The Clergyman's Role in Community Mental Health
7
The Clergyman's Role in Community Mental Health
W. K E N N E T H
BENTZ
A review of the literature in the field of pastoral psychology indicates that much has been written about the emerging role of the clergy in community mental health. In most of these articles and books this role is defined largely in terms of kinds of things the clergyman should or should not do. For example, it is suggested that he make an effort to understand the emotional needs of his parishioners as well as create an atmosphere in his church where the isolated person can seek out and establish relationships of mutual trust with others. But he is cautioned against acting as an authoritarian figure when counseling an emotionally disturbed parishioner. He is also cautioned against attempting to cope with problems beyond his competence as a counselor. These kinds of prescriptions and proscriptions provide, in effect, a normative definition (i.e., a set of expectations for behavior) of the mental health role of the clergy as defined in the literature. The existence of a defined mental health role in the literature does not, of course, guarantee that it has been accepted as a legitimate part of the pastoral ministry. In view of this, one can ask the following questions: This investigation was supported by Public Health Service Fellowship No. 5F1MH-22,094-02 from the National Institute of Mental Health. W. KENNETHBE~TZ, Prt.D., is an Assistant Professor of Sociology in the Department of Psychiatry at the University of North Carolina, Chapel Hill. He is currently the field director of a five-year study designed to assess the feasibility of providing mental health servicesto rural areas.
8
Journal of Religion and Health
First, what are the major dimensions of the mental health role of the clergy as defined in the literature? Second, what are some of the typical activities ministers are expected to perform while acting out this role? And third, to what extent is there an acceptance of this role by the average pastoral minister? It is the purpose of this paper to shed some light on these questions. Method and sample
Interviews were conducted with one hundred Protestant clergymen who are actively engaged in the pastoral ministry. The religious denominations with which the ministers in this study are affiliated represent most of the maior denominations in the country. Most, but not all, of the ministers had attended a seminary, Their ages ranged from twenty-five to sixty-five; a majority were in the thirty- to forty-yea'r-old range. Three-fourths of them have served a congregation for ten years or more. An extensive review of the literature in the area of pastoral psychology was undertaken to determine the major dimensions and behavioral prescriptions of the clergy's mental health role as defined by a cadre of well-known writers in this field.* Based upon this review, a Clergymen's Role Definition Instrument containing forty-three behavioral items was developed. Some of the items are verbatim quotations, while others are paraphrased statements of expected role behavior. Each statement describes a type of activity a minister may be expected to perform, according to these writers. Some of the statements tend to be very broad and of a general nature, such as "Focus on the social needs of his congregation as well as the spiritual needs." On the other hand, some of the statements are much more specific, such as "Visit with members of his congregation who are patients in mental hospitals." * Some of the major sources include: Hiltner, S., Pastoral Counseling (New York, Abingdon Press, 1959); Johnson, P. E., Psychology o[ Pastoral Care (New York, Basic Books, Inc., 1962); Oates, W. E., The Christian Pastor (Philadelphia, The Westminster Press, 1951). A complete bibliography of the resources used in this study is availablefrom the author on request.
