Burden of Stigma

Mental health has always been an integral part of human existence. Although it is not generally given the same degree of attention and interest as physical health issues, it is no less important. The lack of interest by public and welfare organisations to embrace mental health issues is traceable to societal stigma about mental illness. The mislabelling of mental health problems and the negative images that have historically been associated with mental health challenges and illnesses are also part of the burden. Unfortunately, the church and faith community in general, ancient, historical, and contemporary, have not been left out of these negative beliefs. Often there is a reluctance to admit or to label a condition as a mental health problem.

The burden of stigma is perhaps much more pronounced in established institutions such as the church and other faith communities because of the shared boundaries between mental health and spirituality. It is also known to account for the reluctance to seek help for mental health problems in ethnic minority communities in the United Kingdom. Unfortunately, despite the

prominence of mental health problems amongst the church congregants, and the overwhelming needs of people thronging faith assemblies and meetings, there is still a disturbing silence amongst faith communities and faith ministers about this well-known “elephant in the room”. At best when

attempts have been made to address it, it has always been from the spiritual perspective, with a disproportionate emphasis on spiritism, demonology, and deliverance, whilst the notion of biological, psychological, and sociological afflictions are utterly disregarded. There is a need to strike the right balance of understanding between the spiritual, sociological, psychological, and biological models of the causation of mental disorders, and recognise that not every mental ill-health is due to demon possession or some sort of spiritual attack, or the individual’s wrong-doing.

The recurrent nature of mental disorders with episodes of instability can form a major disturbance in the membership of a church or faith community and can be a hindrance to having an

enriching worship experience for the individual and the wider congregation. This is not surprising given the participatory and fellowship nature expected of members in faith communities.

Several notable champions of the Christian faith such as Martin Luther, Charles Spurgeon, Florence Nightingale, and Mother Teressa had moments of suffering from serious and enduring mental health conditions which may have caused moments of disruptions and interruptions in the course of their ministry. Nevertheless, history tells us that these had not been a barrier to them fulfilling their ministry, and they had been a blessing to the Church and the charitable organisations associated with them.

The attempts to embrace mental health well-being as an integral part of human existence have increasingly gathered momentum over the years, with directed and assertive approaches to demystify and destigmatize mental health problems. These include the efforts by the WHO (World Health Organisation) to have a dedicated period in the year for raising mental health awareness. WHO conceptualises mental health as a “state of well-being in which the individual realises his or her abilities, can cope with normal stresses of life, can work productively and fruitfully, and can contribute to his or her community”. The WHO theme for mental

health awareness in 20221 was, “Mental health awareness: A global priority”. With the world having recently been bedevilled by the deaths and the long-lasting health consequences of the Covid-19 pandemic, there has been a more focused interest in making better use of existing health and welfare resources to lessen the gravity of the profoundly serious lingering impact of the pandemic on the mental well-being of the populace, especially the younger and employable generation. This has created an added burden and strain on the existing mental health services’ ability to deliver and meet this population’s needs.

While depression and anxiety disorders have become much less stigmatised in society, because of the drive by interest groups and organisations to make mental illness easier to understand, the more severe mental disorders have not received the same degree of acceptance and recognition.

No health without Mental Health

In keeping with the saying that there is no health without mental health”2, it can also be said that “there is no church congregation or church community without mental health needs”. Therefore, the church community as a natural and integral part of society ought to rise to meet and address its congregants’ felt mental health needs . By so doing, the church will be more relevant, in terms of showing a commitment, and interest in recognising, supporting, and joining up with established healthcare organisations to address the mental health needs of its congregants from a holistic perspective. These approaches can only be affected when the ministers, church workers, the congregation, and the charitable organisations connected to the church are well-informed and enlightened about mental health. Ultimately, they will be able to promote and embrace a broader understanding of mental health from a holistic perspective.

Role of the church in Mental Health

The frequency and rates at which mental health problems are reported in the population are on the increase, and the statistics are clear indications that the problems could take an epidemic proportion in our increasingly diverse communities. This is more likely given the evolving man-made technological and sociological vices, and effects of social and economic migrations across the world. Therefore, the church and the ministers have a very important role to play in the prevention of mental health problems and the promotion of healing mental illness. Generally, the required knowledge is lacking in the church community, and ministers and church workers feel unprepared, untrained, and unequipped to address mental health issues.

The boosting of the knowledge of ministers and church workers on mental health issues will enable them to have a broader scope of understanding of the causation and the proven help available within mental health services. These efforts will be complimented by the traditionally sympathetic role of the church towards the plight of mentally challenged individuals, with the full persuasion that the ministry is called to heal the broken-hearted,

preach deliverance to the captives, and recover sight to the blind, set at liberty and proclaim liberty those that are bruised3. As Mental health care can be viewed in terms of persons being provided with encouragement, reassurance, and a conducive environment to enable them to grow as unique individuals, the church community fits into this role.

