Dear Shepherd Heart,
Help! I’m in way over my head in the pastoral care of a parishioner who seems to need so much more care than I can give. It’s becoming a crisis, and I don’t know if the parishioner is safe from hurting or maybe killing themselves, at some point. What should I do now? Is there a way I might have seen this coming?
Thanks,
Rev. Overwhelmed
Dear Overwhelmed,
Thanks so much for reaching out. I can guarantee you that there are many pastors out there who can relate to exactly the same overwhelming feelings you describe. You’re not alone.
With many parishioners finding mental healthcare either inaccessible in their immediate area, or else having a hard time finding care that’s within their insurance coverage– or perhaps they just find the very idea of therapy scary or intimidating– parishioners may be much more likely to see you, their clergyperson, first, for care before they would ever go see a “shrink.” The truth is that many parishioners come to pastoral care presenting with clinical issues. That means that it will serve clergypeople well to recognize pastoral care issues that also suggest a need for clinical help from a licensed mental healthcare professional, like a psychologist or a psychiatrist. Like it or not, clergypeople are often on the frontlines of mental healthcare. But that doesn’t mean that you as the pastor should be out there all alone in this, like The Lone Ranger. Your training is not the same as that of a mental health professional — you’re a pastor, and that’s great. It’s good and necessary for you to know when you’re at the limit of your scope of competence. Sometimes, you have to call in for help. Making referrals to your mental health colleagues in your area to expand the circle of care for a parishioner is *not* a sign of failure on your part; it’s in fact an act of pastoral integrity.
You may be wondering, how do I find clinicians that I would be willing to send or refer my parishioners to? Well, among other resources, Shepherd Heart maintains a database of licensed clinicians across the country who have indicated that they understand issues that clergypeople and parishioners face on a regular basis, and we’re happy to support you to do your own research to find appropriate referrals inside or outside of that network. Did you know that some licensed clinicians even post profiles on our website to help pastors get to know their work better? And there have been developments in telehealth and license reciprocity (e.g., PsyPact) that allow some psychologists to work across jurisdictions. There are more options than there used to be, and you can help direct your parishioners to good mental health help.
With regard to learning how to recognize clinical issues, as a pastor, that indicate a need for referral to a therapist — things like clinical depression or bipolarity, trauma or abuse history, intimate partner violence, disordered eating (just to name a few…), Shepherd Heart has got you covered. Shepherd Heart holds workshops on Recognizing and Referring, which can be quickly requested by church leaders to help them identify clinical issues, and support them to find referrals to licensed mental health practitioners, like psychologists & psychiatrists, in their area. This training is so important that we recommend that every denomination and credentialing body request this training workshop for all their credentialed leaders.
In the workshop on recognizing and referring clinical issues in pastoral care, we teach pastors how they can make a quick risk assessment of immediate danger (given their scope of training), for when pastors find that they are indeed the “first responder” in a potential emergency situation. Pastoral assessment includes comprehending and directly addressing situations of either suicidal or homicidal ideation (thoughts), intent, means, and/or plan, and then getting immediate outside support from qualified professionals ASAP. Remember, in an active mental health emergency where you’re worried about someone self-harming, calling 988 can bring mental health help in a pinch. If there is need for medical intervention, like an ambulance, for self-harm that has happened, calling 911 can save a life. Don’t be worried about breaking confidentiality in situations of immediate harm to self or others… More on that another day.
Please, “Overwhelmed,” both for your sake and the sake of your parishioners, I encourage you to equip yourself with such a training, which you can request for yourself and your leadership team by registering for it here. You don’t have to wait for your ministry conference or denomination to organize the event for you. We respond to all requests for workshops to your ministry team promptly.
If you need one-on-one support, “Overwhelmed,” for your self-care as a leader, as you navigate tricky pastoral care issues, please know that you’re welcome to schedule Leader Soul Care, or else a ministry consultation. We are here for you. You’re not on your own.
Thanks again for your letter, “Overwhelmed”. It may inspire a whole series on pastoral care in the near future, because there is just so much to say! Blessings to you.
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Letters may be edited, compiled, and composited. Responses are for educational purposes only. They do not offer legal advice or psychological services of any kind.