Catholic Mental Health Ministry: Guidelines for Implementation
Used with permission: Wendell J. Callahan, Liberty Hebron, Alissa Willmerdinger, 2022.
St. John wrote, “The thief comes only to steal and kill and destroy. I have come so that they may have life and have it to the full.” For many Catholics suffering from mental illness the stigma, shame and in some cases shunning they experience creates a barrier to engaging meaningfully in the life of the Church, moving closer to Christ and indeed living life to the full (Page 9).
An active Mental Health Ministry equips the church to help connect parishioners with appropriate referrals as well as to provide prayerful accompaniment as parishioners navigate treatment, crisis and healing. In the healthcare community, mental illness is viewed as having clear neurobiological and genetic correlates, and treatment for most major psychiatric conditions involves both physical as well as psychological components. Mental illness should never be viewed as the consequence of character flaws or lack of faith. Imagine how ridiculous it would be to judge or stigmatize a parishioner with cancer or assume that a lack of faith caused their illness! Yet, we continue to view mental illness as somehow different in its origin. As Catholics, we are called to reach out and embrace all of our brothers and sisters suffering from illnesses, and we need not treat mental illness as different from any other medical condition. An effective and sustainable response to mental illness in the Church requires a collaborative approach (Page 10).
Our sisters and brothers coping with mental illness are sitting next to us in the pews during Mass as well as sleeping in the Church parking lot at night. This means (Page 10) that we should design outreach efforts to both engage known parishioners more deeply as well as connect our efforts to the community around us. How we organize our ministries will determine our degree of success in these efforts (Page 11). Suicide is tragically a common symptom as well as complication of mental illness. It needs to be understood as such, with no judgement. Instead, many loved ones of decedents from suicide may live with shame or guilt. Therefore, we must respond with embrace, compassion, love and prayer. Our response as compassionate and prayerful companions can help to relieve this unnecessary pain and also make our parishes more welcoming and Spirit-filled communities (Page 11).
We have organized this to inform the implementation of Mental Health Ministry either at the diocesan or parish level. With that said, the methods outlined could also apply to the implementation of ministries in other Catholic settings such as schools, colleges and hospitals. Irrespective of setting we emphasize the importance of a common understanding, vocabulary and specific skills to engage individuals with mental health problems as critically important for an effective ministry. We refer to this as Mental Health Literacy and recommend anyone seeking to implement mental health ministries invest the time in completing a basic 8-hour course (i.e., Mental Health First Aid or equivalent) on this topic. We have also learned that the content and resources for ministry activities are an important part of implementing an active and effective ministry. How ministry teams evaluate the impact of their ministry is also discussed as an important ongoing aspect of ministry implementation (Page 11).
In order to build a successful Mental Health Ministry Team a grounded foundation in Mental Health Literacy is key. Mental Health Literacy is simply defined as a person’s knowledge and beliefs about mental illness. There are five main components of Mental Health Literacy:
One – recognizing disorders and signs of psychological distress,
Two – knowledge of risk factors, causes and interventions,
Three – awareness of mental health professional support available to the community,
Four – attitudes and beliefs that encourage help-seeking behaviors, and
Five – acknowledging when to obtain mental health information and guidance (Page 13).
Keep in mind a Mental Health Ministry Team is not a clinical team; however, a Mental Health Ministry Team’s ability to combine faith-based practice and the use of language, knowledge, and support consistent with Mental Health Literacy can directly influence the attitudes and perceptions surrounding mental health. Essentially, the goal of improving Mental Health Literacy is to promote the reduction of mental illness stigma, encourage conversations around mental illness, and create a safe environment for individuals to share and seek help surrounding their mental illness (Page 13).
It is important for the Mental Health Ministry Team to practice and increase the use of Mental Health Literacy as Clergy and Ministers are often the “first line of defense” or “first contact” for those suffering from mental illness, and this initial experience can shape an individual’s perception of seeking help within the Church and/or seeking help in the community (Page 13). Think of the Mental Health Ministry Team as “Gatekeepers” With research pointing to people of diverse backgrounds identifying help from Clergy or Church communities as more comfortable than seeking direct help from mental health professions, the Mental Health Ministry team has a responsibility to be familiar with a general understanding of common signs and symptoms of mental illness, be able to gather a sense of a presenting concern/issue and risk factors, and have knowledge of local services and community resources (Page 14).
