Mental health issues in the local congregation

Do you have a member exhibiting symptoms of a mental health condition?

Daniel M. Forbes, EdD, is senior pastor of the Bushnell and Inverness Seventh-day Adventist Church district in Florida, United States.

One evening, after attending a full day of activities and training at a ministers’ meeting, a small group of ministerial colleagues gather in a more informal setting for fellowship. In time, they begin sharing “war” stories from their own church districts.

One pastor begins the conversation: “I’ve got a member in my church whose behavior leaves me baffled. No matter how hard I try to be upbeat and positive in my interactions with him and to encourage him to broaden his way of thinking, it doesn’t seem to have any effect. Much of my time is spent trying to convince him that there are different ways of accomplishing a particular task or of addressing a particular issue at the church. His social skills are severely lacking, and he’s always ready to argue with anyone at church who wants to suggest a different way of doing things. I can never seem to please him or satisfy his pastoral needs. I’m losing hours of sleep, thinking about my interactions with him and trying to figure out why he acts the way he does and what I can do better to minister to him. Do you have anyone in your church like that?”

“Yes, I do,” says a second pastor, “except my member engages in some of the most selfish, un-Christian behaviors—and not just against me or other church members. I’ve seen it even with her own family members and their pets. Maybe it’s me, but it seems as if she doesn’t even have a conscience. When I try to discuss it with her, she doesn’t seem to show any remorse or guilt at all for her actions or even acknowledge that she has conducted herself in any other way than admirably. She always has an excuse and wants to argue about it, blaming someone else. Every time l talk with her, I already know what the end result is going to be.”

A third colleague, overhearing the conversation, adds his story.

“That’s nothing,” he begins. “I have a member whom I never know how he’s going to be from one day to the next, or one moment to the next, for that matter. One day he acts like he is my best friend and supporter. The next time I see him, he couldn’t care less about me or anyone else. I’ve noticed that some days he seems so happy with his life and other days he acts so depressed and discouraged that I am concerned for his safety. This same cycle of emotions has been repeated over and over. He has been like this ever since the first Sabbath I arrived as the new pastor three years ago. What do you do with a person like that?”

Recognizing mental health in the local congregation

As most pastors know, such congregational scenarios are all too familiar. With their pastoral empathy and love for souls, clergy learn by God’s grace, along with time and experience, to apply techniques of good listening skills and a Christ-centered understanding of human nature when interacting with the saints under their care.

Some clergy might consider such challenging members to simply be people possessing a few annoying or puzzling personality traits that may, at times, seem directed toward the pastor. Yet with a basic understanding of human behavior and the psychology of mental health, pastors might be less inclined to take such members’ behaviors as personal attacks and be better able to recognize possible symptoms of mental illness that would best be served with professional intervention.

Mental illnesses

Take the three hypothetical member scenarios described above. According to the Diagnostic and Statistical Manual, fifth edition, of the American Psychiatric Association, the first example describes someone who may fall on the high-functioning range of a group of psychological conditions called autism spectrum disorders (ASDs), also known as pervasive developmental disorders. ASDs range in severity. Autism is the most debilitating form.1

Symptoms of ASD vary but often include the need for sameness, a lack of social skills, difficulty interpreting what others are thinking or feeling, difficulty regulating emotions, a tendency toward repetitive behaviors, and communication problems. They also often have what are called splinter skills, such as remembering names, dates, and details in history or figuring complex math problems in their heads, among other such skills.2

According to the Centers for Disease Control and Prevention, ASD has been identified in 1 in 68 children, more in males than in females. And these children grow up to become adults and members of society at some level, according to their abilities and opportunities to progress, with some individuals more limited in their abilities than others.3 Some individuals with ASD even become outstanding members in the church.

In the second earlier scenario, the individual is similar to someone diagnosed as antisocial or otherwise termed as sociopathic personality disorder. In the field of mental health, sociopathy is a condition where the individual is characterized as possessing little or no conscience. Other characteristics include failure to conform to social norms, a deceitful and manipulative nature (though they can display charm), impulsivity and failure to plan ahead, irritability and aggressiveness, reckless disregard for the safety of self or others, consistent irresponsibility, and lack of remorse after having hurt or mistreated or stolen from another person. An individual who possesses any three of the above mentioned characteristics might be diagnosed with a sociopathic disorder. Prevalence of the disorder is present in about 4 percent of the population.

So, statistically speaking, in a church with one hundred members, four might exhibit symptoms at some level consistent with sociopathic behavior. That is important information for a pastor to have in mind when trying to understand human behavior and the best approach to take when dealing with such challenging individuals in their church.

