GLOBAL MENTAL HEALTH
CHALLENGES:
EXPLORING STRATEGIC ROLES FOR
CHURCHES AND FAITH-BASED
ORGANIZATIONS
AACC, Sept.
24, 2015
Bradford M. Smith, PhD
Fred C. Gingrich, DMin
Objectives



1. Summarize the recommendations of the
WHO Mental Health Action Plan and the
NIMH Grand Challenges in Mental Health
Initiative that are most relevant to faithbased organizations.
2. Describe the advantages and
challenges of faith-based organizations’
involvement in global mental health.
3. Critique the approaches presented as
examples of faith-based mental health
programs.
When Jesus saw the crowds, he…




Proclaimed the good news
Healed every disease and sickness
Had compassion on the harassed and
helpless.
“The harvest is plentiful, the workers few.
Ask the Lord of the harvest, to send out
workers into his harvest field.”
Matthew 9: 35-38
Lausanne’s emphasis on holistic mission

“The claim that Jesus is the truth must
be demonstrated in the Christian praxis
of attending to human pain and meeting
human needs.”
 The
Lausanne Movement (www.lausanne.org)
Lausanne Committee for World Evangelization
Theology Working Group
The Cape Town Declaration on Care
and Counsel as Mission


Introduction & Christian
 Holistic and Systemic
 Indigenous
 Collaborative
www.belhaven/careandcounsel/
Global
Mental
Health:
Integration
& Culture
JPC, 2014,
Summer, 33(2)
For example: The case of prayer camps in Ghana
www.youtube.com/watch?feature=player_detailpage&v=XHqdTUlcD4U
Global Mental Health: The Need
Nearly 450 million people are
affected by mental illness worldwide
Depression is the leading cause of
disability worldwide
Mental illness accounts for 15% of
the global burden of disease
Global Mental Health: Consequences of Mental Illness








People die younger
Have more health problems
Get worse medical care
They suffer
Less productive
Are poorer
Relationships are less fulfilling
Their children are impacted
Global Mental Health: The Treatment Gap
The gap between the number of
people with disorders and the number
who actually receive evidence-based
care — is as high as 70% to 80% in
many developing countries.
“CARE AND COUNSEL AS
MISSION”
What business are we in?
Railroads or
transportation?
An Unpopular Message
Developing nations must stop aping
the North's mental health services and
use strategies tailored to their own
needs,
--Vikram Patel, psychiatrist and senior lecturer
at the London School of Hygiene & Tropical
Medicine
http://www.scidev.net/global/health/opinion/
mental-health-in-the-developing-world-time-forinn.html
Uninterested?
“The biggest challenge is that most
mental health professionals in the
developing world (psychiatrists, clinical
psychologists, psychiatric nurses and
social workers) seem uninterested in
responding to the treatment gap.”
--Vikram Patel
Specialist Mental Health Professionals
“But in developing countries, if we
continue to focus almost entirely on
hospital or clinic based patient
management, the specialist mental
health professions will remain, at
best, only a marginal player in
improving mental health care.”
--Vikram Patel (2003)
WHO Pyramid of Mental Health Services
Task-shifting
Developing countries are already advocating
and evaluating this sort of task-shifting
strategy for a wide range of other health
concerns, such as maternal and child health.
“Non-specialist healthcare workers should
become the front-line of mental health services
in poor countries and be incorporated into the
core of mental health provision.”
--Vikram Patel
Who is WHO?


The World Health Organization is a specialized
agency of the United Nations (UN) that is concerned
with international public health. It was established
on 7 April 1948, headquartered in Geneva,
Switzerland.
The WHO Action plan complements WHO’s mhGAP
(mental health gap action programme) focused on
expanding services in low resource settings.
Overall Goal of the Action Plan

“Promote mental well-being, prevent mental
disorders, provide care, enhance recovery, promote
human rights and reduce the mortality, morbidity,
and disability for persons with mental disorders.”
WHO’s Comprehensive Action Plan:
Objectives
1.
2.
3.
4.
Strengthen mental health leadership and
governance
Provide comprehensive, integrated and responsive
mental health and social care services in communitybased settings.
Implement strategies for promotion and prevention in
mental health.
Strengthen information systems, evidence and
research for mental health.
NIMH “Grand Challenges”




National Institute for Mental Health (www.nimh.nih.gov)
“Transforming the understanding and treatment of
mental illnesses.”
http://www.nimh.nih.gov/about/organization/gmh/g
randchallenges
Collins PY, Insel TR, Chockalingam A, Daar A, Maddox YT
(2013). Grand challenges in global mental health: Integration in
research, policy, and practice. PLoS Med 10(4): e1001434.
doi:10.1371/journal.pmed.1001434
New Directions




