Sunday, July 18, 2010

pastoral care: parishioners with mental illness

I recently read Howard W. Stone's Depression and Hope: New Insights for Pastoral Counseling -- which I was optimistic about based on the table of contents, etc., but which failed to live up to that optimism.

From page 67:
Obviously some depression is so severe that it requires hospitalization. The vast majority of melancholics seen by ministers and other church professionals are only mildly depressed, however, and will benefit from skillful pastoral care. [...] As a rule of thumb, ministers do best to see mildly and some moderately depressed individuals, referring the more serious cases to pastoral counseling specialists or mental-health professionals. Both minister and congregation, however, still offer support and pastoral visitation to seriously depressed members who are on medications, have periodic psychotherapy, or are in and out of psychiatric hospitals throughout their lifetimes.
The author doesn't really elaborate on what this "support" would look like, and I am genuinely curious -- you who are in pastoral ministry or pursuing that vocation -- What do you do if you have a parishioner who struggles with severe depression that includes suicidal ideation and self-harm impulses? This hypothetical parishioner has a qualified psychotherapist they see weekly, is on psychiatric medication that seems to be working fairly well, and is "high-functioning" enough to hold down a steady job and present as "fine." But this person was also suicidal enough to go in-patient at a psychiatric hospital for a few days recently. As their pastor, what do you see as your role in their support system? (They have explicitly stated that one thing they need is more one-on-one time with you. How frequent do you imagine that one-on-one time to be? What do you imagine those pastoral care sessions might entail? What do you do if you have a lot of other time commitments -- e.g., a second job, a family, commitments to other justice organizations -- where do you place these pastoral care sessions in your prioritizing of your time?)

I would be hard-pressed to "define" pastoral care (though I'm developing ideas), and I am really interested in what actual pastors would say in answer to this question. (And also what parishioners might want pastors to say.)

1 comment:

  1. Having been trained in pastoral care/ counseling, I'll take a stab at answering the "support" question. I think it probably means whatever can be done to be helpful that is appropriate to the nature of the situation and the relationship between pastor and minister. The family may or may not need helping seeking community resources to deal with their relative's suicide attempts and/ or hospitalization. Pastors can provide that help if so. And the family may be more comfortable asking the pastor certain questions during a pastoral visitation than they would feel asking a health care professional... perhaps about the nature of life and death, or where God is in all this. The pastor can support in that way, which is the "classic" notion of pastoral care.

    Also, the family might be in the middle of something and counting on the hospitalized person's help. Say they were planning to transport a large piece of furniture to someone's house and were using that person's brawn or truck to help do it. The pastor could mention to a congregation member with a truck that so-and-so's family needs help. These incidentals of life always seem to come up, and pastors should use the support network they build throughout the community to assist in whatever unexpected things happen.

    As for the hospitalized person themselves, if I were her/his pastor I would make sure s/he is aware: 1) that I care about her wellness and that includes taking her meds; 2) that I have a discretionary fund to help her if she ever runs out of money for meds; 3) that there is no shame in having depression, going to a therapist, or taking meds and that I believe they are important for her journey to wellness; 4) that she is always welcome at church and that no one is going to treat her any differently just because she went to the hospital; 5) that God and the church accept her just the way she is; 6) that I am glad she didn't succeed in committing suicide because I am so glad to have her in my life and relieved that I don't have to do without her.

    I would want her to know that I'm always there for her if she needs help and would make sure she has my cell number, email, Facebook, and Skype information.