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Journal of Psychology and Christianity
2021, Vol. 40, No. 1, 50-60
Copyright 2021 Christian Association for Psychological Studies
ISSN 0733-4273
Why Church Attendance is Difficult for Children with
Common Mental Health Conditions and Their Families
Stephen J. Grcevich1 and Mira B. Grcevich2
1
Department of Psychiatry, Northeast Ohio Medical University
2
Department of Psychology, Belmont University
Children and adolescents with mental health conditions are less likely to attend religious services than
unaffected youth. Depression is associated with a 73% reduction in the likelihood of attending a worship
service, while the presence of disruptive behavior disorders, anxiety disorders, or attention-deficit/hyperactivity disorder are associated with 55%, 45% and 19% reductions, respectively. In this paper, we
hypothesize lower rates of church attendance result from functional limitations associated with mental
health conditions that make entry into a church difficult. Children and youth with mental disorders experience more difficulty meeting common expectations for social interaction and self-control in worship
services, small groups, Christian education, service activities, and other church functions. Given the heritability of these conditions, their parents often experience similar challenges engaging in ministry activities. We propose a mental health inclusion model for use in churches of all sizes and denominations. The
model facilitates recognition of common barriers to church engagement and assimilation and application
of inclusion strategies across ministry activities and environments offered to all.
Keywords: mental health, church, inclusion, children, families
Why Church Attendance is Difficult for Children
with Common Mental Health Conditions and
Their Families
death from despair (i.e., alcohol, drugs, suicide)
among women and a 33% lower hazard among
men compared with participants who never attend
(Chen et al., 2020).
There is similar outcome data for anxiety disorders. Religious interventions decreased symptoms more rapidly than secular interventions in
randomized studies of participants with anxiety
disorders (Koenig et al., 2012).
The presumption throughout the literature is
that participation in worship services and other religious activities promotes positive mental
health outcomes. An alternative hypothesis is
that persons with more severe manifestations of
mental illness experience greater difficulty participating in church or other religious activities. The
ability to engage in church activities self-selects
individuals with less functional impairment from
their mental health conditions.
A random sample of 1,714 adults were interviewed about health and religiosity in the third
wave of the Baylor Religion Survey (Dougherty et
al., 2011). Worriers—people who self-identified as
feeling worried, tense, or anxious for ten days or
more in the preceding month (17% of the U.S. population)—were less likely to have attended a religious service in the past year (67% vs. 75%), attend
religious services on a weekly basis (17% vs. 37%),
read the Bible on a weekly basis (13% vs. 29%), or
Little data are available examining the impact
of mental illness upon church attendance, despite
mental illness representing the most common
cause of disability worldwide among youth ages
10-24 (Gore et al., 2011). The preponderance of
research on mental health and religion examines
religion and religious participation as a psychological and social resource for coping with stress
(Koenig, 2009).
Religiosity has been associated with reduced
risk of depression and is robustly associated with
more rapid remission of depression in patients
with serious mental illness and reduced risk of suicide (Koenig et al., 2012; Koenig, 2007). In a study
of over 100,000 U.S. healthcare professionals, attendance at religious services at least once per
week was associated with a 68% lower hazard of
Author Note
Stephen J. Grcevich
https://orcid.org/0000-0002-3312-6625
Mira B. Grcevich
https://orcid.org/ 0000-0003-4943-1090
Dr. Grcevich receives royalties from Harper Collins/
Zondervan Publishers.
Correspondence concerning this article should be
addressed to Stephen J. Grcevich, P.O. Box 26109,
Cleveland, OH 44126. E-mail: sgrcevich@neomed.edu
50
�Why Church Attendance is Difficult
consider themselves religious (19% vs. 39%) compared to non-worriers. Adults who experienced
sadness or depression for ten or more days (11%
of participants) during the preceding month were
less likely to have attended a religious service in
the past year (61% vs. 78%), attend services weekly (15% vs. 36%), read the Bible weekly (13% vs.
28%), describe themselves as “very religious” (20%
vs. 37%) and more likely to identify as religiously
non-affiliated (23% vs. 10%) compared to participants free of depressive symptoms.
Whitehead (2018) examined the impact of physical, mental health, and developmental disabilities
upon church attendance using data generated
from nearly 100,000 phone interviews conducted
in each of three waves (2003, 2007, 2010-2011) of
the National Survey of Children’s Health (NSCH).
Families of children with no chronic health condition were less likely to report never attending
church services compared to the overall sample.
