The church is the first place most individuals with mental illness seek help, even those with serious mental illness. We speak with Dr. Matthew Stanford about the scope of the mental health crisis and the divine opportunity given to churches to respond in constructive ways.
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The church is the first place most individuals with mental illness seek help, even those with serious mental illness. In this Leading Ideas Talks we speak with Dr. Matthew Stanford about the scope of the mental health crisis and the divine opportunity given to churches to respond in constructive ways.
And Michel: I’m Ann Michel, one of the editors of Leading Ideas e-newsletter, and I’m pleased to be your host for this episode of Leading Ideas Talks. I’m speaking today with Dr. Matthew Stanford, who’s CEO of the Hope and Healing Center and Institute in Houston, Texas. He’s also an adjunct professor of psychiatry at Baylor College of Medicine. He’s the author of a new book, Madness and Grace A Practical Guide for Pastoral Care and Serious Mental Illness. And I’m pleased to be talking with him today about the church’s role in responding to mental illness. So thank you so much for being with us, Dr. Stanford.
Matthew Stanford: Thanks for having me.
Ann Michel: So I thought it would be helpful as a way of introducing our listeners to the subject for you to provide a very general overview of the magnitude and scope of mental illness within American society today.
Matthew Stanford: We have a real disaster in the context of mental health in the US today and that really existed well before we ever had a pandemic. The pandemic has only made things far, far worse. So in the United States today, one out of every five adults and also one out of every five children and adolescents will suffer with a mental health problem in a given year. That’s an enormous number. You’re looking at probably close to 70 million individuals in the United States. Half of all chronic mental health conditions are in place by 14 years of age and 75 percent by 24 years of age. And probably the most disturbing statistic is that the majority of individuals, children and adults in the US with mental health problems, will never receive any treatment. These are serious and devastating conditions. We simply do not have a system that adequately treats them. For those who do receive treatment, the average period of time that passes from the onset of symptoms to first treatment is 11 years. So, just put that in the context of any other medical condition. There’s virtually nothing you have that you would wait 11 years to take care of. And that leaves 11 years of trauma and devastation, relational problems, academic issues, employment issues. By the time a person receives treatment, if they ever receive treatment, they have a lifetime of baggage they’re carrying along with them, that they’ll have to deal with again for the rest of their life. We can just go on and on about the horror of the mental health care system that we have now and the people that suffer. But, you know, one of the bright spots is that people in psychological distress, people who are struggling with these problems are more likely to engage a clergy before they engage a mental health care provider or physician. And that’s an incredible opportunity for the church to be a real front door to helping people get to care.
Ann Michel: Thank you for mentioning that. That was exactly what I wanted to talk about next. Because the central premise of your book is that congregations do have a key role. And yet I believe you say that only a quarter of congregations have any kind of organized response in terms of mental health ministry. So can you speak a bit to the contours of that reality?
Matthew Stanford: Yeah, it’s a little surprising. You know, when I speak to pastors, a lot of times they’re very surprised to hear that they’re more likely to be engaged than physicians or mental health care providers. And then some people might say, “Well, perhaps those are just people that aren’t as ill.” But research shows us that those individuals that engage clergy for assistance are equivalently ill to those seeking out psychiatrists. So these are people with very serious mental health care problems. They don’t walk in and say, “I woke up today and I think I’m bipolar.” When they walk in and say “I’m having spiritual problems. I’m having a relational problem. I’m having financial issues.” And they talk about the same kind of things that anybody would come to a pastor for. They just aren’t aware that it’s a mental health problem generating it. And when you survey pastors, the vast majority, 70 to 80%, will tell you they don’t feel adequately trained to recognize a mental health condition in a congregant. But 90% of pastors say that they provide some type of pastoral counseling. But then less than 10% ever make a referral. And as you said, only really less than a quarter of congregations ever develop any kind of structured approach to caring for or serving individuals mental health problems. So we have this large number of people that are coming, but very few of them are being picked up. And again, it’s a real opportunity, both from a straight service provision view of getting people to care. But it’s also an incredible opportunity for the church, both from a ministry and an evangelistic perspective. Because those people that are seeking assistance, data show us they’re not necessarily people that are associated with churches or even believe in God. Anyone in the general population struggling with these problems is more likely to engage a clergy first. And so this is a real ministry opportunity as well as a service opportunity to get people to care. This is an opportunity to draw people into your fellowship and really grow your church, to help your congregation learn what it is to show grace and care, and to really help people that are suffering. And I think that’s really what God calls us to do.
Ann Michel: And I believe you mentioned that’s even more true in minority communities, that people are more likely to seek out help from a church or clergy person than from a mental health professional.