The Clergyman's Role in Community Mental Health
9
Regardless of how broadly or narrowly the items are formulated, they all reflect things ministers should do while functioning in this role. In other words, these behavioral role prescriptions can be considered as constituting a definition of the normative behavior of ministers acting out this role. Each minister was asked to respond to the forty-five role definition items in terms of various degrees of agreement or disagreement with each item. A role definition score was computed for each minister and the resulting data were subjected to a factor analysis in order to identify the underlying or conceptual dimensions of the minister's mental health role as defined by the pastoral ministers. In the survey of the literature, four major dimensions seem to receive the most attention by writers. These are: 1) counseling, 2) prevention, 3) referral, and 4) detection. Not every writer identifies or discusses all four dimensions. Most write only about one, counseling, while others emphasize several areas. In the present study, the results of the factor analysis of the forty-three role definition items show that there is consensus between writers and pastoral ministers on three of the four dimensions: counseling, prevention, and referral. The remaining factor, detection, could not be identified from the data. Two possible reasons for this occurrence can be offered based upon their responses to the detection items and comments made by them during the interview. First, most of the ministers expressed a reluctance to assume a role that requires competences and knowledge that they feel they lack. In this respect, the detection, i.e., recognition of mental illness, presupposes a good deal of knowledge and understanding of the subject. Since there is considerable confusion among well-trained psychiatric personnel as to what constitutes mental illness, these ministers felt that it would be presumptuous of them to view themselves as "qualified" to discern the symptomatology of mental illness. Their response to one of the detection items clearly illustrates this feeling. This item states, in essence, that ministers should use a variety of psychological tests, such as the T A T , Rorschach, etc., as aids in detecting mental illness. This directive is overwhelmingly rejected by a majority of the ministers. Only 9 per cent reported ever using these tests. The negative
10
Journal of Religion and Health
response to this behavior suggests that a majority of the ministers realize that they do not possess the requisite skills to use these tests effectively. This factor was brought out during several interviews in which some ministers vehemently objected to the use of these techniques by other ministers. They averred that these tools should remain in the hands of well-trained psychiatric or psychological personnel and that ministers should not attempt to play the role of an amateur psychologist or psychiatrist. A second reason for their rejection of a detective function as part of their mental health role may be the negative connotations the concept of detection seemed to arouse in the ministers. They viewed the detection of mental illness as an activity in which they would be required constantly to seek out the mentally ill in their congregation. Thus even though three-fourths of the ministers in this study reported that they are attentive to the signs and symptoms of potential mental disorders among their parishioners, they still feel that it is not their job actively to seek out the mentally ill. Let us turn our attention now to the three role dimensions on which there is consensus between pastoral ministers and writers and examine some of the specific tasks ministers agree they should do while functioning in this role. The first dimension, consisting of six items, was designed as the counseling factor, since each statement describes a type of behavior that a religious counselor might perform (see Table 1). The first and sixth statements present the idea that ministers, through counseling, can help to ease the tensions of family life both before and after mental illness strikes. Items three and five refer to the availability of ministers for counseling. In the former instance, ministers have indicated that they would counsel with any member of the community, even though he was not a member of their congregation. As a matter of fact, several ministers commented that they would prefer to counsel members of congregations other than their own. One clergyman said that it was his policy never to counsel his own parishioners around nonchurch-related problems. The responses to item five indicates the clergy's willingness to counsel people regardless of the hour of the day. The fourth item focuses upon the minister's task in counseling people about the many social conflicts
The Clergyman's Role in Community Mental Health
11
TABLE 1 Indices and Factor Loadings for the Counseling Dimension of Actual Role Behavior Indices
1. Help to lessen intrafamily tensions that may foster mental breakdowns. 2. Counsel on only limited number of "minor" emotional problems using whatever psychological insights he has at his disposal. 3. Be available for counseling anyone in the community who seeks help for his emotional problems, i.e., counsel people other than his own church members about emotional problems. 4. Reduce anxiety and tensions of parishioners by helping them to clarify their conflicting social values regarding things such as dating behavior, premarital or extramarital sex, race relations, etc. 5. Be available for counseling with the emotionally ill person at any time of the day or night. 6. Help the family of a mentally ill person accept the fact that one of its members is mentally ill.
Factor Loading .8308 .7636
.7249 .7223 .7066
.6218
with which a great number of people are faced because of the rapid pace of social change occurring in modern life. One of the most interesting items to be found in the counseling factor is the second one. The content of this item states that ministers should limit their counseling to relatively minor problems. Curiously, a considerable number (35 per cent) of the ministers in this study disagree that they should limit themselves to just minor emotional problems. Even more curious is the finding that it is the less-educated minister who fails to recognize his limitations in dealing with serious problems of mental illness. As it turns out, the clergymen who are the least equipped educationally to cope with serious problems report relatively more activity than their better-prepared brethren. By engaging in counseling activities without an adequate background, some ministers apparently may do more harm than good to their parishioners.
