Jeff Lofting
Director of Education
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Psychotic, delusional, schizophrenic. These words make many feel squirmish. Yet, given the statistics, you are likely to encounter mental illness if you work in some form of outreach or ministry to those in poverty. 50% of the sheltered homeless and 78% of unsheltered homeless individuals suffer from some form of mental health condition.
Many, including those in ministry to the poor, feel ill-equipped to deal with those experiencing serious mental illness and feel they need to immediately refer struggling individuals to professional mental health services. But, Dr. Matt Stanford, author of Madness & Grace, posits that there is a place for you in the process and seeks to equip lay persons “to better serve and support those suffering with mental illness” (11). He provides “4 Rs”—recognition, referral, relationship, and restoration—that provide a faith-based framework for involvement in mental health care while dealing with misconceptions surrounding the mind and the spirit.
Dr. Stanford identifies the target audience of Madness and Grace as “pastoral counselors,” and he regularly refers to these individuals as pastors, ministers, and priests. However, those involved in faith-based charity work outside of the walls of a church will undoubtedly find themselves in the role of a pastoral counselor in the lives of those they encounter and serve, perhaps the only person they have ever had to fill this role. Dr. Stanford believes that, if a pastoral counselor can take the right steps to help begin an individual’s journey to recovery from serious mental illness, it can make the process much smoother and help them to avoid potential adverse experiences.
Dr. Stanford is CEO of the Hope and Healing Center and Institute in Houston, TX, and an adjunct professor of psychiatry at Baylor University. He is well-known for his research into the interplay between psychology and faith. His experience goes beyond the academic, though; throughout his extensive career, he has treated individuals with a spectrum of mental health challenges.
As a Christian, Stanford is able to view mental illness from the fullest perspective. He writes to fellow believers to emphasize the importance of engagement by those in the faith community with those who are experiencing mental health issues. He points out research that reveals that those experiencing mental illness do not usually turn first to a physician or a psychiatrist but rather to someone who serves a pastoral role in his or her life.
He contends that when the pastoral counselor works collaboratively with mental health professionals, it can have enormous benefits for the individual being treated and his spiritual well-being.
Dr. Stanford contends that the 4 Rs of recognition, referral, relationship, and restoration are integral to better serving and supporting the mental and spiritual well-being of those experiencing mental illness. The process occurs through building and maintaining relationships with, not only the one suffering, but with others clinically treating his condition. In each of the Rs, Stanford provides practical tools and resources to equip the lay person for on-going supportive relationships. He includes specific questions, risk factors, and scripture to help support you or the individual with whom you are working.
Recognition
If you regularly work with those in poverty, you are on the front lines of mental health support. You are in a position to recognize the signs of general mental illness and help direct them to further treatment, if needed. To recognize mental illness, though, we must first understand what it is and is not, as well as what causes it.
“Mental illness,” also know as a mental disorder, is defined as a “disruption of a person’s thoughts, moods, behavior, and/or ability to relate to others that is severe enough to require treatment or intervention” (17). In our lifetime, all of us will experience disruptions of those aspects listed, but those won’t necessarily require treatment or intervention. According to Dr. Stanford, “only a small percentage of people are ever diagnosed with mental illness” (18).
Stanford explains that mental illness is a result of living in a fallen world. It’s another example of the brokenness of creation and our need for a “Savior who can heal and make us whole again” (21). More specifically, it results from a complex interaction of the biological and environmental or, in other words, nature and nurture. We are all born with varying genetic predispositions that interact differently with our external experiences, such as poverty, abuse, or military combat.
There are some common environmental factors, though, that are associated with a higher risk for the occurrence of mental illness. These include physical or sexual abuse or neglect as a child, divorce, financial stresses, substance abuse, lack of social support, and poverty, many of which we can recognize in those served in charitable efforts. Generally, it is a combination of these factors and others that result in serious mental illness.
Stanford provides a detailed list of common mental illnesses, including ways to identify them and short examples of individuals who exhibit these symptoms. Additionally, he explains the various clinical treatments for serious mental disorders.
As previously discussed, Stanford contends that a lay person can help identify specific mental disorders and direct individuals to appropriate treatment so that care can be expedited. Stanford provides a chapter full of assessment questions to help evaluate whether an individual needs to be referred directly to a mental health professional.