Then, finally, the individual presented in the third scenario exhibits behaviors that are similar to someone diagnosed as having a bipolar disorder. According to the National Alliance on Mental Illness (NAMI), bipolar disorder, sometimes referred to as manic depressive disorder, is a chronic mental illness characterized by extreme high and low shifts in one’s moods. It affects the energy level and ability to think clearly. Each phase, both manic and depressive, can last from one day to months or years. In the manic phase, the person may feel irritated or euphoric. They may experience feelings of agitation, sadness, or hopelessness or experience sleeplessness or talkativeness. They may also exhibit a need for extreme pleasure-seeking or risk-taking behaviors. In the depressive phase, the individual may have feelings of sadness or hopelessness and may lose interest or pleasure in most activities.4

Although bipolar disorder can develop at any age, the average age for the condition to show up is 25, but it has been seen in children as young as 6.5 In the United States alone, there are 5.7 million adults living with some level of bipolar disorder. Each year 2.9 percent of the population is diagnosed with a bipolar disorder condition. Of that, 83 percent are considered severe cases. It crosses all lines of race, ethnicity, and socioeconomic groups. Also bipolar disorder affects males and females equally. If left untreated, the condition often gets worse.

About 1.1 percent of the world world population more than 18 years old has this disorder, a figure that translates into 51 million people.6 Bipolar disorder is the sixth leading cause of disability worldwide.7

Responding to mental health in the local congregation Of course, such diagnoses as illustrated in the three cases above can never accurately be made with the little information presented here. Proper testing, evaluation, and observation is necessary, requiring time as well as training and clinical expertise. To do otherwise would be both unethical and unprofessional, with a high possibility of being inaccurate as well.

During my years of serving as a pastor, I have ministered to people who exhibited symptoms of autism spectrum disorder, depression, bipolar disorder, narcissism, sociopathic personality disorder, schizophrenia, anxiety disorder, suicidal ideation, posttraumatic stress disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, and dementia, to name a few. And then there were some who possessed personality traits that were simply annoying or puzzling. Each person has presented behaviors and thought processes unique to their condition. Yet each person has also presented an opportunity to minister to another of God’s children, a soul to be saved for the kingdom. Sometimes, of course, such individuals are not always willing to admit there is a problem, much less accept a referral to a mental health professional.

In cases like these, I sometimes found it helpful to suggest to these people that they see their personal physician for a full checkup and a mental health screening. It is a way, I say, to show their loved ones or even themselves that there is no need for concern and that their health status is fine. The latter suggestion often appeals to them. Use of this approach has sometimes been successful in convincing the individual to see someone qualified who can do a proper screening for potential physical and mental issues and offer an appropriate treatment response.

The sad truth remains that for the majority of cases, people do not receive treatment for any of these mental health conditions. They do not pursue professional treatment for various reasons (such as denial of a problem, lack of finances, minimal availability of qualified health care providers, or a desire to avoid any stigma that may come if they were to seek treatment for a mental illness). The number of persons who do not receive treatment for their mental illness is even higher among ethnic minority groups.8

Research shows that in developing countries, about 50 percent of the population do not receive treatment for mental illness. In developed countries, that same lack of treatment being sought rises to 90 percent.9

Approximately 450 million persons suffer from such conditions globally, with about one in four people experiencing a mental or neurological condition at some time in their lives. These findings rank mental disorders among the major reported cases of illness and disability worldwide.10

In addition there is the fact that those who suffer from a mental illness will often have a co-occurring addictive disorder, thereby complicating their mental health status even further.11 For example, depressive disorder cases are often seen combined with substance abuse and anxiety disorders.12

Referring those with mental health issues in the congregation

Clergy, as a rule, are not trained or qualified to formally make judgment calls of such a psychological nature or to provide mental health treatment for such conditions. Their expertise lies more in the areas of spiritual and pastoral counseling and support, which, in their own right, can be of great benefit to these individuals.13

Yet, cases of mental illness in its various forms are becoming more and more prevalent. To think that the same conditions would be reflected in the church, which is a cross section of the population of the country in which church members live, in my opinion, would only be logical.

With the overall rise in the number of mental illness cases, the possibility that mental health problems, for whatever reason, have affected particular members in the congregation of the church where you minister is something real to consider and be prepared to address. It can prove reassuring to members to know that you, as their pastor, have an understanding and empathy for what they and their family members are going through.

There may be members of your congregation right now who are exhibiting symptoms of one or more mental health conditions. Perhaps it is an undiagnosed illness. They might have been that way for so long that, to them, their behavior is “normal” and in their minds everyone else has the problem. They may even hold positions of leadership and influence in your church.

You may have thought before that their behaviors seemed odd, but you never considered the possibility of one of the saints having a mental health issue as an explanation for their adamant need for sameness when you want to suggest change in the order of the worship service.

Perhaps you never considered that the difficult member in your congregation, who is sometimes deceitful and manipulative, yet so charming that they easily win the support of others to get their way; also has shown a striking similarity to the behavioral symptoms seen in a sociopathic personality disorder.

