Pastors sometimes struggle to know when to refer a church member to a mental health professional for treatment. Some are also concerned about referring to a mental health professional if they are unsure whether he or she believes in Christ.

For church members struggling with mental health issues to grow in Christ and as a member of the body of Christ, they must have good mental health as a part of their personal foundation. Christ-centered mental health professionals can help stabilize and strengthen the mental and emotional foundation of church members so pastors can focus on the spiritual foundation, which is Christ (1 Cor 3:10-11).

Let's think about a scenario together:

John is the senior pastor at his church. He meets with Eric weekly for biblical counsel and prayer. Eric spends their time together discussing the loss of his job and feelings of hopelessness about the future.  Now that unemployment benefits have run out, Eric’s wife has taken on a second job, and they are struggling financially.

Eric expressed feeling like a failure for not being able to provide for his wife and children. He recently stated that he is so sad at times he has thought about dying—that it might be better for his family if he weren’t a burden to them, and they would be better off without him. 

John is concerned about Eric’s feelings of hopelessness and thoughts about dying and feels Eric needs more mental health support than he is qualified to give. What can John do to help find more support for Eric?

According to Dr. Matthew Stanford, psychologist and CEO of the Hope and Healing Center in Houston, Texas: 

In any given year in the United States today, one in five adults and also one in five children and adolescents will suffer with a mental health problem. That’s an enormous number, probably close to 70 million individuals. Half of all chronic mental health conditions are in place by 14 years of age and 75 percent by 24 years of age. And probably the most disturbing statistic is that the majority of individuals — children and adults — with mental health problems will never receive any treatment.

Dr. Stanford also points out that the church is the first place most individuals with mental illness seek help, even those with serious mental illness.

When should pastors refer to a mental health professional?

When considering a referral, it is important for pastors to assess three aspects of the church member:

1. Level of Distress:

• How much mental and emotional anguish is the person experiencing?

• How well is the person tolerating and coping with this distress?  

2. Level of Functioning:

• Is the person able to care for himself or herself?

• Is the person capable of problem solving and making decisions?

• Is the person able to complete daily responsibilities?

3. Possibility for Danger:

• Is the person having thoughts of harming himself or others?

• Is the person engaging in risky behaviors?

• Is the person struggling with addiction?

If a church member has trouble in any of these areas, then referral to a Christ-centered mental health professional would be beneficial. If a church member is in imminent danger of harming himself or others, always call 911 and, if safe, stay with the church member until help arrives.

What kind of counselor should you refer to?

Make sure you are aware of the various kinds of mental health professionals in the community, and what they do:

1. Licensed Mental Health Providers – Master's Degree

•  A Licensed Professional Counselor (LPC) or Licensed Clinical Social Worker (LCSW) does individual/couple/family counseling and psychotherapy.

• A Licensed Marriage and Family Therapist (LMFT) does couple/family counseling and psychotherapy.

• A Licensed Psychological Associate (LPA) does psychological testing and some counseling/psychotherapy.

• Licensed Chemical Dependency Counselor does counseling for issues of addiction.

2. Licensed Mental Health Providers – Doctorate Degree

• A Licensed Psychologist (LP)—PhD or PsyD—does psychological testing, individual/couple/family counseling, and psychotherapy

3. Physicians

• Board Certified Psychiatrist—MD or DO—prescribes medication for mental health disorders, some counseling/psychotherapy.

• Primary Care Physician (Family Practice or Internal Medicine)—MD or DO—prescribes medication for some mental health disorders.

Developing a Referral Network:

1. Start with mental health professionals and physicians in your congregation.

The best place to start for counselors and mental health professionals are those who are already in your church.  Being familiar with you and fellow members, they are a great resource for consultation and referrals.  

Some mental health professionals in your church may not be able to see members themselves, as it could be an ethical conflict of interest.  Their fees may not be affordable for some as well.  However, church members in the profession may know of other mental health professionals in the community who would be a good fit for a church member in need.  

2. Schedule meetings with Christ-centered mental health professionals to build relationships.

UBA staff members keep a list of counselors in the area if you need to get started. 

• Inquire about their areas of specialization

• Ask what kinds of payment they accept—insurance, private pay, sliding scale—and how much they usually cost.

• Check to see if they have a statement of faith.

• Ask if they use a release of information to work together with pastors.

• Referral process?

• When in doubt, connect with a therapist you can call to consult as you’re meeting with someone.

3. Who should be in my referral network?

• Primary Care Physicians

• Psychiatrists

• Christ-centered Counselors/Social Workers

• Clinical Psychologists

• Hospitals and Treatment Facilities

• Specializations in adults, children, couples, and families.

• Specialization in mental disorders, grief/loss, addiction, trauma, etc. with the ability to work within a Christian worldview

• Providers who accept insurance, offer sliding scale fees, or non-profit/low-cost services

How else can I serve my congregation?

According to research by Lifeway, only 4% of pastors speak about mental illness in sermons or in large group messages.  66% of pastors speak about mental illness once a year, rarely, or never.  

1. Talk about mental health issues in your sermons, in Bible class, and during prayer.  

The less sigma church members about mental health issues, the more open they will be to seek help when they or a family member needs it.

2. Educate your congregation about mental illness.  

If it’s not an area you are familiar with, invite guest speakers or share opportunities to learn more within your community.

3. Provide reputable, Christ-centered materials from local mental health providers, blogs, podcasts, and videos.

4. Start a pastoral care team or lay counseling ministry.  Offer support groups.

Ministry can be challenging in our fallen world, but God works through us in our respective vocations to serve His children. Knowing how to assess and then refer church members with mental health challenges helps us to be instruments of God’s peace within the body of Christ.

Robert LaBarbera is a graduate student at Houston Baptist University working toward his MA in Christian Counseling.  He is completing his practicum and internship training at HBU’s Gideon Counseling Center, part of the Gideon Institute of Christian Psychology and Counseling.  

Diane Lamberson, LCSW-S is the director of HBU’s Gideon Counseling Center.

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