Mental health provision in the UK - a system in crisis? 5 Things the church can do.
It’s pretty impossible not to have picked up on recent worries over the state of services available in the UK for mental health. Newspaper reports have been full of accounts of the ‘Uk’s mental health crisis’ (for example with accounts of what it is like to work in a swamped in-patient unit, concerns that budget cuts mean people struggling with mental health will not be able to get the treatment they need, or calls from patient charities highlighting the need for change). Radio 4 program 'All in the mind' featured concerns about the state of mental health services along with an interview with Sue Bailey, president of the Royel College of Psychiatrists last week, and you only need to talk to someone who has suffered with mental health problems, or supported a sufferer, to hear stories of frustrations and inadequacies within the NHS system.
The particular tragedy of these stories is that the challenges to our mental health system come at a time when mental illness in general and emotional health problems in particular are exploding in frequency. Most if not all of us will know someone who has struggled - really struggled - with their emotional health in recent years. Issues such as depression, self harm and eating disorders now affect alarmingly high numbers of teenagers and young people. And the age that problems begin to develop seems to drop every year. Studies report that 1 in 10 children have a clinical mental health problem. 80 000 in this country are struggling with severe depression. 8 000 of those are under 10.
The stats are even more concerning if you think about what you might call ‘low level’ emotional ill health - things that are not severe enough to meet the criteria for diagnosis and treatment, and yet have a massive influence on people’s lives. Problems like anxiety, anger issues, depression, stress and insomnia are incredibly common in adults - and have been strongly linked to serious physical illnesses like high blood pressure, cardiac problems and the risk of stroke. Mental and emotional ill health currently has a huge impact on our nation.
The church’s response
What then, should be the churches response to this situation? Historically religious institutions like the church have always been intricately involved in the day to day community support of those dealing with mental illness. Although the advent of the NHS and improving treatment for mental illness at the end of the 20th century reduced the need for this, our current crisis situation means that the need for the church to intervene is stronger than ever. Jesus came so that we might have ‘life to the full’ - translated in the message as ‘more and better life than you ever dreamed of’ (John 10:10). How then can doing something about this incredible tsunami of emotional ill health not be part of our calling?
There is a cry from the heart stirring in the church - and not just in this country. Many families, themselves affected by emotional ill health, by tragedies and lost lives that could have been prevented are in the midst of what I believe is a God and holy spirit generated call for change (check out this interview with Rick and Kay Warren, from the recent HTB leadership conference). It is not enough to be concerned about issues like food and housing and education - though those are important we cannot underlie the emotional issues that often them. And we mustn’t forget those who do have enough to eat, somewhere to live and apparent success - but who have failed to achieve that sometimes too elusive thing in life - happiness.
As the church, a people working for God, we must aim to enable people to live lives that are happy and fulfilled - lives where they reach their full potential - true life to the full.
A need for re-education
In spite of the growing desire to see the church do more with issues of emotional and mental health, there remain some worrying perspectives within the church. Research in America demonstrates that sometimes the church can persist with misunderstandings about mental health that are much rarer in people without a church background. For example, in one telephone study although over 60% of Christians agreed that the church should do more to prevent suicide, around half (these are people who describe themselves as born again or evangelical Christians) felt that with bible study and prayer alone people could recover from serious mental illness - which of course just isn’t true. I don’t have figures for the Uk, but we do have a lot of testimony and personal experiences from people who have found that, though often well meaning, many churches can offer some pretty bad advice to those struggling with mental and emotional ill health.
Put down the ‘happy’ mask
The church can be one of the hardest places to admit you are struggling with your mental health. Back to that research from the US for a moment - just over half of people they interviewed who did not have a church background felt that they would be welcome in church if they had a mental health issue. Sadly this fell to under a quarter when the people questioned were church-goers. Many people who are part of loving, caring and enthusiastic churches feel this mysterious pressure to always appear happy. ‘Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have.’ says 1 Peter 3:15 - a book written for early Christians in very tough times when they had scattered and fled due to persecution. This was not a verse written for people who were feeling happy, but a verse written for people who might need to explain why they hadn’t just given up completely! But many Christians today feel under pressure to explain a constant joy they feel they are supposed to have rather than this always reliable rock like hope that we can be grounded to even in the worst stormy times.
