Caring for the Soul Conference
October 27, 2004
Presented by the Mental Health Association in Milwaukee County

The Milwaukee Experience
Related on behalf of "Caring for the Soul" and "Faith and Recovery"
by Barry Blackwell

As the title and attribution imply, this is a story told on behalf of others who have collaborated over the past five or more years to develop and implement a model for initiating mental health ministries in faith communities. While our experience has been in several Catholic and one United Methodist parish, our intent and hope has been, and is, ecumenical.

When it comes to religion, mental illness is an equal opportunity event that afflicts one in four or five families in every faith denomination. As State and Federal funding sources continue to discriminate against people with mental illness, more and more health care facilities are restricting or eliminating their treatment programs for people with mental illness. A program that fails to generate profit is seldom considered viable. The administrators of our "not for profit" corporations are proud to affirm the slogan, No margin, no mission".

The potential role of faith communities in supporting people and families dealing with mental illness is obvious and increasing. In this presentation, I will lay the groundwork for our afternoon workshop in which all of the participants in our ministry to date will provide a "Toolkit for a Mental Health Ministry". My remarks will follow the same outline as the toolkit that will include handouts that cover all its main components. If you plan to attend the workshop or to pick up the handouts, you will not need to take notes now. This presentation focuses on the broad themes; the workshop and the toolkit provide more detail.

Spirituality, Faith and Mental Illness: An Overview.

The role of spirituality, in whatever faith tradition, has a long and variable history reaching back to Jesus' ministry of miracles, including the "casting out of demons". During the nineteenth century, the Quakers in England began "moral" treatment as the organizing principle of institutional care. The model was promoted in America, by Dorothea Dix, where hospitals for people with mental illness were often co-administered by clergy and physicians. This led to humane and considerate conditions; certainly an improvement on earlier asylums and prisons where those with mental illness had previously been hidden from the world and often subjected to barbaric and ineffective "treatments". As time progressed, conditions in the institutions began to deteriorate once more. During the Second World War, Quaker and Mennonite conscientious objectors who shunned the military were assigned to work in State mental institutions. They began to discover and expose the "snake pit" conditions they encountered.

The discovery of the first effective medications, beginning with Thorazine in the mid-nineteen fifties, provided the tools to change all this. Soon, people benefited sufficiently to be discharged from institutions back into the community where they all too often relapsed and were re-admitted - the so-called "revolving door syndrome". Unfortunately, the financial savings from closing hospitals were often diverted elsewhere and seldom ploughed back into community support programs.

For most of the remainder of the twentieth century the spiritual dimension took a back seat to scientific hopes of a complete cure as new and improved medications appeared. Mental health professionals developed a reputation for religious skepticism that often shaded into agnosticism or even atheism. Whatever spiritual support had existed in the earlier institutional settings did not follow people into the community where stigma and discrimination flourished even, sadly enough, in faith communities.

This mid twentieth century parting of the ways between medicine and spirituality in the treatment of mental illness was similar in many ways to the Enlightenment of the eighteenth and nineteenth centuries. Discoveries and developments in science and philosophy promoted reason over faith, challenging core religious beliefs. Just as a more mature spirituality eventually reunited science with faith, so has there been a recent recognition that medical and spiritual factors are both vital to well being in mental illness.

Two developments contributed to this shift in emphasis, one medical the other spiritual, coinciding in time over the last ten to fifteen years. A whole new generation of medications began to appear with broader therapeutic properties and fewer side effects. These enabled people to live much fuller and more productive lives. Almost simultaneously the Procovery concept developed, pioneered by Katherine Crowley. This describes an individual's unique adaptation to illness that allows the person to live a satisfying, hopeful and contributory life despite any limitations of their disorder. Procovery encourages people to view themselves as valuable members of a community rather than being "disabled" or "handicapped". This invites them to be more open about their illness and to share their talents with the community, both of which have powerful effects in reducing stigma and discrimination.

Central to the Procovery process is a person's hopeful, optimistic attitude and a courageous commitment that focuses on strengths. This is fueled by grace. Pat Deegan, a consumer herself, has described it as, "The birth of hope called forth by the possibility of being loved. All of the polemic and technology of psychiatry, social work and science cannot account for this phenomenon of hope. But those of us who have recovered know this grace is real We lived it. It is our shared secret. (Quoted in "'A Conceptual Model of Recovery" by Nora Jacobsen, July, 2000). For those individuals with spiritual beliefs, this grace is found in their relationship with the Divine and is nurtured by their faith community.