The percent increase in odds of children with
chronic health conditions never attending church
was 84.1% for children with autism spectrum disorders, 72.7% for children with depression, 54.6%
for children with oppositional defiant disorder or
conduct disorder, 44.7% for children with anxiety disorders, and 19.3% for children with attention-deficit/hyperactivity disorder (ADHD). Conditions not impacting church attendance included
asthma, diabetes, Tourette Syndrome, epilepsy,
hearing or vision problems, intellectual disabilities, and cerebral palsy.
According to the U.S. Centers for Disease Control (2020), 9.4% of children aged 2-17 years (approximately 6.1 million) have received an ADHD
diagnosis, 7.4% of children aged 3-17 years (approximately 4.5 million) have a diagnosed behavior problem, 7.1% of children aged 3-17 years (approximately 4.4 million) have a diagnosed anxiety
disorder, and 3.2% of children aged 3-17 years
(approximately 1.9 million) have a depression diagnosis. Comorbidity is common, in that children
with ADHD display elevated rates of depression,
nearly three in four children with depression also
have anxiety, and almost one in two children with
ADHD also have behavior problems. For children
with anxiety, over one in three also have behavior
problems and approximately one in three also have
depression.
These data suggest that an inclusion strategy for families of children with common mental
health conditions is needed. ADHD is five times
51
more common than autism and eight times more
common than intellectual disabilities (Zablotsky et
al., 2019). Given the prevalence of anxiety, depression, and disruptive behavior disorders, mental
illness is the most common disability impacting
church attendance and engagement in children
and youth.
Multiple factors contribute to the absence of
programs and strategies for inclusion of children,
adults, and families impacted by mental illness.
One is the “hidden” nature of many mental health
conditions. Children and adults with these conditions who come to church often seek to avoid
calling attention to themselves and reject any
special treatment or supports that might single
them out as “different.” Stigma regarding mental
illness prevalent in multiple strains of American
Christianity causes many to keep their struggles
to themselves (Peteet, 2019). Mental health-related disability may be reflected in some, but not
all, day-to-day activities. A person with a mental
health condition associated with sensory processing differences may have no difficulty sitting
through a Bible study or sermon but experience
profound distress in a worship service with especially loud music.
Impacts of Church Culture on
Attendance and Engagement
We now present a model for mental health inclusion in churches, grounded in a recognition of
how functional limitations associated with mental
health conditions often clash with “church culture”—defined here as expectations for how attendees will act and respond when gathered for
worship, Christian education, missional service,
social activities, and other functions of the local
church.
Carter (2007) developed a framework for conceptualizing impediments to church attendance
and engagement for individuals with intellectual
or developmental disabilities, categorizing barriers as architectural, attitudinal, communication,
programmatic, or liturgical. His framework offers
a useful starting point for considering the barriers
to church attendance for all with mental health
disorders.
This framework has worked well for guiding
inclusion strategies for children and adults with
physical disabilities. Thousands of churches have
taken steps to make their facilities more accessible—providing elevators, restrooms, wheelchair
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Why Church Attendance is Difficult
ramps, amplification equipment, or interpreters for persons with hearing impairments. Some
churches provide nurses to assist attendees with
significant medical needs. Excellent ministries
have emerged for serving children and adults with
“special needs” offering a modified Christian education curriculum, “buddies” for children or teens
who require individualized attention, and special events, such as respite events for parents or
proms as outreach to adults in assisted living facilities.
Established models of disability ministry designed to serve children with physical, intellectual, and developmental disabilities are not working
for those with common mental health conditions.
Disability ministry in the late 20th and early 21st
centuries has largely served persons who unequivocally bear no personal responsibility for their conditions, exemplified by the man with congenital
blindness miraculously healed by Jesus in John 9.
Church leaders recognize the diminished capacity for moral agency among children and adults
with more profound intellectual or developmental
disabilities. Mental illness forces us to consider
the individual’s ability to make moral judgments
grounded in biblical teaching and their capacity
to refrain from actions and behaviors identified as
sinful in Scripture. The extent to which mental illness mitigates a child’s ability to control their own
behavior or reflects upon the quality of parenting
they receive is far more ambiguous.
Several hypotheses have been proposed for why
children and adults with mental illness have been
poorly served by existing disability ministry models.
• The term “mental illness” is used to describe a
very broad range of conditions affecting cognition, perception, mood, emotions, and behavior.
The support needs of a child with social anxiety
are radically different than those associated
with oppositional defiant disorder or a teen
with early-onset schizophrenia. Recognition of
these distinctions within the church is rare.
