Mental health and the Church
1:4 people will experience a Mental Health problem that could warrant seeing a GP at some point during each year. This is 1:4 people whoever they are, across the age ranges, cultural or racial backgrounds, class or education, whatever their faith or denomination!
If I was to ask you whether Christians experienced problems with their health then I am sure everyone here would say yes. But if I were to ask many the same question about Mental Health the answer would often be more reticent and sometimes no. This is strange as range and causes of mental health problems are just as varied and complex as with physical health.
Furthermore if you went to your GP or hospital consultant for your physical health and were given medication then it is normal to take it. However, there are many people questioned as to whether they should take medication for their mental health when prescribed in the same way. It is as if there was something very different about mental health.
When a person has a physical illness or long term physical condition it is seen as a normal occurrence, and consequently it is expected that they will seek treatment. So why, when that same person has a mental illness, would they be told not to seek help or take medication, and be seen as a failure by others or even themselves? We do not need to hold seminars based on the question "Should Christians take Insulin if they're Diabetic?", so why do we do have to have seminars entitled "Should Christians take Anti-Depressants?"
Many disabilities are physical and can be recognised as they are visible. Others are less obvious. However, mental health problems are often a challenge as they are not physically visible because they affect the mind, thoughts, emotions, and behaviours. Yet the range of conditions covered by mental health is as broad and deep as that of physical health, and therefore the occurrence of mental illness is likely to be as common as physical illnesses.
The statistics are: 1 in 4 adults in the United Kingdom experience at least one diagnosable mental health problem in any one year, and 1 in 6 are experiencing mental health problems at any given time (Office for National Statistics: Psychiatric Morbidity Report, 2001). In the same way, mental illnesses vary in degree from mild to severe and in duration from short-term to enduring.
The culture in parts of the Church to deny or undermine the treatment of mental health conditions can be just as dangerous as challenging the medical diagnosis for a serious physical illness.
Over the years, many people have struggled with mental health issues privately not telling anyone at Church about what they are going through for fear that if they do they will be criticised, condemned, misconstrued, or rejected. Many have been told to "Pull yourself together," "Repent of the sin of self-pity," "Count your blessings," "Stop lacking faith," or "What you need is deliverance", when all they have really needed from the Church is a listening ear, acceptance, encouragement and support. In fact, a bit of love in action.
One of the key aspects of mental illness is that by and large it starts to impact people during their life as opposed to being something they are born with and have to adapt to from their earliest years.
For some it may develop in childhood, but for others it could begin in adolescence or in early adult life. Others still will develop mental health problems at varying stages of adulthood or in senior years. Thus it can be seen that anyone has the potential to experience mental health problems. Mental illness is something that affects often otherwise healthy individuals and can strike at any age.
Schizophrenia, a particularly disturbing condition which may include the symptoms of thought disorder, hallucinations, paranoia and delusions, is often first experienced when a person is in their teens or twenties. Up to that age, the individual may have had a normal childhood, with all the usual expectations for their future including school, college, career and relationships, but at some point they begin to experience disordered thoughts and their life changes direction. Their sense of loss can be great, along with their family’s, when they realise the impact of the condition on their life.
Some conditions creep up and take a person unawares; others can have quite a sudden onset. They can be triggered by stress, pressure, illness, medication, drug use, relationship breakdown, hormonal changes and a whole range of other factors. Some may be the result of choices such as alcohol and drug use. Others will be due to unexpected life events such as experiencing trauma or the death of a loved one.
Imagine a person with a career, full of hopes and dreams for the future, suddenly hit with a mental health problem. This may be schizophrenia but could just as easily be bipolar disorder, depression, post traumatic stress disorder or borderline personality disorder. Work becomes impossible, life goes into turmoil; thoughts and feelings are in disarray, hopes and dreams go out of the window. Little wonder some people lose hope and consider suicide.
Living with a mental illness is a challenge to the individual and they have to come to terms with the changes (if they are even able to recognise that they are ill); it is also a challenge to all those around them, including the Church.