Unlike much of traditional ministry based on the "charity" model, Procovery based programs seek to avoid "doing to" people with mental illness. Instead they embrace "doing with". Essential to the Procovery concept and the role of faith is empowerment of the individual dealing with mental illness. Full partnership in the community and its liturgical life is the goal. When those with and without mental illness regard one another as equals stigma and discrimination are eliminated.

The National Scene.

Attention to the spiritual aspects of mental illness began to appear in the last decade of the twentieth century in the form of books, organizations and individuals. In 1995, a Mennonite psychiatrist and an adult education specialist published "No Longer Alone" exploring the boundaries between spirituality and mental illness with a scriptural basis for community action. At about this time, an interfaith group of fourteen agencies in St. Louis combined to form Pathways to Promise, an organization that publishes training manuals, videotapes and other scriptural materials for faith communities interested in developing programs for people and families dealing with mental illness. In 1997, the National Alliance for the Mentally Ill published a scripture based curriculum for adult study, "Creating a Circle of Caring: The Church and the Mentally Ill". In 1999, a professor of Religion at a Lutheran University published, "In the Shadow of our Steeples" for families dealing with mental illness in the parish.

In the same year, Russell Shorto charted the course of interest in spirituality within the mental health field in his book, "Saints and Madmen; Psychiatry Opens its Doors to Religion". He acknowledges today's keynote speaker, Nancy Kehoe, and the Milwaukee Behavioral Health Division as leaders in that movement. Finally one knows when a topic is timely if it is endorsed by the President of the United States and the Federal Government. President Bush's interest in "faith-based initiatives" was echoed by a conference sponsored by the Center for Mental Health Services in October 2002 on "Building Bridges". Our other keynote speaker, Susan Gregg-Schroeder, participated together with two members of "Caring for the Soul" from Milwaukee - Dr. John Prestby and Sister Ann Catherine.

The Milwaukee Scene.

Approximately seven years ago, the Milwaukee County Behavioral Health Division began to pay attention to the spiritual dimension of the Procovery process. Dr. John Prestby, Director of Day Treatment Programs, heard Nancy Kehoe speak at a national conference. Encouraged by the Administrator, Kathie Eilers, Dr.Kehoe agreed to become a consultant to the Behavioral Health Division. With the support of the chaplains, Father Antoine and Gloria Krasno, the "Caring for the Soul" project began. Consumers on the inpatient units were offered the opportunity to participate in non-denominational spirituality groups co-led by a mental health and faith-based person.

The success of the "Caring for the Soul" groups led to a regional conference in 2000 co-sponsored by the Behavioral Health Division and the Mental Health Association (MHA). This, in turn, led to the setting up of a "Caring for the Soul" Committee with representatives from major faith groups in the city as well as consumers, family members, parish nurses and mental health professionals. The MHA sponsored the committee and created a part-time staff position for the Chairperson, Gloria Krasno.

A second "Caring for the Soul" regional conference was held in 2002. By this time, it was clear that the success of the hospital based groups had affirmed the significance of people's faith lives in the Procovery process. The obvious challenge was how to extend the concept into our faith communities to support people and family members dealing with mental illness. The first to do this were John Prestby and Sister Ann Catherine at their own parish of Our Lady of Lourdes.

My own involvement in picking up this challenge developed after I retired as a psychiatrist and became a graduate student at Saint Francis Seminary. It seemed a natural ministry for a person with mental health and advocacy experience to pursue. As news of this interest spread through contacts in community based organizations like NAMI and the Grand Avenue Club, we soon had a core group of individuals interested in starting a mental health ministry in their own faith community. We began by naming these ministries "Faith in Recovery" and have so far succeeded in setting up successful programs in five of the six parishes with which we are involved. The individuals are all participants in our afternoon workshop and are named in the program'".