The Mental Health Ministry Team needs to be able to provide spiritual support and recognize warning signs of mental illness that need to be treated professionally. Having a general idea of signs and symptoms as well as a basic understanding of what common disorders look like will help teams to know when to appropriately refer and/or encourage professional treatment. Research shows people most often seek Clergy assistance with the following concerns: depression, anxiety, substance use, (Page 16) bereavement and marital problems. Less sought out, yet equally important, concerns include psychotic disorders and suicide thoughts/attempts. From a faith-based or religious perspective, suicidality (i.e., an individual’s tendency to experience and/or express suicidal thoughts, gestures, or attempts) is perhaps one of the most daunting aspects of the expression of mental illness (Page 17). The topic cannot be avoided. We understand that death, in and of itself, is a difficult topic to discuss. When an individual takes their own life, the conditions of death and even the grief that follows, is complicated. Simply put, we hope you consider that suicidality and suicide risk are symptoms of various mental health disorders, most notably depression. If a person’s death were noted to be a result of ‘complications from cancer,’ we would feel tinges of sorrow and sympathy. If a person’s death is described as a result of ‘complications from depression,’ also known as suicide, we should feel the same and remain wary of any judgments or exclusions. After all, the individual who has taken their own life has most likely suffered enough judgment and exclusion in their life (Page 17).
Even among highly trained physicians (non-mental health professionals), recognizing the signs and symptoms of mental illnesses can be difficult. Primary care physicians identified psychiatric disorders in their patients with an average 41.5 percent accuracy. Physicians do not use structured assessments to determine psychiatric disorders, and neither will clergy or ministers. What is important is to recognize and support an individual with a presenting mental illness concern, and follow-through when referral to mental health professionals is necessary (Page 25). Saint Paul reminds us in his first letter to the Corinthians that through our baptism, we are “one body with many parts.” Each of us have unique backgrounds, talents, gifts, and knowledge to offer. By embracing diversity as a strength, there can be learning, growth, and authentic fellowship in any ministry program. The same acknowledgment of the multitude of mental health issues is necessary for us to thrive as one body of Christ. However, embracing mental health challenges can be difficult due to biases and beliefs that develop over time. Within the context of a faith-based congregation, some may have difficulty reconciling the omnipotent and healing power of God with the presence and course of disease, especially the often misunderstood and mysterious origins of mental health disorders. It is important, therefore, for Mental Health Ministry Teams to work to address the stigmas surrounding mental health and approach sensitive situations with careful consideration (Page 27).
As the Mental Health Ministry Team forms, each individual should take the time to identify personal beliefs, attitudes, and mindsets regarding mental health. Each person’s background and depth of exposure to a variety of mental health conditions will inform these personal beliefs. Those with lived contact and experience with psychological issues may come in with a perspective that is intimately informed in some areas of mental health, but not fully developed in other areas. As such, it is important for Mental Health Ministry Teams to communicate within the group – to share knowledge, admit concerns, challenge attitudes, and continually grow and develop without limit. The most productive Mental Health Ministry Teams will constantly find themselves doing internal check-ins as individuals and as a group (Page 27).
Making Mental Health Literacy a priority for all ministers and church staff, not just those working within the Mental Health Ministry Team, will ensure that any parishioner accessing church services will find a safe space, therefore potentially improving help-seeking behavior in those with mental health concerns. Providing education and distributing information to the whole congregation will also assist in creating an environment and community where mental health misperceptions are challenged. When the parish as one unified church is open to dialogue about mental health, the impact is far-reaching. Because mental health concerns can affect anyone, of any background or culture, having a church-wide and systemic approach to remaining informed about mental health will support Mental Health Ministry in countless ways (Page 28).
With all clergy, church staff, ministers, and volunteers maintaining basic Mental Health Literacy, and the Mental Health Ministry Team providing more in-depth knowledge and accompaniment, the mental health needs of the church can be addressed. While Mental Health Ministry calls us to welcome, embrace, and accompany parishioners of various backgrounds, the Mental Health Ministry Team has a responsibility to pay special attention to these populations for the purpose of anticipating mental health needs and potential referral. As a team preparing to serve the mental health needs of your church, it is important to remain sensitive and take basic considerations to approach mental health concerns respectfully (Page 28).
