Mental Illness and the Call of the Church
Today, I write to you with a simple invitation—that the Church is called to address mental health and mental illness. To support us in this discernment, I will seek to answer the question, “Why does the Church have this call?” and will propose ways in which the Church might respond to this call, with a particular emphasis on your roles as ministers and educators.
Before I begin exploring this “why,” I would like to address my qualifications to speak on this matter and answer the question “why me?” I am a psychiatrist—a medical doctor trained to assess and treat people suffering from mental illness with medication, therapy, or other interventions. However, I am only a physician because I once studied theology; after a captivating introductory theology course, I was swept away by the exploration of mystery, suffering, and hope, and by the radical notion that every person is made in the image and likeness of God. I encounter these truths every day as a physician, and they are deeply relevant to the practice of psychiatry.
I am only a psychiatrist because I was once a patient of psychiatrists. As a teenager, I experienced severe Obsessive-Compulsive Disorder that ultimately led me to take a yearlong medical withdrawal from college to engage in intensive treatment, and, more recently, I experienced a severe episode of postpartum depression following the birth of my daughter, Cecilia. I owe my health to the compassionate providers who walked with me on my worst days, and I ultimately came to understand my vocation to psychiatry in the light of the Catholic tradition and my own suffering.
First, I want to say a word about mental health and mental illness. What is mental health? What is mental illness? I would like to offer some working definitions, as well as some caveats, so that we have a shared foundation for our conversation.
The World Health Organization defines mental health as “a state that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.” I am going to work from this definition for several reasons. First, it aligns with key aspects of human flourishing emphasized within a Catholic worldview—life is hard and we will be faced with challenges, stressors, and suffering that we have to deal with; we are at our best when discerning and responding to our vocation by sharing our gifts with the world, embracing learning, working, and living in community with the members of the Body of Christ. Second, it does not exclude the possibility of someone with mental illness having good mental health, and it avoids unnecessarily pathologizing any life stressor or challenge as inherently equivalent to mental illness.
What about mental illness? Psychiatrists are trained to diagnose mental illness based on the “DSM,” or the Diagnostic and Statistical Manual of Mental Disorders. The DSM lists diagnoses and their criteria, creating a shared language for mental health clinicians and making research possible. The DSM proposes a general definition of a mental disorder—a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. There are several important parts of this definition that are worth pointing out.
First, a mental disorder is best thought of as a syndrome. In medicine, a syndrome refers to a group of signs and symptoms without reference to its cause. Syndromes can present with similar features but may be caused by different underlying disease processes. It is important that we conceptualize mental illness as syndromes because we do not know the precise underlying causes yet, and we suspect there may be many causes and contributors. There is much that is mysterious about mental illness—in a presentation to mental health professionals, Saint John Paull II once noted, “By its very nature, your work often brings you to the threshold of the human mystery. It involves a sensitivity to the often tangled workings of the human mind and heart, and an openness to the ultimate concerns which give meaning to people’s lives.”
The next part of this definition highlights that mental illness typically causes great distress or problems functioning—this is how we draw rough lines between normal and abnormal, although this remains an area of great debate. Lastly, the definition emphasizes that there can be abnormalities in cognition, emotion regulation, or behavior that are not considered mental illness. Grief, human suffering, and evil acts cannot inherently be dismissed as mental illness.
Now, the most recent version of the DSM includes just under 300 diagnoses. The large number of conditions under the umbrella of “mental illness” alone makes it difficult to navigate conversations about this topic in general terms. Although schizophrenia, anorexia, substance use disorders, and OCD are all in the DSM and considered mental illnesses, the experiences and needs of people with these conditions are vastly different. It is also important to acknowledge that your personal experience with mental health and mental illness will inevitably shape how you conceptualize these terms.
Akin to the Church’s preferential option for the poor, I will focus my remarks on those with serious mental illness. This is yet another term for which there are various definitions. It typically refers to people with a psychotic disorder, like schizophrenia, or a mood disorder, like bipolar disorder or severe major depressive disorder.
This distinction matters because people with serious mental illness experience disproportionately negative outcomes in important domains. The corporal works of mercy offer a framework by which we might reflect on these negative outcomes. To review, the corporal works of mercy include feeding the hungry, giving drink to the thirsty, sheltering the homeless, clothing the naked, visiting the sick and imprisoned, and burying the dead. People with serious mental illness experience negative outcomes in each of these domains; they experience high rates of food insecurity, with a prevalence of 40%. 26% of adults experiencing unsheltered homelessness have a serious mental illness, compared to 5-6% of adults in the general population. They also experience what some have called a “new kind of homelessness” by receiving inadequate psychiatric care—fewer than 40% of people with serious mental illness receive regular treatment.