As the "Faith in Recovery" initiative began to succeed, we joined forces with the larger communitywide "Caring for the Soul" Committee. This resulted in the decision to base the Third Regional Conference of "Caring for the Soul" on our practical experiences to date in setting up mental health ministries. Hence the title of "Best Practices in Mental Health Ministry". By sharing these experiences with colleagues in other faith traditions and different parts of the country, our goal is to vigorously expand the program. We believe that this will provide much needed support and encouragement at a difficult time in mental health care and will also be a powerful influence in lessening stigma and discrimination towards people and families coping with mental illness.

In the Beginning.

We are by no means the first to develop mental health ministries. Most religious denominations have mission statements directed towards people with disabilities in general and mental illness in particular.

In 1997, "Pathways to Promise" conducted a national survey of faith communities to determine which ones had a mental health ministry and what were its characteristics. A summary of the results is provided as part of our Toolkit. Briefly, the survey identified five types of programs, in 142 faith communities, ranging from basic one on one support (befriending) to ambitious multifaceted services covering a wide range of mental health needs in collaboration with local agencies.

All the major faith denominations were involved, but the most common was Interfaith. There were programs in 33 states, most of which had three or fewer communities involved. The highest number were in Missouri (home of Pathways to Promise) with 20 communities. In 1997, Wisconsin had only four communities involved - we have now initiated seven more and we know of another seven in the planning stage; two in Milwaukee and five in Door County.

From Hospital to Faith Community.

The challenge of translating the "Caring for the Soul" philosophy from hospital to faith community is influenced and complicated by several factors.

People in hospital are clearly identified as having a mental illness. Back in the faith community, individuals may prefer to remain anonymous to protect themselves from stigma and discrimination. People discharged home from a mental hospital are less likely to contact their minister than those with a physical disability. As a family member said at the "Building Bridges" national conference, "Mental illness is a 'no casserole' disease. When you have other illnesses, congregations reach out - not always with mental illness".

In hospital, everyone is fully informed about mental illness, its treatment and Procovery. Most people in the faith community know very little about these topics.

In a public institution, spiritual groups must be non-denominational and uniform. In the faith community, each ministry identifies with its own unique culture and faith tradition.

Engaging a Faith Community.

Not every faith community is equally interested in, or prepared to assume, a commitment to a mental health ministry. There are a number of steps that may help obtain support and ensure viability. We have developed a one page description of "Faith in Recovery" to facilitate this process (handout).

Seek the endorsement of the clergy. The interest/sophistication of the pastor/priest varies. Some have degrees in counseling or social work and others have personal experience with mental illness themselves or through a family member. This may affect willingness to preach from the pulpit on the topic or stand behind the ministry. Others have different social or ministerial priorities with realistic demands on their time - especially in areas or denominations where there is a priest shortage. Look for aspects that might appeal to the minister. Will the project satisfy unmet needs in the congregation? Will it help the Parish grow? Will it build bridges to neighboring communities? While support of the clergy is valuable, the success of this ministry is not a "top down" process. Rather, it springs from the grass roots upward and outwards through the faith community.

Identify at least one person who is a "champion" for the ministry and who will own it. This would best be either a person with mental illness and a Procovery outlook or a family member who belongs to NAMI.

Identify and obtain the endorsement of key leadership and committees within the community, such as Social Concerns, Justice and Peace and the Parish Council.

Sponsor an initial educational program designed to attract as large an audience as possible. (Potential topics are provided in a handout.) Explain what a ministry might look like, but be sure to seek feedback about people's perceived needs and interest in participating. (A handout is available.)

Based on the response to the initial meeting and feedback, create a team around the "champion" of five or more people familiar with the community that meets regularly, including as many people as possible with practical experience of mental illness. This step is essential to share the burden of organization and avoid burnout. A critical mass is important. In one faith community, the initial attempt at identifying enough interested people faltered. This is being dealt with by planning additional educational programs and including three affiliated sister parishes.

Define the extent to which your community needs match those of others (next section). The culture of communities concerning knowledge and acceptance of mental illness differs. This may depend on previous educational programs or key parishioners (consumers, family members, parish nurses or mental health professionals) who have brought the topic into the open, made it acceptable and lowered the threshold for disclosure. Once you have a clear view of the needs and how to address them, use your committee to plan to implement them. Inform the community of the new ministry and seek their endorsement.

Explore if the parish or any of its committees can provide modest resources to support expenses; such as copying for bulletin inserts, handouts, announcements, etc. Resources for new ministries differ. A Catholic church with a parish school may have limited resources and a young adult population that is primarily devoted to educational and child rearing priorities.

