Thursday, January 05, 2012

Ministering to People who have Mental Illness

Note from Glenn: This is another post by my friend Marda.  Great information!

Ministering to People who have Mental Illness
In this country, mental illness is more common than generally believed.  Many people suffer with various anxiety disorders and with depression, seasonal affective disorder and other mood disorders.  In the last few years the prevalence of diagnosed bipolar disorder (what used to be called manic-depressive illness) has increased.  In addition, there has been a movement to become more open about mental illness and to remove some of the stigma that has traditionally been linked with it.  Since society in general is becoming more aware of this population it seems reasonable to assume that at some point you will encounter someone with mental illness or at least someone who has close family or friends with mental illness, in church ministry.
Mental illness is, in many ways, an invisible disability since it is often under medical control or is episodic in nature, meaning that sometimes a person will manifest symptoms of the illness and sometimes will not.  Exacerbation of symptoms of a mental illness can be brought on by increased stress, need for medication changes and other factors.  In this series of articles, I will begin with general comments regarding all mental illness and then go into more specifics on how to deal with various conditions.
First, there are two major views of mental illness.  The most commonly practiced one is the medical model, which tends to use drugs as a means of relieving symptoms.  In the medical model, mental illness is thought of as a disease like a physical illness.  Psychiatrists are medical doctors who generally work within the medical model, working with the patient to find the correct medications to ameliorate the symptoms.  In some of these illnesses, such as schizophrenia, schizo-affective disorder and bipolar disorder, where there is clearly chemical imbalance in the brain, medications can be extremely helpful.  Sometimes medications will stop working or a new and better medication will come out and those things as well as other factors can necessitate a medication change.  In some instances, this needs to be done under medical supervision in a hospital, often in a psychiatric hospital or psychiatric unit of a general hospital.  In these days of shrinking insurance coverage, most such hospitalizations will only last a week or two at a time.  But if a person misses church and you know they have a mental illness, it is possible that they are being hospitalized.
The most important thing in dealing with hospitalization, taking of medication or other kinds of symptoms of mental illness is that the mental illness is not the person's fault.  It is not a simple matter of telling someone to pray more for healing of their illness and have more faith.  Telling a schizophrenic person to stop taking their medicine is the same as telling someone to stop taking their blood pressure medicine.  You man not notice immediate deterioration but the person is a time bomb waiting to go off and more than likely symptoms will return.
The second model says that mental illness or disorders are caused by other factors such as environment, personality, reaction to stress and so on.  The primary treatment modality of these people is psychotherapy, which is often referred to as "talk therapy" though there are many other kinds of therapies and alternative healing methods.  In cases of serious mental illness there is often a combination of therapies including medications as well as other treatment approaches. 
So what do you do when a person comes into your Bible study class in a clearly manic state or a schizophrenic psychotic episode?  Patience is paramount.  The person is not likely to just snap out of it.  What you can do is ask for compliance with general rules of courtesy and respect.  A quiet "Someone else is speaking now and in this class we don't interrupt".  Make your statements brief and concrete.  Do not challenge a person's fixed delusion.  It doesn't work and can only make the person more agitated.  If the person continues to be disruptive you might have a designated person to escort him or her from the room and talk to them individually.  Some churches train volunteers to do this kind of thing.  If they are caring and nonjudgmental, possible guilt and shame can often be avoided.
If the person says they are hearing voices that are telling them to kill themselves or someone else, there are several things you can do.  One is to have trained people who can take the person aside and deal with the issue.  Such a trained person will ask if they can talk back to the voices and tell them no, they're not going to kill or whatever the voices are demanding.  Ask if the voices are in the background or are so loud that they can not be ignored.  Generally, the person will say that the voices are distracting and sometimes loud but will often say that they can handle them.  If a person seems to be becoming violent and can't be calmed down and if that person appears to be a threat to him/herself or others, it is time to call either the person's psychiatrist, psychologist or social worker or call 911 and explain the nature of the emergency, where it is taking place and so on so that the appropriate personnel can be dispatched.  While waiting for help, it is best not to leave the person alone unless you think you are in immediate danger.
