The Role of Congregations in Community Mental Health Care
Pamela Prickett, Ph.D. Postdoctoral Fellow, Rice University
Since deinstitutionalization, the locus of care for individuals with serious mental health problems in America has resided in local communities, the goal being to spatially integrate patients into the fabric of everyday life (Dear and Wolch 1987). This necessarily involves local neighborhood organizations, like churches and mosques, in the provision of care by increasing the likelihood that individuals suffering from mental disorders will seek faith-based support (e.g. McRoberts 2003). In fact, religious leaders are often the first point of contact for individuals concerned about their mental well-being, especially among African American communities (Wang, Berglund, and Kessler 2003; Young, Griffith, and Williams 2003). Yet, we know little about the ways congregants make sense of and interact with fellow members who display or experience mental health problems. This gap limits our ability to understand the construction of mental illness in local faith communities and the burdens both sets of actors face. This study draws on more than five years of participant-observation in an African American-led mosque in a low-income neighborhood in Los Angeles to understand how members made sense of and responded to disturbances by individuals suspected to suffer from mental illness. I find that members of the mosque responded by tacitly accepting “crazy” behavior provided it did become too disruptive. When behaviors violated acceptable limits, members avoided involving law enforcement and instead worked out their own system of social control, often leading to the removal of disruptive persons. While this exiling of disruptive behaviors resolved the interactional problem members faced dealing with disturbances it also pushed those in need onto the street, exposing them to others who could fear or punish them. All of this contributed to the troubling situation whereby people who exhibited mental health problems and clearly needed help were left in a liminal space between inclusion and exclusion. At the same time, I argue that the community was overwhelmed by the needs of members with mental health problems given the limited mental health services available in the area. I identify this as the “burden of community care” in which members of faith communities feel obligated to help fellow believers but have little mental health training and thus few tools to respond to troubling situations. In light of this year’s conference theme, I will conclude my talk by suggesting ways in which mental health professionals can work with faith communities to improve practices of care for believers suffering from mental health problems.
Since deinstitutionalization, the locus of care for individuals with serious mental health problems in America has resided in local communities, the goal being to spatially integrate patients into the fabric of everyday life (Dear and Wolch 1987). This necessarily involves local neighborhood organizations, like churches and mosques, in the provision of care by increasing the likelihood that individuals suffering from mental disorders will seek faith-based support (e.g. McRoberts 2003). In fact, religious leaders are often the first point of contact for individuals concerned about their mental well-being, especially among African American communities (Wang, Berglund, and Kessler 2003; Young, Griffith, and Williams 2003). Yet, we know little about the ways congregants make sense of and interact with fellow members who display or experience mental health problems. This gap limits our ability to understand the construction of mental illness in local faith communities and the burdens both sets of actors face. This study draws on more than five years of participant-observation in an African American-led mosque in a low-income neighborhood in Los Angeles to understand how members made sense of and responded to disturbances by individuals suspected to suffer from mental illness. I find that members of the mosque responded by tacitly accepting “crazy” behavior provided it did become too disruptive. When behaviors violated acceptable limits, members avoided involving law enforcement and instead worked out their own system of social control, often leading to the removal of disruptive persons. While this exiling of disruptive behaviors resolved the interactional problem members faced dealing with disturbances it also pushed those in need onto the street, exposing them to others who could fear or punish them. All of this contributed to the troubling situation whereby people who exhibited mental health problems and clearly needed help were left in a liminal space between inclusion and exclusion. At the same time, I argue that the community was overwhelmed by the needs of members with mental health problems given the limited mental health services available in the area. I identify this as the “burden of community care” in which members of faith communities feel obligated to help fellow believers but have little mental health training and thus few tools to respond to troubling situations. In light of this year’s conference theme, I will conclude my talk by suggesting ways in which mental health professionals can work with faith communities to improve practices of care for believers suffering from mental health problems.