Fear, isolation, anxiety, despair, distress—words used in medical and spiritual settings alike. While psychiatry is (and must be) based on the most rigorous science, we often encounter patients at the bedside, in our consulting offices, and in the emergency room who are isolated and bereft of hope. We also know that many people may turn first to their clergy or faith communities in times of emotional or mental distress. According to some, upwards of 30 percent of individuals with mental disorders reported using prayer, spiritual healing, or other spiritual practices to help address their mental health problems.
Given the importance of communities of faith in the United States and the shared language, the idea of APA partnering with a widely inclusive group of interested clergy to improve the understanding of mental illness and to reduce stigma in communities of faith is a logical step to help increase access to mental health care.
That was the premise behind a gathering in July of 40 psychiatric leaders and clergy who met at APA headquarters as part of the Mental Health and Faith Community Partnership. In addition to APA, the convening organizations were the American Psychiatric Foundation (APF) and the Interfaith Disability Advocacy Coalition, a program of the American Association of People With Disabilities. Senior psychiatric leaders, including former APA President Richard Harding, M.D., and academic leaders such as Grayson Norquist, M.D., James Griffith, M.D., and Robert Cloninger, M.D., were in attendance. Former Congressman Patrick Kennedy brought energy and unique insights about the important role that spirituality has played in his own recovery and his views on the intersection between faith and mental health. Charles Nemeroff, M.D., Ph.D., provided grounding in the neurobiology of serious mental illness and the impact of early-life trauma. And Sister Nancy Kehoe, R.S.C.J., Ph.D., a clinical psychologist, contributed insights based on her own research and long history of teaching.
We know many people may turn to supportive communities in difficult times, including faith-based institutions and the resources they provide. However, for many individuals and their clergy, it may not always be clear when medical intervention is warranted. When is despair an existential or developmental crisis, and when is it a symptom of a depressive episode? Clergy may not be equipped to respond to people with more serious mental health issues, and in some traditions, seeking psychiatric care is seen as a “failure of faith.” Or as one participant put it, “mental illness is the ‘no casserole’ disorder in many congregations.” He was referring to the fact that when an individual is suffering from an illness like cancer, fellow congregants often provide meals or other help. That may not happen in the case of mental illness.
In evaluating our patients as whole human beings, psychiatrists need to understand the totality of a patient’s symptoms, medical condition, and life history—including how to take a spiritual history. I remember well the teaching of my chief of psychiatry at Massachusetts General Hospital, Ned Cassem, M.D., the most medically oriented of consultation psychiatrists, on how to take a spiritual history and consider the state of an individual’s relationship with his or her own spiritual life and faith traditions. It also didn’t hurt that Dr. Cassem was also Father Cassem, S.J., and that he wore both identities so seamlessly that it was impossible to tell where one started and the other ended.
Reaching people most in need of our services means meeting people where they are. From a public-health perspective, clergy can be gateways to mental health care. This means there’s a window for informed faith community leaders to emphasize the importance of psychiatric care, helping members of their congregation obtain evidence-based treatment when needed.
One of the most compelling aspects of our discussion was the shared view that stigma of mental illness is a social-justice issue and a moral issue. Congressman Kennedy reminded us that the civil rights movement had strong roots in black churches. He urged “a lunch counter” moment as an inflection point in our battle against stigma and discrimination.
While this partnership is new, it builds on work APA began a number of years ago. Each year, APA honors an outstanding contributor in psychiatry and religion with the Oskar Pfister Award, a collaboration with the Association of Professional Chaplains. In 1997, APA developed a manual for clergy, the “Mental Illnesses Awareness Guide for Clergy and Other Spiritual Leaders.” APA’s resource document “Religious/Spiritual Commitment and Psychiatric Practice” reflects our interest in informing members about religious and spiritual issues. And APA’s OMNA on Tour series, under the leadership of APA Deputy Medical Director Annelle Primm, M.D., M.P.H., reaches out to underserved communities to address mental health disparities. (OMNA stands for the Office of Minority and National Affairs, now called the Division of Diversity and Health Equity.)
The Mental Health and Faith Community Partnership also follows the APF’s many bridge-building efforts to other communities and professions where mental health is a central issue. APF has partnerships in the judicial world, through the Judges Leadership Initiative and the Psychiatric Leadership Group for Criminal Justice, which help judges identify mentally ill defendants, and in the educational realm, with “Typical or Troubled?,” which trains teachers and other school personnel to assess the complex boundaries between normal development and more serious psychiatric illness.
The agenda we set for the partnership’s July meeting was ambitious, because it reflected the work that needs to be done to reach those who are suffering where they live and present. We are expanding this discussion and look forward to your thoughts and guidance regarding ways we can proceed that incorporate our grounding in science and medical training, can be nondenominational and inclusive of all faith communities, and can reach individuals during formative moments in the training of faith community leaders and psychiatrists.
Psychiatry and spirituality not only share the language of distress and despair, they also share the language of hope and health. With our partners in this initiative, we can open an often overlooked door to mental health care and hopefully engage new resources for our patients and families. And more casseroles too. ■