The church community as well as other religious organisations, including the ministers and church workers that are central to spiritual care, ought to be well-informed and enlightened on the identification, recognition, and delivery of appropriate interventions. They also need to be well informed about how to access mental health services in the healthcare sector, as this can lead to a better quality of life for their congregants and people who receive help from church-based charitable organisations. Attention to spiritual needs in the context of health, in general, has been recognised as an essential need, and for the adherents of the Christian faith, their relationship with Christ gives meaning and purpose to their lives in the face of the challenges of mental health.

Despite the demands on ministers and church workers to support people with mental health problems, there is a general lack

of knowledge and relevant information for them to support their congregants and members in the face of such challenges. It is also known that several issues that are brought to the attention of the minister for pastoral counselling directly or indirectly involve mental health concerns.

In a United Kingdom survey of medical practitioners and clergy by William Heseltine and Mathew Hoskins4 It was found that though the clergy (ministers) have often been identified as “frontline mental health workers” and gatekeepers to the mental health services, a collaboration between them and the specialist mental health services and other related agencies has been poor. This relationship is ridden with distrust. Although they provide regular support and pastoral care for those with mental health problems, the role of the clergy in mental health is generally overlooked and not accorded much place. Unfortunately, this is the case despite the significant impact of the spiritual state on the patient’s overall mental health and well-being. Medical professionals generally seem to be reluctant to expand their spiritual knowledge or collaborate with the clergy, ignore taking a “spiritual history”, and hold a negative view of such practice. Some of these could be due to professional

regulatory issues, medico-legal constraints and indemnity coverage (medical insurance) around medical practice.

The provisions of spirituality and religion workshops and training for healthcare professionals have been recommended. These will help in improving their engagement and confidence in exploring the spiritual needs of the patients, and also improve collaboration with the clergy, ministers and church workers for the overall benefit of the mental health of the patient. The creation of faith-friendly practitioners and counsellors in health services as intermediaries, and facilitators of contact between the clergy and mental health services, is an innovative way of improving interpersonal relationships and promoting collaboration between the ministers and the health practitioners. There have been some positive results from training and workshop schemes to promote collaboration between the clergy and healthcare professionals. Such schemes need to be more widely available.

It has been noted that whilst the clergy or ministers frequently come across mental health cases, they appear to be very effective at

identifying and referring to one, especially where the person presents a high risk to themselves or others. Such include cases of psychosis, suicidal ideation, and substance misuse, which are referred to responsible agencies for help. However, they are less effective at identifying clinical depression and anxiety which are the most common forms of mental disorders in the community or a group setting. Given the common boundaries, shared values, and overlap of areas of interest between the two groups (clergy and medical professionals), it was felt that both groups needed to engage in a more collaborative relationship in the overall interest of the patients. For this to happen, there has to be a greater level of awareness of mental health problems in the church community by ministers, and training for them to improve their knowledge to be able to recognise a mental disorder. This will include addressing anti-psychiatric ways of thinking and beliefs that promote stigma around mental illness, while also attributing it solely to a lack of faith or demonic attacks.

It is also important for mental health services to recognise the pastoral role of the minister vis-à-vis the mental health of members of the church and collaborate with them because of their presence in the community setting. There is a huge potential for collaboration with the community mental health team (CMHT) and primary health

care (General practice) and this should be utilised to a greater advantage.

The description, mental illness, mental health problems, mental health difficulties and mental health issues are used interchangeably, and the book refers to the same condition. The word minister in this book refers to the leader or the minister in charge of the place of worship and the church workers are those who are often delegated to help the minister or faith leader. The word ministry is used to describe the role of the church and its associated charitable organisations and networks in the community.

There are notable scriptural references to mental health issues in the Bible that are referred to in this book; these include, the recognition of the need for help in times of trouble (Psalm 34;17-20; Phil 4:6-7); the spirit of fear (2 Timothy 1:7; Isaiah 41:10; Psalm 56:110); the coping with care and stress (1 Peter 5:7); depression and suicidal thoughts (Psalm 143:4).

Prophet Elijah, a particularly interesting example in the scripture suffered from an episode of depression and contemplated suicide despite his great accomplishment in his ministry. In this discourse, we must beware of modern scientific reductionism, which seeks to explain away what is not scientifically provable, but we must also avoid the equal error of believing that every manifestation of a mental disorder must be demonic. Such an attitude denies moral choice and personal responsibility.