Since 2005, I have served on my church staff to provide clinical mental health counseling services to our congregation and others in our area. Over the years, I have known people who wanted counseling but couldn’t get it, and others who had access to counseling but didn’t get it. I’ve known pastors who burned out without even considering seeking mental health treatment, and I’ve also known pastors who sought periodic counseling just as a personal self-care routine. Why is it that some people with symptoms of a mental illness go to counseling while others don’t? Are there specific barriers to mental health treatment that Christians experience?
In 2011, the World Health Organization (WHO) conducted a study of 24 countries that included 63,678 survey participants (Mojtabai et al., 2011). This survey was replicated in 2014 by Andrade et al. Those two studies found that the largest barriers to mental health treatment (listed in order) were the following: low perceived need for treatment, stigma, negative expectations of treatment, prohibitive costs, and location/scheduling barriers. Given the fact that there are so many campaigns to decrease stigma, both in the church and in society, I was quite surprised to find that it was not the biggest barrier to mental health treatment. Let’s explore each of these barriers in more detail, specifically when applied to an American Christian subculture.
Low Perceived Need
What exactly is “low perceived need?” Unlike stigma, low perceived need is not a fear of being stereotyped. We simply just don’t think we need help. In my experience, many people only come to counseling after a friend, doctor, or pastor has told them they could benefit from counseling. The research studies mentioned earlier showed that people often believe their problems will resolve on their own. In fairness, mild or moderate symptoms sometimes do. People also often believe that they would rather handle their problems themselves or with a family member or friend for support. Mental health treatment is perceived as something that only those in crisis need. Many Christians, and especially pastors, sadly wait until symptoms or problems have reached a major crisis point before seeking help. To work on this barrier, we need to educate people about warning signs of mental illness and burnout, to help them understand that counseling is beneficial even when symptoms are just beginning or are mild/moderate. For example, a depressive episode is officially clinical after only two weeks of symptoms—including low mood, irritability, restlessness, unexpected weight or sleep changes, and/or thoughts of death/suicide. I’ve known many who wait months or even years before seeking help because they have told themselves, “It’s not that bad.” Bottom Line: You don’t have to wait for a crisis to get help.
Stigma
We all know this buzzword, and many in the Church are seeking to decrease the stigma of mental illness. But did you know there are actually two types of stigma? Patrick Corrigan’s research (2004) describes public stigma as well as self-stigma. Anti-stigma campaigns are often aimed at public stigma, trying to teach society or church members that mental illness is not dangerous or rare, and it is not equivalent to sin. Self-stigma is the way in which those with mental illness may negatively view themselves. Some advocates on social media encourage those with mental illness not to blame themselves or internalize public stigma. However, self-stigma requires personal, one-on-one conversations to really address how a person with mental illness views him- or herself. The church is uniquely positioned to do this work, from pastors and ministry leaders to peer groups and friendships—we can all encourage and lift up those who are struggling with depression, anxiety, or other mental illnesses. Bottom line: Talking about mental illness publicly and privately can change stereotypes.
Negative Expectations
Some people know they need help, and they know that mental illness is not their fault. Yet they still may not seek mental health treatment. This third barrier is often the reason: they don’t believe they will have a good experience with a counselor. Sometimes these negative views come from hearing friends’ horror stories, and sadly these are out there. In the church world, some have negative views of all secular counselors. Others have been harmed by counseling provided in church settings, often by those who are not professionally trained. Research has shown that all types of counseling are effective for reducing symptoms of mental illness. Regardless of the specific technique or method used by the counselor, clinical mental health treatment is effective. Are there bad counselors out there? Unfortunately so. However, it’s far more likely that a counselor will be helpful in working through all kinds of struggles. Bottom line: Counseling is effective in reducing symptoms of mental illness.
Practical Barriers
Unfortunately, some people know they need help, have overcome stigma, hold positive and hopeful views of counseling, and still don’t get mental health treatment. How could this happen? Here, it is barriers like cost, location, and scheduling challenges that get in the way. Not all mental health treatment providers take insurance, and some charge $100-200 per session. Some locations are more rural, with no counselors in a reasonable driving distance. In some urban areas, where insurance coverage and proximity might be better, counselors’ practices are full and many have long waiting lists. The reality is that mental health treatment is not always easy to get. It’s important to consider these practical barriers when we are doing advocacy work. Messages like, “Go to counseling!” and “It’s not your fault!” need to be accompanied by new ideas and solutions that can make counseling more accessible. Currently, I run a non-profit that places Master’s-level counseling students in churches around our area to provide clinical mental health care under supervision. These students gain a positive internship experience and the clients are able to access very low cost counseling services at a site where they are already comfortable. In addition, these students are learning about creative ways to make counseling affordable and hopefully will replicate this or other models in churches over many generations. Bottom line: Mental health care can be more accessible when pastors and counselors work together.
If you are passionate about mental health, there are several things you can do to help those you know overcome these barriers. First, you can talk to people about what counseling is and help them recognize early warning signs that can be brought into counseling. Second, you can lead a small group at your church to help decrease stigma. You can find my curriculum for an adult 8-week small group here. Third, you can meet some of the counselors in your area and share positive stories of the great work they are doing. Finally, you can help meet practical needs by giving rides to therapy or babysitting during a session. You can start a counseling scholarship fund in your church or assist people in applying for public health insurance. If you are interested in partnering with my non-profit, Church Therapy Associates, and you live near a Christian seminary or graduate school that offers a counseling degree, reach out! We are looking to network and expand into new states. Let your passion fuel your action—do something. Just one small act can make a big difference.
References
Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., . . . Kessler, R. C. (2014). Barriers to mental health treatment: Results from the WHO world mental health surveys. Psychological Medicine, 44(6), 1303-17. doi:http://dx.doi.org.ezproxy.regent.edu:2048/10.1017/S0033291713001943
Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7). 614-625.
Mojtabai, R., Olfson, M., Sampson, N. A., Jin, R., Druss, B., Wang, P. S., . . . Kessler, R. C. (2011). Barriers to mental health treatment: Results from the national comorbidity survey replication. Psychological Medicine, 41(8), 1751-1761. doi:10.1017/S0033291710002291
Kristen Kansiewicz is a Licensed Mental Health Counselor on staff at her church, who also leads a non-profit placing counseling students in church settings to provide clinical mental health care. In addition to counseling and supervising students, she is currently pursuing her doctorate in Counselor Education and Supervision at Regent University. She lives in the Boston area with her husband, two children, a dog, a cat, and a turtle. You can follow Kristen on Twitter @ChurchTherapist or take a look at her blog on ChurchTherapy.com. She is also the author of several books, available on Amazon.