• Mental health disabilities can be difficult to recognize. Symptoms are often episodic. A child or
adult with a mood disorder may function well
for months or years until signs of depression
or mania emerge. Families are often reluctant
to disclose a child’s mental health condition to
church staff and volunteers. Many adolescents
will avoid any ministry or support that draws attention to their differences.
• Mental illness is stigmatized in many churches
in ways other disabilities are not.
• Functional impairment from mental illness is
often situation specific. The aspiring valedictorian may be overwhelmed by the social demands
of youth group, or the star quarterback may be
unable to sit through a chapel service because
of vulnerability to panic attacks inside crowded
or confined spaces.
Grcevich (2018) introduced a framework for
church-based mental health inclusion building
upon the established practice in disability ministry
of identifying impediments to church attendance
and engagement, taking into account the heterogeneity of functional impairment associated with
common mental health conditions; the extent to
which impairment is present some of, but not all,
the time in some, but not all, situations; and the reluctance of affected individuals to self-identify to
pastors, church staff, and volunteers. It identifies
seven barriers to church attendance for children
and adults with mental health conditions and their
families: stigma, anxiety, executive functioning,
social communication, sensory processing, social
isolation, and past experiences of church, along
with a set of inclusion strategies for overcoming
existing barriers sufficiently flexible for use in
churches of all sizes and denominational traditions.
Stigma
LifeWay Research (2013) conducted a telephone study of 1,001 U.S. adults in which 55% of
non-churchgoers disagreed with the statement: “If
I had a mental health issue, I believe most churches would welcome me.” One explanation may be
outsiders suspect the presence of ongoing mental illness will be interpreted by churchgoers as
evidence of a lack of faith or diligence in religious
practice. Evangelicals or fundamentalists were
more likely than other Americans (48% vs. 27%) to
endorse the statement that people with serious
mental illnesses like depression, bipolar disorder,
and schizophrenia can overcome their conditions
through Bible study and prayer alone.
Historically, churches have been on the forefront of caring for persons with conditions now
understood as mental illness. The church became
increasingly disconnected from mental health
care throughout the twentieth century as influential theories arose to conceptualize and guide
treatment grounded in principles in conflict with
�Why Church Attendance is Difficult
traditional church teachings.
Freud’s theoretical framework for psychoanalysis viewed guilt as pathological and rejected the
concept of guilt as a warning from the conscience
of the need to recognize and deal with sin. The
psychodynamic psychotherapies derived from
Freud’s work attribute behavior to instinctive urges or drives—a stark contrast to centuries of Christian teaching that views human behavior as actions resulting from humankind’s exercise of their
God-given freedom to choose right from wrong,
for which the individual bears personal responsibility.
Two foundational assumptions of behaviorism are that nature is the only reality and reality
can only be measured through our senses. From
a Christian perspective, behaviorism is fatally
flawed because its practitioners neglect to consider spiritual dimensions of human existence that
cannot be readily quantified and measured. Pure
behaviorism is antithetical to the construct of free
will and biblical teaching on the importance of the
soul.
Humanistic therapies emerged in the mid-20th
century in response to the determinism inherent
in psychoanalytic and behavioral theory. Self-fulfillment and self-actualization are the goals of humanistic treatment conducted under the assumption the individual is responsible for their own
happiness and accountable to only themselves.
Adherents of humanism struggle to acknowledge
there is a God to whom individuals are accountable. The emphasis on subjective experience and
rejection of moral absolutes is incompatible with
two thousand years of Christian teaching.
Powlison (1996) detailed how the growing cultural influence of secular therapies triggered an
anti-psychiatry movement among conservative
Protestants. Many influential pastors and church
leaders concluded it was impossible for Christians
to be helped by therapies grounded in understandings of humanity incompatible with biblical truths.
Psychotherapy constituted a threat to the faith of
believers. Nouthetic counseling emerged as an
alternative treatment approach grounded in the
ideas that everything necessary to counsel people
for emotional or behavioral problems that are not
unequivocally organic can be found in Scripture;
the Bible is sufficient for counseling; the underlying cause of mental illness is sin; and mental health
practitioners dissuade people from taking responsibility for their emotions and behavior (Adams,
53
1986). Criticism of secular approaches to mental health led to criticism of individual Christians
seeking secular mental health services. Highly
respected church leaders within the reformed and
evangelical traditions continue to express suspicion of medical and psychological approaches to
mental health diagnosis and treatment.
