Philhaven Behavioral Healthcare Services nestles between a wooded ridge and rolling farmland near Mt. Gretna, Pa. Philhaven's 24 psychiatrists and 800-plus other professionals each year care for 18,000 patients with a full spectrum of diagnoses at 20 locations, using the same treatment approaches as psychiatrists elsewhere. Yet Philhaven and its five sister institutions in the Mennonite mental health system approach psychiatry with their own history and philosophy.

The system grew out of one of the most significant moments in the history of American psychiatry and today expresses a day-to-day care contemporary psychiatric practice built on a religious foundation.

Care for people with mental illness has long been associated with religious bodies. Some Catholic monasteries in medieval Europe offered refuge and care for those with mental illness. Residents of Gheel, Belgium, have taken mentally ill pilgrims to the shrine of St. Dymphna into their homes for observation and care since the 13th century. Quakers helped establish the York Retreat in England and the Friends Hospital in Philadelphia, two pioneering 19th-century institutions in psychiatric treatment.

For the last six decades, the Mennonites have practiced what they have preached about mental illness. The Mennonite mental health system arose both from the denomination's beliefs and from its members' response to the conditions of American psychiatric care in the 1940s.

The system's deepest roots go back nearly 500 years, however. The Mennonites are one of four main branches of the Anabaptist movement—along with the Hutterites, Amish, and Church of the Brethren, according to Donald Kraybill, Ph.D., a sociologist and senior fellow at the Young Center for Anabaptist and Pietist Studies at Elizabethtown College in Elizabethtown, Pa. There are about 860,000 Anabaptists in the United States today, including about 360,000 Mennonites. Anabaptists separated from the mainstream Protestant Reformation in 1525, mainly because they rejected infant baptism. They emphasized the authority of the New Testament and, among other tenets, refused to swear oaths, rejected violence, and demanded the separation of church and state. Such views led many Anabaptists to reject military service and embrace Christian pacifism.

In World War I, conscientious objection, even on religious grounds, often meant imprisonment. However, by World War II, U.S. law made allowance for religious objection to military service but required civilian public service instead.

Over 1,000 Mennonites performed their civilian public service (CPS) work in mental hospitals. For many, often from farms or small towns—with only high school educations—the sights, sounds, and smells of the large public psychiatric hospitals that predominated in 1940s America were a sobering revelation (see facing page.

"No other church group ever had such a concentrated experience with mental illness as the American Mennonites during World War II," recalls If We Can Love, a history of the system. The Mennonites in civilian public service "developed a vision of what might be done with rightly motivated psychiatric aides and mental health professionals."

By the end of the war, the Mennonites working in mental hospitals began discussing what they had observed. They published a magazine to educate fellow psychiatric aides about their field and returned to their home congregations after the war to recount their hospital experiences. The Anabaptist tradition already included an ethos of service to people suffering from poverty, conflict, oppression, and disaster. The Mennonite Central Committee, supported by the Mennonites and Brethren in Christ, today has an annual budget of $60 million and deploys about 1,300 volunteers in 57 countries.

The Mennonite CPS men followed talk about changing psychiatric care with action. They provided much of the information for the exposés of public psychiatric hospitals that led to changes in that system following World War II. They didn't stop there, however. The first Mennonite center, Brook Lane, arose on a farm outside Hagerstown, in western Maryland, a site that had housed a CPS soil conservation camp. Planning for Brook Lane began in 1946, and the first patients were admitted three years later. Today, there are five Mennonite mental health centers in addition to Brook Lane: Philhaven and Penn Foundation (both in Pennsylvania), King's View (California), Prairie View (Kansas), and Oaklawn (Indiana).

"The Mennonite mental health movement sought to create alternatives to the prevailing custodial model," said Kraybill.

How does the Mennonite religious world view connect with current psychiatric practice?

Not by injecting religion into therapy, said Mim Shirk, vice president of the MHS Alliance, the coordinating body of the system.

