The Stigma of Mental Illness in the Church - An Excerpt from Mental Health and the Church

The church across North America does a weak job of welcoming and including families of children, teens, and adults with common mental health conditions or trauma. One obstacle is the absence of a widely accepted model for mental health inclusion ministries for kids, teens, adults, and their families.

In Mental Health and the Church, Dr. Stephen Grcevich seeks to put forth a model for a mental health/trauma inclusion ministry of sufficient flexibility to be implemented by churches of all sizes, denominations, and organizational styles. In today's excerpt, he reveals how the stigma of mental illness impacts families relationship to the church.

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I believe most pastors and church leaders are unaware of the extent to which the experience of a mental health disorder—“serious” mental health conditions such as depression, bipolar disorder, or schizophrenia and more common conditions, including anxiety disorders, ADHD, and PTSD—impacts attendance and engagement in worship services and church programming. Most have likely given little thought to how someone with social skill deficits can fit into a church where small group participation is expected, how a first-time visitor with social anxiety might experience a worship service in which newcomers are singled out for special recognition, or how the bustle and chaos of the children’s ministry check-in process might affect the family of a child who has sensory processing differences.

Churches represent subcultures with norms and expectations—often unwritten—for appropriate conduct and social interaction. Let’s consider the behavioral expectations for kids attending children’s ministry programming. We expect school-age children to listen quietly when adults are talking, to follow directions the first time, to raise their hand and ask permission before speaking, to take turns speaking (and allow others to speak without interruption), to keep their hands and feet to themselves, to demonstrate respect to teachers and one another, to maintain high levels of self-control, and to suppress any aggressive impulses toward peers or adults.

Furthermore, we assume that when kids come to church, they will easily separate from their parents or caregivers upon arrival and tolerate separation from parents or caregivers during the worship service. We assume children will be comfortable interacting with unfamiliar peers, speaking when they’re spoken to, and reading aloud in front of a group. Kids with common mental health conditions often struggle to meet those expectations.

An essential first step for church leaders who want to minister more effectively with individuals and families affected by mental illness is to acknowledge that assumptions regarding the ability of attendees and visitors to meet our expectations for conduct or social interaction may need to be revisited. A next step involves developing a deeper understanding of how children and adults with common mental health conditions experience our ministry environments differently than other attendees do. Church leaders involved in inclusion efforts can then review established ministry customs and practices from the perspective of a child, teen, or adult affected by a significant condition.

In the remainder of this chapter and in the following chapter, I’ll introduce you to seven ways in which the experience of having a mental illness can represent a barrier to church attendance or participation. The first four of these barriers represent specific traits or attributes associated with common mental conditions—or with an array of mental health conditions. They are stigma, anxiety, executive functioning, and sensory processing. I’ll cover the first two—stigma and anxiety—in this chapter. These are among the most common barriers that families and individuals face when trying to participate in the life of a church. In the next chapter, I’ll look at the final five barriers.

THE FIRST BARRIER: STIGMA

In the previous chapter, I identified several attributes of mental illness that require a different approach to ministry than the strategies currently used for persons with special needs—physical, intellectual, and developmental disabilities. One of the attributes was the hidden nature of mental illness—our inability to know from looking at someone whether they have a disability and if our words and actions are likely to be helpful or hurtful. Our challenge in serving those with mental illness is heightened because they often try hard to hide their disability from others. They may be especially hesitant to share psychiatric diagnoses they’ve been given by mental health or medical professionals or discuss past or current treatments.

I often find the children and families served by my practice to be very reluctant to disclose the presence of a mental health condition to teachers, school administrators, coaches, and other adults involved in the child’s life—including grandparents or extended family members. Many refuse to accept beneficial accommodations and supports. Stigma perpetuates the resistance to acknowledge the presence of a mental health condition and to seek effective treatment. We need to recognize how two different types of stigma impact the challenges churches face in outreach to individuals and families impacted by mental illness—the stigma in our general culture connected to persons with mental illness and specific treatments for mental illness, and the stigma uniquely connected with mental illness in the church. Let’s examine how each type of stigma impacts our efforts to welcome children and adults into our churches.

More than half of the patients in my practice are teens. During their years in middle school and high school, they experience significant pressure from their peers to conform to interests, fashion, and behavior common to their subculture. Most kids in my practice are terrified by the prospect of being viewed as “different” by their peers. They may resist accepting any help that could lead to undesired attention from their peers.

My practice serves an area known for its outstanding public school systems. Families of children with special education needs often purchase homes within specific school districts because of the availability of excellent support services. Nevertheless, many kids in my practice with identified support needs who are offered services by their schools don’t receive them. If I were making a conservative estimate, I would say that up to half of my patients who qualify for school-based accommodations or special education services refuse the support they need. Why do they refuse help? Many tell me they’re embarrassed to be seen walking into a special education classroom or dread feeling pressured to explain to their friends why they get extra time for tests or take tests in a different room than the rest of their class does.

This observation points to why most children and teens with common mental health conditions are poorly served by the special needs ministries established in recent years by a growing number of churches. As we’ll note later, a broad array of mental health conditions has been associated with challenges in emotional regulation, social communication, and self-control. Over time, they often internalize a sense of being “different” from others. Subtle differences in thinking, speech, and behavior from their peers make them prime targets for bullying. The resulting hurt and shame often produce a determination to avoid the attention of others. Many of the kids I’ve come to know through our practice desperately seek to blend in to what others are doing while avoiding the notice of their peers.

The takeaway for pastors and church leaders is that kids with mental health-related disabilities and their families will flee from any ministry programming or activities that draw attention to their differences. Attempts to serve them through a ministry designed for persons with obvious physical, intellectual, or developmental disabilities will intensify their sense of being different from their peers and are likely doomed to failure.

Many children and teens don’t get the support they need at church because their parents are unaware that their child has a problem. I often ask parents who come to our practice after years of family conflict, academic underachievement, and difficulties with peers why they waited so long to seek help. A frequent response reflects the attitudes and beliefs associated with mental illness in our culture: “I didn’t want my child to be labeled.” When parents avoid seeking professional help because of fear their kids will be stigmatized, their children lose the potential benefits of simple, nonintrusive accommodations or strategies that can enhance their experiences of school, home, extracurricular activities, and church. The parent who remains unaware of their child’s social anxiety or performance anxiety may fail to recognize that the meltdowns they witness when they tell their child to get ready for church may stem from their child’s fear of being called on to answer questions or to read aloud from the Bible in front of a large group of peers at Sunday school.

Is it any wonder that parents who resist sharing information about their child’s mental health diagnosis or treatment with the teachers and counselors who spend much of the day with them or are embarrassed to be seen near a psychiatrist’s office are unlikely to disclose their child’s emotional or behavioral challenges to church staff or volunteers? Is anyone surprised when a man or woman who suddenly stops coming to a church or a Bible study they’ve attended for years chooses not to tell anyone that fatigue associated with their depression keeps them bedridden for weeks at a time?

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To read about the second barrier, and more about how churches can better understand and integrate those with mental health conditions into their church, buy your copy today on Amazon, Barnes & Noble, or Christian Book.