Church services are not tied to health insurance or health-services bureaucracy. Therefore, parishioners can find immediate assistance for their mental health concerns without the need for prior approval or referral, concern for payments and fees, or the presumed involvement of other agencies. Additionally, especially due to the vows maintained around the sacrament of Reconciliation, people assume that seeking help from clergy comes with a level of confidentiality and therefore proceed to seek help with a sense of security and comfort. Knowing this, Mental Health Ministry Teams should be prepared to respond to those at every stage of help-seeking behaviour: those with an immediate crisis and high need for assistance to those who have had or will have a long journey with a chronic or long-term mental health condition. Those seeking support in later stages of a psychiatric condition (i.e., they or a loved one has a recognized condition, has been diagnosed, and/or has entered treatment for a mental health issue) will be best served through the accompaniment of Mental Health Ministers (Page 29).
By providing a place for vulnerable conversations and informed and intentional responses, the Mental Health Ministry Team can help combat one of the most universal effects of dealing with mental health concerns – the sense of isolation. Those who need long-term support for mental health afflictions may seek spiritual companionship from Mental Health Ministers. It is understandably easy to question God’s presence and intention when facing mental health difficulties, yet whether it is through faith-based reflection and discussion, attending meetings or groups with those in need, or maintaining prayer intentions, Mental Health Ministry Teams can find many ways to accompany those with long-term mental health needs.If faced with immediate crisis situations, Mental Health Ministry Teams have much to consider. There may be times when church-goers, feeling most comfortable and confident in finding solace from a minister, come forward with a serious concern or crisis either they or a loved one are facing. A mental health crisis will require careful response depending on the situation (Page 30).
Mental Health Ministers should recognize when a parishioner displays or describes witnessing these signs of a mental health crisis. It is important for Mental Health Ministers to maintain consistent and intentional responses to these situations. Of equal importance is the ability for a Mental Health Minister to assist others in recognizing a mental health crisis and how to Respond (Page 31).
Any Mental Health Literacy training held for the Mental Health Ministry Team or other church staff, volunteers, or parishioners, should involve how to recognize mental health crisis situations and how to respond in the most safe and productive ways (Page 32). Mental Health Ministers are not obligated to provide treatment for these mental health concerns, but Ministers should work to be as informed and prepared for a multitude of situations they may encounter (Page 32).
Collaborating with mental health professionals will encourage help-seeking behavior and will ensure that those seeking help have quality care and treatment, along with the companionship and support of the Mental Health Ministry Team. Ministers and mental health professionals share values that make collaboration a no-brainer: both ministers and mental health professionals act from the desire to serve and help others, both recognize the dignity of the human person, and both value the need for people who are suffering to find personal connection to others. Mental Health Ministry Teams should recognize when and how to involve mental health professionals out of the best interest of those in need (Page 34).
As with any church program or ministry, acting from a place of humility is paramount. In the case of Mental Health Ministry, humility looks like reaching out for wisdom and help when needed, and referring to professional mental health treatment providers in a timely manner. Ultimately, acting with humility can be life-saving. At first, accompanying church community members with mental health concerns may be straightforward and easily done. These church-goers may present with what are called “subclinical” mental health concerns, meaning that their identified symptoms or challenges do not meet criteria necessary to be formally diagnosed and/or they may not be receiving any psychological aid or treatment. For these community members, simply having a conversation or prayer partner may be enough. It is important for Mental Health Ministry Teams to be mindful of complacency when working with these “easy” parishioners. At the same time, Mental Health Ministers should recognize that some people are hesitant to seek and accept professional help due to the stigma behind mental health. As Mental Health Ministers, there will be a fine balance between encouraging and advocating for someone to seek professional help and allowing people to take steps toward treatment when they are ready (Page 35).
Therefore continual dialogue with mental health professionals is necessary for consultation and connection of services. Should the “subclinical” concerns become more than temporary challenges, more severe or influence multiple areas of functioning, Mental Health Ministers should strongly encourage the involvement of professionals (Vermaas et al., 2017). Having pre-established relationships with local resources, support services, and mental health providers will make the referral process easier and streamlined (Page 35).
