Taking a cue from the pews, Texas churches expanding mental health services

People attend praise and worship service at Rehoboth Baptist Church in Austin on March 24, 2024. The church has expanded their services to include mental health counselors as a resource for the congregation. (Credit: Montinique Monroe for The Texas Tribune)

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For 24/7 mental health support in English or Spanish, call the Substance Abuse and Mental Health Services Administration’s free help line at 800-662-4357. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988.

The Rev. Michael Marsh stood before his congregation at St. Philip’s Episcopal Church in Uvalde, knowing his grieving community needed more from him than prayer.

It had only been a few days since a gunman killed 19 children and two adults at Robb Elementary School in 2022, and with very few mental health resources in the city of 16,000, Marsh knew he had to find a long-term solution to heal his community not just spiritually, but mentally as well.

“I was talking to my own therapist, and she told me to contact the Children’s Bereavement Center of South Texas in San Antonio because they’re well-respected and credible. I reached out to them, and in a couple of days, a parishioner told me the Children’s Bereavement Center was looking for a space to set up long-term here in Uvalde,” Marsh said.

Two years later, there’s a partnership between the mental health organization and St. Phillips Episcopal Church. The Children’s Bereavement Center of South Texas in Uvalde is housed inside the church’s former storage building. This collaboration has allowed the center to expand its services to not only children affected by the deadliest school shooting in Texas history but also adults, first responders, teachers, and anyone else who might need it.

“I have had people whose children were directly impacted by the shooting come up to me, and I will ask them if they are going to counseling, and they will say, ‘Well, my child doesn't’ want to go to counseling,’ Marsh said. “I said ‘it’s not a question of whether he or she wants to go. If your child broke his arm, would you let him decide whether or not to go to the doctor? If the answer is no, then why would you let them decide whether to see a counselor?”

Tragedy may have led the Uvalde church to forge a mental health partnership, but their move is part of a growing trend among churches to offer more services to congregants and the public, particularly after so many experienced depression and isolation during the coronavirus pandemic. And many Texans emerged only to discover the state’s severe mental health workforce shortage.

Christian churches have offered a limited array of counseling services to their followers, either from church leaders or fellow members, more are stepping in to expand existing programs and services or banding together with other churches to offer a network of help. In some ways it’s a no-brainer. A 2003 study found that people were more likely to consult clergy for mental health treatment than to seek services from a mental health provider, even if they weren’t religious.

Some, like The Potter’s House in Dallas, the megachurch run by well-known pastor T.D. Jakes, has a counseling center staffed with licensed mental health professionals who incorporate faith-based teachings into improving members’ overall ability to cope during stressful life events. Saint John’s United Methodist Church in Austin has had a mental health ministry team dedicated to removing the stigma of mental illness for the past four years. Community Bible Church in San Antonio has had mental health groups since 2007 focused on those experiencing mental illness because of trauma and a group dedicated to helping teens deal with life's ups and downs.

Rev. Michael Marsh of St. Philip's Episcopal Church speaks on a panel entitled "Uvalde: Resilience, Recovery and Healing" during a community event in Uvalde on May 20th, 2023. (Credit: Chris Stokes for The Texas Tribune)

“I believe there is still a sort of stigma about seeing a counselor, psychologist, or therapist,” Marsh of St. Philip’s in Uvalde, said. “But I also think for rural communities, it’s just more challenging to find mental health professionals, and sometimes the clergy are more readily available.”

No where is this more true than in Texas, which faces a mental health workforce shortage. Today, 98 percent of the 254 counties in Texas are federally designated “mental health professional shortage areas” because there’s only 1 clinician for 30,000 residents. That number is expected to worsen.

This workforce shortage has prevented private and state-run mental health hospitals from operating at total capacity, created long waitlists for therapy services, and forced many private providers from taking on new clients as the demand has exceeded scheduling capacity.

Mental health providers in Texas believe if adequately resourced, pastors and other religious leaders can offer a valuable contribution to taking on the mental health crisis in Texas. It’s a role more churches are taking on.

“The church needs to be able to provide actual care rather than telling the person to pray more or be more spiritual,” said Denise Espino, a mental health provider and director of Mental Health Support Groups for Community Bible Church.

She said one of the main challenges she has witnessed is church leaders being fearful of letting someone with mental illness in their own lives participate in support groups on their campus.

“Many church leaders are more willing to allow family members to meet [meet with pastors or deacons], but when it comes to the person with a diagnosis themselves, they shy away from providing support,” she said.

