There is a growing global mental health movement around the world today;^[1] and the global church is beginning to recognize mental health problems, which are the leading cause of disability worldwide—more disabling than such conditions as heart disease, stroke, or diabetes^[2]—as a major ministry priority.

Mental health problems are usually the result of a combination of many factors, including family environment, biology, personality, spirituality, and challenging community contexts, including poverty and violence. Increasingly, the impacts of traumatic events such as childhood abuse, interpersonal violence, or natural disasters are being recognized as major causes of mental health problems.

Scriptural roots

We often think only of one-on-one counseling as the best approach to addressing needs. However, increasingly community-based approaches are being identified as essential to addressing the need on a global level;^[3] and churches, as communities of faith where people can find safety and help in times of need, can have a key role.

Mental health care is rooted in Scripture:

• The prophet Isaiah described part of the mission of the coming Messiah ‘to bind up the brokenhearted’ (Isa 61:1).
• Jeremiah wrote of the Messiah: ‘I will turn their mourning into gladness; I will give them comfort and joy instead of sorrow’ (Jer 31:13).
• In the New Testament, we see that, ‘Jesus went through all the towns and villages, teaching in their synagogues, proclaiming the good news of the kingdom and healing every disease and sickness’ (Matt 9:35).

The Holistic Mission Issue Group of The Lausanne Movement’s 2004 Forum for World Evangelization explicitly included mental health as part of holistic mission, noting thus:

Holistic mission is mission oriented towards the satisfaction of basic human needs, including the need of God, but also the need of food, love, housing, clothes, physical and mental health [our emphasis] and a sense of human dignity.^[4]

To address this issue, the Movement created a new Senior Associate role in Care and Counsel as Mission in 2009. In 2016, this focus was more clearly defined as ‘Global Mental Health and Trauma’ (GMHT) with Drs. Gladys Mwiti and Bradford Smith, co-authors of this article and clinical psychologists in Kenya and the US respectively, as Catalysts.

Lack of attention

GMHT may best be understood as an issue that intersects with many issues with which the global church is already engaged such as, health, disabilities, children at risk, refugees, business, community development, and social justice. Yet, because of stigma and lack of consensus in the church about its definition and causes, mental health is often lost in the global dialogue when the focus turns to more obvious dimensions of these problems.

The lack of attention to this important issue both by the church and secular society has left thousands of people with mental health problems stigmatized, judged as spiritually deficient, and sometimes, in the case of major mental illness, locked up and even chained in institutions where they are exposed to poor living conditions, sexual and physical abuse, and neglect.^[5] Those with mental health problems have poorer health care, diminished human rights, and higher mortality. They comprise one of the largest mission fields for the church worldwide.

New treatment strategies and the church’s role

The global mental health challenge concerns not just how common and disabling mental health disorders can be but also the ‘treatment gap’. Globally, less than 50 percent of those who need mental health treatment receive it. This gap climbs to over 90 percent in the least-resourced countries in the world.^[6]

To address this inequity, new strategies have been developed. They encompass a much broader approach including education, health promotion, prevention and ‘task-shifting’ of treatment approaches. Task-shifting is a strategy of training people who may not have, for example, graduate-level education, to perform specific therapeutic tasks under the supervision of more highly trained clinicians. These new approaches, which create new roles for non-professionals working in mental health, provide an open door for the strategic involvement of churches in offering support, education, and basic people-helping skills.

Research in the US shows that often pastors are the first persons a family calls when there is a mental health crisis.^[7] Yet, pastors are often reluctant or feel ill-equipped to speak about mental illness from the pulpit. Dr Ed Stetzer, Executive Director of Wheaton College’s Billy Graham Center, urges pastors to speak openly about mental health problems as one would about any other health issue and to educate their congregations. Stetzer has coined the phrase, ‘sermons stop stigma’.^[8]

There are additional challenges. For example, the lack of consensus around appropriate terminology—mental health, emotional health, behavioral health, Christian wholeness—and around the relationship of mental health to spiritual causes, has hindered attempts at more collaboration. Another key issue is the role of culture and the critique that much of mental health is understood through the lens of Western assumptions.

Despite these challenges, the belief appears to be growing that the global impact of mental health problems is now too large for the church to ignore:

• Saddleback Community Church in California has created a church-wide emphasis on mental health that spans all of their ministry programming. They hold a Gathering on the Church and Mental Health each year.
• World Vision, following recommendations by the World Health Organization, is building mental health response into many of its programs.
• The German Institute for Medical Mission (DIFAEM) runs projects for traumatized women in the Democratic Republic of Congo, integrates mental health care to address a high and growing rate of depression and suicide partly caused by gender-based violence in India, and is launching a project in Germany entitled ‘Congregations and Depression’.^[9]

Mental Health Ministries^[10] recommends a five-step program for creating caring congregations in the area of mental health:

1. 1
   Education
2. 2
   Commitment
3. 3
   Welcome
4. 4
   Support
5. 5
   Advocacy

The urgent need for trauma response

A priority issue in global mental health is providing care to those who have experienced traumatic events—which are becoming increasingly common.^[11] A traumatic event is defined as one in which an individual or community experiences or witnesses actual or threatened death or serious injury to self or others.^[12] Trauma overwhelms the capacity to cope. Examples of traumatic experiences include sexual abuse, physical maltreatment, exposure to war, terrorism or political violence, kidnapping or abduction, traumatic loss and bereavement, terminal illness in the family, and forced displacement and extreme interpersonal violence.