John Piper (2009) described five-year-olds with
self-control difficulties as “unregenerate” and attributed their behavior to parents who fail to “restrain the egocentric impulses of their children
and confirm in them every impulse toward courtesy and kindness and respect.” John MacArthur
(1996) described parents who give permission for
their children to take medicine for issues with
self-control as doing so “when they will not do it
God’s way” and implied that parents who do so are
choosing to turn their children into “drug addicts.”
Such attitudes help to explain the perception
among many parents that “people in the church
think they can tell when a disability ends and bad
parenting begins,” (Grcevich, 2018, p. 151).
Anxiety
Children and adults with an identified anxiety
disorder experience excessive and persistent anxiety or fear inappropriate for their level of maturity
that significantly interferes with tasks of daily living, including participation at church. Anxiety disorders represent the most common mental health
condition in adolescents and adults and the second most common condition in children (National
Institute of Mental Health, 2017).
While many factors contribute to the development of anxiety disorders, a key finding from
neuroimaging studies is a relationship between
abnormal limbic system activity (the brain area
responsible for modulating emotions) and a propensity for overestimating risk in new or unfamiliar situations. Abnormal connections between the
limbic system and prefrontal cortex (an area of the
brain responsible for higher order thinking and
self-control) have been associated with anxiety
disorders in children (Blackford & Pine, 2012).
Anxiety represents a significant barrier to
church attendance for children in large part because it represents a barrier to church attendance
for their parents or caregivers. A parental history
of anxiety (especially maternal history) contributes to a twofold to sevenfold increase in the risk
for anxiety in their offspring (Low et al., 2012). Consider the range of challenges adults and children
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Why Church Attendance is Difficult
with anxiety disorders may experience in visiting
or assimilating into a new church.
· They may fear being dressed differently than everyone else or becoming the center of attention.
· A child may worry they will not know or recognize anyone else in their Sunday school class.
· A parent may presume the adults they encounter on an initial visit—greeters, the children’s or
student ministry director, their child’s Sunday
school teacher, ushers, other worshipers, the
pastor in a smaller church—are harshly scrutinizing them.
· A child with separation anxiety may become
demonstrably emotional at a church where parents are discouraged from bringing children into
the adult worship service.
· An adult might experience great discomfort
from expectations for self-disclosure in the
presence of relative strangers in churches
where small group participation is encouraged.
· A child or adult with obsessive-compulsive disorder (OCD) may go to great lengths to avoid
physical contact with other worshipers, objects,
or furniture because of contamination fears.
Sermons or Sunday school teaching may trigger
obsessive fears of losing their salvation.
· A child or adult with agoraphobia may avoid
church if they are not assured of seating near
an exit at worship services where they can leave
without drawing undue attention to themselves.
· A teen or adult may be less likely to register for
church activities if a phone call to an unfamiliar
person is a necessary step in the registration
process.
· A child or teen with separation anxiety may feel
overwhelmed by the prospect of participating in
overnight retreats and mission trips.
· A child or adult with performance anxiety may
avoid joining a church if a public profession of
faith or baptism is required.
· A parent of a child with anxiety may never return
to church if arbitrary rules or decisions cause
their child to be separated from someone they
depend on for companionship—if they cannot
attend Sunday school with a family member or
friend in a different grade or age group.
A useful exercise for pastors and ministry leaders is to consider how they would redesign their
church’s worship services, Christian education,
outreach, and fellowship activities if 100% of their
attendees experience one or more anxiety disorders.
Executive Functioning
Executive functioning refers to the cognitive
abilities involved in modulating other abilities
and behaviors. Executive functions represent the
means through which children and adults acquire
language, make plans, establish priorities, manage
time, delay gratification, and exercise conscious
control over thoughts, words, and actions.
Executive functioning difficulties are a core feature of ADHD and very common among persons
with autism spectrum disorders (Barkley, 1997).
Executive functioning is often compromised in
children and youth with mood disorders, anxiety
disorders, and fetal exposure to alcohol, drugs,
and other toxins. Additionally, executive functioning is adversely affected by stress hormones and
neural pathways activated in response to adverse
childhood experiences, including trauma and
abuse (Fisher et al., 2011). This capacity is often
greatly compromised in children, teens, and adults
with intellectual or developmental disabilities and
represents an area of overlap between mental
health ministry and special needs ministry.
Scripture places a high value on self-control.
The capacity to control one’s words and actions
are evidence of God’s work within us and a key
marker of spiritual maturity.
Hathaway and Barkley (2003) hypothesized that
persons with ADHD face greater difficulties in religious socialization, religious focus, internalization and integration of faith, stability of spiritual
growth, and religious alienation. Their capacity
for self-control is often highly dependent on their
level of interest in the task at hand and characteristics of the environments in which they find themselves.