Matthew Stanford: Yes, absolutely. In minority congregations the church is still seen as much broader than just a place to go and get some type of spiritual intervention or involvement or comfort. It’s seen as a part of the broader community. And so in those communities, you have an even higher rate of individuals that will seek assistance from churches. Here in Houston, where we do a lot of training with our clergy and our congregations, we’ve seen just an incredible response from the African-American and Hispanic community. Because they are even more greatly overwhelmed by these problems with people coming in and just not really being equipped to deal with that.
Ann Michel. So, you mentioned the impact of the coronavirus crisis on the mental health crisis. And I think everyone’s concerned about the impact of the pandemic on people’s mental health. So what are you seeing at this specific point in time as a consequence of the pandemic? And what should pastors and church leaders be looking for, particularly during this post-pandemic period?
Matthew Stanford: We have a clinic here and we see people that have serious mental illness. And one of the first things that we saw was that those who were doing well prior to the pandemic, because of the isolation and the disruption in schedules and inability to access consumer goods or medications, things like that, people that were doing very well, that were stable, suddenly kind of decompensated and really have struggled through the pandemic. So they’ve struggled to maintain their stability. So one thing pastors should look for are the individuals who you know have mental health problems. They are going to be the first ones that are going to struggle. And the goal is to try and help them get back to stability.
A second thing we’ve seen more globally is with the isolation, the disruptions, the changes in school and family dynamics, concern for infection, we’re seeing dramatic increases in anxiety and depression. Frankly, this is in just about everyone. The studies done with parents have found that 50% of the parents of teens in the U.S. are reporting that their teen is showing a worsened or new mental health care problem since the beginning of the pandemic. And most of that is depression and anxiety. And it’s worse in young women than it is in men. But it’s bad in men, as well. So I would suggest pastors watch out for really heightened depression and anxiety. But at this point, since the pandemic has gone on so long, some people have probably figured out a way to kind of minimally cope with that and kind of get by. So they may not be complaining about depressive symptoms or anxiety. What they may be complaining more about are things like “It’s hard for me to maintain a relationship. It’s hard for me to get up and get out. It’s hard for me to continue to do my job well.” So they’re struggling in daily activities. But they aren’t really coming in and complaining “I’m fearful,” or “I’m sad,” because it’s going on for so long. So that’s what we’re seeing. A lot of depression, a lot of anxiety.
Ann Michel: So in terms of a church’s way of engaging in mental health, you emphasize four main components – what you call the “Four R’s.” There’s so much detail in your book. We don’t have time for all of it this morning. But I wondered if you could just name those to give our listeners a sense of what a more holistic approach to mental illness might involve.
Matthew Stanford: We think of a mental health equipped church as one that can or does perform the “Four R’s.” First, they’re able to recognize when an individual is struggling with mental health care problem. Second, they are able to make a professional referral for that individual and connect them to a mental health care provider. Third, they are trained to relate to individuals with mental health problems and/or their families in a compassionate and grace-filled way. And four, they have restorative programs. They’ve set up some type of restorative programs that can meet the special needs and problems of individuals and families that struggle with mental health problems.
Ann Michel: Thank you for that. That clarity is extremely helpful because I think this seems like such a big and overwhelming problem in so many ways. Just stating those things so clearly, I think can help congregation leaders begin to embrace what it might mean within their own congregation to think about mental health ministry a bit more intentionally. You made a point that I found quite provocative in a way, but also very true. You said that for churches that are engaged in prison ministries or recovery ministries or homeless ministry or disaster response ministries — these churches are already engaged in mental health ministry, they just don’t realize it. And I thought that was really interesting. And so I wondered, just very generally, what advice do you have for the many congregations that are involved in that kind of work?
Matthew Stanford: I do see that all the time. Lots of churches have those ministries. They’re very common and very important ministries. I would also add to that list human trafficking ministries. But rarely do those ministries have a specific mental health component. Typically, they focus only on the spiritual aspects of those people. And I’m not in any way saying that’s a bad thing. I’m just saying that the ministry could actually be more effective if we added in a mental health component and helped those individuals dealing with a mental health issue in addition to these other issues. So that could be as easy as building relationships with local mental health care providers and working as a team. So the church’s ministry is working on the spiritual aspects and the personal growth of the individual and the mental health providers are focusing on the mental health aspects. And they’re working together as a team because ultimately the goal is that the quality of life for these people is improved, they draw closer to God, and faith is built up. And so anything that we can do to help that individual move forward, I think, is really part of our ministry. And so I think in the modern church — I mean the “Big C” Church — we have a tendency to focus primarily on the spiritual. The spiritual is what we do. That’s our wheelhouse. And most of these ministries are built around the spiritual. They’re going to share the gospel with the individual. They’re going to provide them with some kind of discipling. But the truth is, that’s not really how the church has always been. If you look at the New Testament Church, they talk a lot about selling their goods and caring for one another’s physical needs and eating together and serving one another in the very physical temporal way, in addition to the spiritual aspects of our existence. And so I think we need to get back to that. We need to acknowledge that this person in front of me, this person that God’s brought to this ministry, has some physical needs. They have some mental needs. They have relational needs. And as a minister of reconciliation, a minister of the gospel, I have an opportunity to not only help them in a spiritual sense, but to help them in these other ways as well. And as I do that out of my ministry to Christ, I’m able to not only improve their life spiritually, but in a temporal sense. Really it all goes together because God made us physical and non-physical as well. And so really, it’s just ministering to the individual, in my opinion.
