Saving Minds along with Souls
Mental Health and the Church
Their goal is not only to reduce stigma for people with schizophrenia, bipolar disorder, depression and the like, though that is an important part of it. “We are all broken,” Mr. Warren said in his remarks — a phrase Christians often use to describe the many imperfections of the human world. “We’re all a little bit mentally ill.”
The larger goal is to get the church directly involved with the care of people with serious psychiatric illness by training administrators and pastors to handle psychiatric crises, to set up groups within the church for people with serious mental illness and to establish services within the church for people who need them. (Rick and Kay Warren’s earlier initiative on AIDS in Africa created what they called “the clinical church” and trained church members to deliver care.)
These churches are not trying to supplant traditional mental health care. “When someone asks, Should I take medication or pray?” one speaker remarked, “I say, ‘yes.’ ” But they think that there aren’t enough services available for people who are really sick, and they think that many people don’t turn to them anyway because of the stigma. And so they think that there are a lot of people who aren’t getting the help they need.
They are right. The public mental health system is a woefully underfunded crazy-quilt of uncoordinated agencies whose missions shift depending on who gives them money and for what. It can be hideously difficult to navigate even for someone who is not hearing hallucinated voices. Many people with serious mental illness use the public mental health system at best intermittently for psychiatric care. That’s one reason behind the new mental health services bill now wending its way through Congress, which not only expands funding for outpatient care but also includes involuntary outpatient commitment — a more controversial measure that will require very ill patients to take medication. Many psychiatric clients hate the idea of being forcibly medicated.
But they do often go to church. More than 40 percent of Americans say that they attend church nearly every week. Even people who have nowhere to live often go to church.
In an urban Chicago neighborhood where I did many months of research with homeless psychotic women, I found that these women often refused psychiatric care. They’d be angry that someone wanted to diagnose an illness, or sometimes they found the system so bewildering that they just gave up. A woman could be given a month’s worth of medication, get a place in a shelter, and find that to refill her prescription she would have to take three bus rides and maybe she’d miss her place in line to get back into the shelter that night. So she just didn’t bother. In my formal sample of nearly 90 women, only one in four said that they liked psychiatric services. But fully half of them said that they had a church and that they went to that church at least twice each month, and over 80 percent of them said that God was their best friend — some, that he was their only friend.
Mr. Warren’s initiative is remarkable for several reasons. Evangelical churches don’t go in much for hospital-type care. That has traditionally been a more Catholic concern. Even in the social-justice-oriented evangelical churches I know, people are more likely to take meals to the homeless or hold worship services in jails than to set up an actual clinic.
In a world that takes demons seriously, it is easy to interpret psychotic symptoms as demonic. One man who gave a testimony at Saddleback’s conference recalled ruefully that when he told his pastor that his son was hearing voices, the pastor told them only to pray more forcefully.
Even more remarkable is the initiative’s interest in training the ordinary people who work in church offices and hold prayer circles to be actively involved in mental health care. This can sound a little alarming. But in fact, Sangath, a program based in Goa, India, has demonstrated that it is indeed possible to train local community members to identify mental illness and deliver care. A study just published in the Lancet demonstrated that this community care even produced modestly better outcomes for patients with schizophrenia than care in the psychiatric facility.
These programs were funded for the same reasons given by the Warren initiative: that the people who need clinicians do not always find their way to them and that there are not enough clinicians in any case.
Mr. Warren is right, too, about another point. Being in church automatically gives someone what the great sociologist Erving Goffman would have called an “unspoiled” identity. In the conference announcing the initiative, person after person said: “I am not defined by my mental illness. I am a person with mental illness, and I am defined by Christ.” In a world in which serious mental illness is like a punishing badge, that is a powerful shift. And the safer identity may make it easier for people to accept care.
Psychiatrists are the least religious of all physicians, and the new initiative may leave them cold. But Mr. Warren has made an impact before: His initiative on H.I.V.-AIDS was partially responsible for generating George W. Bush’s President’s Emergency Plan for AIDS Relief. If this works, it could have a real impact on the mental health system.
We’re desperately in need of something that does.