How does the Church respond to someone who is suffering from a mental illness?
Identifying someone’s mental ill-health can be the initial challenge: recognising the change in a person who has been in the Church for years, the change in their personality, behaviour, speech, interests, activities, or involvement. This change can show in the form of withdrawal but also in either over-involvement or over-demanding behaviours, depending on the condition. Some will develop bizarre behaviours, which are more obvious.
Different conditions result in different needs
Depression may be caused by a build up of circumstances and therefore be traced to life events; however, it can creep from the inside out. Either way, once depression has taken hold it can be all-consuming, and you cannot simply tell people to “Snap out of it”. People in the depths of depression may experience being in a confined dark place or pit. The walls may feel as if they are closing in. They can feel isolated and alone. It can seem as if a dark cloud has enveloped them, or that they are in an endless tunnel with no sign of light. Even if they are Christians, they can feel totally alone and “cast … into the lowest depth” as the famous preacher Charles Spurgeon described it in his talk “When a Preacher is Downcast”, “knowing by most painful experience what deep depression of spirit means”.
David, when he wrote Psalm 23 v. 4, said, "Even though I walk through the valley of the shadow of death, I will fear no evil, for You are with me; Your rod and Your staff, they comfort me" (NIV). Suffering from depression can feel like going through the valley of the shadow of death – the mountains may tower on either side; it may feel as if all is closing in. There is a need for support, care, and help.
We know God is there but we may not see or feel him. At times like these there is a need to hold onto the promises of God and trust that as we reach out to him He will hold us up. In Psalm 40 v. 1-2, David recalls, "I waited patiently for the LORD; He turned to me and heard my cry. He lifted me out of the slimy pit, out of the mud and mire; He set my feet on a rock and gave me a firm place to stand" (NIV). Suffering from depression can feel like the slimy pit, the mud, the mire, the place of distress, despair and despondency. It is only once we have travelled through it that we can look back and see God lifting us out.
A mental health condition which impacts all Churches sooner or later is dementia, when a person who has been active all their life in Church will begin to find it harder to cope with services and activities due to memory loss and disorientation. They still have spiritual needs and even with dementia and significant memory impairment, they can respond to Bible stories and well-known hymns, songs and choruses.
If a person is on medication do not dissuade them from taking it. This is unethical and potentially very dangerous. They have been prescribed the medication for a reason by a qualified health professional. The person may not feel they need to take it or that it is having any effect and you may agree with them; however, it may well be keeping them mentally stable and you will only know this after they have stopped and they suffer a relapse in their mental health. Stopping medication suddenly can have significant adverse effects especially if it is the type of medication that requires a planned reduction programme. If you or the person taking the medication question its appropriateness, then the way forward is to ask for a re-assessment by the Doctor prescribing the drugs and if necessary a second opinion.
It is important for the Church family to be there for individuals with mental health needs, not to make demands but to support. Some may need practical help; others emotional support. Sometimes just 'being there' is what is needed.
For some, their mental health problems are temporary and they come out of the other side. For others these problems can be life changing and longer lasting, and the Church needs to plan a course of action and support for these individuals.
If there are a number of people in the Church with mental health problems, each will have their own particular needs. There may be activities that can be arranged collectively, but the needs may be very different. Some will cope well with services, others will not. Some may cope with small groups; others with larger gatherings; others still may need one-to-one interaction. For some an informal, regular drop-in meeting place is important.
Do not be a "Pollyanna Church" where, in the words of Adrian Plass, "everyone is so neurotically positive that nothing negative can be admitted."
The challenge is to listen to God, treat everyone as a unique individual loved by God, and to ask for wisdom to meet their needs.
- Ask God to show you how He sees the person and what His heart is for them.
- Accept them with unconditional love in the same way that He has accepted you and me.
- Do not become transfixed with the diagnosis or label - remember this is a person first. Offer them the Church as a welcoming place of safety where they can be handled with great care and treated as a precious gift from God.
- Do not focus on “fixing” individuals with mental health needs. However, do not be afraid to offer prayer. Prayer ministry and counseling can be of great benefit to people.
