Reaching the Mentally Ill Millions

Today millions of Americans will wake up and battle with themselves simply to get out of bed and go through the motions of their everyday routines. They will do the same tomorrow, the next day, and even the next—ad infinitum, without hope that anything ever will change. Why such hopelessness? Anyone who has ever experienced a mental illness firsthand will explain: It just feels impossible to break free.

That’s one of the many lies that mental illness tells, and according to the National Alliance on Mental Illness (NAMI),one in four Americans believe it. More than 60 million people suffer from some kind of mental illness, from mild depression to the debilitating neuroses that, left untreated, manifest in dangerous ways. Fortunately, modern treatments for many mental conditions are as effective as antibiotics or vaccines are for physical conditions. Yet nearly two-thirds of people don’t seek mental-health care, even when they desperately need it.

Among the factors that keep people from seeking care is our society’s failure to acknowledge mental illness as a policy priority, which has left us with no comprehensive system of mental-health services. Instead of recognizing mental illness as a policy issue in and of itself, policymakers prefer to address corollary issues, evidenced most recently by the rhetoric that emerged in the wake of mass shootings: Gun-control reform erupted as a huge policy issue, but mental-health policy received comparatively little attention. The World Health Organization has been calling for reform in this arena for nearly 20 years,noting even in 1996 that “everyone in need should have access to basic mental health care” that is not only affordable and equitable, but also preserves “the dignity of the patient.” Such language is interesting; it implies a call for justice, for both legislation and services that combat the stigma of being mentally ill.

The government attempted to combat that stigma when it de-institutionalized mental-health care and moved to a community-based care model in the mid-20th century. “Unfortunately, local communities largely failed to provide the services necessary for all the people sent their way,” says author Amy Simpson, whose mother has schizophrenia. “At the same time, stringent privacy laws, strict standards for committing a loved one to care, and insurance limitations have left many families in way over their heads, trying to care for people who desperately need professional help or residential care and won't seek it on their own.” Further complicating the matter is that most private insurance companies still fail to offer adequate coverage for mental illness—not at all comparable to the coverage available for physical illnesses. All of this results in a system where “jails and prisons become our default care centers (for extreme cases of mental illness),” Simpson states. “Sadly, commission of a crime is the only way for some people to get the care they need.”

But simply offering greater access to those clinical services is not enough; almost 2 in 3 adults who suffer from mental illness do not seek help, or even know when it is available, in earlier stages of illness. Unlike physical ailments, mental illnesses come with a huge degree of shame, the burden of which might be greater than the burden of the illness itself in some cases. Our culture prizes perfection—having it all together—and admitting to others that one struggles with a mental illness—not having it together at the core of one’s self—is seen as the ultimate failure.

  More than 60 million people suffer from some kind of mental illness, from mild depression to the debilitating neuroses .

More than 60 million people suffer from some kind of mental illness, from mild depression to the debilitating neuroses .

Unfortunately, this shame is especially prevalent in the church, the one place where we should be able acknowledge that we are broken and failing. That’s hardly the reality in many churches, which can feel more like museums of saints than hospitals for sinners. Even the most well-meaning Christians inadvertently can minimize mental illness by attributing it only to fallen human nature, treating it as if it were only a spiritual problem that can be alleviated through greater faith or more diligent prayer.

In doing so, the church fails to see mental illness as a marginalizing factor with the power to violate one’s inherent dignity. Extreme cases of mental illness violate dignity in visible ways, manifesting alongside other societal ills—including homelessness, poverty, broken families, crime, among others—or occurring as a result of them, so it should come as no surprise that the list of conditions associated with mental illness encompasses many of the marginalized groups to whom Christians minister. Are we as Christians called to alleviate homelessness? The government reports that “approximately 26 percent of homeless adults staying in shelters live with serious mental illness and an estimated 46 percent live with severe mental illness and/or substance use disorders.” Do we focus our efforts on underprivileged youth? “Seventy percent of youth in juvenile justice systems have at least one mental health condition,” NAMI says. Of course, that’s not always the case; it would be foolish to assume that these conditions always go hand in hand. Yet, it is equally foolish to ignore or remain ambivalent toward mental illness, which signals willful disregard for the whole Christian mission.

It is part of our calling as Christians to advocate care for the mentally ill—just as we do for the poor, the widows, the orphans, the disabled, and others—because millions who suffer from minor mental illnesses may never fall into these other categories. Rather, we must acknowledge the mentally ill as their own population and do more than simply pray for individuals’ mental disorders to be absolved. As Simpson points out, ignoring mental illness leads us to “acquiesce our responsibility to be the church, who ‘must clothe yourselves with tenderhearted mercy, kindness, humility, gentleness, and patience’ (Colossians 3:12).” It is even more troubling not to ignore mental illness but to treat it solely as a spiritual problem; in so doing we “suggest that suffering people aren’t eligible for God’s grace. We behave like the Pharisees, whom Jesus said ‘don’t practice what they teach. They crush people with unbearable religious demands and never lift a finger to ease the burden’ (Matthew 23:3-4).” Instead, Christians are called to do more. We must advocate better care for the mentally ill in the form of policies that provide adequate support and accommodation for mental illnesses across the spectrum, as well as support for families whose mentally ill members refuse treatment.

Moreover, a comprehensive system of mental-health services would require many institutions working together to provide funding and access to treatments, ranging from medicine to counseling. Local churches can lead the way among those institutions, not only by advocating increased funding but also by providing low- and no-cost access to counseling as a ministry, either through licensed members of the congregation or through partnerships with local Christian counselors who volunteer their time and services. Esperanza Health Center in Philadelphia, Pa. for example, provides holistic care—including psychological services—”without regard to an individuals’ ability to pay.” Across the country in California, Rick Warren’s Saddleback Church offers emotional health resources for congregants who struggle (It’s also worth noting that Warren’s son Matthew committed suicide this past spring after a lifelong struggle with depression). A third option for a counseling ministry would be to offer mentorships with other Christians who may not be licensed professionals but who have faced—and overcome—similar struggles.

Such encouragement, that these real and present struggles can be overcome, is among the most important things that mentally ill people need to hear. Even though the most extreme cases are those in which we see the external symptoms, millions of Americans exhibit less visible signs of their internal struggles. The majority of those who suffer from mental illness battle for their dignity not against society, but against themselves. They fight against a brain that lies, telling them they have no inherent dignity. And so goes the lie: Mental illness makes you believe that you are unworthy of love as a person—and if you’re not worthy of love, you certainly don’t deserve help. And with 40 million Americans who never seek help for their mental illness, that’s one of the most dangerous lies in society today.

-Melissa Steffan is the assistant editor for 1776 in Washington, D.C., and is a 2012 graduate of Seattle Pacific University. She previously interned at the Washington Post and the Center for Public Justice, and was the 2012-13 Editorial Resident for Christianity Today magazine. You can follow her on Twitter at @melissasteffan.