12
Journal oJ Religion and Health
Regardless of the extent of involvement in counseling, every minister acts out this role to some degree. For most ministers surveyed in this study, it is an interesting and challenging role and provides more satisfaction and feeling of accomplishment than any other feature of the over-all pastoral role. It should be noted also that sometimes the minister is more or less forced into the role of counselor because of the absence of other c o m m u n i t y resources to handle mental health problems. In these cases the task of dealing with such' problems m a y be thrust u p o n the minister whether or not he wants the job or is qualified to cope adequately with it.
TABLE 2 Indices and Factor Loadings for the Prevention Dimension of Actual Role Behavior
Indices 1. Develop through the social resources of the church 'an atmosphere in which the isolated person will find responsive relationships of mutual trust and appreciation. 2. Work for secure and sustaining group relationships in the church. 3. Attempt to understand the emotional needs of his parishioners in order to prevent disturbances from arising. 4. Instill spirkual support to emotionally ill persons during times of stress and crisis. 5. Help the over-righteous parishioner to learn how to understand better and to express his feelings, anxieties, and aspirations.
Factor
Loading .7473 .7070 .6553 .6518 .6158
T h e second factor of role dimension identified was termed the prevention factor (see Table 2). It consists of five items, each of w h i c h contains the c o m m o n element, p r e v e n t i o n of mental illness. Basically, this aspect of his role consists of understanding the emotional needs of his parishioners and helping them to cope constructively with their life problems in such a way that serious emotional and mental strains can be minimized or avoided. T h e r e is almost unanimous consensus among ministers as to some of the things that
The Clergyman's Role in Community Mental Health
13
can be done in order to accomplish this goal. Through the medium of religion, the minister, especially in times of crisis, can focus upon the spiritual welfare of his parishioners by acting as a mediator between them and God (item 4). In this respect he must help them to grow spiritually so that satisfactory adjustments to the problems of daily living can be made. The fifth item indicates that some parishioners may need guidance from the minister so that they can adequately express their feelings, anxieties, and aspirations. To do this the minister should help them become independent and self-reliant by building, directing, and evaluating their life experiences. In this way they should be better equipped to understand the nature of their actions before the problem gets out of hand. The minister is in an especially good position to gain an insight into the mental health of his parishioners because of the many opportunities he has for seeing people (item 3). More than any other mental health professional, he is in a particularly strategic position to recognize people in trouble because he is in close touch with them in times of crisis situations such as sickness and death. Additionally, while making his pastoral visits he can observe tensions developing from faulty interpersonal relationship in the home. To be truly effective in this role, the minister should have some knowledge of how such difficulties arise. Equipped with this information, the chances are good he will be able to spot minor emotional difficulties before they erupt into a serious problem. It must be emphasized once again that the minister is not expected to be a Sherlock Holmes in detecting situations that could possibly result in mental illness. His sole motive should be the sincere desire to understand the emotional needs of his parishioners and get help for them as soon as possible. In the process of reviewing the literature on the mental health role of the minister it was observed that there is a considerable emphasis being placed upon the minister's leadership role in a variety of group activities within the church. The minister is encouraged time and again to work constantly at developing his skills in group leadership because he is the key figure who sets the tone for church-related group activities. It has been suggested that the minister can foster a sense of "group belongingness" by initiating and actively
14
Journal of Religion and Health
participating in a variety of church programs. Furthermore, he can aid the various groups by clarifying their goals, by pointing out their limitations, by discovering and mobilizing their resources, and by relating the church groups to other groups in the community. Apparently this norm is accepted by the ministers participating in this study. The two items with the highest loadings both focus upon the role of the minister in the group activities of the church. There is, moreover, almost total agreement (99 per cent) among these ministers that they should be expected to engage in the preventive behavior described by items 1 and 2. TABLE 3 Indices and Factor Loadings for the Referral Dimension of Actual Role Behavior lndiees 1. Establish and maintain open channels of communication with other community resources dealing with problems of mental illness. 2. Make an effort to become familiar with the community mental health resources and their functions. Establish a personal relationship with the professional people in other 3. community mental health resources. 4. See that a mentally ill person is helped even if the minister can't do it himself. 5. Refer people to the appropriate psychiatric resource when the problem is too serious for him to handle alone.
