Los Angeles County is currently facing a potential meltdown of its entire health services network, both medical and psychiatric, as a $600 million deficit threatens to close down most inpatient hospital beds and numerous county clinics. For years, mental health care budgets have been among the first to be slashed, and part of the proposed solution to the current crisis asks county psychiatric services to cut spending by 20 percent or lose all funding.
But, as psychiatric social worker Marrie Swanson explains, the County Mental Health Centers (CMHCs) are already down to bare bones services. "CMHCs aren't set up for therapy, but for medications," she says. "They won't see dysthymia or adjustment disorder [two forms of depression] as it is." This trend is troubling, given the significantly higher success rates of patients treated with talk therapy along with medications.
Private insurers also vary widely in which mental health services they will cover. Premiums and co-pays are increasing, and people who are already hesitant about pursuing mental health care may forego it entirely. As insurance rates are back on a double-digit rise this year, the number of people who have private insurance at all will inevitably decline, landing them in the broken public system. This situation is not unique to Los Angelesthe injustices of our health care system exist nationwide.
How are we, as people of faith, to respond to this crisis? The Christian church has a long history of healing that lays the groundworkin fact, "mental health care" is one way of describing what the church has been doing for hundreds of years, through pastoral care, the Catholic confessional, and even laying-on of hands. Dr. Ron Mumbower, director of counseling ministries at First Baptist Church in Jackson, Mississippi, says, "Just look at our language! The Christian faith is full of what we need to help those with mental illness. You've already got sanctuary,' a safe refuge, a place of peace and rest, where people can find renewal and healing." The counseling program at First Baptist is dynamic, with several full-time pastoral counselors and support groups and frequent seminars on topics ranging from grief to being "Single Again" to coping with a sick child. Even in smaller churches, pastoral counseling remains a vital element of the church's ministry, whether it's carried out by the pastor, staff member, or lay people.
But faith-based mental health care is expanding beyond traditional pastoral counseling. Opportunities have emerged for combining the best of today's medical knowledge with religion's heritage of hope and healing. For instance, many churches are developing health ministries in order to more concretely carry out Christ's command to "heal the sick." My own church, All Saints (Episcopal) Church in Pasadena, California, recently surveyed more than 400 of its members to assess which health care needs the church could address. The response was overwhelming, with mental health care topping the list of what people are desperately seeking. From broken pasts to broken relationships, from anxiety to depression, from unwanted pregnancies to sexuality issues, needs exist in the church as much as anywhere else. Our health ministry is planning a full program of education, information sharing, and a discussion series on theology and mental health, with the hopes of expanding this ministry in future years.
Yet another exciting model of faith-based mental health care is parish nursing. The QueensCare Health and Faith Ministry in downtown Los Angeles partners with more than 60 churches, schools, and faith-based nonprofit organizations to provide basic health care services. QueensCare is collaborating with UCLA Medical Center to investigate ways to meet the demand for mental health care. One possibility is incorporating medically proven mental health screening tools into parish nursing services. Also, as talk therapy becomes more effective and its methods more easily taught, parish nurses or lay people can be trained to conduct brief six-week therapy sessions within the church. Working with groups of churches makes it easier to develop a good referral network, a necessity for a parish nurse, pastor, or pastoral counselor. "The wise leader," Mumbower says, "is the one who knows how to access the referral network within the community."
And the community is more willing to work with the church than before. Part of this is out of necessity: The financial barriers to access almost demand that faith-based mental health care continue to expand. More important, the church has the capability to reach those for whom cultural barriers impede access to secular psychiatric care. Churches that serve immigrant, ethnically diverse, or non-English speaking congregations enjoy a level of trust among their members that a psychiatrist or secular counselor might never be able to achieve. Numerous studies have shown that members of black, Mexican, and Korean congregations, among others, are more likely to turn to their church community for help than to a more Western or medically oriented mental health care provider. At the same time, mental health care professionalstraditionally a quite nonreligious groupare realizing how deeply faith influences much of the public they are trying to serve. The number of professional journals dedicated to psychiatry, psychology, and religion increased from 23 in 1986 to 36 in 1996a significant increase in the willingness of a secular field to pay attention to religion.
But, as with all issues of social service and justice, the church can't do it all by itself. In fact, when it comes to mental health care, it can be dangerous for the church to even try to act alone. Certain mental illnessesschizophrenia, bipolar disorder, suicidalityare clearly beyond the realm of faith-based care without incorporating medical professionals. People with these disorders often need medication, frequent hospitalization, and life-long care. The church alone simply can't provide that. Also, as a church begins considering a mental health ministry, a basic understanding of mental illness and its relationship to spirituality must be discussed. As Swanson, whose husband is a Presbyterian minister, explains, "Churches sometimes see mental illness as a spiritual problem, and think that maybe people can pray away their problems, when in fact often they need medications too." She continues, "People who work in this field [psychiatry] and our religious friends need to do some educationa meeting of the two fields together. People who understand both are far more helpful."
But even more crucial, the church has the prophetic voice needed to speak up for those who are disorganized (a psychiatric term denoting a jumbled thought process), depressed, or in denial until they are well enough to speak for themselves. This is the call of the church: to serve "the least of these" while confronting the larger forces that prevent wholeness for all people.
Mental illness can rob a person of peace of mind, relationships, and sense of purpose in life. But mental illness is not a life sentence, and biomedical, psychological, and spiritual treatments continue to improve. The church is in a unique position to combine all three, as well as to reach people who, for financial or cultural reasons, can't or won't seek more traditional mental health care.
Emily C. Dossett was a Sojourners contributing writer and a fourth-year medical student at UCLA when this article appeared.