Referral
When an individual meets at least one of the following four situations, it’s necessary to refer them to the appropriate community resource.
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- Experiencing hallucinations and/or delusions.
- Actively abusing alcohol and/or drugs.
- Showing signs of significant psychological distress.
- In danger of self-harm.
To help the reader understand the assessment process more fully, Stanford provides specific case examples that walk through the question and potential answers.
Dr. Stanford provides an extensive list of resources and health providers generally available within a community for both crisis and non-crisis situations and practical steps you can take when connecting individuals with mental health resources.
Stanford makes a point in this section to emphasize the importance of “pastoral counselors” proactively building relationships with mental health providers in their community, such as counselors and psychologists. Many Christians experiencing mental illness are hesitant to engage with a psychologist or counselor who does not understand their faith. Stanford suggests having coffee or a meal with various providers over time will allow you to identify those who will be sensitive and respectful to spiritual issues and affirm the individual’s Christian faith. Additionally, it’s important that the provider understands the continued role that you would desire to play in clients’ treatment, as described in the next R.
Relationship
Isolation and loneliness are often associated with mental illness. This can sometimes be a result of the interpersonal challenges of the mental illness, but it might also be due to the stigma associated with mental illness. This is why a continued relationship with those receiving treatment is imperative. Although a psychologist can provide help in the realm of the body and mind, your continued spiritual support and guidance can be key to that individual returning to a flourishing life.
Dr. Stanford discusses practical ways on how to provide spiritual hope and encouragement during one’s treatment, helping to establish an understanding of her identity in the eyes of her Creator. Additionally, he covers how to de-escalate situations in which an individual is distressed or communicating in an illogical manner.
Restoration
Because you offer hope in your organization or ministry, you will draw those who are in need of hope, including those in mental distress. In this section, Dr. Stanford advocates for establishing mental health ministries that meet the needs of your community. These might include services addressing, addiction, homelessness, and trauma, and can provide frontline support for individuals in need and referring to the appropriate community resources, as needed, while continuing to maintain relationships throughout their treatment.
In the remainder of this section, Dr. Stanford features a number of ministries meeting various needs with details about how they operate to help inspire establishing similar ministries in your community.
As the subtitle of the book suggests, A Practical Guide for Pastoral Care and Serious Mental Illness, this book provides in-depth information about serious mental illness along with case studies, assessment questions, and suggested actions for various scenarios. It is not only a primer for understanding mental illness from a faith perspective but also a handbook that can be used while working with those experiencing mental illness. This is the kind of practical resource True Charity seeks to identify and provide to those working to positively impact those in poverty.
The emphasis that Dr. Stanford places on maintaining relationships with those suffering from mental distress is significant and refreshing, including a chapter on how to support family members who are caring for that individual. He also promotes replacing isolation with healthy community, particularly a faith community that rightly understands mental illness rather than stigmatizing it.
The target audience of this book is clergy. As mentioned before, though, we believe that many in poverty-fighting ministries will be able to identify as a “pastoral counselor” to those they serve, and you might be the only person who has ever played this role in their lives. That being said, if you are not in a traditional church pastoral role, there might be some information that you find irrelevant.
Stanford acknowledges the difficult reality that not all people with severe mental illness are capable of working a job that can provide for their needs. In those situations, he refers his readers to various government entitlement programs, such as Supplemental Security Income (commonly referred to as “disability”) as well as government housing vouchers. While we acknowledge that current long-term solutions are scarce for people in these situations, we always encourage leaders to exhaust family, church, and community solutions before relinquishing responsibility to federal programs.
We believe that assistance is most effective when it is provided voluntarily at the most local level by those engaging the individual with personalized support versus a distant bureaucracy providing impersonal transactional assistance.
Stanford’s book Grace for the Afflicted, is a good supplement to this book for readers who may feel unsatisfied with Stanford’s discussion of the interplay between the spiritual and the psychological. A synopsis of that book can be found here.
Because the target audience is those in the traditional pastoral role at a church, it is highly recommended for pastors and those in a non-licensed pastoral counseling role. Additionally, because mental illness disproportionately impacts those in poverty, we believe those who are actively engaging with those experiencing poverty would greatly benefit from the guidance provided.
Madness & Grace can be purchased at Amazon. If you purchase the book through this link, True Charity will earn a small amount as an Amazon Associate
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