~aGto~
Loading .7863
.7688 .6890 .6890 .6556
The third and final dimension resulting from the factor analysis was called the referral factor. (See Table 3) There is little doubt that ministers perceive this dimension as one of the most important aspects of their role. Consensus with respect to the following role behaviors was unanimous: 1) the establishment and maintenance of an effective communication network between the minister and other community mental health resources; 2) a familiarity with these resources; and 3) the building of a personal relationship with personnel in these resources. With respect to this latter role prescription, Fairchild and
The Clergyman's Role in Community Mental Health
15
W y n n have suggested that the tendency to refer depends more upon the personal relationship built up between the minister and other helping professions (e.g., physicians, psychiatrists, mental health clinics, etc.) than on the seriousness of the problem presented to the counselor. ~ Unfortunately, although ministers agree that they should perform the above-mentioned behaviors, they report that they do not always do so. This is especially true of the less educated who, in general, fail to establish a working relationship between community mental health agencies and their personnel. Perhaps this is due in part to a lack of understanding and appreciation of the kinds of services these agencies can perform. In the main, however, it seems to stem from a basic distrust of psychiatrically-oriented resources among the lesseducated ministers. From their responses during the interview, it appears that they view the role of psychiatric treatment as being detrimental to their religious beliefs and to those of their congregation. The latter two items in the referral role dimension indicate that a minister should make every effort to insure that a person who needs help gets it. To accomplish this end, a minister should have the ability to recognize his limitations in dealing with the more serious problems of mental illness and be willing to send a person to the appropriate mental health resource if this is deemed necessary. It has been said repeatedly that the wise pastor should be able to recognize his limitations in dealing with the more serious forms of mental illness. He should realize that if one uses psychological or psychiatric techniques without a thorough background in the psychological principles underlying them, the tension and frustration of the person involved is likely to be intensified. Such a realistic appraisal of his inadequacies and lack of competence in the treatment of mental illness, however, should not make him feel that he can be of no assistance to the community mental health team. In reality, by facing his limitations squarely and referring the sick individual to a qualified professional when it is indicated, he is performing a real service to the person and to his community. * Fairchild, R. W., and Wynn, C. J., Families in the Church: A Protestant Survey, New York, Association Press, 1961.
7
The Clergyman's Role in Community Mental Health
W. K E N N E T H
BENTZ
A review of the literature in the field of pastoral psychology indicates that much has been written about the emerging role of the clergy in community mental health. In most of these articles and books this role is defined largely in terms of kinds of things the clergyman should or should not do. For example, it is suggested that he make an effort to understand the emotional needs of his parishioners as well as create an atmosphere in his church where the isolated person can seek out and establish relationships of mutual trust with others. But he is cautioned against acting as an authoritarian figure when counseling an emotionally disturbed parishioner. He is also cautioned against attempting to cope with problems beyond his competence as a counselor. These kinds of prescriptions and proscriptions provide, in effect, a normative definition (i.e., a set of expectations for behavior) of the mental health role of the clergy as defined in the literature. The existence of a defined mental health role in the literature does not, of course, guarantee that it has been accepted as a legitimate part of the pastoral ministry. In view of this, one can ask the following questions: This investigation was supported by Public Health Service Fellowship No. 5F1MH-22,094-02 from the National Institute of Mental Health. W. KENNETHBE~TZ, Prt.D., is an Assistant Professor of Sociology in the Department of Psychiatry at the University of North Carolina, Chapel Hill. He is currently the field director of a five-year study designed to assess the feasibility of providing mental health servicesto rural areas.