Common challenges to church participation
among children and youth with executive functioning weaknesses include the following:
· The process of preparing a child with severe executive functioning deficits for and transporting
them to church may leave parents or caregivers
exhausted.
· Parents choose to not bring their child to church
out of concern for their inability to keep impulsive or aggressive behavior in check.
· They may experience more difficulty sitting,
standing, or kneeling for an extended time
during worship services designed for adults, especially when they become bored.
· They may experience embarrassment or frustration if expected to memorize Scripture or
�Why Church Attendance is Difficult
prayers.
· Some parents are instructed to avoid use of prescription medication on weekends essential to
their child’s ability to maintain focus and impulse
control.
· Excessive stimulation from children’s or student ministry worship activities may negatively impact the ability of some youth to maintain
self-control.
All too often the very people who should be turning to the church for help experience embarrassment and shame. The inadequacy of the church’s
understanding of mental illness is demonstrated
by each failure to respond compassionately when
children and adults struggle to fulfill expectations
for self-discipline and emotional control.
Sensory Processing
Sensory processing disorder (SPD) is not currently recognized as a stand-alone medical condition, but sensory processing difficulties are
frequently associated with common mental health
conditions. The link between sensory processing
and mental illness is sufficiently strong to merit inclusion in the National Institute of Mental Health’s
(NIMH) Research Domain Criteria (RDoC) framework for identifying the root causes of mental illness (Harrison et al., 2019; NIMH, 2019). Five percent or more of children and teens in the United
States experience significant functional impairment because of abnormal sensory processing
(Ahn et al., 2004).
Persons with sensory processing differences
often become overwhelmed because of difficulty
integrating too much or too little incoming information from their senses—sight, smell, touch,
hearing, and taste. Children and teens with hypersensitivity often have marked aversion to noise,
light, touch, and taste. They may be extremely
picky about the feel of clothes against their skin,
pull away from others in response to touch, experience pain in the presence of loud noise, or become nauseous around persons wearing strong
fragrances. They may be accident-prone and often avoid gross motor activities involving strength,
balance, or coordination. Youth with hyposensitivity are often sensory seekers. They love tight hugs,
physical contact, amusement park rides, trampolines, climbing, jumping, and splashing. They
may also have a hard time sitting still and keeping
their hands to themselves at a worship service or
church activity. Some may experience hypersensi-
55
tivity and hyposensitivity simultaneously.
Families of children and youth with sensory
processing differences face multiple potential pitfalls when attending a worship service. Areas near
entrances and exits are often crowded. Ambient
noise levels and multiple conversations taking
place at once produce distress. Physical proximity
often results in lots of bumping and touching. Children with an exaggerated “fight or flight” response
may attempt to run away or experience severe
emotional outbursts.
Worship services frequently produce sensory
overload. While high-energy worship experiences
with loud music and bright lights may be engaging
for persons with sensory hyposensitivity and capture the attention of children and adults otherwise
preoccupied with electronic devices, persons with
high sensitivity to sensory stimulation often avoid
this type of service. Extended periods of standing
or kneeling in some Christian traditions may result
in excessive discomfort. Handshakes or hugs are
unpleasant, as is physical contact during prayer.
Seating is often experienced as uncomfortable.
Expectations for appropriate dress may preclude
some children from attending church who insist
upon wearing athletic wear or soft, casual clothing. Children or adults with sensory processing
differences may struggle to tolerate the scent of
perfume or cologne worn by multiple worshipers
seated nearby.
Special church events often produce unique
sensory challenges. Church festivals and Vacation Bible School experiences often combine high
levels of physical activity and sensory stimulation.
Children and adults with hypersensitivity may
avoid weekend retreats at outdoor campsites and
mission trips where the comforts of home are not
readily available.
Social Communication
Social communication deficits are common
among persons with a broad range of mental
health and developmental disabilities. In addition
to representing one of the two defining features
of autism spectrum disorders in the DSM-5, social
communication is often a major source of functional impairment among children and adults with
psychotic disorders, ADHD, anxiety disorders, and
pragmatic language disorders (American Psychiatric Association, 2013).
Desire for community is reported in a Gallup survey to be one of the top reasons given for attend-
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Why Church Attendance is Difficult
ing church (Newport, 2007). Studies have identified friendliness of members and fellowship as key
reasons for choosing a church and maintaining a
high level of involvement at church (Rainer, 2008).
Children and adults who struggle with social communication often desire authentic friendships in
which they can be known, understood, and valued.