The Bible is full of examples of people who hit rock bottom, and what happens when they do. As Christians we need to be able to put down the happy mask, be real with each other and follow the example of people who wrote the books in the Bible and were all too prepared to tell it how it was.
We do have limits
Sometimes when you hear sad stories where the church has added to people’s burdens rather than helping carry them, its easy to feel like the people behind the story were heartless or uncaring. However the truth is that a lot of unhelpful or even damaging experiences with the church have their roots in people who actually want to give too much. We are human beings, not able to love without limits. We cannot change everything about people’s circumstances, and much as we know prayer and God can heal them we need to accept that that kind of instant healing rarely occurs in mental and emotional health. This is for good reason - people who have experienced recovery generally talk of how much they learned through the experience of gradually getting better - but as much as we rejoice in the recovery some people experience, sometimes we face situations where even with good treatment, great support and loads of prayer, some people just don’t seem to get better.
We have so many limits - our time, our energy, our theology, our faith and our understanding. When we don’t admit these limits our frustration tends to boil over and very often rebounds on the person we try to support. Why didn’t they get healed? Perhaps they didn’t pray hard enough. Why don’t they feel better? Perhaps they didn’t turn things over to God totally. We mustn’t fall into these spiritual short cuts which can be so damaging. We must admit that sometimes everyone can do everything they are supposed to do and we still don’t see the kind of breakthrough we pray for. We must find appropriate ways to deal with the all too real frustration and anguish when that happens.
You see, most of all the church has this amazing calling, to be the body of Christ (1 Cor 12:27) the hands of God here on earth. We should be here throughout people’s lives, steady and reliable, helping and enabling them to understand God, get to know God and connect with God. But our mission, like Jesus’ is to enable them to have life to the full. We know that John 8:32 declares that knowing the truth will; set people free - but I prefer the message translation which talks of people experiencing for themselves the truth - and how that will free them. What a great way to describe what is involved in recovery from mental and emotional health problems - that someone can have an experience of truth which sets their mind straight and enables them to find real peace. This experience can take a lifetime of learning, experiencing and perhaps relearning things about ourselves.
As those who care we must never forget to care for ourselves. Even Jesus - God in a human body - at times walked away from need in order to rest and pray. We must recognise our limits and work within them rather than trying to become superhuman and inevitably failing.
Not by our strength …
Perhaps the most important thing we need to remember working in this field is that it is not actually by our own efforts that people will come through the difficulties they are currently facing. When we are faced with what can feel like overwhelming and insurmountable problems, we have a power behind us which is many times greater than any of those things.
It’s easy to feel powerless, ineffective or impotent when faced with the great need and the often difficult circumstances people experience alongside mental health problems. I often remind myself that all I can do is what I am called to do. If I try to do more, I start to try to do God’s job - which I am vastly under qualified for! When I work best it is not under my own strength, but when I recognise and am sensitive to God working through me. Or, to put it better, “What I’m getting at, friends, is that you should simply keep on doing what you’ve done from the beginning… Be energetic in your life of salvation, reverent and sensitive before God. That energy is God’s energy, an energy deep within you, God himself willing and working at what will give him the most pleasure.” (Philipians 2:12-13, from the message).
Faced with immense need, we can be thankful that “we have this hope as an anchor for the soul, firm and secure.” (Hebrews 6:19, NIV) Rooted in God, firm and secure, we can carry that hope to the people we support. And with God’s anointing, that may just carry them through the darkest times they face.
What can the church do?
So, with this background of struggling, underfunded and overwhelmed NHS services, what can and should the church be doing to support those who are struggling with mental and emotional health problems?
5 things that the church can do:
(1) Support those who are struggling to engage with local services
Probably one of the most daunting things someone who is in the midst of emotional ill health has to face is an appointment with a health professional. I know, it shouldn’t be the case, and some people have amazing GPs, psychologists, therapists etc. But very often that isn’t the case, and almost always the first steps towards getting help are incredibly difficult.