8
Journal of Religion and Health
First, what are the major dimensions of the mental health role of the clergy as defined in the literature? Second, what are some of the typical activities ministers are expected to perform while acting out this role? And third, to what extent is there an acceptance of this role by the average pastoral minister? It is the purpose of this paper to shed some light on these questions. Method and sample
Interviews were conducted with one hundred Protestant clergymen who are actively engaged in the pastoral ministry. The religious denominations with which the ministers in this study are affiliated represent most of the maior denominations in the country. Most, but not all, of the ministers had attended a seminary, Their ages ranged from twenty-five to sixty-five; a majority were in the thirty- to forty-yea'r-old range. Three-fourths of them have served a congregation for ten years or more. An extensive review of the literature in the area of pastoral psychology was undertaken to determine the major dimensions and behavioral prescriptions of the clergy's mental health role as defined by a cadre of well-known writers in this field.* Based upon this review, a Clergymen's Role Definition Instrument containing forty-three behavioral items was developed. Some of the items are verbatim quotations, while others are paraphrased statements of expected role behavior. Each statement describes a type of activity a minister may be expected to perform, according to these writers. Some of the statements tend to be very broad and of a general nature, such as "Focus on the social needs of his congregation as well as the spiritual needs." On the other hand, some of the statements are much more specific, such as "Visit with members of his congregation who are patients in mental hospitals." * Some of the major sources include: Hiltner, S., Pastoral Counseling (New York, Abingdon Press, 1959); Johnson, P. E., Psychology o[ Pastoral Care (New York, Basic Books, Inc., 1962); Oates, W. E., The Christian Pastor (Philadelphia, The Westminster Press, 1951). A complete bibliography of the resources used in this study is availablefrom the author on request.
The Clergyman's Role in Community Mental Health
9
Regardless of how broadly or narrowly the items are formulated, they all reflect things ministers should do while functioning in this role. In other words, these behavioral role prescriptions can be considered as constituting a definition of the normative behavior of ministers acting out this role. Each minister was asked to respond to the forty-five role definition items in terms of various degrees of agreement or disagreement with each item. A role definition score was computed for each minister and the resulting data were subjected to a factor analysis in order to identify the underlying or conceptual dimensions of the minister's mental health role as defined by the pastoral ministers. In the survey of the literature, four major dimensions seem to receive the most attention by writers. These are: 1) counseling, 2) prevention, 3) referral, and 4) detection. Not every writer identifies or discusses all four dimensions. Most write only about one, counseling, while others emphasize several areas. In the present study, the results of the factor analysis of the forty-three role definition items show that there is consensus between writers and pastoral ministers on three of the four dimensions: counseling, prevention, and referral. The remaining factor, detection, could not be identified from the data. Two possible reasons for this occurrence can be offered based upon their responses to the detection items and comments made by them during the interview. First, most of the ministers expressed a reluctance to assume a role that requires competences and knowledge that they feel they lack. In this respect, the detection, i.e., recognition of mental illness, presupposes a good deal of knowledge and understanding of the subject. Since there is considerable confusion among well-trained psychiatric personnel as to what constitutes mental illness, these ministers felt that it would be presumptuous of them to view themselves as "qualified" to discern the symptomatology of mental illness. Their response to one of the detection items clearly illustrates this feeling. This item states, in essence, that ministers should use a variety of psychological tests, such as the T A T , Rorschach, etc., as aids in detecting mental illness. This directive is overwhelmingly rejected by a majority of the ministers. Only 9 per cent reported ever using these tests. The negative
10
Journal of Religion and Health
response to this behavior suggests that a majority of the ministers realize that they do not possess the requisite skills to use these tests effectively. This factor was brought out during several interviews in which some ministers vehemently objected to the use of these techniques by other ministers. They averred that these tools should remain in the hands of well-trained psychiatric or psychological personnel and that ministers should not attempt to play the role of an amateur psychologist or psychiatrist. A second reason for their rejection of a detective function as part of their mental health role may be the negative connotations the concept of detection seemed to arouse in the ministers. They viewed the detection of mental illness as an activity in which they would be required constantly to seek out the mentally ill in their congregation. Thus even though three-fourths of the ministers in this study reported that they are attentive to the signs and symptoms of potential mental disorders among their parishioners, they still feel that it is not their job actively to seek out the mentally ill. Let us turn our attention now to the three role dimensions on which there is consensus between pastoral ministers and writers and examine some of the specific tasks ministers agree they should do while functioning in this role. The first dimension, consisting of six items, was designed as the counseling factor, since each statement describes a type of behavior that a religious counselor might perform (see Table 1). The first and sixth statements present the idea that ministers, through counseling, can help to ease the tensions of family life both before and after mental illness strikes. Items three and five refer to the availability of ministers for counseling. In the former instance, ministers have indicated that they would counsel with any member of the community, even though he was not a member of their congregation. As a matter of fact, several ministers commented that they would prefer to counsel members of congregations other than their own. One clergyman said that it was his policy never to counsel his own parishioners around nonchurch-related problems. The responses to item five indicates the clergy's willingness to counsel people regardless of the hour of the day. The fourth item focuses upon the minister's task in counseling people about the many social conflicts
The Clergyman's Role in Community Mental Health
11
TABLE 1 Indices and Factor Loadings for the Counseling Dimension of Actual Role Behavior Indices
1. Help to lessen intrafamily tensions that may foster mental breakdowns. 2. Counsel on only limited number of "minor" emotional problems using whatever psychological insights he has at his disposal. 3. Be available for counseling anyone in the community who seeks help for his emotional problems, i.e., counsel people other than his own church members about emotional problems. 4. Reduce anxiety and tensions of parishioners by helping them to clarify their conflicting social values regarding things such as dating behavior, premarital or extramarital sex, race relations, etc. 5. Be available for counseling with the emotionally ill person at any time of the day or night. 6. Help the family of a mentally ill person accept the fact that one of its members is mentally ill.
