Mental health is not often a public topic of conversation—or even a private one. That avoidance appears to be just as prevalent, if not more so, in church settings. In recent years, however, a plethora of research has shown that mental health issues are more common than one might think, cutting across gender, ethnicity, and socioeconomic status. According to the Substance Abuse and Mental Health Services Administration, it’s estimated that almost one in five Americans suffer from some form of mental illness each year.
As churches become increasingly aware of the widespread and serious nature of mental illness, church leaders may wonder how they should engage mental health ministry in the church—and what legal risks they may face in doing so.
The most important mental health case to date
Lisa Runquist, an attorney specializing in nonprofit law, has researched the issue of liability for churches that have chosen to counsel individuals with mental health issues.
For Runquist, the most important court case regarding churches and counseling came in 1988 when a lawsuit—Nally v. Grace Community Church of the Valley—was ultimately decided by the Supreme Court of California. An individual, Kenneth Nally, had sought help from counseling through Grace Community Church of the Valley and later committed suicide. Nally’s parents then brought a wrongful death action lawsuit against the church and four church pastors, alleging “clergyman malpractice” (negligence in failing to prevent the suicide).
Runquist explains the verdict and its importance:
The Supreme Court of California . . . found that the church was not liable for clergy malpractice and did not violate any legal duty to Mr. Nally. Specifically, there was no duty on the church and its pastors (and other “non-therapist counselors”) to refer suicidal persons to licensed psychotherapists. In addition, there was no cause of action for wrongful death based on intentional infliction of emotional distress. Since that time, there have been other cases brought in various other states, also finding no breach of duty by clergy.
For churches worried about the risk of liability for counseling someone with mental health issues, that’s good news. But it’s not the full scope of the issue.
Runquist is quick to note that although the Supreme Court of California ruled in favor of the church in this case, it did so based—at least in part—on several key facts of the case that might not be applicable to future lawsuits against churches. Those key facts in this specific case were:
- The individual voluntarily sought counsel from the church.
- The church did not have a professional or clinical counseling ministry. They responded on a spiritual, biblical, or prayer level. "In essence, defendants held themselves out as pastoral counselors able to deal with a variety of problems—not as professional, medical, or psychiatric counselors," according to a concurring opinion from the court.
- Both the individual's mother and father had been informed by several physicians and psychologists that he needed acute psychiatric care and should commit himself or be committed. The parents rejected this advice.
- The church actually arranged several visits to physicians or psychologists in addition to encouraging the individual to continue to see and cooperate with the physicians and psychiatrists he was already seeing.
“Although the California Supreme Court rejected the Court of Appeal’s imposition of a duty to refer on pastoral counselors, the facts surrounding the case cannot be overlooked,” says Runquist. “In fact, a concurring opinion found that there was a duty [on the part of the church], but that it was not breached in this case” (emphasis added).
This means that churches may indeed be taking on some legal duty by offering counseling—even if the counseling is solely spiritual in nature and that spiritual nature is made explicit. How much liability they take on, however, depends on the church and what it communicates to its counselees and community.
Pastors need to weigh carefully the help they offer to those dealing with mental illness and how that help is conveyed. This is especially true given the scope of the issue—and the inadequate preparation for it on the part of most pastors.
Pastors have ‘next to zero’ training
The reality of mental illness is larger than has been historically acknowledged in our culture—both in Christian circles and outside of them.
Brad Hoefs is a pastor who started Fresh Hope for Mental Health (or “Fresh Hope”), a peer-to-peer support group similar to Alcoholics Anonymous, for both individuals and the families and friends of those dealing with mental health diagnoses. Hoefs himself has been diagnosed with bipolar disorder and believes the church has a long way to go to adequately minister to people in this area. He sees the issue of mental health as widespread, urgent, and a prime opportunity for ministry.
Take the issue of suicide. There are “now more suicides per year than there are [fatalities due to] car accidents,” says Hoefs. “More people are shot by their own hands than are shot by guns by other people.”
Not all mental health issues are as life-threatening as depression with the risk of suicide, but all mental illness is serious for those who experience it. Of those with a mental health issue, three out of five receive no treatment, according to Dr. Matthew Stanford, an adjunct professor in the Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine and the Department of Psychology at the University of Houston.