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Perspectives of Mental Health and Religion

Ebony Gaffney, MD, PhD, MBA

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Disclosures

Disclaimers

None

Personal bias

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Objectives

Understand the role of Faith Based Organizations as gate-keepers.
Understand the difference between Religion and Spirituality as it relates to psychological distress.
Understand the affect of Religion and Spirituality on mental health and physical health outcomes.
Understand the relevance of Religion and Spirituality in treatment for mental illness.

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Introduction

The role of the church….
General aversion to formal mental health services.
Faith based organization versus evidence based medicine.
The church or a faith based organization (FBO) continues to be an avenue or gateway to at risk populations.

The role of African American churches in decreasing mental health disparity and stigma within the African American community is important to acknowledge (Belin et al., 2006). Studies show that mental health is essential in the ministry of African American clergy (Spriggs & Sloter, 2003; Vassol, 2005; Young, Griffith, & Williams, 2003). Clergy attempt to address the complex needs of their congregants, whether they are social, psychological, spiritual, or physical. Their role could also include linking congregants with mental health professionals in order to provide the best treatment options, just as they would with physical health providers.

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Personal background information regarding being a minister
Attitude influenced by diverse backgrounds, personal perspectives; however so powerful that it can influence a behavior and how one perceive the information
General aversion
Those of faith receive more help for their psychological distress from their faith based organization than from medical professionals .
General aversion to professional mental health service is secondary to preferring friends, family, and their religious beliefs for support (Hardy, 2012).
FBO: A faith based organization has the general trust of the community they are providing for when it comes to their personal business and lives
Which leads to…health fairs, pamphlets, and free clinic (to name a few)

increase engagement in treatment due to the churches with positive attitude toward attitudes toward seeking treatment

Gateway

(African American, Latinos, Africans) faced with healthcare disparities in different areas of medicine (diabetes, obesity, breast cancer).

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Faith Based Organizations

Inconsistent messages
Impact of Attitudes

underutilization of professional mental health services
“…the duration, course, and outcome for treatment of those who actually seek professional psychological services”. (Obasi & Leong, 2009)

Intervention development model (Kramer et al., 2006)

Obasi, E. M., & Leong, F. T. L. (2009). Psychological distress, acculturation, and mental health-seeking attitudes among people of African descent in the United States: A preliminary investigation. Journal of Counseling Psychology, 56(2), 227–238. doi:10.1037/a0014865

Kramer, T. L., Blevins, D., Miller, T. L., Phillips, M. M., Davis, V., & Burris, B. (2006). Ministers’ perceptions of depression: A model to understand and improve Care. Journal of Religion and Health, 46(1), 123–139. doi:10.1007/s10943-006-9090-1

Several belief systems concerning mental illness versus mental health, therefore inconsistent

Conflicting messages to the community
For example, African American Baptist clergy share the same denomination and doctrine, however they are still diverse in their education, theological beliefs, and personal experiences with mental illness, factors that could influence their attitude toward congregants seeking professional mental health counseling.

Intervention development model

provide opportunities to build trust between African American clergy and mental health professionals, decrease the stigma and increase awareness of mental illness, and improve treatment outcomes.
clergy can intervene at this stage by being open to talking about mental illness from the pulpit to lessen the stigma
Kramer et al., 2006, p. 125). This study presented different perspectives based on race regarding how to handle depression in their congregants, but the model showed a consensus to address it from an institutional religious approach.

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Clergy/Leadership

Spiritual religious framework

Conservative views

Fear of mental health professionals lacking the understanding of the God-concept

Obasi, E. M., & Leong, F. T. L. (2009). Psychological distress, acculturation, and mental health-seeking attitudes among people of African descent in the United States: A preliminary investigation. Journal of Counseling Psychology, 56(2), 227–238. doi:10.1037/a0014865

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May be considered

Religious beliefs may hinder believers from seeking professional services secondary to being viewed as being weak or having a lack of faith
Additional barriers include stigma, shame/embarrassment, cultural mistrust, lack of knowledge, access and transportation with lack of insurance or financial resources

Which can delay services secondary to a decrease in understanding and fear of the mental illness

Study: Obasi & Leong (2009)

Inverse relationship btw strong religious faith and trust in professional mental health services, associated with stigma and their interpersonal openness
Surveyed African descents if faced with psychological distress, would predict attitudes toward seeking professional psychological services
That psychological distress does affect the attitude of help seeking behavior (ADVERSLY)
Psychological distress is perceived as an internal cause therefore the more you have the less likely you are able to be spiritual I believe this goes both ways.