"We don't promote a religious point of view," she said." This is not an evangelistic endeavor, but we are motivated by a spirit of Christian concern for patients. The difference is primarily infused in the culture of the organization.

"Organizationally, we are fundamentally committed to the people who need these services. We are there to figure out how to make things work, even when things get difficult. You can't shut down when a program starts to lose money. Walking away is not an option."

Each hospital's board members are usually nominated by local church conferences and formally appointed by the MHS Alliance. The Alliance provides no financial support but shares information and offers strategic planning and consulting services, said Shirk.

Brook Lane and the other centers began with much volunteer enthusiasm generated by the returning CPS men, but they soon realized that professional medical direction was essential for carrying out the mission they had set for themselves.

"If the Mennonites were going to do it right, they needed the best professional people, but those people needed to carry the same values, too," said Shirk.

"The religious orientation is expressed in compassion, empathy, and collaboration with the community," said Francis Sparrow, M.D., a child psychiatrist and medical director of Philhaven, in an interview. Most of the patients and staff are not Mennonites, he said. Philhaven offers inpatient services; it also has satellite facilities in Lancaster, Harrisburg, and York and provides services in schools and patients' homes.

There's also a willingness to try new things and integrate them with accepted therapies, he said. For instance, Philhaven adopted a recovery model before many other institutions had and moved to biological treatments early enough to earn, for a while, the nickname "Pillhaven."

"It's a very flexible organization," said Sparrow. "We try to find new ways to do things better."

Brook Lane now focuses more on behavioral and educational interventions than on psychiatric services and includes school programs on and off its rural Maryland campus. Its 44 inpatient beds and outpatient services offer the only comprehensive child and adolescent programs in the state west of Baltimore.

Brook Lane's size may be an advantage, said Medical Director David Gonzales, M.D. "Being smaller allows us to be more responsive and use therapeutic approaches others have given up."

The Mennonite service ethos comes into play when evaluating possible programs, said Brook Lane CEO Lynn Rushing. "We've sometimes approved a financially borderline program that fills a need." He cites Brook Lane's provision of counseling services in the schools of nearby Frederick County. The program has never turned a profit in its eight years of existence, and Brook Lane has covered the difference out of general operating revenues. But as margins on inpatient services have tightened and a local shortage of social workers has driven up staff costs, filling that gap has become harder.

"Staffing is something you constantly struggle with," said Rushing. "It's hard to offer salaries to compete with general acute hospitals, so you have to look for staff whose heart is into treating mentally ill patients. We're serving others in need, but we're also serving the needs of employees to have a livable wage. It's a tough balance."

Of course, as at other medical institutions, pastoral services are available for patients who want them, said Philhaven CEO LaVern Yutzy, who has worked at the facility for almost three decades. "For some patients, faith is an important part of the healing process, so we build on that."

Some patients still may view mental illness as a form of moral weakness or abandonment by God. "Many patients who come from a religious background may think that God is punishing them," said Kraybill. However, this attitude may not represent stigmatization but rather a use of familiar religious symbolism and language to represent their condition. At Philhaven, the staff works with patients to explain the origins of psychiatric disorders and tries to persuade them not to blame themselves (or God) for their conditions.

Spiritual issues are raised in only three of the 150 questions asked on the intake questionnaire, said Cornell Rempel, M.Div., associate director of clinical pastoral education at Philhaven: "How important is faith to you? Is there a spiritual issue troubling you at this time? Will you let us tell your clergyperson that you are here?" The last question has additional value for the future continuity of care and for ascertaining the patient's social contacts in the community, he said.

Whatever a patient's personal religious viewpoint (if any), the system continues seeking to integrate a long-standing tradition with contemporary medical practice.

"The role of religion is more philosophical than therapeutic," said Philhaven's Yutzy. "Good medical treatment meshes with the Mennonite view of the world, so this is a way to live out one's faith rather than just talk about it."

Further information about the MHS Alliance, Brook Lane, and Philhaven is posted, respectively, at<www.mhsonline.org/>,<www.brooklane.org/>, and<www.philhaven.org>.▪