I woke up one early morning to the sound of my phone ringing. I reluctantly reached over and picked it up from the nightstand and saw that it was Tom* on the line. Tom began his one-sided stream of consciousness conversation with me as soon as I pressed the answer button. Actually, it appeared that he had been talking long before he picked up his phone and dialed at random the first name in his contact list.
After listening for a few seconds, my mind was fully awake. I realized that he was in the middle of a mental breakdown, and he needed help but was utterly unable to tell me where he was, let alone realize on his own that he needed professional help because his mind was completely disconnected from reality.
A few years later, I was at a barbeque when a friend called. She was at a bible study and she felt that one of her contact’s relatives seemed to be “possessed.” She was worried about her contact, while I was worried about her personal safety. I quickly called my In-Ministry Pastor-Mentor and raced over to the Bible study. As my mentor drove, I went over the checklist of what to do in the case of demon possession.
When we arrived, we evaluated the situation and realized that this relative was high on Marijuana. We relaxed and let the Bible study continue without interruption. After the study, we all knelt for prayer, and I made the mistake of closing my eyes, because the next second this Bible study contact fell forward and his head crashed into my head leaving me with a lasting lesson: Never close your eyes in unknown situations.
Not too long ago, a friend of mine reconnected with a long-lost friend of his at a vespers program. As they caught up on their lives, this person confided to my friend that they were currently contemplating suicide. This particular case took several months of personal financial help, a year of legal representation in federal court, and a trip to a Behavioral Health Hospital. Fortunately, with the consistent care of a local church pastor, this person was able to stabilize their life.
Over the course of in my short ministry career, I’ve attended the funerals of individuals who have committed suicide. Have intervened in fights between seminary attending-husbands and their wives to protect battered spouses. Dealt with rape accusations between two members of the church. And have visited church friends in prison. I’ve sat in the church pastor’s office and heard wives and husbands pour out their hearts in grief over the breaking up of their marriage, the emotional distance from their children and what seems like a private never-ending battle against themselves.
These and other experiences have taught me that mental illness, sexual and drug abuse, or chemical dependency problems aren’t just prevalent in the world, they are also present in the church. They represent a unique challenge to members and the clergy alike and few in our church are equipped to adequately deal with it. I count myself incredibly lucky to have had extensive training in the management of assaultive behavior during EMT training and having spent a year working at an Adventist Behavioral Medical Hospital working with children and adolescents in acute psychiatric care.
In this article, I will briefly explore the prevalence and ramifications of mental illness, sexual abuse, and drug abuse and chemical dependency, as these issues often present themselves among church membership and pose serious challenges to the local church and the clergy.
I then will propose a simple triage system to help differentiate between lifestyle-related problems and potentially life-threatening scenarios that require mandatory reporting and professional help. Finally, I will demonstrate the advantages of building an accountability system that is built on Scripture and the Adventist model of lay-led ecclesiology.
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Prevalence of Mental Illness
According to the National Institutes of Health,
Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year.
Approximately 1 in 25 adults in the U.S.—9.8 million, or 4.0%—experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.
Approximately 1 in 5 youth aged 13–18 (21.4%) experiences a severe mental disorder at some point during their life. For children aged 8–15, the estimate is 13%.
1.1% of adults in the U.S. live with schizophrenia.
2.6% of adults in the U.S. live with bipolar disorder.
18.1% of adults in the U.S. experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias.
Social Effects of Mental Illness:
Adults in the U.S. living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions. African Americans and Hispanic Americans each use mental health services at about one-half the rate of Caucasian Americans and Asian Americans at about one-third the rate.
Consequences of lack of treatment:
Each day an estimated 18-22 veterans die by suicide. Serious mental illness costs America $193.2 billion in lost earnings per year. Over one-third (37%) of students with a mental health condition age 14–21 and older who are served by special education drop out—the highest dropout rate of any disability group.
The church has a burden and a responsibility to share the Gospel with the world. A large part of the process involves working with others which are enhanced through effective communication, and coordination of the work in all its facets. Obviously, this involves a significant input of individual minds and that coordination may be compromised if those minds aren’t working at optimal strength.
Renowned neuroscientist and artificial intelligence expert, Karl Friston, says in his Free Energy Principle, that our minds process data through sources and when it places a particular or heightened emphasis on a single source it can become unbalanced.
The insidiousness of mental illness is that unlike almost any other physical ailment, the person may be unaware that what they are experiencing is not normal. Our minds can be tricked into thinking that depression or even hearing or seeing things is a normal state of existent.
Even when those suffering from mental illness seek help, it is hard to consistently receive care. Personal rights laws prevent doctors from forcing care on mental illness patients and so if they choose not to receive care, there is nothing that health care providers can do beyond a narrow set of personal safety limitations. So, in the face of these very real problems, what can local churches do to combat mental illness, keep their members safe, and get help for those who need it most?