However, now there are entire curriculums dedicated to faith-based mental health to educate clergy on how to respond to mental illness in their communities.

“Resources are out there - the church just needs to make a commitment and jump in,” Espino said.

People pause in prayer before the ceremonial release of 21 butterflies, in remembrance of the victims of the Robb Elementary school shooting a year ago, at the St. Philip's Episcopal Church in Uvalde on May 24, 2023. (Credit: Evan L'Roy/The Texas Tribune)

Partnering with secular resources

This alliance between secular mental health providers and churches is one that has slowly grown over the last few decades.

“For a long time, there has been a disconnect between clergy and psychiatrists,” said Doug Beach, chairperson of the NAMI’s FaithNet Advisory Group. “I think there has always been skepticism on the part of psychiatry about faith. But now the data has made it clear the importance of community to mental health, and we have recognized that if faith is important to you, then it’s important to your mental health.”

A 2023 study found that people who are deeply religious usually have better mental health as long as they stay connected to the church. But the study also found older congregants with depression relied more on prayer and were less likely to seek mental health treatment.

Beach, of NAMI, said that when he started holding mental health wellness classes over a decade ago at his San Antonio church, he noticed that most of the people attending the meetings were from other churches, not his own.

“I had a woman after one of my classes tell me where she lived, and I told her you know there is a church in your neighborhood that does classes like this, and she told me she already knew, but people might recognize them there,” he said.

Historically, there’s been a stigma around mental illness in many Christian denominations. But since World War II, there’s been a growing conversation within faith communities about mental illness and treatment. In 1993, Pope John Paul II spoke before the international delegation of psychiatrists to express the church’s esteem of psychiatric medicine.

“The idea of demonic possession and stuff like that when it comes to mental illness was probably 15 to 20 years ago. I hardly run into anybody anymore who says that,” Beach said. “I am sure there a few pastors who still do, but they’re pretty much in the minority today.”.

Christians aren’t the only faith considering how to reach followers in need of mental health help. This renewed focus on mental wellness has highlighted the mitigation efforts others have established in their community over the years.

While some faith communities have taken to addressing mental health inside their facilities using in-house programs, others have systems built up already that allow them to redirect those who are having a mental health crisis to care that takes their religion into consideration.

Multiple mosques in the Dallas and Fort Worth area carry information about the Al-Shifa Clinic, a charitable Muslim medical clinic in Richland Hill, near Fort Worth. This clinic allows religious leaders to redirect those needing help to a center with licensed social workers and two psychiatrists.

“Initially, the center was established to provide medical and social services to immigrants and refugees arriving from Bosnia, Iraq, Somalia, and other Middle Eastern and South Asian countries,” said Ahmed. “Since 2004, the center has been providing these services to all indigent residents residing in the DFW area, irrespective of country of origin, ethnicity, and religious beliefs.”

Ibn Sina Foundation, a nonprofit organization serving the Houston area for over 20 years, organized the first Muslim Mental Health Conference for Community Leaders in 2022 to address addiction and mental health in their community. Over 30 mosque leaders attended the conference.

Something similar occurs at the Jewish temples across Texas, where Judaism-based health service agencies have been established to give rabbis the ability to redirect them to faith-based mental health care handled by professionals.

Shalom Austin is a program dedicated to adding mental health resources and awareness in Central Texas communities through financial support and collaboration between temples and mental health providers.

“We offer a variety of mental health programs and services for the community,” said Rabbi Amy Cohen, Shalom Austin’s chief social services officer for Shalom Austin. “This includes one-on-one counseling with a licensed therapist, support groups, and case management services.”

Cohen said the center is currently offering a five-week program to synagogues titled “Life Transitions” to help people through specific events that might cause someone’s mental wellness to suffer.

“Participants will focus on areas such as navigating relationships, career shifts, exploring gender identity, and more,” she said.

Even the federal Substance Abuse and Mental Health Services Administration has a page of links dedicated to getting mental health resources into every religious organization. The agency recommends all faith communities invite mental health experts to speak to their congregations, learn the primary signs of mental illness, and share the 988 Suicide and Crisis Lifeline in their publications.

Wellness director Angela Bigham outside Rehoboth Baptist Church in Austin on March 24, 2024. Bigham has helped bring in mental health counselors as an available resource for the congregation. (Credit: Montinique Monroe for The Texas Tribune)

Despite this new level of mental health awareness, some churches, particularly those in Black and Hispanic communities, have been more reticent. But that too is now changing.

