Gatekeeping for Faith Leaders, Part 1:
How do I know when to refer someone to counseling?
I have been a church kid my entire life, and involved in the mental health community for my entire adult life. My experiences in these spaces have led me to realize that, on the topic of mental health, there is nothing more beautifully supportive than a well-intentioned Christian.
On the same topic, there is nothing more harmful than a well-intentioned Christian.
Hold up. What now?
It is true. The difference in whether a well-intentioned person is helpful or harmful is the knowledge of their own competencies and limitations in the service of another person.
Your neighbor, a member of your local church, has a burst pipe at his house. It is flooding and the water is seeping everywhere, but he is out of town taking care of his ailing mother. You, with zero plumbing experience but a big heart and desire to help, grab a flashlight and wrench and determine that you will singlehandedly solve this problem for your friend and neighbor.
I am almost certain that your friend would prefer that you instead call a plumber and help by overseeing that the repairs are completed in a timely manner.
Ok, silly example is complete.
The point made here is that caring about someone does not necessarily make us competent to serve them with every need that arises. Sometimes it is kindest to know where our abilities end. We all have roles and gifts; one of the ways we use them discerningly is by helping people seek additional support that we cannot personally give them.
The next three Gatekeeping articles are for everyone involved in a faith community, but are especially meant for leaders, pastors, preachers, and mentors; your attention to this matter is vital in the well-being of the people you serve and live amongst.
I am a therapist who has worked with many people of faith. I cherish the moments that church leaders and mental health professionals work in tandem to provide care for the people of God’s kingdom. It is what, in some ways, brought me to this field.
Both of us, mental health professionals and faith leaders, must work diligently to build our individual competencies and to also have the discernment to know when to say “hmmm, you know who I think maybe you should talk to?”
Here are my tips for faith leaders in their role as gatekeepers for mental and emotional health services.
1. Know that your role is invaluable in the mental and emotional well-being of the people in your church.
Especially in certain demographics and regions of the country, many people are more likely to approach their faith leader about a mental illness prior to a therapist.
You are a trusted resource. You take the initiative to be active in the lives of the people you serve. You yourself are a safe space. And because of this, your guidance could positively impact the way in which a person decides to seek professional help.
But you are not the only gatekeeper; the gatekeeping roles are exchangeable. There are many moments in the counseling room in which I have encouraged a client to speak to their faith leader or mentor about a specific doctrinal topic because their discussions began to move into territory in which I am not qualified to guide them. It is also a major part of my counseling process to help clients cultivate support systems; I frequently ask about their relationships with their faith communities and how these spaces could be part of their healing.
We need each other in a professional sense. But most importantly, the people we serve need us to be revolving-door types of gatekeepers. When these individuals can move freely between our church buildings and counseling rooms with confidence that both their spiritual identity and their emotional pain can be respected and nurtured, then we are doing our job well.
For a person of faith, there is a deeply spiritual aspect of the therapeutic process. The more we embrace these connections, the more our clients are able to be genuine, open participants in the counseling process and in their community of support.
2. Know that you are only one person.
Another reason to refer a person to professional counseling resources is because you, my friend, are a single person. It should not be your responsibility to carry the mental and emotional burdens of every individual in your congregation when an entire community of believers exists to support them. Community means that you are not the only person responsible for another’s well-being. As Mother Theresa famously stated, “we belong to each other.” That includes you, too. Let us help you help them.
3. Know when to refer.
Sometimes part of your role as a mental health gatekeeper will be to triage a client’s ability to remain safe until an appointment with a professional. In these moments the immediacy for professional intervention will be clear.
(Note: In the third installment of this series, we will cover safety assessments and emergency resources. I also suggest completing a training in Mental Health First Aid ).
Substance abuse, infidelity and marriage issues, trauma, abuse, and self-harm are some obvious examples of experiences that easily warrant a referral to professional resources.
Plenty more concerns can fly under the radar, though, and it is important to be attuned to some of the clues that a person may benefit from counseling services.
