The advances of the web have changed the world. Now we must learn to use it at its best.
Binding up the brokenhearted.
There is a growing global mental health movement around the world today;i and the global church is beginning to recognize mental health problems, which are the leading cause of disability worldwide—more disabling than such conditions as heart disease, stroke, or diabetesii—as a major ministry priority.
Mental health problems are usually the result of a combination of many factors, including family environment, biology, personality, spirituality, and challenging community contexts, including poverty and violence. Increasingly, the impacts of traumatic events such as childhood abuse, interpersonal violence, or natural disasters are being recognized as major causes of mental health problems.
We often think only of one-on-one counseling as the best approach to addressing needs. However, increasingly community-based approaches are being identified as essential to addressing the need on a global level;iii and churches, as communities of faith where people can find safety and help in times of need, can have a key role.
Mental health care is rooted in Scripture:
The Holistic Mission Issue Group of The Lausanne Movement’s 2004 Forum for World Evangelization explicitly included mental health as part of holistic mission, noting thus:
Holistic mission is mission oriented towards the satisfaction of basic human needs, including the need of God, but also the need of food, love, housing, clothes, physical and mental health [our emphasis] and a sense of human dignity.iv
To address this issue, the Movement created a new Senior Associate role in Care and Counsel as Mission in 2009. In 2016, this focus was more clearly defined as ‘Global Mental Health and Trauma’ (GMHT) with Drs. Gladys Mwiti and Bradford Smith, co-authors of this article and clinical psychologists in Kenya and the US respectively, as Catalysts.
Lack of attention
GMHT may best be understood as an issue that intersects with many issues with which the global church is already engaged such as, health, disabilities, children at risk, refugees, business, community development, and social justice.
Yet, because of stigma and lack of consensus in the church about its definition and causes, mental health is often lost in the global dialogue when the focus turns to more obvious dimensions of these problems.
The lack of attention to this important issue both by the church and secular society has left thousands of people with mental health problems stigmatized, judged as spiritually deficient, and sometimes, in the case of major mental illness, locked up and even chained in institutions where they are exposed to poor living conditions, sexual and physical abuse, and neglect.v
Those with mental health problems have poorer health care, diminished human rights, and higher mortality. They comprise one of the largest mission fields for the church worldwide.
New treatment strategies and the church’s role
The global mental health challenge concerns not just how common and disabling mental health disorders can be but also the ‘treatment gap’. Globally, less than 50 percent of those who need mental health treatment receive it. This gap climbs to over 90 percent in the least-resourced countries in the world.vi
To address this inequity, new strategies have been developed. They encompass a much broader approach including education, health promotion, prevention and ‘task-shifting’ of treatment approaches.
Task-shifting is a strategy of training people who may not have, for example, graduate-level education, to perform specific therapeutic tasks under the supervision of more highly trained clinicians.
These new approaches, which create new roles for non-professionals working in mental health, provide an open door for the strategic involvement of churches in offering support, education, and basic people-helping skills.
Research in the US shows that often pastors are the first persons a family calls when there is a mental health crisis.vii Yet, pastors are often reluctant or feel ill-equipped to speak about mental illness from the pulpit.
Dr Ed Stetzer, Executive Director of Wheaton College’s Billy Graham Center, urges pastors to speak openly about mental health problems as one would about any other health issue and to educate their congregations. Stetzer has coined the phrase, ‘sermons stop stigma’.viii
There are additional challenges. For example, the lack of consensus around appropriate terminology—mental health, emotional health, behavioral health, Christian wholeness—and around the relationship of mental health to spiritual causes, has hindered attempts at more collaboration.
Another key issue is the role of culture and the critique that much of mental health is understood through the lens of Western assumptions.
Despite these challenges, the belief appears to be growing that the global impact of mental health problems is now too large for the church to ignore:
Mental Health Ministriesx recommends a five-step program for creating caring congregations in the area of mental health:
The urgent need for trauma response
A priority issue in global mental health is providing care to those who have experienced traumatic events—which are becoming increasingly common.xi A traumatic event is defined as one in which an individual or community experiences or witnesses actual or threatened death or serious injury to self or others.xii
Trauma overwhelms the capacity to cope. Examples of traumatic experiences include sexual abuse, physical maltreatment, exposure to war, terrorism or political violence, kidnapping or abduction, traumatic loss and bereavement, terminal illness in the family, and forced displacement and extreme interpersonal violence.