Central role for community based
care
Greater emphasis on human rights
Introduces notion of recovery and away from a
pure medical model
Addresses social determinants of mental
health: income, education, housing, social
services as part of a comprehensive
response.
Emphases


Empowerment of people with mental disabilities
Need for a strong civil society including promotion
and prevention activities including suicide
prevention.
Civil society

Organizations of persons with mh disorders
Family member and carer associations
Mh and other related NGOs
Community-based organizations
Human rights based organizations

FAITH-BASED ORGANIZATIONS





Development and mh networks and associations of
health care professionals and service providers
Where from here?
1.
2.
3.
Reduce stigma by educating pastors,
church leaders, congregations, and
communities
Integrate mental health into church
health ministries or include both when
starting up.
Advocate for the just allocation of
resources for mental health at all levels.
4.
5.
6.
Use comprehensive strategies that
include a continuum of care: education,
prevention, screening, support and
group approaches
Offer services to the community as a
witness to Christ
Collaborate with other community
groups and agencies.
7.
8.
9.
10.
Utilize task-shifting to increase
resources by training laypeople and
volunteers for appropriate work while
providing supervision
Address social factors impacting mental
health like poverty and racism
Include indigenous approaches to
healing
Consider using available technology
integrated with personal contact
11.
12.
Broaden training for counselors to
include program development,
community approaches, supervision.
Develop forums, networks, and
partnerships for mutual learning and
collaboration.
IS ANYONE DOING THIS?
Denominational statement
United Methodist Church: Ministries in Mental Illness
(www.umc.org/what-we-believe/ministries-in-mentalillness)

 Stigma
 Incarceration
 Deinstitutionalization
 Misunderstanding
of faith
 Responses: healing, congregations, communities, clergy
support, legislation, seminaries
Saddleback Church, CA
Rick & Kay Warren

Signature Issues:
 Purpose
driven life
 Celebrate Recovery
 HIV/AIDS
 PEACE Plan
 Orphan Care
 Daniel Plan (physical disabilities)
 Hope for Mental Health


Annual Conference: Oct. 8-10, 2015
www.saddleback.com
Saddleback’s mental health ministry
C – Care and support for ind. and families
H – Help for practical needs
U – Utilize volunteers
R – Remove stigma
C – Collaborate in community resources
H – Offer hope
- The church has responded to crisis needs, but not so well
to chronic mental health needs
- don’t fix them, friend them (“I have called you friends”
(John 15:15)
Saddleback activities
advertised on website






Suicide loss support group
Autism Spectrum Disorder support group
Depression/Bring back the hope
Bipolar workshop
Eating Disorders support group
The Gathering on Mental Health and the Church
conference
Living Hope & King of Kings Baptist
Church, Cape Town, SA

John V Thomas founded Living Hope (non-profit) in
2000, and has been Senior Pastor of King of Kings
Baptist Church in Fish Hoek since 1987.
(www.livinghope.co.za)
 Living
Care (health care)
 Living Grace (homelessness & addiction)
 Living Right (HIV/AIDS education & prevention)
 Living Way (economic
empowerment)
Armonia , Mexico City
…a journey toward wholeness in
which both helpers and the
person/community in need are
transformed
The PEWS Program




Promoting
Emotional
Wellness and
Spirituality
 “Implementing
a Mental Health Ministry Committee in
Faith-Based Organizations: The Promoting Emotional
Wellness and Spirituality Program.” Williams, L.,
Gorman, R., and Hankerson, S. Social Work in Health
Care, 53:4, 414-434, DOI
10.1080/00981389.2014.880391.
Program Goals







Educate clergy
Reduce stigma
Promote treatment seeking for depression
Educate clinicians about the importance of assessing
client’s spiritual beliefs, by:
Forming partnerships with church staff and senior pastor
Utilizing community based participatory approach
Flexible implementation
Community-based participatory research
(CBPR)


A methodology in which mental health professionals,
researchers, and community members are equal
partners throughout intervention planning,
development, and implementation.
An especially promising approach for African
Americans, many of whom distrust healthcare
professions due to the Tuskegee Syphilis Study and
enduring racial discrimination.
Program elements




Formed a PEWS Advisory Committee composed of
three ministers, one mental health consumer, one lay
community leader and four mental health providers.
Sponsored a “Spirituality and Wellness Conference”
at a trusted venue.
Conference included mental health leaders and faithbased leaders.
Governmental and community nonprofits, academic
institutions, and hospitals
PEWS Curriculum




Day 1 (2 hours)
 Welcome and Introduction
 Pre-Test
 Overview of Mental health Issues and treatment
 Effective communication
Day 2 (3 hours)
 Communication and helping techniques
Day 3 (2 hours) – Crisis intervention
Day 4 (3 hours)
 Referral and community links
 Posttest
 Q and A
Questions to think about…
1.
2.
3.
How significant are the WHO
and NIMH documents?
What concepts from the
Cape Town Declaration and
the twelve recommendations
particularly resonate with
you?
What kinds of information
and connections would help
you in what you are doing?
Discussion Questions