Factor Loading .8308 .7636
.7249 .7223 .7066
.6218
with which a great number of people are faced because of the rapid pace of social change occurring in modern life. One of the most interesting items to be found in the counseling factor is the second one. The content of this item states that ministers should limit their counseling to relatively minor problems. Curiously, a considerable number (35 per cent) of the ministers in this study disagree that they should limit themselves to just minor emotional problems. Even more curious is the finding that it is the less-educated minister who fails to recognize his limitations in dealing with serious problems of mental illness. As it turns out, the clergymen who are the least equipped educationally to cope with serious problems report relatively more activity than their better-prepared brethren. By engaging in counseling activities without an adequate background, some ministers apparently may do more harm than good to their parishioners.
12
Journal oJ Religion and Health
Regardless of the extent of involvement in counseling, every minister acts out this role to some degree. For most ministers surveyed in this study, it is an interesting and challenging role and provides more satisfaction and feeling of accomplishment than any other feature of the over-all pastoral role. It should be noted also that sometimes the minister is more or less forced into the role of counselor because of the absence of other c o m m u n i t y resources to handle mental health problems. In these cases the task of dealing with such' problems m a y be thrust u p o n the minister whether or not he wants the job or is qualified to cope adequately with it.
TABLE 2 Indices and Factor Loadings for the Prevention Dimension of Actual Role Behavior
Indices 1. Develop through the social resources of the church 'an atmosphere in which the isolated person will find responsive relationships of mutual trust and appreciation. 2. Work for secure and sustaining group relationships in the church. 3. Attempt to understand the emotional needs of his parishioners in order to prevent disturbances from arising. 4. Instill spirkual support to emotionally ill persons during times of stress and crisis. 5. Help the over-righteous parishioner to learn how to understand better and to express his feelings, anxieties, and aspirations.
Factor
Loading .7473 .7070 .6553 .6518 .6158
T h e second factor of role dimension identified was termed the prevention factor (see Table 2). It consists of five items, each of w h i c h contains the c o m m o n element, p r e v e n t i o n of mental illness. Basically, this aspect of his role consists of understanding the emotional needs of his parishioners and helping them to cope constructively with their life problems in such a way that serious emotional and mental strains can be minimized or avoided. T h e r e is almost unanimous consensus among ministers as to some of the things that
The Clergyman's Role in Community Mental Health
13
can be done in order to accomplish this goal. Through the medium of religion, the minister, especially in times of crisis, can focus upon the spiritual welfare of his parishioners by acting as a mediator between them and God (item 4). In this respect he must help them to grow spiritually so that satisfactory adjustments to the problems of daily living can be made. The fifth item indicates that some parishioners may need guidance from the minister so that they can adequately express their feelings, anxieties, and aspirations. To do this the minister should help them become independent and self-reliant by building, directing, and evaluating their life experiences. In this way they should be better equipped to understand the nature of their actions before the problem gets out of hand. The minister is in an especially good position to gain an insight into the mental health of his parishioners because of the many opportunities he has for seeing people (item 3). More than any other mental health professional, he is in a particularly strategic position to recognize people in trouble because he is in close touch with them in times of crisis situations such as sickness and death. Additionally, while making his pastoral visits he can observe tensions developing from faulty interpersonal relationship in the home. To be truly effective in this role, the minister should have some knowledge of how such difficulties arise. Equipped with this information, the chances are good he will be able to spot minor emotional difficulties before they erupt into a serious problem. It must be emphasized once again that the minister is not expected to be a Sherlock Holmes in detecting situations that could possibly result in mental illness. His sole motive should be the sincere desire to understand the emotional needs of his parishioners and get help for them as soon as possible. In the process of reviewing the literature on the mental health role of the minister it was observed that there is a considerable emphasis being placed upon the minister's leadership role in a variety of group activities within the church. The minister is encouraged time and again to work constantly at developing his skills in group leadership because he is the key figure who sets the tone for church-related group activities. It has been suggested that the minister can foster a sense of "group belongingness" by initiating and actively
