Responding to mental health crises: A guide for pastors

When people face a mental health crisis — their own or a loved one’s — clergy are often among the first they turn to for prayer, comfort and guidance. But too often, pastors lack the tools and support needed to respond in these moments.

According to research published by Barna, only two in five pastors (40%) have a plan for supporting families of those with mental illness, and only 15% reported feeling “very well-equipped” to support someone in their congregation dealing with significant trauma.

As one person reflecting on her family’s experience put it, the questions linger: What if mental illness carried less shame? What if families didn’t have to hide? What if someone had offered guidance when it mattered most?

These questions point to a larger truth: pastors need better resources to recognize mental health challenges, respond appropriately and guide individuals and families toward care.

Recognizing early signs of mental health challenges

Many mental health problems start in either early childhood or puberty when the brain is going through periods of rapid change called blooming and pruning. Parents may not know whether what their child is communicating is something they can and want to handle on their own. Other conditions may emerge in young adulthood or even among older adults (e.g., onset of depression in older adults).

Pastors are not trained as clinicians, nor should they be expected to assess mental health conditions — but they are often uniquely positioned to observe changes in a member of their congregation over time. Jane G. Tillman, a psychotherapist, the Evelyn Stefansson Nef Director of the Austen Riggs Center’s Erikson Institute for Education, Research, and Advocacy, and an Episcopal priest, recommends considering two questions that can serve as practical guideposts: Is what you’re seeing persistent — meaning it isn’t resolving on its own? And is it impairing the person’s ability to function in school, work, or relationships? Persistence and profound functional impairment are among the hallmarks clinicians look for (as such, the 2 P’s).

When either is present, the most caring thing a pastor can do is warmly and clearly encourage the person to seek a professional evaluation.

For many individuals, exploring their concerns and taking a step towards the right clinical care may begin with clinically validated, anonymous screening tools and integrated educational resources such as those offered by Mental Health America (MHA). Since 2014, MHA has offered its free online mental health screening platform as a place to start for common mental health conditions, along with educational resources.

What to do during a mental health crisis

When time is of the essence

• 911 – for medical emergency
• 988 – 24/7 suicide and crisis hotline; available by phone or chat
• NAMI Helpline – Call 800-950-6264 OR text NAMI to 62640 (available 10 am – 10 pm Eastern weekdays)

When cost becomes a barrier

When we buy health insurance, we expect access to competent clinicians and coverage of the care that they determine is right for a family member or us. When these expectations are not met, the result can be frustration and unaffordable care.

With mental health care, stories of insurance companies falling short has become a part of our national conversation. Insurance companies may have inadequate clinician networks and otherwise restrict or delay necessary mental health care

Accessing mental health care made affordable by insurance may require guidance and practical resources for overcoming obstacles. A non-profit organization, Cover My Mental Health, provides such resources at no cost with support for immediate-actionable steps to overcome insurance barriers, such as no suitable in-network clinician, denials for “not medically necessary,” opaque insurance processes, and more, including:

• Resources to document the search of an insurer directory and failure to find a suitably competent, available in-network clinician.
• Specific guidance for support from a treating clinician when the health insurer has concluded that the care is “not medically necessary.” A template letter helps the clinician document that they are fully-trained and competent to make clinical decisions and in the best position to know what treatment is appropriate. 
• Spanish language resources.

Perhaps the most important aspect of this website is that it provides encouragement that individuals do not have to take “no” for an answer when their insurance company lets them down.

Why connection and community matter in recovery

Faith communities are wonderful places to mitigate feelings of loneliness and isolation. But sometimes in the face of mental health challenges, a support setting with others facing similar challenges may provide needed comfort. With mental health and addiction challenges facing so many, the breadth of available family and patient support organizations is truly remarkable, and reinforces the mantra that “You are not alone.”

Across the country, organizations are available to provide support from individuals with comparable “lived experience.” Accompanying this article is a starter list, including website links, that may be invaluable when someone is feeling alone or like they are the only one to have faced the challenges of mental health.

Equipping pastors to offer hope and guidance

As reported by Lifeway, “[b]eyond talking about it from the pulpit, 9 in 10 U.S. Protestant pastors (89%) say local churches have a responsibility to provide resources and support for individuals with mental illness and their families. Few pastors (10%) disagree. We believe the resources shared here can support the essential presence, accompaniment, and guidance that all clergy want to bring to their community in moments of need. 

From the diverse vantage points we three authors have experienced firsthand, we see the benefit of making the resources shared here available to a family facing a seemingly insurmountable mental health challenge. And while these resources will not fully resolve such challenges, the hope and confidence to get started, both for a pastor and for their congregant, can make all the difference in the world. 

Many of the organizations listed below have local affiliates or representatives around the country available to support their peers, that is, with individuals seeking support from the same or similar challenges that they have faced.

Key crisis resources every pastor should know

Disclosure: Joseph Feldman is the president and founder of Cover My Mental Health, and Theresa Nguyen is the chief research officer and leader of the Center for Research and Innovation at Mental Health America. These organizations are referenced in this article as resources.