You might be pondering, “But how are relationships with support services and mental health professionals even established?” Maybe your parish has no known local resources at the start. Or, your Mental Health Ministry Team may have inherited a list of local mental health providers from your parish records that is dated two or three years, or even a decade old. Creating and maintaining a record of current, legitimate, open mental health resources is paramount. As you look to refer parishioners to professional support, make sure that the professional support maintains a current license in the least, and is willing to take on a new client who may want spirituality incorporated into their treatment (Page 35).
A common and consistent response from all members of the Mental Health Ministry Team, and perhaps extending to the ordained, other ministers, and church staff, will build a stronger program (Page 36). A shared response will ensure that Mental Health Ministry is providing legitimate support, so all members of the team should acknowledge and agree to refer parishioners to other resources and mental health professionals when presenting with severe mental health concerns or are in crisis. Whether it is through the development of formalized protocols or guidelines, holding regular meetings to communicate concerns and seek consultation, or setting aside time to find resources that will meet parishioners at their level of comfort, there can be a variety of ways to support church community members’ mental health needs (Page 36). Mental Health Ministers can invite parishioners to local mental health-related events, go to a resource centre or agency with a church-goer, or make calls and appointments with the person in need as direct service. In a more passive manner, resources and steps for help-seeking can be posted on the parish website to capture those who may not ready to engage with Ministers but are desiring more information. Ultimately, discussing as a Mental Health Ministry Team what you yourself would want if seeking help – an active companion on the journey, help with referral and seeking treatment, or more passive support – will inform how your Team can proceed to serve the mental health needs of your church (Page 36).
As much as the Ministry involves having background knowledge of mental health conditions, in the end, Mental Health Ministry is distinct from mental health treatment. The focus of Mental Health Ministry, as with any ministry, should be to journey with others as they experience God and all His works, and to encounter the Trinity in others. Pope Francis has spoken and written about our call as Catholics and Christians to encounter or meet others, especially those who are most in need, with grace through Christ.
There is a misperception that mental health problems should be treated in secrecy, subsequently increasing the sense of isolation and despair. Ministry has the power to pull people in. As Pope Francis puts it, we are called to go out into the “periphery” and encounter one another (Page 38).
Rarely does mental health treatment trek to these ends. Likewise, rarely does professional treatment ask the question, “Where is God present in this?” or “Where is God in the suffering?” there is no doubt that the distinction of ministry is that it exists as faith-based and God-centred without direct implementation of psychological interventions (Page 38).
Mental Health Ministry should be considered a part of the support system necessary for successful professional treatment. A person under the treatment of a mental health professional should be encouraged to find a renewed sense of meaning and purpose, feel grounded in faith or other spiritual practice, and increase social connection as needed – all of which can be found through an active and caring Mental Health Ministry program. Transformation and healing can be a spiritual and ministerial philosophy behind the program (Page 38).
However, to expect that treatment of mental health disorders happen only at a church level – again, treating mental health problems in secrecy – is not embracing of the community and the gifts and talents others may have at addressing mental health issues from an evidence-based approach. Again, we are reminded that we must encounter people as they are, at whatever stage of their mental health journey they may be (Page 39).
From a psychological perspective, a mental health diagnosis will manifest itself in a pervasive manner, affecting multiple areas of living (i.e., occupational, financial, interpersonal, spiritual, etc.). Given this, sound mental health treatment may involve a number of professionals and support collaborating together – a psychologist or therapist to guide the treatment, a psychiatrist or primary care physician to monitor medication management or any other medical concerns, family and caretakers to provide continual support in the home, and other social supports – such as Mental Health Ministry programs – to share in the everyday journey. Mental Health Ministers provide a spiritual and social support that mental health professionals cannot provide. Treatment can involve theoretical approaches that allow space for making meaning and finding purpose, but the ultimate goal is to address the symptoms and treat the disorder. Ministry, in contrast, has the distinct pleasure of incorporating the all-important existential questions to seek God’s will and presence during the hardship (Page 39).
Across both Mental Health Ministry and mental health treatment, communication and collaboration are necessary. Mental Health Ministry Teams and treatment providers need to come together to acknowledge that there are mental, emotional, physical, behavioural, and spiritual components to mental health. Finding balance and holistic wellness that addresses all of these areas will not be possible without both ministry and treatment co-existing. Treatment may have its limitations – existing in a system of managed care and insurance barriers, not having the freedom to intimately involve faith and religion – but there are methods behind the interventions. Similarly, Mental Health Ministry will have its limitations, but its maintenance as God-centred will undoubtedly contribute to healing and wellness (Page 39).