Most of the time, and depending on factors like nature of trauma, resilience, individual coping skills, social support, and spiritual resources, psychological trauma heals with time.xiii
However, for others, the impact of traumatic stress may persist over time and lead to other negative outcomes such as depression, physical illness and relational struggles, making it difficult to cope. Serious symptoms of post-traumatic stress disorder (PTSD) can be debilitating, with the more affected survivors of trauma wearing down family members.xiv
Traumatic exposures may eventually lead to PTSD, depression, anxiety, and other mental health conditions, risk-taking behavior, and chronic physical disorders.xv In addition to mental health stressors, traumatic stress increases the likelihood of social problems such as substance abuse and lowered productivity.xvi
Sexual, physical, and psychological abuse frequently occur together, as do child abuse and exposure to domestic violence.xvii The adverse effects on the survivors influence the whole personality leading to shame, fear, guilt, and low self-esteem.xviii
Repeated massive trauma over a period of time causes individual, community, and structural devastation that breeds mistrust, anger, and betrayal between individuals and impedes efforts at peacebuilding and reconciliation.
Research indicates that even if war stops, negative interpersonal attitudes often remain and violence may recur.xix
A study of Rwanda Gacaca courts, where truth-telling was used as a means of reconciliation and healing after the 1994 genocide, indicated that, contrary to claims of psychological health, truth-telling rarely contributes to trauma healing because it fails to underline trauma effects.xx
Trauma healing is a complex process that must be carefully managed to achieve the effects of post-conflict peace building.
Psychological trauma: a Christian integrative perspective
Christians often navigate their understanding of healing from traumatic stress between the extreme of expecting total deliverance from the effects of trauma at the one end of the spectrum or leaving a survivor to nurse their suffering endlessly.
A theologically balanced approach acknowledges the reality of trauma and suffering and then embraces unique means of healing and living that enable post-traumatic growth through time.
The ability of the wounded to find peace and the speed of this healing depend on several factors:
The ability of the human heart to cry out unreservedly to God creates the opportunity for a healing relationship between wounded humanity and a caring God.xxi Lament, as described in Psalms, models deep cries of the believer to God in times of despair.xxii
Laments are raw, unrefined cries that remind us that we do not have to package our pain into tidy bundles before we ask God to make sense of disaster. He meets us there in our pain and weeps with us.
Willow Creek Church, Chicago, is in partnership with Christians in DR Congo in an intervention labeled Congo Initiative. This nation has been steeped in a crisis that has destabilized the economy and resulted in violence by armed groups against civilians in the eastern region.
Congo Initiative is a community of Christ-centered Congolese leaders and global partners united to create a sustainable Congolese society by empowering leaders, and developing initiatives for peace, hope, justice, and trauma healing.
Such multidisciplinary, transnational partnerships can bring healing and transformation to traumatized communities.
In his abundance, God has strategically placed churches to meet the needs of those with mental health problems including those suffering from the wounds of trauma.xxiii
Churches as Christ-centered communities of faith and healing can bring the resources of Biblical teaching, prayer, fellowship, hospitality and caring, counseling, and advocacy for justice to address the needs of those suffering with mental health problems.
What can churches do? With no additional budget or staff, churches can:
1. Talk about the issue using language that is appropriate for the church and cultural setting. There is tremendous stigma-breaking power in a pastor addressing mental health and trauma from the pulpit.
2. Encourage the congregation to offer practical help and hospitality to those who are suffering and their families, as a church body would for any illness or crisis.
3. Help connect those in need with trustworthy community resources. Have referral resource information available and make sure the congregation is aware of it.
4. Reach out and extend Christ’s love through friendship. Those who struggle often feel excluded and isolated and may need extra outreach to know that they are welcome as part of the fellowship.
It is essential we continue to communicate that mental health is a high priority and work together to address it. As the World Health Organization states, ‘There is no health without mental health.’xxiv
Addressing issues of mental health and trauma may be one of the most urgent, emerging priorities within the wholistic mission of the global church.
Gladys Mwiti, a Consulting Clinical Psychologist and author of five books, serves as Founder and CEO of Oasis Africa Center for Transformational Psychology & Trauma, as Chairperson of the Kenya Psychological Association (KPA), and as a Lausanne Catalyst for Mental Health and Trauma. She obtained her PhD in Clinical Psychology from the Graduate School of Psychology, Fuller Theological Seminary, Pasadena, CA.
Bradford Smith is a Licensed Psychologist and serves as the Dean of Arts and Sciences and the School of Fine Arts at Belhaven University in Jackson, Mississippi, and as a Lausanne Catalyst for Mental Health and Trauma. He holds PhD degrees in Clinical Psychology from the University of Massachusetts - Boston and in Education from Claremont Graduate University. He received his theological training at Gordon-Conwell Theological Seminary.
