Ministry to the Mentally ill

Mental illness takes many forms.[1] Generally speaking, a mental disorder or mental illness can be understood in terms of persons suffering from psychiatric or psychological distress. This may manifest as difficulty with emotions, thinking (cognition), behaviour and abnormal experiences of the world. Mental illness can occur as the result of biological factors, psychological factors, and/or social factors. Its impact is wide-ranging and can include impairment in functioning in multiple areas, including social, recreational, relational, cognitive, and employment. It can be short-term or long-term in its duration. It can affect people at any age or stage of life. Psychiatric and psychological difficulties can co-exist with other disorders. Treatment may be required, which may include short term or long term medication use and/or various therapies, as well as a range of initiatives for attaining personal and social wellbeing.[2]

Mental illness no longer carries the stigma that it once did. Not only do we know more about mental illness these days, we also are more aware of its prevalence. For example, approximately one in five people will become depressed at some stage in their lives, as depression is one of the most common manifestations of mental distress. Persons with depression may have relatively mild symptoms, where they are able to struggle on with their normal lives and relationships, although their quality of life suffers. Or, with severe depression, their ability to function in any normal way is completely undermined.

We are also more aware these days of the extent to which many people in society struggle with various forms of addiction, including alcohol, drugs, gambling and sex. Many people are familiar with the twelve-step recovery programme pioneered by Alcoholics Anonymous in 1939 and adapted to provide therapeutic treatment to other forms of addiction. Places like the Ashburn Clinic in Dunedin provide an individualised combination of medical, educational and therapeutic interventions to break the addiction cycle and guide a person towards recovery.

Although pastoral responses will vary considerably according to the nature of the mental disorder, there are some things to think about if you are ministering to somebody with a mental illness:

1. Find out as much as you can about the nature of the illness and the person so that you can develop a pastoral response that is both well informed and appropriate to the situation.

2. Consult with others who have a pastoral relationship with the person. Work collaboratively wherever possible. At the same time, respect the privacy and dignity of the person you’re dealing with. Don’t allow collaboration to descend into gossip.

3. Identify the key pastoral relationships, and develop strategies for each. In many situations, for example, there might be a pastoral relationship not only with the person suffering mental illness, but also with their primary caregiver(s) and their family (including dependent children).

4. Map out short-term and long-term strategies.

5. Make sure that pastoral strategies support and dovetail in with whatever professional health services the person might be receiving. Find out what health services (public and private) are available for persons suffering from this particular condition. Know the limits of your own expertise, and refer to health professionals sooner rather than later.

6. Do a risk assessment. Is the person a danger to themselves? Are they a danger to others? If the answer to either of these questions is ‘yes’, what safety measures need to be put in place? Who needs to be notified? If in doubt, seek professional advice.

7. In your communication with a person suffering from mental illness, always bear in mind the extent to which their ability to understand or perceive things accurately might be compromised. Tailor your communication accordingly. By all means listen and express sympathetic support, but don’t get drawn into feeding delusions or condoning bad behaviour. Be honest.

8. Be alert to the dangers of the person to whom you are ministering becoming dependent on you. Set boundaries. Let them know that you are not at their beck and call. Ensure other support structures are in place.

9. Don’t underestimate the role that a congregation can play in providing a supportive and healing environment for the mentally ill. It’s not just the network of pastoral care; it’s also the prayer, worship and fellowship. Having said that, be aware that some forms of mental illness render their sufferers particularly prone to religious delusions. One of the most common indicators of this occurring is when the complex task of spiritual discernment is reduced to a simple declaration that, “The Lord has told me...”

Have you suffered personally from mental illness or known somebody who has? What has your experience taught you about pastoral care in these situations? What would you add or change in relation to the above list of things to be aware of?

 

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[1] The Diagnostic and Statistical Manual of Mental Disorders (a standard reference for the American Psychiatric Association) lists over 400 types of mental disorders. These range from various forms of dementia to clinical depression to eating disorders to anxiety disorders to bipolar disorder to schizophrenia to mental retardation to paranoid personality disorder to addictions to autism to psychotic disorder to Huntington ’s disease.  

[2] Dr Megan Bryan definition of mental illness (email correspondence, 12.9.12). Dr Bryan is a Consultant Psychiatrist at the Ashburn Clinic in Dunedin.