Ann Michel: Yes, it’s part of a holistic mindset when engaging people’s needs. And I would imagine that the same “Four R’s” you articulated would apply to any of these types of ministries with regard to responding to mental health needs. So you make a strong case, I think, for better educating and equipping clergy to recognize and respond to different types of mental illness. I am not a pastor, but I have served in professional ministry for 30 years. And something that struck me as I was reading the book is that this seems to go beyond just clergy and pastoral counselors. And so my question is, what does a congregation need to do to equip other frontline leaders? I’m thinking of staff, small group leaders, youth workers, mission workers — those people who are likely to be the face of the church interfacing with people regularly.
Matthew Stanford: Yeah, and when I wrote the book, I had clergy in mind as well, but I didn’t think of these people or anyone that would that you might be in front of a congregation that is looking for some kind of some type of ministry. It can be good for that. But, you know, I think that, you know, a congregation needs to equip itself before people show up. I think that’s really one of the keys. You have to do your due diligence before the person is standing in front of you needing the assistance. And, you know, I think not everyone has to be trained at the same level. If a process is put in place where, say, all of the clergy, all of the ministry staff, all of the lay leaders that are involved in ministry, and volunteers are trained to recognize mental health issues, then that’s kind of the foundation. Not everyone needs to be making referrals. But everyone needs to be able to recognize what’s in front of them is more than just a spiritual issue and may require a mental health care provider. And then a subset of people within the church or congregants, maybe some ministry staff, are trained to be the point people that can do some kind of an assessment, make a referral, do a follow up to make sure the individual made it there, and then make sure the person is connected with the right ministries, say support groups or whatever ministries in the church dealing with these needs. And so, it really is kind of a stairstep approach. At one level, everybody can recognize mental health care problems. And then they move the individual on to more specialized ministries and trained individuals within the church. And ultimately, it allows the person to access some level of therapeutic support for free. Because mental health care is extremely expensive and finances are a huge barrier to people getting to care. So if they can provide that kind of support and ongoing care there at the church, then the person only has to access maybe a one mental health care provider in the community and it really takes a burden off of them as well.
Ann Michel: So what first steps can a congregation take if it’s just beginning to think about this issue? You’ve just named a very good one in terms of training people to recognize the manifestations of mental illness. But I think your book also has an important message around destigmatizing mental illness and having more open conversations. So what are some first steps congregations can take to just begin the conversation and begin the process of educating people on the issue of mental illness?
Matthew Stanford: I often put this in the context of a conversation. And it’s a conversation. And really it’s up to the leadership of a church to start that conversation. Undoubtedly, there are people in the church who want to have the conversation, but the leaders are the ones who can really get it off the ground. So, I recommend perhaps a sermon series on mental health issues or on particular biblical characters that struggled with mental health. David is a great one if you want an easy, easy one — David as he struggles with his depression. The vast majority of his Psalms are songs of lament as he struggles with this. And so, something like that to kind of kick it off, but also making sure that you’re communicating to the congregation, where the touch points are within the church. Do you have support groups? Are you talking about the support groups? Have you had someone give a testimony of how the support groups have been effective and helpful for them? Do you have specialized ministries like addiction ministries and homeless ministries? Are you communicating with the church that those exist? How people get into those programs? How they work? Again, testimonies are always very important. So, when it comes to mental health response in faith communities, there is often a breakdown in communication. A churches may actually have referral lists and opportunities for referral, but they simply never communicate it to the church. They wait until somebody comes in and ask for that. So, it’s very important to communicate from the start. Again, I like testimonies. I like Sunday school classes or Bible studies that focus on, say, mental health for a certain season, just to get an opportunity to attend both those who have been real problems and those who are just interested. So, you know, I think that there’s a lot of opportunity. I love pastoral care teams where you have congregants that can walk along with individuals, really if nothing more than offering a listening ear and just being there for support. I think these are all ways to get the conversation going. But also, bring in mental health care providers to do trainings or workshops. Every church could benefit from having a mental health care provider come in and do a one-time training on suicide prevention. No one really gets upset about that. Everybody wants to attend it because no one wants anyone to die by suicide. And it’s a great way to kind of begin to help get your congregation equipped.
