish to increase their involvement in community mental health programs.
Acquaint mental health professionals with the significant roles which clergymen and congregations can and should play in community mental health services.
Delineate some of the unique contributions of clergymen and religious groups to mental health action on both the therapeutic and preventive-educational fronts.
Arouse enthusiasm among laymen, clergymen, and denominational and ecumenical leaders for effective participation in community mental health on local, state, national, and international levels. Suggest ways of facilitating interprofessional collaboration between clergymen and mental health professionals for the benefit of the parishioner-patient.
Describe some training patterns designed to release the mental health potentialities of clergymen and church laymen. Provide some guidelines for clergymen who desire to enter specialized ministries in the mental health field, and to mental health program leaders who are considering such appointments. Describe some of the ways in which clergymen are now involved in community mental health. Explore the directions which research on the churches and mental health can profitably take in the years immediately ahead. In retrospect, these objectives seem overly ambitious, even grandiose, so far as their possible accomplishment in any one volume. But each of these objectives reflects an urgent need in the present relationships between religious and mental health organizations. It was believed that the probability of making significant progress toward these objectives would be increased by inviting "mini-chapters" from a considerable number of persons actively involved in community mental health as it relates to the churches. From my perspective as editor, I am impressed with the variety and combined richness of experiences and backgrounds represented among the authors. The interprofessional and ecumenical nature of the authors certainly adds to the chapters’ usefulness as resources in our pluralistic society. Clergymen from twelve different denominations are represented. These authors, from a variety of professional settings, are among those who are providing dynamic leadership in the teaching and practice of pastoral care as it relates to community mental health. Those who have contributed from the perspective of psychiatry are persons who are aware of the church’s multiple roles in mental health and are helping to build communication bridges between clergymen and mental health professionals. The degree to which the book achieves its objectives is, in my view, a direct result of the caliber and the insights of these knowledgeable authors, both clergymen and mental health professionals.
Following an overview chapter, the book consists of four major sections. The first deals with the crucial matter of the church’s role in prevention, including the dual thrusts of community outreach and change, on the one hand, and stimulating the growth of persons within the life of the church, on the other. The next section focuses on various facets of the church’s role in treatment of the emotionally and spiritually disturbed. Following this is a section dealing with the clergyman’s role in community mental health services. The final section highlights some aspects of training and organizing for mental health action within churches and temples. Included also are chapters dealing with inter-professional cooperation, research, governmental programs, and mental health as it relates to family life around the world.
It will be evident to the perceptive reader that none of the sections is fully comprehensive in covering its subject. The book does not aim at a systematic discussion of the church’s roles in community mental health. There are numerous gaps which could not be filled because of limitations of space. The topics which are discussed open windows of interest and understanding into areas which are much wider than those covered in the book. Each chapter aims at being such a window-opener.
I must report that the authors contributed their chapters because of their interest in advancing the effective involvement of churches and temples in mental health. Royalties realized from the project will be divided between the American Association of Pastoral Counselors and the Association of Clinical Pastoral Education, two professional groups which have helped raise the level of training and practice in the pastoral care field.
Howard J. Clinebell, Jr