As with any ministry or church program, there are ethical considerations that each lay minister or volunteer will be expected to know and understand. A diocese should have “Standards of Conduct” or “Ethical Standards” that outline expectations for all clergy, pastoral counsellors, volunteers and lay ministers within that diocese. Additionally, diocese should have a clearly defined scope of duty for lay ministers and volunteers. It is important that anyone who comes forward with a desire to serve on a Mental Health Ministry Team consider a variety of legal and ethical issues that are not only guided by the principles of ministry or the diocese Ethical Standards, but by the sensitive nature of interacting with a person experiencing mental health afflictions (Page 41).
Those Mental Health Ministers who hold active professional licenses or credentials in the mental health field should consider the legal and ethical expectations set by their licensing agency. Although these ministers are volunteers and not formally working in their capacity as a mental health professional, there should be a personal understanding of any moral obligations (or state/licensing agency ethical and legal obligations) that may apply to a variety of situations. Indeed, it is our recommendation that health and mental health practitioners involved in Mental Health Ministry assume roles that support the ministry directly (i.e., organizing, leadership, facilitating large group presentations) but do not necessarily involve individual accompaniment for parishioners. This practice helps limit the potential for (Page 41) dual relationships and confusion of the nature of the lay ministerial relationship on the part of the parishioner.
Whether a mental health professional by trade or not, Mental Health Ministers should always maintain appropriate ministerial boundaries and adhere to the scope of duty defined by their diocese. The line between minister and mental health professional can seem convoluted (Page 42).
However, we must always keep the heart of ministry and the function or purpose of ministry in perspective. While engaging in a ministerial relationship with someone is a personal experience, because of the intimacy of knowing someone’s mental health challenges and suffering, it can easily become an enmeshed helping relationship that far exceeds what is appropriate for ministry. The Mental Health Ministry Team should set its own list of expected behaviour for its ministers when interacting with the congregation (Page 42).
While we have emphasized that Mental Health Ministers should be invested and knowledgeable companions that come alongside others in their journey, it is important to be explicit about when and where Mental Health Ministers can engage with the congregation. For instance, we have suggested that Mental Health Ministers offer to accompany parishioners to community-based support groups or other events that are relevant to mental health support. However, this is within the scope of encountering the congregation on their path to help-seeking. We are not suggesting that Mental Health Ministers extend themselves to all moments of mental health treatment developments. We certainly would not want Mental Health Ministers to feel the need to be “on call” or responsible for immediate communication and companionship (Page 42).
Mental Health Ministers will be in positions to serve, but service still has boundaries. As Saint Paul writes, “Indeed, I worked harder than any of them – though it was not I, but the grace of God that is with me” (1 Corinthians 15:10). That is, the boundaries for serving can be further clarified – it is not the Mental Health Minister at work and providing the grace in this ministry; it is ultimately the work of the Trinity and so the ministerial boundary is simple – do what is humanly reasonable, but allow space for the Trinity to do what it does best (Page 42).
A parish’s Mental Health Ministry program will need to be firm and clear on its purpose/mission, scope of work, intention, and boundaries or limitations (Page 43). Mental Health Ministry is not mental health treatment; this cannot be emphasized enough. While that limitation is clear, in practice, setting boundaries can be far more challenging. In the end, all ministers should be able to manage their emotional reactions and boundaries with any parishioner with whom they may potentially work (Page 43).
It is important to acknowledge how difficult help-seeking for mental health concerns can be for people in general, but especially for those whose culture may stigmatize mental health and its treatment. Gender and LGBT-related concerns can also impact how parishioners respond to Mental Health Ministry. Definitions of masculinity and gender roles have long been inspected and debated throughout many religions and cultures. There are certainly many within the LGBT community who have their own personal experiences of shame, guilt, and trauma when chastised by members of the church or even members of their own family who have remained staunch in religiosity without any acknowledgment of the compassionate love of Christ we are all called to give. There is a space within Mental Health Ministry for those who have questions, who seek understanding, and are defining their identity or discovering the identity of others and are hoping for the identity of Christian to remain constant (Page 44).