Angela Bigham, the wellness director at Rehoboth Baptist Church in Austin and community engagement director for the University of Texas at Austin School of Nursing, said the hesitancy over the past decade was primarily due to the cultural disconnect between religious leaders and the predominately white mental health field.

“I had an African American woman come up to me saying she wished she could do counseling, but when she went to the psychiatrist, she [the therapist] didn’t understand her background,” Bigham said. The provider, the woman told him, insisted that spanking in the home wasn’t abuse but discipline, and the woman seeking help felt that the therapist kept trying to pin her problems on spanking as a child.

Bigham also recalled that several years ago, when she was doing volunteer work for the University of Texas in Austin, the school was part of an effort to bring mental health resources into African American churches, but the effort fell flat.

“It turns out they were sending like some young girl … wearing thigh-high shorts and flip-flops, into these churches to tell them how many free resources they have,” Bigham recalled. “These elders don’t care if there are free Cadillacs in the parking lot; they are trying to figure out why you are disrespecting their church in your thigh-high shorts and flip-flops.”.

Bigham eventually took over the program and held a town hall event at a Black church where a pastor got up and introduced mental health providers to the congregation and gave them time to describe what free services they had to offer.

“The reaction was great; people were shocked by the things available in their community. They had no idea because there was such a disconnect between everyone,” Bigham said.

Church members attend worship service at Rehoboth Baptist Church in Austin on March 24, 2024. (Credit: Montinique Monroe for The Texas Tribune)

Bridges to Care, a program developed in 2020 by the San Antonio chapter of the National Alliance on Mental Illness, connects the clergy and the congregation with mental health service providers and helps improve the congregation’s understanding of their mental health. Churches that participate must also invite the other churches near their neighborhood.

“We have learned that the program tends to stick longer when you involve the entire neighborhood. Well, we have had 2,000 people go through our program and have worked with 70 congregations in our community,” Beach said.

Beach said the Bridges to Care program has thrived in east San Antonio, a historically Black area of the city.

“I think one of the reasons is that when we asked church leaders to go get your compadres and work together on this, it became their program and their neighborhood’s effort, and it was all being done by their church,” he said.

Beach said the organization is trying to do the same thing on the city’s west side, which is primarily Hispanic, a demographic that has been hard for mental health providers to reach.

“Last year at our Pathway to Health conference, we had a session for Hispanic families to educate them on how to talk about mental health,” Beach explained. “People were in tears because they had been living with this mental illness for years but were unable to explain it to their families, or they realized what was happening to one of their family members. It was overwhelming.”

The COVID-19 pandemic revealed to everyone, church leaders say, that mental illness wasn’t something happening outside of the church but a crisis within their congregation.

“I haven’t met a faith leader recently who doesn’t recognize the impact of the pandemic,” Beach said. “I mean, honestly, most of them know members of their congregation who are dying by suicide, or they have family members who have bipolar disorder or are under psychiatric care. It’s not like mental illness is hiding.”

The critical piece in solving this problem is for religious leaders to do something that can be pretty hard: show vulnerability to their congregations.

“We have found that if pastors are willing to get up in the pulpit and talk about mental health issues, and, in some cases, talking about themselves or their family, it makes all the difference in the world. Suddenly, they give permission to the people in the flock to talk about these issues,” Beach said.

Speaking from the pulpit

Robyn Bishop, lead pastor of Memorial United Methodist Church in Austin, has always had a strong belief in God’s healing power, but in college, she struggled with an eating disorder and needed counseling. Because of this experience, she knew mental health and faith could co-exist, but in 2011, when she was a pastor for a church in Houston, she decided it was time to tell her story during a women’s retreat. The response she received was overwhelming.

“I asked afterward if anyone wanted to ask for prayer, and the next two hours, women started coming forward sharing their stories about how this family member was struggling with bipolar disorder, or this family member was struggling with anxiety or addiction,” Bishop said. “It showed me that if I talked about it more than other people would talk about it.”

The people who stand behind the pulpit are considered among Christians to have faith so strong that they can lead others. But even they can struggle with their mental health, and more religious leaders are starting to tell their stories in hopes of helping others.

“We know now that having a mental illness is like having a broken arm. You need to go to the doctor for it,” Bishop said.

Disclosure: Cadillac and the University of Texas at Austin have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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