What are the Community Needs?

When we combined the feedback from the introductory programs in our first three parishes (handout), we found a marked consensus. The biggest needs are for support groups (for consumers and family members), someone to call in a crisis, knowledge about community resources and educational programs about mental illness.

Implementing a Mental Health Ministry.

We have found that after we have obtained support for a ministry, identified a "champion" and set up a supporting "Faith in Recovery" committee, that the needs we have defined can be met in two simple ways. This section and the handouts describe that process and the resources available to do so.

1. Educational Programs.

This is placed first for two reasons. Discrimination and stigma are based on attitudes that derive in part from lack of knowledge about mental illness, its causes, effects and treatment. Secondly, simply presenting the facts in a calm, neutral setting provides a forum in which people dealing with mental illness can begin to feel more comfortable, get to know one another and feel more comfortable talking about themselves and the illnesses. Often it is not just the formal presentation, but the opportunity to mingle, ask questions and share experiences afterwards that creates a stronger sense of community that ignites a ministry. Providing hospitality and seeking feedback facilitate this process. Handouts give examples of announcements, topics and programs.

While each parish has gone about this in its own way, there are two times in the year when educational programs are especially appropriate. May is Mental Health Awareness Month and October has Mental Illness Awareness Week. This is coupled with National Depression Screening Day. Using these occasions to present programs emphasizes the scope and commonality of mental health issues.

2. Support Groups.

The initial educational programs, bulletin inserts and word of mouth serve to identify those who seek and may benefit from a support group. The speed with which this happens varies and membership is diverse. Group members include people with mental illness, family members, parish nurses, ministers, mental health professionals and interested parishioners. This mix has a normalizing influence when those with and witpout mental illness mingle around a common purpose. It promotes mutual respect and stifles stigma. As a group evolves, members explore ways to provide mutual support in times of crisis and how to share information about community resources.

Early on, we defined the characteristics of a support group with some basic guidelines, including privacy protections (handout). Today the groups vary in size, frequency and format. There are no attendance requirements, so people come and go depending on need.

What was much slower to develop was an understanding of ways to encourage and deepen a spiritual dimension. Our relationship with the Divine is often taken for granted and not often discussed. Not much is written about how this can be fostered in a group setting around a theme of coping with mental illness. Opinions differed and some people made it clear they did not seek "another prayer group or bible study". This vacuum in our knowledge and a lack of consensus created the opportunity for every community to find its own path. Whichever way was chosen - and there were several (handout) - all our communities have experienced spiritual growth and a deeper understanding of its role in coping with mental illness as the group evolves and trust deepens over time.

Diversity and the Spirit.

This presentation has emphasized some common features of a mental health ministry and our afternoon workshop provides a "toolkit" for a faith community to develop one. This "how to" emphasis does not do justice to one prominent aspect of our shared experience. That is the diverse and unique way in which every individual ministry evolves. This reflects the charisms of its members and the work of the spirit. To capture this element, each ministry has provided a one page summary of its growth experience (handout).

Challenging accepted wisdom, we did not set rigid guidelines for the leadership or evolution of the ministries. As a result, we now have mixed memberships, varied pathways to spiritual growth and differing leadership that includes consumers, family members, ministers and mental health professionals working singly or in pairs.

Likewise, we did not dictate educational topics and each ministry chose its own to reflect the communities interest. For example, initially we omitted stress management because we believe that the major mental illnesses are brain disorders, not caused by stress. Then we realized that stress is a human experience shared by everyone, with or without mental illness and that coping with anxiety is an important part of Procovery, just as in everyday life. It is an educational topic that can unite a community around a common concern.

Hope for the Future.

We cannot predict the future, but should remain open to where the spirit is leading us. This conference relates a short journey in a longer pilgrimage. We hope that our mission will spread to fresh communities and to friends in other faiths.

When today is over, we will begin planning for a fourth conference in 2006. This afternoon, following the workshops, we are seeking your input into its agenda.

We hope that it will include diverse ministries of many faiths devoted to the common good of empowering people and families with mental illness to find strength, support and companionship within their faith community.

Story reprinted by HopeToHealing.com
with permission of Barry Blackwell.
© 2004 Barry Blackwell