Local Church Triage & Accountability System
Every hospital’s Emergency Room department has a triage center. This group of nurses determine the seriousness of the emergency and which person’s problems should be prioritized first. I would like to show how such a triage system could work at the local church level. But before I do that, I need to explain how things are at the local church right now.
Due to long-standing practices and culture of clergy-dependence, our churches are currently designed to burden just a few individuals and the pastor with all the work of the local church. Most members are merely pew warmers and are not empowered to take initiative or action.
Consequently, when problems arise they are often all referred to the pastor to deal with them. Often the pastor is untrained to deal with serious issues that require extensive therapy or professional care of a psychologist. And yet, they are forced to deal with “problem” individuals, or individuals who seek their attention etc. All too often the pastor ends up burned out and leaves the ministry.
Occasionally, while counseling a member of the opposite sex, a pastor may cross the lines into abuse of power, or fall into an adulterous affair. This is the danger of pushing all problems onto one person and no one is immune to the consequences that flow from such activities. God never intended for our church members to be reliant on pastors this way.
God has not given His ministers the work of setting the churches right. No sooner is this work done, apparently, than it has to be done over again. Church members that are thus looked after and labored for become religious weaklings. If nine-tenths of the effort that has been put forth for those who know the truth had been put forth for those who have never heard the truth, how much greater would have been the advancement made! God has withheld His blessings because His people have not worked in harmony with His directions.
Let us consider briefly a few biblical passages on member to member care. 1 Timothy 5:8 has harsh words for members who do not provide for their own family. Galatians 6:2 encourages us to carry each other’s burdens.
In reality, most members put their burdens on the pastor and expect him or her to carry them for everyone. The effects of this practice, of course, would be as disastrous as if an entire mountaineering expedition placed all their backpacks on a single Sherpa.
Members are to look to others’ interests and place them first according to Philippians 2:4. Romans 12:10 states that we are to be devoted to each other in love. Hebrews 10:23-25 establishes the principle of regularly meeting other members and encouraging them to hold unswervingly to the hope that we profess. Ephesians 4:32, 1 John 3:17-18, 1 Thessalonians 5:11 all provide rich texts for consideration of the care that members are to exercise toward each other apart from that of the clergy.
The triage classification system takes advantage of the New Testament member-care model of local church leadership. Members should be taught to care for themselves and other members in the local church. Responsibility for oversight and accountability should be shared across the entire church. Only when members shed their reliance on their pastors and depend on their spiritual sustenance on God’s word, then and only then will they become spiritually and mentally strong to deal with the vicissitudes of life.
Our local churches need to set up a classification system that helps to sort people into categories of care and attention that is needed. If we make four concentric circles, we can place increasing focus in each circle until it comes down to 1-1 attention between the pastor and an individual with oversight provided by the local church.
First, let us have a simple classification system to triage individuals according to their needs.
Classification of Individuals
I suggest classifying individuals within the small group into four broad categories:
Category 1: Individuals whose habits need to be changed.
Most of us fall into this category. We all need to work on our diet, get better sleep, cut bad habits, exercise etc. Simple accountability in these areas should be encouraged and tracked.
Category 2: Individuals who have chemical dependency issues such as excessive alcohol use, drug use, or chemical imbalances in the brain.
These are people who either self-confess to not taking their meds or self-confess within the trusted confines of the small group to a drinking or drug problem. Their minds can be altered by taking substances or when they don’t stay on their medications.
Local AA and Narcotics support group attendance should be encouraged and accountability provided for. As for taking medications, individuals should be connected to local social work agencies or have their spouse or other family members keep them accountable as far as possible.
Category 3: Individuals who present themselves as being under personal threat to themselves, or were under threat from others.
These individuals could be severely depressed, there may be signs of spousal abuse etc., or they might self-identify for suicide ideation as that one person did to my friend. In these cases, mandatory reporting is required.
The small group leaders should report these individuals to the pastor and the pastor needs to connect them with a hospital, or state agencies as required by law. Pastors and child caregivers are mandated reporters by law, meaning there are several cases that must be reported even if the person doesn’t want them too.
Category 4: Finally, the last category is reserved for the truly rare people with broken minds.
It is rare to come face to face with a serial killer, serial rapist, psychopath, narcissist or a sociopath outside of clinical and law enforcement settings. It is impossible to be able to correctly identify someone as such because very few of us have the adequate professional training to be able to do that.
However, there are times when certain behavior is just so bizarre or is clearly outside the bounds of normal social human behavior. In these cases, it is important to realize that these individuals have minds that may be physically broken or lack crucial development of certain areas of the brain which emphasize empathy. These individuals need advanced care that is far beyond what a local church can provide.