Mental Health Ministry can demand for many “considerations” to be made – ethical, legal, multicultural, and more. Because it will take great effort to maintain all these considerations, Mental Health Ministry Teams have an obligation for consultation with mental health professionals, collaboration with others in Mental Health Ministry, and continued education out of respect for the dignity of those we serve. Through humble admission that Mental Health Ministers do not need to know everything about the world of mental health, we can offer a safe space to learn and grow and experience together (Page 44).
The most responsible caretaking involves responsible accompaniment (Page 45) and boundaries will ensure that proper ministerial relationships exist. However, boundaries are equally important for the balance they can bring Mental Health Ministers on a personal level. Remaining mindful of our own personal well-being as we serve and accompany those that suffer from terrible and sometimes traumatic circumstances and conditions, will keep us from experiencing our own forms of helplessness, depression, and burnout. It is easy to become entwined in the lives – the ups and downs of treatment, recovery and relapse, progress and backslides – of those suffering from mental health challenges. We may think that answering a call to serve as Mental Health Ministers means sacrificing our own selves so that others can begin to find the light, comfort, and companionship they seek. For many, serving as a Mental Health Minister will be a volunteer position – on top of the demands of our occupation, family-life, and other relationships and responsibilities. Entering into a ministerial relationship can become yet another caretaking role for those already providing so much support to others. Be mindful of this before becoming involved in the Mental Health Ministry program and focus on balance, self-care, and setting boundaries to serve others responsibly (Page 45).
Research indicates that people seek support from clergy due to the premise of confidentiality. While this research reviewed those in a formal position at the church (“clergy”), it can follow that those who access the Mental Health Ministry program will presume a level of safety and desire for confidentiality. To clarify, there is a distinction between confidential communication and private communication. Private communication refers to information that is not typically shared in public, but is more for the individual or for those closest to the individual to know or witness. Confidential communication usually means that information is personal and permission must be given for that information to be shared. Confidential communication is usually protected by law; private communication may not be clearly protected. In nearly all situations of Mental Health Ministry, communication between parishioners and ministers will be considered private, not confidential (Page 45).
It should be clarified from the beginning of the ministerial relationship which communication may be considered confidential and which disclosures will remain private , with both confidentiality and privacy clearly defined. Additionally, Mental Health Ministers should explain their scope – their knowledge and abilities/services (i.e., listening, prayer, accompaniment) that they can provide. We are being mindful of these steps to emphasize the responsible services Mental Health Ministers give. As we have covered, people who access Mental Health Ministry may assume that they can receive treatment from the church programs or may disclose intimate details of their mental health challenges believing these will be held in confidence. Mental Health Ministry is not treatment. However, to provide a safe space where all are welcome and able to find connection, Mental Health Ministers can assure the congregation that they will be cared for. While clergy (i.e. priests, deacons) may be able to give more clarity around private vs. confidential communications, in the end, please remember that Mental Health Ministers should never mislead (Page 46).
It is necessary that Mental Health Ministers know the expectations of their diocese when it comes to working with those who disclose being survivors of or having knowledge of acts of sexual misconduct by clergy. Here we will refer to sexual misconduct as terminology to encompass sexual harassment, sexual exploitation, and sexual abuse. Your diocese may clearly define terminology (i.e., sexual misconduct) for you to consider and use when working with others in your capacity as a Mental Health Minister (Page 47).
Respect for the individual and loved ones should also remain a priority. The survivor and their loved ones may have lived years after the incident before allowing others close enough to know their experience. Many who have experienced such a violation have questions, insecurity, and damaging perspectives of religiosity and faith. These boundaries and wounds must be respected as unique to each survivor and/or loved one (Page 48).
The process of recovering and dwelling as a survivor may be tough to understand but will most desperately require sensitive accompaniment. Mental Health Ministers ought to continue with compassion and a constant sense of welcome, ensuring that the parish is a space where healing and reconciliation can take place (Page 49).
Reference: Wendell J. Callahan, PhD., Liberty Hebron, MA, LPCC, Alissa Willmerdinger, MA, LPCA. 2019. Catholic Mental Health Ministry: Guidelines for Implementation. The Catholic Institute for Mental Health Ministry Department of Counseling and Marital & Family Therapy University of San Diego.