It might be that the member you have spent so much time providing pastoral counseling and support for—to help build their self-esteem and outlook on life, only to have them sink back into a severe state of depression the next time you see them; actually has symptoms of a bipolar disorder. And you never thought that they might be better served by encouraging them to first seek out a qualified health-care provider who could give them a full medical checkup that includes a mental health assessment to see whether there might be a chemical imbalance in their brain that must be treated with proper medication.

As a pastor, I have found it helpful to do a search to learn what mental health resources are available in my community so that I can have a list of them on hand for referring members and others to when the need arises. I also make contact with various counselors, mental health facilities, and other referral sources. I have introduced some professionals and agencies to my church in order to provide appropriate presentations and training for the benefit of my congregation and to familiarize the church regarding their services, such as domestic violence agencies, substance abuse treatment personnel, the local police department community resource division, and individual counselors. Many offer excellent programs for churches.

As cases of mental illness continue to rise, the possibility that it will impact the lives of members in the church will continue to rise as well. Unfortunately, many cases will go undiagnosed and untreated. Yet many people who do seek help usually turn to clergy first. For many, clergy are the only resource that some will ever turn to for help regarding their mental health challenges.14

If clergy had a better understanding of mental illness, what symptoms to look for, and what resources are available in the community, it would equip them to be more effective in their ministry regarding mental health issues when they arise in the church.

With the proper tools and training, along with the motivation to implement them in their ministry, pastors can be better equipped to offer help to those members in their congregations exhibiting symptoms of mental illness and to recognize; respond; and refer them, if necessary, to the resources and licensed professionals who are able to meet their psychological needs.

How to choose the right counselor

1. Shop around for the right counselor as you would in selecting a physician.

2. Ask family, friends, or your personal physician for referrals. Make a list.

3. As a consumer, you have a right to ask questions about fees, insurance coverage, specialties, training, and experience. Therefore, make an appointment to go by or call their office to speak with them. They should welcome such inquiries.

4. Is the counselor a Christian? Their spiritual beliefs will be reflected in their counseling approach.

5. Is the counselor experienced in treating the problems you are dealing with?

6. Do you feel comfortable with the counselor’s counseling approach and talking with them about your life and personal issues that concern you?

7. Is the counselor properly licensed? Does the counselor have the required education and credentials to do counseling?

8. Do you trust the counselor?

9. If you do not feel positive about a particular counselor on any one of the points above, move on and continue your search for one until you do.


1 “Dsm-5 Diagnostic Criteria,” Autism Speaks, accessed May 12, 2016,

2 “Symptoms,” Austism Speaks, accessed May 12, 2016,

3 Martha Stout, The Sociopath Next Door (New York: Broadway Books, 2005).

4 “Bipolar Disorder,” NAMI, accessed May 12, 2015, -conditions/bipolar-disorder.

5 “Bipolar Disorder: Who Is at Risk?” WebMD, accessed May 16, 2016, guide/bipolar-disorder-whos-at-risk.

6 “Bipolar Disorder Facts and Statistics,” Bibpolar Focus, accessed October 11, 2016, /bpfacts.html.

7 ”About Bipolar Disorder,” Impact of Bipolar, accessed October 21, 2016, /about-bipolar-disorder.

8 Harold W. Neighbors, et al., “Race, Ethnicity, and the Use of Services for Mental Disorders: Results From the National Survey of American Life,” Archives of General Psychiatry 64, no. 4 (April 2007): 485–494, doi: 10.1001/aechpsyc.64.4.485.

9 Vikram Patel, “Mental Health for All by Involving All,” video embedded in Kate Torgovnick May, “Some Stats on the Devastating Impact of Mental Illness Worldwide, Followed by Some Reasons for Hope,” TEDBlog, September 11, 2012, /2012/09/11/some-stats-on-the-devastating -impact-of-mental-illness-worldwide-followed-by-some-reasons-for-hope.

10 “Mental Disorders Affect One in Four People,” World Health Report, World Health Organization, October 4, 2001, /press_release/en.

11 “Number of Americans Affected by Mental Illness,” NAMI, accessed May 13, 2016, from

12 Mental Health Disorder Statistics. Retrieved May 15, 2016, from _health_disorders/mental_health_disorder _statistics_85,P00753/.

13 Todd Zwillich, “Rate of Mental Illness is Staggering,” Web MD, June 1, 2004, -health/news/20040601/rate-of-mental-illness-is -staggering.

14 Philip S. Wang, Patricia A. Berglund, and Ronald C. Kessler, “Patterns and Correlates of Contacting Clergy for Mental Disorders in the United States,” Health Services Research 38, no. 2 (April 2003): 647–673, doi: 10.1111/1475-6773.00138.

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Daniel M. Forbes, EdD, is senior pastor of the Bushnell and Inverness Seventh-day Adventist Church district in Florida, United States.

January 2017

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