Supporting People with Mental Illness in Your

ParishHosted and Moderated byDorothy Coughlin, Director

Office for People with Disabilities

Archdiocese of Portland in Oregon

Supporting People with Mental Illness in Your

ParishThomas Welch, MD

Physician, Adult & Forensic Psychiatry

***Sharon Collver, SNJM

Chaplain, Oregon State Hospital

Parishes Need to Knowabout Mental Illness

• Many parishioners or their family/friends are dealing with mental illness

• Parish staff (clergy, religious educator, secretary, janitor, groundskeeper) are often the “first responders” to people experiencing mental health crises

What is mental illness?

• Many different conditions• Can occur at any age to any one• Range of severity• Encompasses biological,

psychological, social, and spiritual dimensions of the individual

Severe and Persistent Mental Illness (SPMI)

• Schizophrenia, bipolar disorder (manic-depressive illness), schizoaffective disorder

• Some types of major depressive disorder, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD)

Not considered SPMI(But can co-occur)

• Intellectual disabilities (mental retardation and developmental disabilities)

• Dementia (Alzheimer’s, vascular)• Substance use disorders

(drug/alcohol abuse & dependence)

Importance of an Accurate Diagnosis

• Not to label or criticize a person• Helps direct treatment• Allows more accurate prediction of

course of illness and prognosis

Importance of Proper Care

• Relief of suffering• Improvement in functioning and

quality of life• Strengthening the Body of Christ• Promoting the Reign of God

Psychotic Symptoms

• Hallucinations• Delusions• Disorganized Speech• Catatonia• Negative Symptoms

Psychotic Symptoms

• Often characteristics of SPMI• Can be present in many other

disorders• Psychotic does not refer to a

person’s character• Schizophrenia is not split mind or

split personality

Hallucination

• A sensory perception that has the compelling sense of reality, but is not actually perceived through the senses

• Can be auditory, visual, olfactory, gustatory, or tactile

Auditory Hallucinations

• Can be perceived as inside or outside one’s head

• May feel others hear thoughts, put thoughts in their head, steal thoughts

• Often are demeaning, critical, but can be pleasant

St. Teresa of Avila

• In Interior Castle (1577) wrote of “locutions”

• Delineated various types of auditory perceptions

• Noted that most often the experience was “a fancy” due to “real melancholy” or “feeble imaginations”

Delusion

• A firmly held false belief based on an incorrect inference about reality

• Not widely shared by others in one’s culture (including culture of the Church)

• Types: grandiose, persecutory, erotomanic, jealous, somatic

Disorganized Speech

• Usually an indicator of thought process

• Can be tangential, flight of ideas, illogical, unintelligible

Catatonia

• Bizarre motor activity• Can include: immobility, excessive

activity, assumption of unusual body postures, and echoing sounds or movements

Negative Symptoms

• Severe deficits in functioning• Diminished range or intensity of

emotional expression• Speech characterized by brief,

empty, incomplete replies• Difficulty initiating activities, loss

of interest or pleasure in activities

Mood/Affect

• Depressed, “blue,” sad • Irritable• Absence of emotion, flat, blunted• Euphoria, elevated, expansive

Depressive Symptoms

• Changed appetite, weight• Altered sleep• Difficulty concentrating• Loss of interest in activities• Fatigue, restlessness, lethargy• Feelings of worthlessness,

thoughts of death

Manic Symptoms

• Inflated self-esteem, grandiosity• Decreased need for sleep• Talkativeness• Racing thoughts• Excessive activity, risk taking,

spending, traveling

Types of Responses

• Biological: Medication, general medical care

• Psychological: Psychotherapy, counseling, behavioral interventions

• Social: Family support, employment, socialization, friends

• Spiritual: Parish community, sacraments, prayer, scripture

Your Parishes

• Attend• Welcome• Include• Accommodate• Pray• Learn and Teach• Know

Attend

• Pay attention!• Who is at Mass? Who is missing

from Mass?• How do people interact with one

another? With a new person?

Welcome

• Greeters, ushers, clergy• Parishioners• Church buildings

Include

• Invite people with mental illness to participate in parish activities, volunteer, bring up the gifts

• Use person-first language• Encourage parishioners to bring

their family members who have mental illnesses to Mass, events

• Companionship

Accommodate

• Pacing, talking, appearance• Analogy of arthritis or lung disease• Does not mean acquiesce!

– Minimum expectations apply to everyone.

– Inappropriate or dangerous behavior must be pointed out so the person has the opportunity to correct it.

Pray

• Praying with and praying for• Prayers of the faithful• Homilies• Message of hope

Learn and Teach

• Seminars• Parish nurses, health fairs• Host NAMI or other support groups• Faith formation• Peace and justice committees

Know

• Local resources for emergency responses and crisis management

• Local options for mental health services

• Hospitals, group homes, and other residences for people with mental illnesses in your parish

Know

• Resources for further information:– NCPD: ncpd.org– National Alliance on Mental Illness:

NAMI.org– NAMI FaithNet: faithnet.nami.org– Pathways to Promise:

pathways2promise.org– Mentalhealthchaplain.org

The Flame of Faith Within

• People of faith with mental illnesses exhibit a wide range of expressions of their faith.

• Their faith experience may be colored by symptoms of mental illness, but the flame of faith within each one remains.

Patients in psychiatric hospitals might…

• Attend worship services offered on-site or prefer to take a pass to a local church

• Read the bible or other religious material

• Talk freely to other patients about their faith even to the point of proselytizing

• Request a religious symbol or article

Patients in psychiatric hospitals might…

• Request a visit by a chaplain or clergy member, especially at times of loss or crisis

• Spend quiet time in prayer and contemplation• Seek spiritual direction• Need help staying connected and/or

reconnecting with a faith community upon their discharge from the hospital

• Participate in a prayer service or group

Patients in psychiatric hospitals might…

• Practice their religion, talk about their faith, and seek spiritual support, just like someone hospitalized for any other medical problem!

Finding the Flame

• In people experiencing psychotic symptoms including religious delusions:– Listening for the kernel of reality beneath

the symptoms– Inquiring about their faith history– Inquiring about the “God language” with

which they were raised– Acknowledging their experiences; affirming

what appears rooted in their religious tradition

Finding the Flame

• In people who are recovering from psychotic symptoms including religious delusions:– Supporting their insight into what had been

misperceptions– Acknowledging the frustration and disappointment of

finding learning the “voices” were not real– Sharing scripture or other accounts of healing,

deliverance, conversion, etc.– Praying in thanksgiving for recovery

Prayer Service or Group

• Environment: quiet music, soft lighting, breathing for relaxation or an opening preparatory/gathering song

• Read a passage from scripture or other text

• Facilitate a discussion of what people were struck by in the passage

Prayer Service (continued)

• Share a psalm or other prayer• Invite people to offer their prayers

for others and for themselves• Sing a closing song together that

reflects the theme of the service• Consider modifications based upon

the participants’ religious, racial, ethnic traditions

Other Considerations

• Providing quiet, safe place• When a priest or parish staff

person experiences a serious mental illness

• Suicide

Questions?

• Click the Q & A button• Type in your question and send• We will respond verbally to the

whole group and try to answer as many questions as we can.