They want to belong to a larger community where
they can be recognized for their gifts and talents.
Many desperately want to belong to a church.
An adult or child who struggles to make or keep
friends is less likely to know someone who would
invite them to church. Attending a worship service
as a passive observer comes with the prospect of
multiple social interactions and potential for embarrassment. One of the most powerful turnoffs
to attending church for middle or high school students with social skill deficits is the experience
of encountering peers who have bullied them at
school or through social media.
Participation in Bible studies or small groups
where deeper connections are formed is difficult
for someone who does not follow social convention regarding appearance or dress or struggles
to follow common rules of social behavior, such as
knowing when to speak or how to take turns while
speaking. Many small groups take place in homes
where youth less familiar with social conventions
are more likely to feel out of place.
Social Isolation
Families of a child or teen with a mental illness
are less likely than other families to experience
the social interactions that bring them into contact with people who might invite them to church.
Multiple factors contribute to their relative social
isolation.
Having a child with a mental health condition
limits available options for childcare. Parents often
have less ability to socialize outside of their homes
because children who struggle with self-control,
anxiety, and emotional regulation cannot be left
with teenage babysitters. Even when childcare
is available, out of pocket expenses for mental
health care often significantly impact discretionary income.
Children with a broad range of disabilities, including mental health conditions, are less likely to
attend private Christian schools where they would
be more likely to connect with other families actively engaged at church (Sutton, 2015).
Children with mental illness are less likely to
be part of the youth sports culture that facilitates connection between families with common
interests. Motor coordination disorder occurs
more frequently in children and youth with mental health disorders or developmental disabilities
than in the general population (Dewey et al., 2002).
Children who are unable to attend a church-affiliated school because of their educational support
needs are more likely to lack the athletic skills necessary to thrive in competitive team sports.
Children with common mental health concerns
are less likely to have friends to invite them to take
part in church-related activities for the reasons
described above. Teens with depression often isolate themselves from peers and withdraw from extracurricular activities. A boy with ADHD who frequently interrupts peers while they are speaking,
lacks the patience to follow the rules of a game,
or struggles to control his temper is less likely to
be invited for playdates, birthday parties, and special events. Boys and girls who do not get invited
to birthday parties may not be invited to Vacation
Bible School.
In a culture where increasing numbers of
non-Christians come to church in response to personal invitations, the absence of a substantial social network reduces the likelihood of being invited
to church (Nieuwhof, 2019).
Family Experiences of Church
A key determinant of a child’s church attendance
is their parents’ pattern of church attendance and
engagement while growing up. A study examining
religious service attendance and affiliation among
young adults noted the likelihood of an adolescent becoming a weekly church attender in young
adulthood is 3.2% if they attend church less than
once a month as a teen (Uecker et al., 2016). This
statistic highlights the need for effective inclusion
strategies for youth with mental health conditions
and other disabilities. It also points to the need for
an inclusion strategy for parents who experience
symptoms of mental illness.
The multigenerational expression of mental illness suggests many children and teens with no
experience of church have parents whose church
experience was disrupted by their own mental
health concerns. Serious mental illness (SMI) is
highly heritable. Roughly one in three children of
parents with schizophrenia, bipolar disorder, or
major depression will develop a serious mental illness—and not necessarily the same mental illness
�Why Church Attendance is Difficult
as their parent (Rasic et al., 2013). A parental history of anxiety (especially maternal history) contributes to a twofold to sevenfold increase in the risk
for anxiety in their offspring (Low et al., 2012).
Parental interactions with pastors, church staff,
and volunteers when a child or teen experiences
mental health-related challenges represent an
additional factor impacting family engagement at
church. When a child of a parent grounded in the
faith has a negative church experience resulting
from disability, the family will often seek another church better prepared to support their child’s
needs. Parents without a strong faith foundation
may be less likely to search for a more supportive
congregation and need much reassurance before
exploring church again.
Discussion: Seven Action Steps for the Church
and the Mental Health Professional
Churches engaged in mental health ministry
have typically focused on providing counseling
and support to individuals who are already part of
a church. Lacking are effective models for building connections and relationships with individuals
and families not currently attending church. What
would a successful inclusion strategy look like for a
church seeking to minimize barriers to church attendance and engagement for children and teens
with mental health concerns and their families?
· Mental health inclusion would be conceptualized as a mindset, not a program. The goal is
to include children and adults with common
mental health conditions into worship services,
Christian education, small groups, and other activities the church.
· Mental health ministry is, by definition, family
ministry. An effective mental health inclusion
strategy addresses the needs of everyone in the
family, especially the most vulnerable children.
