Thursday, July 21, 2011

Ministering to Those Who Have Serious Mental Illness

(This is another guest post from my friend Marda. -- Glenn)



Chances are good that you have at least a few people in your church who have been affected by mental illness to some degree, either suffering with it themselves or dealing with family members who have it.  Major depression and various anxiety disorders are fairly common.  Anxiety disorders can include social anxiety disorder, which might make a person seem shy and standoffish, panic disorder, where a person may go into a panic attack during the service and feel trapped, unable to escape, generalized anxiety disorder, which is a constant level of anxiety and worry, to PTSD (posttraumatic stress disorder) which is well-known to be related to some veterans who, as a result of outside stimuli such as a car backfiring, interpret that as the sound of a gun and re-experience what it is like to be in battle, but which is also seen in survivors of trauma, either a one-time event such as an accident or a natural disaster or something which has occurred over years such as prolonged abuse.  In PTSD a person may experience flashbacks, thinking they are back in the traumatic situation.  These can be scary, both for the PTSD sufferer and for those around him/her but they are manageable with a few simple techniques.
 
The other major class of mental illnesses that you might find are psychotic conditions such as schizophrenia, schizo-affective disorder and bipolar disorder I with psychotic features.  In these conditions, people may see or hear things that aren't there, may have some delusions of grandeur or may be paranoid, afraid that someone or everyone is out to get them.  There are other illnesses, such as personality disorders, but they may not be as easily recognized in a church setting and they are dealt with differently.
 
The important thing to know about all of these illnesses is that the brain of the person has been affected.  These people, if they really have the mental illness, are not malingerers or attention seekers.  They are often on medications to reduce their symptoms but psychiatry is still not an exact science so sometimes the medications won't be working, they need a new medication or they think they're better and they go off the meds and then things can quickly deteriorate.  But these people need to be treated with compassion and love, not stigmatized for being different.
 
Before I go on to the practical ways that we can help this group of people to become Christians or to have a more meaningful church experience and relationship with God, it is important to address several kinds of erroneous thinking about the mentally ill.
 
First, the media is fond of promulgating the myth that mentally ill people are generally violent.  Some are.  But the percentage is small and you are not likely to run into a more violent person in your church.  In general, people with schizophrenia and other psychotic disorders are not violent.  Their thoughts are sometimes disordered and they may seem to be disconnected from what's going on at times but that can be dealt with gently and patiently.  Mentally ill people are often misunderstood but they are God's children too and need to know they are loved by God and His people.
 
If you feel drawn to mentally ill people in your church and want to help, here are a few suggestions.
 
1.  Anxiety and panic attacks can be terrifying experiences.  If someone is having a panic attack, they may be sweating, trembling, hyperventilating, having heart palpitations, and feeling utter confusion and fear.  Often, they are afraid they are in a situation from which they can't escape or they may feel like they're dying.  Speak to them in a quiet, calm,, reassuring voice.  Offer to go with them out of the church or Sunday school class situation if they feel they need to leave the room to get themselves together.  Try to get them to slow their breathing and to take deep breaths.  Do not have them breathe into a paper bag.  That is not medically helpful and can be harmful.  Offer to stay with the person and talk them through the attack.  Generally, a panic attack will peak within about ten minutes and then the person may be tired and drained but will be able to manage on their own.  They may then choose to go back into church, stay outside in the lobby or go home.  Make it clear that you will be happy if they stay but that you'll understand if they have to leave.  Ask them what they need, if they need any help, then act accordingly.  If they want you to sit with them for the rest of the service, offer to do that.  Sometimes knowing there is a "safe" person, one who will accept them where they are and help them to deal with such attacks can make the situation more tolerable and, when they feel more safe, panic attacks can decrease.
 
Don't tell them to "get over it", to get off medication, or that if they just prayed enough and had enough faith they would be healed of their condition.  Any healing is done by God and in His own way and time.  Think of yourself as walking alongside the person as they go on their healing journey.  Don't assume that the panic attacks will go away overnight.  Often, such attacks seemingly come out of nowhere and are physiologically based.  Often, if panic attacks have occurred before, the person is worried that they will again and that can aggravate the condition.  But saying things that would result in the person experiencing further guilt and shame will not be helpful.  Telling someone that you will stay with them through the attack and that it will end can be helpful.
 
2.  Post traumatic stress disorder:
While this condition has many manifestations, one of the most common and sometimes problematic is the flashback.  This is where something, sometimes known to the person and sometimes not, triggers the person to think they are back in the situation that produced the trauma.  If this happens in church or Bible study class, have someone go and speak quietly to the person.  Sometimes it is helpful to get the person into another room away from the group of people.  You can then start having the person do grounding exercises.  This involves asking the person to look around the room and tell you what they see.  Grounding techniques use all possible senses.  So have the person put their feet on the ground and feel them there.  Remind them that they are in church and this is (date, month, year) and that they are safe.  Some people find that holding a piece of ice or snapping a rubber band on their wrists can bring them out of a flashback.  Others find that a certain scent will help.  Some people with anxiety disorders carry a "comfort bag" which contains all sorts of things that can be helpful to them during an episode.  Using a comfort bag can also help ground the person.
 
Flashbacks vary in their length of time.  The sooner into the flashback you can get to the person the better, before it escalates and the person goes further and further into it.  Stay with the person and continue to remind them that they are safe now, the situation they think is happening is in the past, and then continue to help the person to become grounded.  After the flashback ends, the person may or may not want to talk about it.  Don't shrink away from it if they do want to talk but it is important to keep reminding the person that the incident is not happening now and that they are safe at this very moment.  As with panic attacks, flashbacks don't just go away overnight.  As the person gets treatment and heals they may lessen in intensity or frequency. But this will be different for every person.
 
3.  If a person is suffering from psychotic symptoms those are dealt with differently.  Generally, if a person is delusional, you can't break the delusion with words.  If they are seeing or hearing hallucinations, telling them that you're not seeing or hearing those things can sometimes help but often makes the person feel worse or act defensively.  You can encourage the person to talk back to the voices and sometimes that can help the voices to be quieter.  Sometimes, if the person is being disruptive, offer to get to another room and talk or just tell them they need to be quiet and let other group members share.
 
The key to ministering to the mentally ill is to treat them with acceptance and kindness.  They need to be treated as people with worth and dignity like everyone else.  Chances are they've gone through a lot and faced a lot of stigma and people who don't take time to understand them.  If you pray and ask God to give you compassion and a willingness to work with them, if you educate yourself about their condition and how to handle it, that can go a long way toward helping them.  Sometimes, if they are not getting treatment, you may want to encourage them to do so and help them find appropriate means of addressing their issues.  But if you do that, continue to be supportive when their conditions manifest around you.  Pray for discernment as to what you need to do and how involved you need to be.  You can't minister to everyone and sometimes boundaries need to be set.  But these people often have few means of support and the church can be very helpful in that area in a wide variety of ways.
 
I pray that this information has been helpful and that it will make the whole idea of mental illness less frightening and that it will help you to reach out to these often lonely people.

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