What are the advantages and
challenges for churches and other
faith-based organizations being
involved in global mental health?
What are some examples of
church/FBO mental health programs
and what can we learn from them?
A comment from Rwanda:




"We had a lot of trouble with western mental health workers who came here
immediately after the genocide and we had to ask some of them to leave.
They came and their practice did not involve being outside in the sun where
you begin to feel better. There was no music or drumming to get your blood
flowing again. There was no sense that everyone had taken the day off so
that the entire community could come together to try to lift you up and bring
you back to joy. There was no acknowledgement of the depression as
something invasive and external that could actually be cast out again.
Instead they would take people one at a time into these dingy little rooms and
have them sit around for an hour or so and talk about bad things that had
happened to them. We had to ask them to leave."
~A Rwandan talking to a western writer, Andrew Solomon, about his
experience with western mental health and depression.
From The Moth podcast, 'Notes on an Exorcism'.
Selected References


















Berry, J. W. (2013). Achieving a global psychology. Canadian Psychology /Psychologie Canadienne, 54(1), 55–61. doi: 10.1037/a0031246
Collins P. Y., Patel V., Joestl S. S., et al. Grand challenges in global mental health. Nature. 2011 Jul 6; 475(7354): 27-30. doi: 10.1038/475027a.
Gingrich, F. C., & Smith, B. M. (2014). Global realities, cultural diversity and Christian responses: Introduction to a special issue. Journal of
Psychology and Christianity, 33, 99-100.
Gingrich, F. C., & Smith, B. M. (2014). Culture and ethnicity in Christianity/Psychology integration: Review and future directions. Journal of
Psychology and Christianity. 33, 139-155.
Gergen, K. J., Gulerce, A., Lock, A., & Misra, G. (1996). Psychological science in cultural context. American Psychologist, 51, 496-503.
Hook, J. N., & Davis, E. E. (2012). Integration, multi-cultural counseling, and social justice. Journal of Psychology & Theology, 4, 102-106.
Inter-Agency Standing Committee (IASC; 2008). IASC guidelines on mental health and psychosocial support in emergency settings. Geneva,
Switzerland. Retrieved from http://www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_june_2007.pdf
Marsella, A. J. (2011, Oct.). Twelve critical issues for mental health professionals working with ethno-culturally diverse populations. Psychology
International. Retrieved from http://www.apa.org/international/pi/2011/10/critical-issues.aspx
Marsella, A. J., & Yamada, A. M. (Eds.). (2007). Culture and psychopathology: Foundations, issues and directions. In S. Kitayama & D. Cohen,
Handbook of cultural psychology (pp. 797-818). New York, NY: Guilford.
Miller, W. R. (Ed.). (1999). Integrating spirituality into treatment: Resources for practitioners.
Washington, DC: APA.
Moriarty, G. L. (2012). Where do we want to be in 10 years? Towards an integration strategy for clinical psychologists. Journal of Psychology and
Theology, 40, 41 – 44.
Mostert, J. H. (2012). Community psychology as socio-missional entrepreneurship. Journal of Psychology and Christianity, 31(1), 66-70.
Patel, V., Saraceno, B., & Kleinman, A. (2006). Beyond evidence: The moral case for international mental health, American Journal of Psychiatry,
163, 1312-1315.
Smith, B.M., & Gingrich, F.C. (2014). Psychology in the context of holistic mission: The challenges of witness, worldview and poverty. Journal of
Psychology and Christianity. 33, 101-113
Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice (6th ed). New York: John Wiley & Sons.
van de Vijver, F. J. R. (2013, Nov. 1). Contributions of internationalization to psychology: Toward a global and inclusive discipline. American
Psychologist. doi: 10.1037/a0033762
World Health Organization. Mental health action plan 2013–2020. 2013. [Cited 1 April 2014.] Available from URL:
http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf.
Journal connections





Mental Health, Religion & Culture.
Journal of Religion and Health
Global Health Action (public health Sweden)
http://journals.co-action.net/index.php/gha
Advances in Mental Health
Transcultural Psychiatry
Contact info:
Bradford M. Smith, PhD
Lausanne Senior Associate for Care and Counsel
as Mission
Director, Institute for International Care and
Counsel, Belhaven University, Jackson MS
bmsmith@belhaven.edu
Fred Gingrich, DMin
Professor of Counseling
Denver Seminary
fred.gingrich@denverseminary.edu
Copy of PowerPoint

www.belhaven.edu/careandcounsel/

Email Fred (fred.gingrich@denverseminary.edu)