There is another sub-category here for individuals who display cultish behavior or promote extremes such as believing married couples should not have sexual intercourse or other extreme theological or spiritual disciplines. These individuals should be referred to the next level of care within the church.
With our simple classification in place, let us now look at circles of triage for increasing member-care, responsiveness and accountability.
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Triage Circles of Care
This is the broadest circle of member-care and responsibility. The entire church membership should be encouraged to regularly attend at least one small group Bible study during the week. In this way, all the members are spiritually and socially accounted for and no one gets left behind.
As members get to know others in their small group and trust grows, they can begin to share their challenges and others can pray for them and hold them accountable to the changes they seek to implement in their lives. Ninety percent or more of our existence is defined by our habits. When we sleep, how long we sleep, what we eat, whether we exercise, etc., have a large bearing on our overall mental health.
These things can be easily brought up in small groups and encouragement can be given to members to live healthy lives in accordance with God’s laws for health and wellness. Small group leaders can be given additional training to identify those who may need extra care and support. Good small groups diversify accountability and diffuse risk.
This circle is comprised of those in elected positions of responsibility in the local church. They may be Sabbath School teachers, greeters, deacons, service leaders etc. These individuals usually are more mature in their walk with Christ and have been selected to lead or serve in a public capacity in the local church.
Issues involving individuals can be dealt with in team meetings and decisions can be taken to determine whether any of these issues should be referred to the next circle. Most persistently occurring behavior or practices that are out of sync with the local church’s values can be dealt with at this level.
This circle comprises of the church pastor and his immediate board of elders. Issues that are of a theological nature or that require mandated reporting should be brought to their attention immediately by leaders of other circles. A written report of actions taken should be kept and shared confidentially with law enforcement or the Conference as needed.
The pastor may be assigned to confidentially meet with the individual to determine their specific level of need and provide biblical counsel as needed with careful oversight and reporting to the board of elders. This prevents the pastor from getting too drawn in personally into a 1-1 counseling situation that could potentially turn toxic over time.
This circle is the entire local church board, the pastor and the local conference. At this level, problems related to membership in the local church must be dealt with. If every other circle has worked with the individual and there is a track record of persistent refusal to engage in accountability to either seek professional help or make necessary changes in their lives, then the local church board must, in conjunction with the conference, decide the best course of action.
It is important to recognize that modern health care, which includes the fields of psychiatry and psychology, have some foundations that build on schools of thought which are alien to Scripture.
Therefore, some individuals believe that only the Bible and the Spirit of Prophecy should be used for counseling in all types of situations including clinical depression and serious mental imbalances such as schizophrenia. This can lead to serious legal cases of practicing medicine without a license, neglect, abuse, etc.
Others hold that simply improving one’s diet and taking minerals through nuts and flax seed etc. and lifestyle, can remove or cure depression. While there is significant medical and nutritional research to back healthy diets and even some correlations towards alleviating some cases of depression, it is beyond the scope of the care that our local churches can provide to individuals who desperately need help.
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Mental illness is a debilitating disease that affects our community and members in our church. Chances are that your local congregation has members who are severely depressed or are exhibiting signs of distress that most members are not trained to look for until it is too late.
The legal and financial repercussions can be immense when sexual abuse or neglect takes place within the local church. Pastors and their families are especially vulnerable because the level of care needed to take care of these members far exceeds the training and skills gained at the Seminary.
Often members try to self-medicate or encourage natural remedies for seriously under-diagnosed problems in themselves or other members. Occasionally, these attempts at self-medication can lead to overdose in chemical dependency cases or to extremes swings in personality and interactions with others.
Pastors should be trained to institute a system of triaging the needs of their members so that those who are most vulnerable to abuse or neglect can be identified and the appropriate care can be provided from in-hospitalization to legal, and social care.
The Adventist model of biblical care that is centered around the New Testament model of lay members caring for lay members needs to be highlighted as the key to diversifying and leveraging the reach of the local church. Leaders should be trained in confidentiality, and in the needs to isolate habit-driven problems from serious defects that result from mental illness.
Finally, the church should make efforts to make the local church a warm and inviting place so that anyone who feels at risk for self-harm or is experiencing a mental breakdown can safely find the care they need.
*Pseudonyms used for all names in this article to protect privacy.
 Shaun Raviv, “The Genius Neuroscientist Who Might Hold the Key to True AI,” Wired, November 13, 2018.
 Ellen G. White, Testimonies for the Church, vol. 7 (Nampa, ID: Pacific Press, 1902), p. 18.
 For further discussion on Member care models, see: Adrian Zahid, “A More Perfect Union: The Local Church and Mission,” “Beyond the ONE Project: The War Over the Local Church, part 5a,” “Beyond the ONE Project: The War Over the Local Church, part 5b,” Compass Magazine.