This article originally appeared in the November 2018 issue of the Lausanne Global Analysis and is published here with permission. Learn more about this flagship publication from the Lausanne Movement at www.lausanne.org/lga.
i A. Cohen, V. Patel, & H. Minas, ‘A Brief History of Global Mental Health’ in A. Cohen, V. Patel, H. Minas, & M.J. Prince (Eds)., Global Mental Health: Policies and Practices (London: Oxford University Press, 2014).
ii World Health Organization, ‘Mental Health: Strengthening Our Response Fact Sheet’ (2016),http://www.who.int/mediacentre/factsheets/fs220/en/
iii Cohen, et al, ‘A Brief History’.
iv C.R. Padilla, ‘Holistic Mission’, Lausanne Occasional Paper No. 33: Holistic Mission (2005), 11-23, http://www.lausanne.org/docs/2004forum/LOP33_IG4.pdf.
v N. Mehta & G. Thornicraft, ‘Stigma, Discrimination, and Promoting Human Rights’, in Cohen, et al, Global Mental Health.
vi V. Patel, M. Maj, A.J. Flisher, M.J. De Silva, M. Koschorke, M. Prince, et al, ‘Reducing the treatment gap for mental disorders: a WPA survey’, World Psychiatry, 9 (2010), 3:169-76.
vii ‘Mental illness headlines stir pastors to help’, LifeWay Christian Resources (December 2014), http://www.bpnews.net/43879/mental-illness-headlines-stir-pastors-to-help.
viii E. Stetzer, ‘Sermons Stop Stigma’, Plenary address via video at the Summit on the Church, Health, and Mental Health (Belhaven University, Jackson, MI, 2016).
ix B. Jakob, ‘Promoting Mental Health at Congregational Level’, in U. Giesekus, B. Smith, B.M., & J. Schuster (Eds.), Global Mental Health and the Church (Zurich: Lit Verlag, 2017).
x ‘Creating Caring Congregations—Five Step Program’, Mental Health Ministries (2018), http://mentalhealthministries.net/resources/caring_congregations_model.html.
xi Editor’s Note: See article by Olivia Jackson, entitled ‘Sexual Violence in War’, in July 2015 issue of Lausanne Global Analysis https://www.lausanne.org/content/lga/2015-07/sexual-violence-in-war.
xii American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC, 2013).
xiii L. Kiser& C.R. Figley, Helping Traumatized Families (New York: Routledge, 2013).
xiv S.K. Creech G. & Misca, ‘Parenting with PTSD: A Review of Research on the Influence of PTSD on Parent-Child Functioning in Military and Veteran Families’, Frontiers of Psychology, 8, 1101 (2017), published online 30 June 2017, doi: 10.3389/fpsyg.2017.01101. Accessed April 17, 2018.
xv A. McFarlane, ‘The Long-Term Costs of Traumatic Stress: Intertwined Physical and Psychological Consequences, World Psychiatry, 9 (2010), 3-10.
xvi L.M. Najavits, R.D. Weiss, & S.R. Shaw, ‘The Link Between Substance Abuse and Posttraumatic Stress Disorder in Women. A Research Review’, The American Journal of Addictions (Wiley Online Library, 2010), https://doi.org/10.1111/j.1521-0391.1997.tb00408.x. Accessed 17 April 2018.
xvii T.E. Moffitt & A. Caspi, ‘Preventing the Intergenerational Continuity of Antisocial Behavior: Implications of Partner Violence’, in D.P. Farrington & J.W. Coid (Eds.), Early Prevention of Adult Antisocial Behavior (Cambridge, UK: Cambridge University Press, 2003), 109-29.
xviii T.I. Herrenkohl, C. Sousa, E.A. Tajima, R.C. Herrenkohl, & C.A. Moylan, ‘Intersection of Child Abuse and Children’s Exposure to Domestic Violence’, Trauma, Violence, & Abuse, 9 (2008), 84-99, doi: 10.1177/1524838008314797.
xix E.Cairns, T. Tam, M. Hewstone, & U. Niens, ‘Intergroup Forgiveness and Intergroup Conflict: Northern Ireland, a Case Study’, in J. Everett L. Worthington (Ed.), Handbook of Forgiveness (New York: Brunner-Routledge, 2005).
xx K. Brounéus, ‘The Trauma of Truth Telling: Effects of Witnessing in the Rwandan Gacaca Courts on Psychological Health’, Journal of Conflict Resolution 54 (Sage, 2010), 408-37, doi: 10.11*77/0022002709360322, Accessed 20 April, 2018.
xxi W. Brueggemann, ‘The Psalms and the Life of Faith: A Suggested Typology of Function’, Journal for the Study of the Old Testament, 17 (1980), 3-32.
xxii G.K. Mwiti & Al Dueck, Christian Counseling: An Africa Indigenous Perspective (Pasadena, CA: Fuller Seminary Press, 2006).
xxiii Editor’s Note: See article by Kit Ripley entitled, ‘Life after Modern Slavery’, in July 2018 issue of Lausanne Global Analysis https://www.lausanne.org/content/lga/2018-07/life-after-modern-slavery
xxiv World Health Organization, ‘Mental health: Strengthening our response Fact Sheet’ (2016), http://www.who.int/mediacentre/factsheets/fs220/en/