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Mental Health Professionals

Personal spiritual religious framework

Conservative psychiatric views

Fear of psychiatry lacking the understanding of religion

Obasi, E. M., & Leong, F. T. L. (2009). Psychological distress, acculturation, and mental health-seeking attitudes among people of African descent in the United States: A preliminary investigation. Journal of Counseling Psychology, 56(2), 227–238. doi:10.1037/a0014865

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May be considered

Religious beliefs may hinder believers from seeking professional services secondary to being viewed as being weak or having a lack of faith
Additional barriers include stigma, shame/embarrassment, cultural mistrust, lack of knowledge, access and transportation with lack of insurance or financial resources

Which can delay services secondary to a decrease in understanding and fear of the mental illness

Study: Obasi & Leong (2009)

Inverse relationship btw strong religious faith and trust in professional mental health services, associated with stigma and their interpersonal openness
Surveyed African descents if faced with psychological distress, would predict attitudes toward seeking professional psychological services
That psychological distress does affect the attitude of help seeking behavior (ADVERSLY)
Psychological distress is perceived as an internal cause therefore the more you have the less likely you are able to be spiritual I believe this goes both ways.

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Religion and Spirituality

Payne, J. S. (2008). “Saints Don’t Cry”: Exploring messages surrounding depression and mental health treatment as expressed by African-American Pentecostal preachers. Journal of African American Studies, 12(3), 215–228. doi:10.1007/s12111-008-9044-7

Religion and spirituality are equally important determinants of mental health.

The literature does confirm that help seeking behavior toward clergy increases during psychological distress (Chapman & Steger, 2010; Corrigan, 2004).
It is also noted that help seeking behavior can also be affected by an individual’s theological beliefs, church attendance, and certain religious practices (Spriggs & Sloter, 2003).
These interactions are known to have both negative and positive effects in regard to mental illness amelioration.
Less discussion can further lead to denial or rejection of the existence of mental illness within the the church community due to a religious undertone of denial perceived by congregants as emanating from clergy.

Payne (2008) did a qualitative study regarding statements made from the pulpit by African American Pentecostal preachers about depression. The study found that three out of 10 sermons substituted descriptive terms and phrases, such as “bottom falling out” or “cloudy or rainy days” instead of the words mental illness or depression (p. 222). The analyses showed that the term “depression” was associated with having a weak faith and being viewed as having a negative attitude concerning God. The sermons were also clear that using medication for mental illness instead of God was considered a poor substitute to reliance on the Holy Spirit. The study did not determine if clergy actually believe that mental illness existed in general, just that they did not believe it existed among those of the Christian faith. Therefore, it is evident that African American clergy have the opportunity to represent their religious beliefs from the pulpit concerning mental illness (Stansbury & Schumacher, 2008).

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Religion

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Spirituality

Spirituality is a word used in an abundance of contexts that means different things for different people at different times in different cultures. Although expressed through religions, art, nature and the built environment for centuries, recent expressions of spirituality have become more varied and diffuse. This is reflected in the range of vocabulary used to describe spirituality. Some of the more common themes in the literature describe it using one or more of the following elements: a sense of purpose1 a sense of ‘connectedness’ – to self, others, nature, ‘God’ or Other1 a quest for wholeness2 a search for hope or harmony3 a belief in a higher being or beings1 some level of transcendence, or the sense that there is more to life than the material or practical4 , and those activities that give meaning and value to people’s lives

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MENTAL HEALTH

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“the problem point”

“the healthy point”

“the disorder point”

Dual Continuum Model of Mental Health and Mental Illness

The model includes one continuum (or line) to show the presence or absence of signs of a mental health condition, and one continuum to reflect positive (or optimal) to poor mental health.

Mental health is fluid; it is influenced by the social determinants of health

Great news: all mental illnesses can be treated

Top Left: Individuals having high sense of subjective well-being despite suffering from a mental illness

Lower Left: Lowest level of functioning where a person feels languishing and has significant mental illness

Upper Right: ideal state of functioning where a person experiences happiness with no mental illness “the healthy point”

Lower right: subjective state of grief of unhappiness that a person experiences in the absences of any noticeable mental health disorder

Mental health is a spectrum, not binary

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The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The WHO(2014) states that “there is no health without mental health.”

World Health Organization. (2014). Mental health: A state of wellbeing. Retrieved from http://www.who.int/features/factfiles/mental_health/en/

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Hypertension

(29 studies)

Mortality

(61 studies)

Depression

(103 studies)

Suicide

(70 studies)

Sexual

Behavior

(38 studies)

Alcohol Use

(97 studies)

Drug Use

(54 studies)

Delinquency

(46 studies)

Objective hope assessing the effectiveness of Faith-Based Organizations: A review of the literature. Center for Research on Religion and Urban Civil Society. Case Report 2002

A Review of the Research on Organic Religion

majority of published research is consistent with the notion that religious practices or religious involvement are associated with beneficial outcomes in mental and physical health.

Hypertension:

social epidemiologists are interested in the effects of socio environmental determinants of blood pressure.
76% of the studies found that religious activities or involvement tend to be linked with reduced levels of hypertension.

Mortality (75% of the published studies conclude that higher levels have a sizable and consistent relationship)

A substantial body of research reveals an association between intensity of participation in religious activities and greater longevity.
for this report examined the association between degree of religious involvement and survival

Depression

Approximately 330 million people around the world suffer from it. People with depression are also at increased risk for use of hospital and medical services and for early death from physical causes.
Over 100 studies examining the religion-depression relationship are reviewed in this paper and we find that religious involvement tends to be associated with less depression in 68 percent of these articles

Suicide

9^th leading cause of death (87% of studies showed beneficial outcomes)
A substantial literature documents that religious involvement (e.g. measured by frequency of religious attendance, frequency of prayer, and degree of religious salience) is associated with less suicide, suicidal behavior, suicidal ideation, as well as less tolerant attitudes toward suicide across a variety of samples from many nations.