God is still God, and God can and does still heal mental health problems as much as physical health problems. However, in the same way that not every person is healed physically when they are prayed for, nor are they always healed mentally or psychologically when they are prayed for. However, this should not stop us praying and bringing them into the Presence of God, for the Father to touch them in whatever way He chooses.
Case Studies from Churches
A small Church with a residential home for people recovering from mental illness in its catchment area. One Sunday one of the residents arrives at the service. He does not seem quite the normal Church member but it is hard to define why. His clothes are not fashionable; he is a bit disheveled; he is smoking roll ups. He comes in the service but pops out half way through to have a cigarette.
Everyone is welcoming but slightly surprised by him. The next week he comes with a friend. Over the coming weeks a number of the residents attend the services. Some are restless and many pop out for cigarette breaks. The preacher’s rhetorical questions get answered! One resident is very quiet and almost withdrawn, whilst another is hyper and incorrigible.
All in all the Church services are never the same again. The first person felt a welcome and found a mental health friendly Church where he felt accepted. He told his friends and they came along. Over time a number of them made decisions to follow Jesus and asked for baptism. They found a spiritual home.
A Project is set up in an area where the Churches have facilities across that area but the community care resources are sparse and stretched. A worker is employed to work across the area and Churches to establish community resources offered jointly by the Churches to their communities.
Most of the Churches sign up to take part and volunteers are recruited and trained. Drop-in Coffee Mornings/Meeting Places are established in each community, staffed by trained volunteers where people can come, feel safe and welcomed, and find a listening ear.
These are also places where they might meet their key worker informally outside of their home environment.
Additional services established include Carer Support Groups, Adult Literacy Sessions, and Ministers and Professionals Lunch Meetings with speakers and a chance to break down barriers.
A Church is sited opposite a residential home for people suffering from dementia. The residents are not in a position to easily come to Church, but the Church has a history of holding Carol Services in a range of sheltered housing units and the decision is made to offer the residential home visits where a group from the Church will take low key services.
Most of the services are based on seasonal festivals and the hymns and readings are traditional and well known. Other services include songs of praise or family favourites.
The services are carefully crafted. Readings and the talk are kept short, to the point and memorable with illustrations when relevant. Hymns relate to the residents’ school or Church days and only the best known verses are sung. The service is short and succinct but designed to feed their spirits and enable them to sing along with hymns and choruses as the music triggers memories.
Many Churches become involved in outreach to homeless people through soup kitchens and night shelters; the challenge is how to incorporate them into Church.
The concept of Café Church offers an opportunity: a place where everyone is welcome, refreshments are provided and it is as much a drop-in as an informal service.
The worship is accessible and the talks designed to be practical and relevant to daily living.
The informality may appear to others to be unplanned but behind the scenes there is a need for coordination and planning and to ensure that all who come are included, welcomed and feel able to fully participate in “Church”.
Association of Christian Counsellors: Representing Christians who provide Counselling and Pastoral Care; website includes directory of Christian Counsellors; acc-uk.org
Challenge of Self Harm
Ask anyone who works with people including Pastors and Church Leaders as to which events they find most challenging and daunting in their work and two issues are sure to turn up in almost every list.
The first is dealing with a person who is suicidal and the second is what to do when someone is self harming. Often self harm is seen as the most challenging as it goes against our inbuilt expectations and revulsions and is often less easy to understand and make sense of.
Many see suicide and self harm as two aspects of the same issue especially as they are frequently mentioned in the same breath, and yet they are two distinct issues although there can be some overlap.
Suicidal behaviour is first and foremost focused on the ending of life whereas self harm is focused on coping with life. The one common suicidal method that appears similar to self harm is wrist cutting. This is usually very different to self harm cutting in location as wrist cutting is usually across the wrist itself and is aimed at cutting deep enough to cause excessive bleeding whilst self harm cutting is usually higher up on the forearm.