Ann Michel: That’s a wonderful suggestion. I really appreciated how you profiled a number of different congregations in your book that had successful mental health ministries. Many of them were larger churches. But I was surprised to see a few that were smaller. In fact, at least one of the churches you profiled was quite small. Since we all know that the vast, vast majority of congregations in the U.S. are small membership churches, I wondered if you could address what mental health ministry can be like in small or rural church contexts?
Matthew Stanford: Yeah, I did that on purpose, having churches of varying sizes. Because most churches in the United States are 75 or less. And many of these churches may think “We don’t have the resources or the human capital or the ability to start any kind of mental health ministry.” But absolutely they do. And so I’ll give you an example of probably the smallest church where we’ve ever done training. It’s a church that literally worships 15 on a Sunday morning. And they have a bi-vocational pastor who works full time at another job and is their pastor only on the weekend. They don’t have a lot of people to volunteer. And they have very limited physical resources. And so we trained a subset of people — mostly women that oversee a lot of their ministries — to recognize mental health care problems. And we provided them with cards for a mental health referral line. If someone calls that line and explains their problem, clinicians will help them find a mental health care provider in the community. So in this small church with very few resources, they have a subset of people that can recognize mental health care problems. When they recognize them, they provide a phone number that a person can call and then get a referral. It’s that simple. And so, in a larger church, you might have a lot of trained staff, you might have specialized ministries. But really, it’s all about getting people to the starting point. One of the churches that we profiled was in a very rural area that has virtually no mental health care providers in the community. Yet they saw tremendous need through probation and parole in their county. And so they partnered with probation and parole and they offer some support groups and some mentoring. It was a tremendous benefit to the community in that county. So it’s really about assessing what the needs of your area are and how you want to help. I’ve often said every church doesn’t have to do everything. If we could just get every church to do something, it would make a difference.
Ann Michel: Well, that’s an excellent word. So to bring this to a close, I wanted to address the spiritual component of this. I really, really love that your book was so very practical and provides really clear information and recommendations. But it also addresses the spiritual component of ministering to those with mental illness. And so I wondered if you could speak a word of hope or reassurance to listeners who may be struggling with mental illness themselves or within their family or their church community, just what our faith has to say to them.
Matthew Stanford: Absolutely! If you are struggling with a mental health care problem or your loved one is struggling, there absolutely is hope. I’m not sure how much more your mental health problem can be minimized or your symptoms relieved. But there’s a hope that transcends circumstances. And that’s Jesus Christ. And this is a faith of transformation. God is changing us every day into the likeness of his son as we submit to his indwelling Spirit. And you can always grow in your faith regardless of your symptoms. Your relationships can be better tomorrow than they are today. Your symptoms can be better tomorrow than they are today. Recovery is a process just like sanctification is a process. I see the recovery process very much like our own spiritual transformation. We have the salvation experience that’s one and done, but we have the sanctification process. And recovery is much the same way. And a church is a wonderful place for that recovery to occur. Because, again, we have a hope that transcends circumstances, which is not something that the world has to offer. We have a foundation for recovery that is unchangeable and absolute. And on those bad days when circumstances are overwhelming, we still have a Savior that overcame the world and dwells in us. And so we have something to hold on to that really can never be taken away from us.
Ann Michel: I know you’ve convicted me! Not only that this is an issue that we need to be paying attention to, but that we have a real calling and spiritual obligation to be more active in this field. So, again, the book is Madness and Grace: A Practical Guide for Pastoral Care and Serious Mental Illness. Thank you so much, Dr. Stanford, for speaking with us today.
Matthew Stanford: Thanks for having me.
Announcer: On the next Leading Ideas Talks, Randy Casey-Rutland shares insights for the church from the perspective of a business leader.
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- Madness and Grace: A Practical Guide for Pastoral Care and Serious Mental Illness (Templeton Press, 2021) by Dr. Matthew Stanford, available at Templeton Press and Amazon
- “Pastoral Care in the Coronavirus Crisis,” a Leading Ideas Talks podcast episode featuring Michael Koppel
- “A Biblical Perspective on Trauma” a Leading Ideas Talks podcast episode featuring Paul Cho
- “Tackling Tough Topics in Church,” a Leading Ideas Talks podcast episode featuring Elizabeth Hagan
- Ministry with Veterans by Jane Donovan
- Leading a Ministry with Homeless People by Rudy Rasmus
- Doing Good Well Video Tool Kit