14
Journal of Religion and Health
participating in a variety of church programs. Furthermore, he can aid the various groups by clarifying their goals, by pointing out their limitations, by discovering and mobilizing their resources, and by relating the church groups to other groups in the community. Apparently this norm is accepted by the ministers participating in this study. The two items with the highest loadings both focus upon the role of the minister in the group activities of the church. There is, moreover, almost total agreement (99 per cent) among these ministers that they should be expected to engage in the preventive behavior described by items 1 and 2. TABLE 3 Indices and Factor Loadings for the Referral Dimension of Actual Role Behavior lndiees 1. Establish and maintain open channels of communication with other community resources dealing with problems of mental illness. 2. Make an effort to become familiar with the community mental health resources and their functions. Establish a personal relationship with the professional people in other 3. community mental health resources. 4. See that a mentally ill person is helped even if the minister can't do it himself. 5. Refer people to the appropriate psychiatric resource when the problem is too serious for him to handle alone.
~aGto~
Loading .7863
.7688 .6890 .6890 .6556
The third and final dimension resulting from the factor analysis was called the referral factor. (See Table 3) There is little doubt that ministers perceive this dimension as one of the most important aspects of their role. Consensus with respect to the following role behaviors was unanimous: 1) the establishment and maintenance of an effective communication network between the minister and other community mental health resources; 2) a familiarity with these resources; and 3) the building of a personal relationship with personnel in these resources. With respect to this latter role prescription, Fairchild and
The Clergyman's Role in Community Mental Health
15
W y n n have suggested that the tendency to refer depends more upon the personal relationship built up between the minister and other helping professions (e.g., physicians, psychiatrists, mental health clinics, etc.) than on the seriousness of the problem presented to the counselor. ~ Unfortunately, although ministers agree that they should perform the above-mentioned behaviors, they report that they do not always do so. This is especially true of the less educated who, in general, fail to establish a working relationship between community mental health agencies and their personnel. Perhaps this is due in part to a lack of understanding and appreciation of the kinds of services these agencies can perform. In the main, however, it seems to stem from a basic distrust of psychiatrically-oriented resources among the lesseducated ministers. From their responses during the interview, it appears that they view the role of psychiatric treatment as being detrimental to their religious beliefs and to those of their congregation. The latter two items in the referral role dimension indicate that a minister should make every effort to insure that a person who needs help gets it. To accomplish this end, a minister should have the ability to recognize his limitations in dealing with the more serious problems of mental illness and be willing to send a person to the appropriate mental health resource if this is deemed necessary. It has been said repeatedly that the wise pastor should be able to recognize his limitations in dealing with the more serious forms of mental illness. He should realize that if one uses psychological or psychiatric techniques without a thorough background in the psychological principles underlying them, the tension and frustration of the person involved is likely to be intensified. Such a realistic appraisal of his inadequacies and lack of competence in the treatment of mental illness, however, should not make him feel that he can be of no assistance to the community mental health team. In reality, by facing his limitations squarely and referring the sick individual to a qualified professional when it is indicated, he is performing a real service to the person and to his community. * Fairchild, R. W., and Wynn, C. J., Families in the Church: A Protestant Survey, New York, Association Press, 1961.