The easy way to tell the difference is to ask the person for clarification as to their intent when they did it. Was it to cut their wrist planning to die, or to self harm? Sometimes a person may try cutting their wrist initially as a suicide attempt and find a sense of relief through the act of cutting, and then go on to self harming. If a person is regularly self harming they will be unlikely to be looking for death as an outcome but instead trying to find a way to get through the day.
In this, self harm has much in common with alcohol or drug use, and other addictive or dependency creating behaviours. In fact, any behaviour which a person uses to help them cope with the pressures and difficulties of life. Self harm is a coping mechanism. It may, to the person on the outside, appear extreme, violent, abusive and gory but it is still a coping mechanism. As such, if a person is relying on self harm to cope with life day by day, there's a need to be aware that an enforced stopping of it will remove the key method the person has found to cope with life.
So how does Self Harm help a person cope?
To understand this you need to consider what is happening in the person's life. The individual who is self harming will be trying to cope with something(s) deeply distressing deep inside their being. This may be a range of things from recent experiences, or the effect of one or more experiences in the past to an accumulation of stuff from their life so far which has left a legacy of hurt, pain, guilt, distress, anger, fear, bitterness, etc.
With this type of stuff inside, the question is what do you do with it?
Do you seek help? Many have learned that this can make them more vulnerable. Often we seek to meet the need ourselves and to find some way of nullifying the feelings inside, a way to tranquillise them, put them to sleep, escape for a while or be distracted from them. Some will drink alcohol in enough quantity to reach oblivion. Others use prescribed or illicit drugs. Some will use sex, relationships, gambling, risk taking, and reckless behaviours. Self harm falls within these other coping mechanisms as it acts in a very similar and specific way.
So how does it work?
Yes, self harm does work as a coping mechanism. It is never to be recommended, in the same way as we would never recommend other inappropriate coping mechanisms, but for many individuals it is very effective albeit damaging and potentially dangerous..
Self harm usually involves inflicting an injury on the person's own body. It may involve cutting, burning, hair pulling, intense rubbing, scratching, swallowing, punching and head banging. The person may start self harming by learning from others who already self harm but many will find out by accident. They will do something out of frustration, anger, distress or in cutting their wrists as above, and find that by causing an injury or pain they feel a sense of relief, release, and an escape from their hurt and pain.
Most of these methods of self harm have a very specific effect on the person. The effect is based on a natural physical bodily response to attack, injury and pain. Our bodies are designed to respond immediately when they are injured in any way, whether by a cut, blow, or other form of trauma. The body responds by going into emergency mode, calling internally for its own 'emergency services' to come and deal with the injury. This works through chemicals being produced such as endorphins and adrenaline. These are naturally produced chemicals which are designed to assist with the person's ability to cope with the injury.
The effect for the individual is: to receive pain relief, as the chemicals released are a natural tranquilliser; to be given a high, comparable to taking an illicit drug, as endorphin is akin to morphine; to be given energy and feel more alive as the body equips the person to react to "the attack", enabling the fight or flight reflex.
The power of this effect is very strong. It is often compared to taking drugs or sexual orgasm. For a short period the person can find a way to cover their hurt and pain inside. It is not just the physical pain covering the emotional pain, although this can be part of it, but it involves the whole effect of a short term influence of the chemicals on how the person feels.
Self harm gives a short lived effect. It is powerful but short lived.
This leaves the person in the same state as before but they can be even more aware of the pain they are in. This is why there is a pressure to do it again and again to find a way to cope with the pain. It solves nothing but gives temporary relief. In this way it is addictive, and the person becomes dependant on the use of the chemicals they trigger through self harming. It can also be used in combination with other activities including alcohol, drugs, etc.
Once a person has begun to self harm there are therefore two issues to be considered. The first is why they started and the second is the potential dependency on self harming. Both need to be dealt with.
Stopping self harming alone does nothing to deal with the cause and leaves them desperate for a way to cope. Just focussing on the initial problems does not remove the coping habit they have formed.