· A good inclusion strategy benefits everyone in
the church without requiring anyone with mental
health support needs to self-identify. Removing
barriers to attendance and engagement should
enhance everyone’s experience of church.
· Responsibility for mental health ministry is
owned by the people of the church who are supported by staff in their personal ministry.
· No church will develop a strategy to include everyone with mental illness, but every church can
implement a strategy to welcome more children
and adults with mental illness.
The following planning model for mental health
57
inclusion features seven broad strategies designed to identify and address barriers to church
attendance and engagement throughout each
ministry department. The strategies include following:
1. Establish a church-wide mental health inclusion team. The team is composed of leaders
with the necessary authority, responsibility, experience, knowledge, gifts, and talents to implement effective outreach and
inclusion across all the church’s ministries.
Senior leadership does not always need to
be part of the team so long as they unequivocally endorse the process. Mental health
professionals and advocates attending the
church, along with occupational therapists,
architects, interior designers, social service
professionals, and respected members with
firsthand experience of mental illness may
contribute valuable insights to the team.
2. Create welcoming ministry environments.
Consider the physical spaces in which ministry takes place. Do the spaces where most
teaching occurs promote information retention and learning for all attendees, including those with mental health concerns? Are
there unnecessary distractions? How might
someone with sensory processing differences experience those spaces? Is the signage throughout the buildings sufficiently
clear for attendees who struggle to remember multistep directions? Does the décor in
spaces occupied by children and youth help
promote self-control?
3. Prioritize inclusion in activities most essential to spiritual growth. The typical church
emphasizes some activities and practices
more than others in the discipleship process.
Churches with dynamic and effective teaching pastors may prioritize worship service attendance. For these churches, inclusion efforts might focus on the experience of adults
and children during weekend worship times.
Churches where small group participation is
encouraged might focus on their process for
connecting visitors to groups and offer extra
training to group leaders. If involvement in
community service or missions is encouraged, the team might identify volunteer opportunities for children and adults less comfortable with social interaction.
4. Develop a mental health communication plan.
�58
Why Church Attendance is Difficult
A key component of an effective inclusion
strategy involves establishing a church culture in which all attendees are given explicit
permission for mental health to be a topic of
conversation. In the LifeWay study (2014), the
top request of churches from family members of adults with serious mental illness
was for pastors to talk about mental health
from the pulpit. Churches might consider incorporating mental health-related concerns
into pastoral prayers or offering sermons addressing mental-health related topics. Social
media platforms are useful tools in combatting negative community perceptions about
churches and mental health. Online church
services represent a means for congregations to introduce themselves and build connections with families in surrounding communities impacted by mental illness.
5. Offer practical help in response to heartfelt
needs. Most churches have ministries to
provide meals when a family member is in
the hospital. Would families from the church
receive meals if a child is hospitalized for a
psychiatric emergency instead of a medical
emergency? Churches can maintain current lists of mental health professionals and
treatment facilities to share with attendees
in need. They can also help by providing affordable counseling services or peer support or making benevolence funds available
for short-term mental health needs, such as
one-time consultations or prescription refills. Respite events for families of children
with intellectual and developmental disabilities can be redesigned to welcome children
with primary mental health disorders and
their siblings.
6. Provide mental health education and support.
For many churches, initiation of an inclusion
strategy is the result of education offered
to pastors, church leaders, and key volunteers about the needs of families impacted
by mental illness. Establishment of mental
health support groups is a great starting
point for an inclusion strategy and powerful
signal to church members and the surrounding community that persons with mental
health issues are welcome. Such groups help
introduce the church to people who would
never otherwise attend a weekend worship
service and promote relationships between
attendees and members of the community
not connected to a church.
7. Release the people of your church into the
community to invite friends and neighbors
with mental health concerns. The most effective mental health inclusion strategy is often
the presence of a trusted friend to come
alongside someone with anxiety, sensory
processing differences, or social communication challenges to help them recognize
and avoid potential pitfalls for however long
it takes the visitor to acclimate to the church.
Staff can celebrate and encourage acts of
service and outreach through sharing stories
during worship services and on social media
platforms.
A mental health-friendly church is characterized by a demonstrable inclusion planning process, mental health education for pastors, church
staff, and volunteers, implementation of a mental
health communication strategy, provision of tangible assistance to affected individuals and families, and establishment of mental health education and support groups (Grcevich, 2019). Mental
health-friendly churches are addressing inclusion
in innovative ways:
· One church confronted stigma through presenting a sermon series on biblical teaching regarding anxiety. The same church featured video of a
worship band member discussing the impact of
his panic attacks and depression on his spiritual
life during weekend services and hosted a town
meeting in which a psychologist and long-time
member of the church joined a pastor on staff
and a local pediatrician to address misperceptions about mental illness. The livestream of the
town meeting was made available through the
church’s Facebook page.