Most often this drastic action will not be called for as the person can often function in spite of psychotic symptoms.  Sometimes they will be confused and their communication will be unclear.  If words are coming out that don't make sense, a condition unofficially referred to as "word salad", it is best not to demand a clearer explanation.  Just say something like "thank you for that contribution" and move on and if the problem persists, say something like, "We're discussing something else now so it's time to listen" or "That's interesting.  We need to have another person talking now."
What other kinds of manifestations of a mental disorder can happen in a church setting?  Since anxiety disorders are so common, I will deal with them next.
One common anxiety disorder is panic disorder.  In this disorder, a person can have a panic attack, sometimes with no discernible cause.  Again, many anxiety disorders have a biochemical component that is not completely understood.  There is increased production of adrenaline which can cause increased heart rate or palpitations, hyperventilation, sweating, trembling, chest pains, gastrointestinal symptoms, fear of dying just to name a few.  Panic attacks can be frightening to the person having them and to those watching.  They usually peak within ten minutes or so but can sometimes last longer.  The best thing to do again is to have someone take the person to a quiet place and calmly reassure them that they are not dying, they are safe, the panic will subside and so on.  Then it is important to let the person know that you are not ashamed or condemning of them for having the panic attack.
Another increasingly seen anxiety disorder is posttraumatic stress disorder.  This diagnosis was first used when referring to symptoms shown by vets returning from battle who would relive combat experiences in flashbacks as well as being highly anxious or depressed and otherwise having difficulty coping with life.  The term was then expanded to include sufferers of all kinds of traumas, from car accidents, natural disasters and acts of terrorism  to prolonged and severe physical, sexual or emotional abuse.  Posttraumatic stress disorder (PTSD) has a wide variety of symptoms.  Most common are periods when the person is having difficulty in remaining in reality.  They may think they are in the original traumatic situations or they may be overcome with debilitating anxiety.  When someone is triggered into re-experiencing a trauma or aspects of it, they often need to be grounded, or reestablished in reality.  One way to do this is to have someone, either quietly in the room or in another room, have the sufferer take deep calming breaths, then try to have them describe the room, ask if they know who you are and so on.  Sometimes people use things like rubber bands on the wrist that they can snap or ice in the hand, to bring them back to the present.  Personally, I don't like either of those.  I prefer a reassuring voice telling me who they are and where I am.  If I am deeper into an episode, I might need something such as a smell to bring me back.  The main thing is to stay calm and patient.  These episodes are generally short but can be longer.  While you are with the person, ask them to look around the room and describe what's there, have them put their feet flat on the ground (thus the name "grounding") hold onto the chair, etc. and try to get a dialogue going in which you continue to remind them of where they are, what the date and year are, that whatever horrible thing they are experiencing is not happening now and so on.  Frequently, a person who has been living with PTSD for a long time will have developed their own coping skills and will be able to ground themselves.  Sometimes they will carry a "comfort bag" which will contain items with which the person can self-soothe.  So the extreme manifestations will not happen in every case.  Again, it is important to assure the person that you don't think any less of them, that you are there to help in any way you can, that God still loves them and that they are a worthwhile person.
After an episode, or before an episode happens if you know about the person's mental disorder, you can ask what you can do to help should symptoms occur.  Most people will know and be able to tell you.  Remember that you are dealing with another human being, not just a diagnosis.  They are not weak.  They are not malingering.  They are not seeking attention, for the most part.  They do need to know God's love because so often they have experienced little love in their lives.  Try not to fear them and their conditions.  They are children of God, part of his family like you.


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Karen said...

Awesome and informative post, Glenn. Mental illness is so misunderstood. We have a long way to go in removing the stigma. I appreciate your efforts in addressing the issue and helping the Christian community help others.

Karen :)