What they need is for someone (some people) to come alongside them and enable them to feel supported and cared for by having someone being there for them; for them to have the opportunity to express how they are feeling deep down inside; to talk about whatever is on their mind; and begin to allow the built up pressure and emotion to be released. They will need to feel able to trust those who are giving them support and this may take time. It is essential for the supporter(s) to be clear regarding what they are offering and when, and to create realistic boundaries and be consistent. This will give the person a sense of security and stability.
Do not have unrealistic expectations of the person. Show them care and respect. Remember that their lives may have been chaotic for some while and it takes time for them to feel secure and to learn to trust. As they find other ways to express their inner feelings and begin to find healing from the deep hurt and pain then they will feel less pressure to self harm. Encourage them to develop interests and activities which may equip them to find fulfilment and a creative outlet. Help them find hope and a sense of self worth encouraging restoration in their human spirit.
In regards to the self harming activity. It can be unreasonable to insist on their just stopping. However, there are some techniques which may help the person change their behaviour. These are based on creating an alternative activity or response to replace the action and response from self harming. They may work for some and not for others. Often a person finds one is more effective for their individual needs. These can include:
1 Intense exercise either on a regular basis or specifically when they feel the emotional pressure building. For example: cycling; running; working out; even walking. This activates the body and triggers chemicals inside in a positive way.
2 Eating something that gives an intense sensation. We all know what it is like to eat a lemon or grapefruit; a hot curry; strong mint; this sensation can be helpful as it again triggers chemicals similar to those triggered by self harm.
3 Going through the motions of self harming but using something other than a sharp implement and therefore avoiding actual cutting. For example: taking an elastic band and pinging it against their skin; using a blunt knife or implement to give the feeling of cutting without cutting; using the point of a pen to run across the skin without doing harm. This can be effective if it is used to draw a line particularly if it is a red pen.
4 Any other activity which gives the body an intense sensation without it being damaging or harmful. These can include; putting ice on the skin; having a cold shower; expressing emotions through words, singing, music, dance, painting. All of these methods plus any other that the individual can find for themselves are not a final solution or cure but a step in the process of moving on from self harming.
Surely it is a cry for help?
The person might be crying inside, in fact probably screaming out from within, but self harm is not usually a cry for help but a means of self help. Self harming individuals will often try to hide the injuries from others. They are usually on the arms and legs; places that can be covered. Self harm is often a private activity only noticed by accident, or if cuts or scars are exposed in the summer.
As time goes the person might start cutting other places when they need greater effect or are more desperate. This gives yet another factor for consideration of their need for support. The self harm is not enough to help them cope; their distress is such that the expression of their distress is increasing. This is often when additional coping mechanisms are added.
For some self harm may be linked to self punishment based on a sense of guilt or have other symbolic or ritualistic meaning such as sacrifice or release of blood. For others it gives a sense of being alive: being able to feel means that they are real, or it give a sense of being in control of their life, their body, their pain.
So what can I do?
The first and foremost thing is to be there for the person. If they have shared with you it means they are putting their trust in you and being vulnerable with you.
- Pray for them (but not necessarily with them).
- Show them care and compassion.
- Listen to them with respect and treat them as a unique special person.
- Do not to try to "fix them" or "sort them out".
- If there is an injury treat it as matter of fact and deal with it as you would any other cut or injury.
- If the injury needs first aid, give it; if it needs medical attention access this, but avoid making a fuss about it any more than with any other injury.
- Do not use intense emotional response. Treat as "matter of fact".
- Treat the person as a person and not as a self harmer.
- Focus on them and their need and not the injury.
- Depending on their age and your situation or responsibilities, respect their privacy and confidentiality whilst ensuring protocols are fully met.
- Be clear about your role, what you can offer and establish boundaries for your protection and to give the person a sense of security.
- Seek specialist help for them if appropriate from a Doctor, initially their GP, mental health professional or counsellor or encourage them to seek the help for themselves.
- Seek help and advice for yourself and your team to enable you to help and support the person on an ongoing basis.
- Always remember they are a real whole person: see them and their needs as a whole and do not just focus on the self harm.