Our role as churches is not to replace treatment services, or to have a go at them for the things they are not able to do. It should be about working in partnership with them, enabling them and supporting them so that they are able to do what they long to do in the best possible way. The first step in that is very likely to be supporting people as they start their journey getting in touch with them. Simple practical steps - helping people phone for an appointment, planning what they will say when they get there, perhaps attending with them (if they wish), helping them with paperwork, letters and phone calls where we can - these things can be invaluable.
Then when someone does start a treatment or therapy, we can again support this - encourage them in the difficult first few meetings (it takes time to get used to a new therapist or approach), help them ponder things discussed in sessions, perhaps clarify or provide background information if things come up that they don’t understand.
As therapy or treatment progresses there are other things we may be able to help with - encouraging or enabling them to do ‘homework’ assignments, dealing with practical issues like how to keep track of and remember to take medication, helping people get out of the house and get out of isolation.
Most of the steps involved in this kind of support require no special skill or training above a good understanding of people and what it is to struggle with your emotions. On the whole these are practical tasks - coming alongside someone who might be struggling and offering them simple support. These are the kinds of things churches can do incredibly well, and they don’t require a mountain of degrees, just willingness, time and perhaps a bit of background reading or training.
(2) Work on motivation.
As someone supporting people in pastoral care scenarios there is one thing I have seen time and time again that has impacted the effectiveness of various treatments and therapeutic approaches - and that is motivation. The simple but powerful consideration of why people want to be well can never be underestimated. It may seem obvious to those on the ‘caring’ side of the net, but actually from within many mental health conditions ‘recovery’ can be a daunting and scary prospect which is often neglected. Issues like what recovery actually is (it isn’t just having to pretend you feel fine and somehow through great act of will maintain this pretence through the rest of your life), what it might involve (particularly in conditions like eating disorders), how to deal with relapse (which is a normal part of recovery - it is never a straightforward process) and finding things to focus on, dreams and hopes for the future - these things are incredibly hard when in the midst of a very dark and bleak place.
I already quoted the 1 Peter verse ‘‘Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have.’ (1 Peter 3:15 NIV) - and HOPE is the most important thing we can bring to those struggling, particularly with long term mental and emotional ill health. We must be prepared to be carriers and purveyors of hope for the people we support, believing in it even when they feel they can not. Hope allows people to dream of a better time, good things in their future. It drives out despair, like allowing the daylight into a dark room. We must enable people to find hope, and where we can’t, their knowing that we believe it exists may be enough to carry them through the darkest times.
(3) Provide prayer and spiritual support alongside secular services.
There is a troubled history in debate about treatment of mental health problems amongst Christian circles. Some people still believe that Christians should not seek support from therapists or psychologists, but instead turn to God in prayer. This is wrong. Mental illness is just that - illness, and it is right and good to seek treatment for it. As Christians we may seek to turn our minds over to God, but when yours is in turmoil, it can require the help of someone with expertise and experience to help sort it out and put you back in control.
Many Christians worry about what I often hear described as ‘the spiritual side’ of their treatment. They sometimes wonder if they should seek treatment from a Christian therapist, or whether it is ok to work with someone who does not share their faith. My response is always the same. In therapy of any kind it is important to find someone you can work well with - someone you can understand, who you feel you can talk to (although this takes time even with a great therapist) and someone who takes the time to understand you. Your faith is a huge part of who you are, and directs a lot of who and what you want to be. If your therapist cannot take that on board you may hit problems. However, most therapists are very used to taking into account the faith and/or values that people they work with bring with them. Many secular therapists do a fantastic job of working with people of all kinds of faith background, and do that very successfully. In the (luckily rare) event of your therapist being directly opposed to considering your faith in the work they do with you, this is certainly more of a problem. However, they don’t have to personally share your faith in order to incorporate it in their understanding of who you are. Some of the best insights I have heard into the faith of people I have worked with have come from non-Christian therapists!
Having said that, for anyone seeking help for their emotional health, there are some times when having someone with a greater expertise and understanding of their faith might be important. Particular issues may come up - what if they are struggling with an issue of faith or a particular Bible verse? What if a certain sermon or talk didn’t make sense to them, or they misunderstood something someone in their home group said? Most of all when your hope for healing and recovery rests in God as much as it does in therapy, it is important to make time for the spiritual side of your journey, and to include God in all of the work and exploration and thinking you are going to be doing. This is where regular meetings with someone from church can be really helpful.