Most of the time, and depending on factors like nature of trauma, resilience, individual coping skills, social support, and spiritual resources, psychological trauma heals with time.^[13] However, for others, the impact of traumatic stress may persist over time and lead to other negative outcomes such as depression, physical illness and relational struggles, making it difficult to cope. Serious symptoms of post-traumatic stress disorder (PTSD) can be debilitating, with the more affected survivors of trauma wearing down family members.^[14]

Traumatic exposures may eventually lead to PTSD, depression, anxiety, and other mental health conditions, risk-taking behavior, and chronic physical disorders.^[15] In addition to mental health stressors, traumatic stress increases the likelihood of social problems such as substance abuse and lowered productivity.^[16] Sexual, physical, and psychological abuse frequently occur together, as do child abuse and exposure to domestic violence.^[17] The adverse effects on the survivors influence the whole personality leading to shame, fear, guilt, and low self-esteem.^[18]

Repeated massive trauma over a period of time causes individual, community, and structural devastation that breeds mistrust, anger, and betrayal between individuals and impedes efforts at peacebuilding and reconciliation. Research indicates that even if war stops, negative interpersonal attitudes often remain and violence may recur.^[19]

A study of Rwanda Gacaca courts, where truth-telling was used as a means of reconciliation and healing after the 1994 genocide, indicated that, contrary to claims of psychological health, truth-telling rarely contributes to trauma healing because it fails to underline trauma effects.^[20] Trauma healing is a complex process that must be carefully managed to achieve the effects of post-conflict peace building.

Psychological trauma: a Christian integrative perspective

Christians often navigate their understanding of healing from traumatic stress between the extreme of expecting total deliverance from the effects of trauma at the one end of the spectrum or leaving a survivor to nurse their suffering endlessly. A theologically balanced approach acknowledges the reality of trauma and suffering and then embraces unique means of healing and living that enable post-traumatic growth through time.

The ability of the wounded to find peace and the speed of this healing depend on several factors:

• The uniqueness of the traumatic experience
• Presence of other traumatic events
• The individual’s ability to recognize and handle unpredictable trauma triggers
• The nature of one’s spirituality
• The levels of social support and readiness to take up these amenities as we express our pain to a caring God

The ability of the human heart to cry out unreservedly to God creates the opportunity for a healing relationship between wounded humanity and a caring God.^[21] Lament, as described in Psalms, models deep cries of the believer to God in times of despair.^[22] Laments are raw, unrefined cries that remind us that we do not have to package our pain into tidy bundles before we ask God to make sense of disaster. He meets us there in our pain and weeps with us.

Willow Creek Church, Chicago, is in partnership with Christians in DR Congo in an intervention labeled Congo Initiative. This nation has been steeped in a crisis that has destabilized the economy and resulted in violence by armed groups against civilians in the eastern region. Congo Initiative is a community of Christ-centered Congolese leaders and global partners united to create a sustainable Congolese society by empowering leaders, and developing initiatives for peace, hope, justice, and trauma healing. Such multidisciplinary, transnational partnerships can bring healing and transformation to traumatized communities.

Churches’ response

In his abundance, God has strategically placed churches to meet the needs of those with mental health problems including those suffering from the wounds of trauma.^[23] Churches as Christ-centered communities of faith and healing can bring the resources of Biblical teaching, prayer, fellowship, hospitality and caring, counseling, and advocacy for justice to address the needs of those suffering with mental health problems.

What can churches do? With no additional budget or staff, churches can:

1. Talk about the issue using language that is appropriate for the church and cultural setting. There is tremendous stigma-breaking power in a pastor addressing mental health and trauma from the pulpit.
2. Encourage the congregation to offer practical help and hospitality to those who are suffering and their families, as a church body would for any illness or crisis.
3. Help connect those in need with trustworthy community resources. Have referral resource information available and make sure the congregation is aware of it.
4. Reach out and extend Christ’s love through friendship. Those who struggle often feel excluded and isolated and may need extra outreach to know that they are welcome as part of the fellowship.

It is essential we continue to communicate that mental health is a high priority and work together to address it. As the World Health Organization states, ‘There is no health without mental health.’^[24] Addressing issues of mental health and trauma may be one of the most urgent, emerging priorities within the wholistic mission of the global church.