- Lack of social supports
- Low level of functioning in daily activities
- High-stress in the Family system/ chaotic environment
- Developmental delays in individual or other family member
- Extended or abnormal grief
- Lack of variation in emotions
- Extreme variation or changes in emotions
- Strong, identifiable changes in appearance, hygiene, mood, activity level, or participation in once-loved activities or social events
My rule of thumb is that if you are on the fence about making a referral, make it. There is a reason you have a gut reaction that counseling could help (which may even be a nudge from the Spirit). And since attending counseling with a trusted, ethical professional is never something that is going to harm someone, making the referral will not hurt. Worst case scenario is that the person refuses to go, or they determine that counseling is not for them. You, on the other hand, have done your best to provide options for resources that a person may even return to in the future.
I would also suggest familiarizing yourself with the Quick Reference on Mental Health for Faith Leaders and keeping it on hand.
4. Know where to refer.
My biggest suggestion is to know your trusted local mental health resources and keep in contact with them as needed. Maybe even take some training courses from them on topics you would like to brush up on!
Make sure to have a list of referrals for different levels of care. Individual counseling may not be a fit for someone who really needs residential or inpatient services.
Know what referrals you trust before the time comes to need them. Part of this process may include asking counseling centers or individual counselors about whether they are trained in integrating spirituality in the counseling process. Being choosy about where you refer your church members can help build that trusting “revolving gate” between yourself and the professionals who will best serve your community of believers.
5. Know how to have the referral conversation.
First, you need to know what counseling is like. Are you able to describe what a counselor’s role is and how it differs from your own? You are a big part of helping decrease the stigma surrounding mental health support; having an accurate description of it is necessary.
Some of my favorite things to share with someone that I am referring to counseling are:
- Counseling does not have to be forever, and the frequency can ebb and flow as needed.
- Counseling does not have to come with a diagnosis or medication. In fact, only a psychiatrist can prescribe medication, anyway!
- When I refer a friend to a counselor, I am not “pawning them off,” but am “walking with them” on their journey toward healing. I stress that they can always still talk to me as a confidant. I am not going anywhere just because they are seeing someone professionally, too.
6. Know what to do if the person refuses professional counseling.
Assess for safety (Part 3 on safety measures will cover this more fully). If a person is in immediate danger, your options are limited. If they are not, I suggest that you continue to be a support for that person, but make sure clear boundaries are put in place so that you are not being utilized as a mental health counselor.
If you do feel like you are being edged into a counseling role, make sure to clearly identify where your role begins and ends in assisting a person. Sometimes setting these boundaries can be mistaken for abandonment for some individuals.
Let’s address this by using another fun example.
If someone tried to guilt you into performing a brain surgery on them, even though you are not a surgeon, under the guise of “if you truly cared for me you would help instead of referring me,” you’d call the whole thing preposterous. Acting as a professional therapist when you are not one is similar.
Your role as a spiritual support and theological mentor is of paramount importance in a person’s healing, but there are specific ways you are not trained in therapeutic support. Attempting to offer therapeutic support could become harmful.
7. Know that your role continues after referrals:
I hope I have stressed that we absolutely want to have a relationship with you! You are not just a referral source, but a key element of community support for many people. We have a vested
interest in your feeling confident and comfortable in having these conversations. Let us know if you would like to have someone at ChristianWorks train your ministry team. Let us help you!
Stay tuned for Gatekeeping for faith leaders, part 2: What is my role after I refer someone to counseling? And Gatekeeping for faith leaders, part 3: Let’s Talk about Safety
1. American Psychiatric Association Foundation. (2016). Mental health: A guide for faith leaders.
2. American Psychiatric Association Foundation. (2018). Quick Reference on Mental Health for Faith Leaders. Washington, DC; American Psychiatric Association Foundation.
3. Bolger, D., & Prickett, P. J. (2021). Where would you go? race, religion, and the limits of Pastor Mental Health Care in Black and Latino congregations. Religions, 12(12), 1062. https://doi.org/10.3390/rel12121062
4. National Guidelines for Behavioral Health Crisis Care – Samhsa. (2012, October 16). Retrieved March 16, 2023, from https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf
5. Smith, J. (2019, July 25). A free mental health guide for faith leaders. Key Ministry. Retrieved March 15, 2023, from https://www.keyministry.org/church4everychild/2019/7/2/a-free-mental-health-guide-for-faith-leaders
6. Training videos on mental health inclusion. Key Ministry. (n.d.). Retrieved March 15, 2023, from https://www.keyministry.org/training-videos-on-mental-health-inclusion