So what form does that support take? It certainly isn’t about providing a second, this time Christian, therapist. In fact I’d strongly advise against doing this when also working with someone else. Therapeutic treatment is hard work and it needs you to be totally engaged with it - its very hard to follow two different approaches at once. Instead support from the church is about listening, clarifying, advising and offering space to pray and listen to God. This support could from a minister, a member of the leadership team, a pastoral team member, or even a friend from home group - whatever works within the framework of the church. What is important is that it is someone who is wise enough to know when to speak and when to stay quiet, mature enough to be able to keep healthy boundaries (avoiding issues like dependence, and knowing how to deal with any tricky situations that may come up) and aware enough to know where their expertise begins and ends.
NB - In any meetings to support someone, be aware of general good practice for working with people who are likely to be vulnerable. Your church should have a vulnerable adult policy - be aware of it. Make sure other people (esp the church leadership) are aware of what you are doing. And most of all, be prepared to be in it for the long haul. Very few people are ‘cured’ after a short course of any form of treatment. Therapy and support can take months or even years. So be wise and do not offer more than you can sustain over a longer period of time.
(4) Stand in the gaps
The reality is that in the current circumstances, there are gaps in the services offered by mental health providers. Ezekiel 22:30 strikingly says ‘I looked for someone among them who would build up the wall and stand before me in the gap on behalf of the land … but I found no one.’ One of our most essential roles as churches is to ensure that people do not fall through gaps - that we are there looking out for them. Again this doesn’t mean we have to become the professionals. It is about watching out for people, speaking for them when they may be unable to do so, and doing what we can to help keep them safe.
In practical terms what this means is keeping in touch with people, reaching out when they may be unable to come to us. Do you know someone who has just been released from in-patient care? Catch up with them and make sure that they have been able to make contact with whoever is providing ongoing support. Has someone from your community going through a difficult time emotionally? Meet with them and find out if they have been able to talk to their GP. Know a family where a teenager is going through some tough stuff? Find out if the parents need some support and space to deal with their own emotions. During difficult times many people find themselves unable to come to church, so building relationships is essential. We need to tread carefully the path between allowing people to have their privacy, and making sure they are still ok.
NB - If you are providing regular pastoral support for someone who is struggling emotionally, its always worth asking them if you can have details of their GP, and if they would be happy to give permission for you to talk to them should you feel the need. This isn’t about going behind someone’s back - you can explain that you will always let them know what you are going to do and say before talking to the GP. But it is vital that you have somewhere to go if you do become concerned, and if for whatever reason they are not willing or able to make that step themselves.
(5) Care for the carers
If you have a heart for those struggling with mental health problems, I imagine you long to see them get well and recover from their problems. You probably become frustrated when services seem to fail and they cannot get the treatment they really need. You most likely feel that waiting lists and inadequate buildings, and underpaid staff and so many other things affecting the mental health system are really unacceptable. You know what? So do most of the people working for it!
In your work caring for those in need don’t forget the professionals - people with a heart and passion for those in need that took them into training for jobs that are often incredibly hard work, long hours on not a lot of pay. Do you know the people in your local mental health team? How could you get to know them better? Is there a way you could serve them? Is there anything practical you could do, for example, to improve the appearance of where they work, or to make their job any easier? In your work building relationships, do not forget the other people trying to help. You are on the same team! It is so easy to end up in a ‘them vs us’ mentality and it just needn’t be the case. Do what you can to build relationships and work together. Perhaps make a first step, run a lunch for your local team, arrange some free training or find someone you can talk to about practical needs they or their service have that you might be able to help with.
Its easy to forget in caring for those with emotional health problems that there are others who could benefit from our support too. Don’t neglect the other carers. The team around someone in need could include parents, friends, children (don’t forget them - many children act as carers to parents in need) as well as professionals. All often benefit from extra practical support. Remember that your role may not be to provide additional therapy, but to better enable the people already working with someone. The better you work together as a team the better the impact for the people you all want to help.
Kate Middleton, 16/05/2014