· The senior pastor of another church opened
worship services with prayer for attendees with
depression after the church hosted a training
for several hundred volunteers on mental health
inclusion. The same church reserves aisle seats
next to exits for attendees with panic disorder
and produced a video featuring an usher who
came to church for the first time once such
seating was made available.
· One church appointed a mental health liaison to
help acclimate first time visitors with anxiety to
the church and interface with ministry leaders
when they need additional support.
· A church attended by many families involved
�Why Church Attendance is Difficult
·
·
·
·
with adoption and foster care ministry noticed
a reduction in aggressive behavior during children’s ministry activities after reducing the intensity of lighting and repainting their space in
more subdued colors.
A church’s founding pastor filmed a video for
their social media platforms explicitly extending a welcome to families in the community affected by mental illness in which he shared the
struggles his father experienced as a pastor
with depression.
One church opened a mental health resource
center staffed during worship services by a
member of their inclusion team that features a
prominently located booth with free resources from the National Alliance on Mental Illness
(NAMI), as well as other educational resources
personally vetted by members of the team. The
church also makes space available to a local
community mental health agency to provide
services onsite.
Hundreds of churches throughout the U.S. have
launched Christian-based mental health support groups affiliated with Fresh Hope or the
Mental Health Grace Alliance.
Church members are being trained as “hope
coaches”—individuals trained to come alongside
attendees going through a difficult situation or
a crisis, walking with them, listening, helping
them process their pain, fear, and frustrations,
and speaking a faith-filled hope into their situations based upon Romans 8:28 (Fresh Hope,
2020).
Conclusion
Families raising children with common mental health conditions such as depression, anxiety disorders, disruptive behavior disorders, and
ADHD are far less likely than unaffected families
to attend church services regularly and represent
a large, underserved people group. Attributes associated with common mental health conditions
cause children and families to struggle to meet
cultural expectations within the church for social
interaction, social communication, and self-control and impact their experience of the physical
environments where most ministry takes place.
Effective outreach and inclusion with families
impacted by chronic mental health conditions is
made possible through inclusion strategies designed to help church leaders identify potential
59
obstacles to attendance and engagement in all
ministry departments and minimize or eliminate
the impact of these obstacles.
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Author
Stephen J. Grcevich (MD, Doctor of Medicine, Northeast
Ohio Medical University) is a child and adolescent psychiatrist and Associate Professor of Psychiatry at NEOMED. He
serves as President and Founder of Key Ministry, a Christian-based nonprofit providing training, consultation, resources, and support to churches seeking to minister to
children with disabilities and their families. His research
interests have focused on the safety and tolerability of
commonly used psychotropic medications in children and
youth.
Mira B. Grcevich (Department of Psychology, Belmont
University) is pursuing graduate studies in clinical psychology. Her undergraduate research has focused on the development of statistical and analytic models for predicting
outcomes of professional athletic events.
�
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https://orcid.org/0000-0002-3312-6625
NEOMED College
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Title
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Why Church Attendance is Difficult for Children with Common Mental Health Conditions and Their Families
Creator
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Grcevich S
Publisher
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Journal of Psychology and Christianity
Date
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2021
Subject
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mental health, church, inclusion, children, families
Description
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Children and adolescents with mental health conditions are less likely to attend religious services than unaffected youth. Depression is associated with a 73% reduction in the likelihood of attending a worship service, while the presence of disruptive behavior disorders, anxiety disorders, or attention-deficit/hyperactivity disorder are associated with 55%, 45% and 19% reductions, respectively. In this paper, we hypothesize lower rates of church attendance result from functional limitations associated with mental health conditions that make entry into a church difficult. Children and youth with mental disorders experience more difficulty meeting common expectations for social interaction and self-control in worship services, small groups, Christian education, service activities, and other church functions. Given the heritability of these conditions, their parents often experience similar challenges engaging in ministry activities. We propose a mental health inclusion model for use in churches of all sizes and denominations. The model facilitates recognition of common barriers to church engagement and assimilation and application of inclusion strategies across ministry activities and environments offered to all.
Format
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journalArticle
2021
church
Department of Psychiatry
Families
Grcevich S
inclusion
Journal of Psychology and Christianity
Mental Health
NEOMED College of Medicine