Promiscuous Sexual behavior (97% of those studies reviewed)

According to the Centers for Disease Control, unmarried motherhood is also associated with significantly higher infant mortality rates. those who are religious are less likely to engage in premarital sex or extramarital affairs or to have multiple sexual partners (

Drug and Alcohol Use

Both chronic alcohol consumption and abuse of drugs are associated with increased risks of morbidity and mortality.
Less tendency to use or abuse drugs (87%) or alcohol (94%)

Delinquency

78 percent of these studies report reductions in delinquency and criminal acts

to be associated with higher levels of religious activity and involvements.

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Objective hope assessing the effectiveness of Faith-Based Organizations: A review of the literature. Center for Research on Religion and Urban Civil Society. Case Report 2002

To summarize, a review of the research on religious practices and various measures of well-being reveals that, in general, higher levels of religious involvement are associated with increased levels of: well-being, hope, purpose, meaning in life, and educational attainment.
substantial body of evidence shows quite clearly that those who are most involved in religious activities tend to be better off on critical indicators of well-being. Just as the studies reviewed earlier document that religious commitment is a protective factor that buffers individuals from various harmful outcomes (e.g., hypertension, depression, suicide, and delinquency, etc.), there is mounting empirical evidence to suggest that religious commitment is also a source for promoting or enhancing beneficial outcomes (e.g., well-being, purpose or meaning in life).

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“these phenomena…the church as having powerful potential to affect the health of half the population… We are convinced that a church with a vigorous life of worship, education, and personal support together with the promotion of wellness has more of an impact on the health of a community than an addition to the hospital or another doctor in town. Right now this is a hunch; in five years, we’ll have the data to prove it.”

B. Peterson, “Renewing the church’s health ministries: Reflections on ten years’ experience,” Journal of Religion and the Applied Behavioral Sciences, (1983): 17.

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For Practice

Ask questions

Remain Non-judgemental

Show genuine interest and respect

Assess your own spiritual beliefs, values and biases

Should not be over looked

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What do we do now?

Do I ask a patient about their spiritual beliefs?
What if I do not know their religion or anything about their practices?
Will they ask me to pray with them?
Can I pray with them?
Am I qualified to answer those questions?
What if I tell them wrong?

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Implications

Opportunities for dialogue
Determine the willingness to refer based on theological beliefs, and what treatment options do the clergy actually recommend (religious versus secular or both)
Improved resources for congregants and enhancing the referral process between clergy and mental health professionals (Weaver, Flannelly, Flannelly, & Oppenheimer, 2003).
Improve treatment outcome for the patient (congregant) by generating a more holistic treatment approach.

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Weaver, A. J., Flannelly, K. J., Flannelly, L. T., & Oppenheimer, J. E. (2003). Collaboration between clergy and mental health professionals: A review of professional healthcare journals 1980-1995. Counseling and Values, 47, 162–171.

Recommendation of change with theological beliefs can be difficult to address due to most African American clergy being “followers” of a faith, versus originating one. With this in mind, creating opportunities of dialogue among religions and MHP would help gain insight into positive approaches to mental illness without compromising ones faith (Farrell & Goebert, 2008; MR McMinn & Runner, 2005; Moran et al., 2005; Vassol, 2005).
More research is needed to determine the willingness to refer based on theological beliefs and what treatment options do the clergy actually recommend (religious versus secular or both) to their congregants when they are presented with a mental illness.
Understanding these influences could benefit the practices of psychology, psychiatry, and religion by spurring improved resources for congregants and enhancing the referral process between clergy and mental health professionals (Weaver, Flannelly, Flannelly, & Oppenheimer, 2003). This can also improve treatment outcome for the patient (congregant) by generating a more holistic treatment approach.

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Recommendations

For both the mental health professional and clergy to become equally engaged with the faith-based community.
Re-education of clergy who think negatively toward seeking professional mental health services
Decrease the barriers through conflict resolution (barriers)
Discuss therapeutic approaches together

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For Research

Explore the impact and effectiveness of the ‘healing’ dimensions of different spiritual activities

Develop measures of religion and spirituality that cut across a range of religious traditions

Consider using spiritual or religious activity as an outcome measure and to explore the impact of mental health on different expressions of spirituality

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Summary

Faith Based Organizations as gate-keepers play an important role in the lives of our patients.
While there are differences between Religion and Spirituality the effect is the same on mental health .
The effects of Religion and Spirituality on mental health and health outcomes is positive.
The role of Religion and Spirituality in treatment planning is essential.

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Contact Information

Ebony Gaffney, MD, PhD, MBA
ebony.gafffney@scdmh.org
Work Cell: 864-542-4144

THANK YOU FOR YOUR ATTENTION!