Considering stigma as a kind of “nakedness,” people with serious mental illness experience high rates of stigma. One study indicates that the majority of people would be unwilling to work closely with people with schizophrenia or have someone with schizophrenia marry into the family. With regard to visiting the sick, loneliness is extremely common in serious mental illness; a recent study reports that 41% of patients with serious mental illness were “severely lonely” compared to only 7.3% of those without serious mental illness. People with serious mental illness are often involved in the justice system, and the three largest inpatient psychiatric facilities in the United States are the LA County Jail, Rikers Island, and the Cook County Jail. Finally, people with serious mental illness experience excess mortality relative to peers without serious mental illness; on average, they die 10-20 years earlier than the general population. There are also high rates of suicide in this population. In summary, the corporal works of mercy offer us a window into the importance of understanding and prioritizing serious mental illness in discussions about mental health and mental illness.
Now that we have defined Mental Health and Mental Illness, let us discuss the Church’s call to serve those with mental illness. This call flows, first and foremost, from Christ himself. Jesus healed the sick. There are eighteen healing miracles documented in the Bible; each one begins with an encounter between the person and Christ. Christ did not perform healing miracles from afar—he entered into the lives of those he healed, and he calls us to do the same.
Inspired by Christ’s healing ministry, the Church has a rich tradition of caring for the sick over the centuries. Dr. Gary Ferngren, an expert on the history of hospitals, argues that hospitals are, “in origin and conception, a distinctively Christian institution, rooted in Christian concepts of charity and philanthropy. There were no pre-Christian institutions in the ancient world that served the purpose that Christian hospitals were created to serve.”
What about psychiatric care in particular? Well, as it turns out, the world’s first psychiatric hospital was also founded by the Church, specifically by Father Juan Gilabert-Jofre. Father Jofre was the leader of the Mercedarians in Valencia, Spain. He was inspired to found the world’s first psychiatric hospital in 1410 after an encounter with a man with a mental illness.
As the story goes, Fr. Jofre was walking to the Cathedral when he encountered a group of children hitting and mocking a man with a mental illness. They shouted, “The mad man, the mad man!” Fr. Jofre stepped into the scene and placed his body between the children and the man. He embraced the man, calmed him, and then carried him to the convent to be tended to by the members of his order.
Father Jofre preached the following sermon shortly thereafter:
In this city, there are so many good, faith-motivated initiatives, arising from the charitableness and support of the faithful. However, our city is missing one very important thing: a hospital or a home where cognitively impaired and mentally ill people would be welcomed. The thing is, many of those who are impoverished and cognitively impaired roam the city. And they suffer the pains of hunger, of cold, and of injury. And because of their impairment and insanity, they don’t know how to get or even ask for the basic things they need to sustain their lives. And as a result, they sleep in the streets, and they die from hunger and cold. Beyond that, there are many evil people, who do not have God in the eyes of their conscience. These evil people, hurt and harass the impaired and insane persons of our city; and, outrageously, they abuse those vulnerable people wherever and whenever they find them sleeping; and they kill others, and they rape women who are cognitively impaired. And, I should add, the impoverished mentally ill, wandering throughout the city, sometimes harm people—these things are known throughout the city. For all these reasons, it would be a holy thing, a very holy undertaking, for us to build a home or a hospital where cognitively impaired and mentally ill persons of this sort (or of whatever other form) could be gathered, so that they wouldn’t be left to wander in streets, and so that they couldn’t harm anyone or be harmed.
Less than two years later, the Hospital of the Innocents was opened and dedicated to Our Lady; many scholars consider it to be the first psychiatric hospital in the world, and some even argue that it was the first to offer actual medical care to people with mental illness, as opposed to merely warehousing them away from the public in chains. In his reflection on this story, scholar Miguel Romero writes the following:
Captivated by the splendor of a historical curiosity, we could easily miss the living heart of what we can learn from Fr. Jofre . . . Following Fr. Jofre’s example, amid our mental illnesses and cognitive impairments, the work of contemporary Christians to re-imagine our life together does not begin with a roar of activity; rather, it begins with our mundane, unexceptional, and routine formation into the bodily rhythms of Christian holiness. The timely Christian response to the ordinary challenges that arise when members of a Christian community have a mental illness or impaired cognition begins with a full-bodied, but utterly mundane devotion to works of mercy; an unexceptional recognition of human dignity that others in our culture often ignore; and the routine commitment to embrace forsaken and forgotten persons, as they are found in our community, in our streets, in our families, and in our homes.
Romero refers to the “unexceptional recognition of human dignity.” On the one hand, I appreciate this frame—the Catholic notion of human dignity may feel comfortable, familiar, routine in today’s world—and, if we have been well-formed, it should be. On the other hand, mental illness offers a special challenge to the truth of human dignity and the Imago Dei. This challenge was taken up by the Pontifical Council for Pastoral Assistance to Health Care Workers; in 1996, they held their eleventh international conference. Its theme? “In the Image and Likeness of God—Always? Disturbances of the Human Mind.” That question, “Always,” is well-placed to disturb us. What are we to make of this? One conference presenter, Ignacio Carrasco de Paula, expounds:
Is the most important anthropological statement of the Bible in relation to the greatness and value of man not perhaps contradicted by the widespread experience of illness, especially where it involves an attack on the most precious faculty of man, his intelligence and his freedom, that is, his mind?
In his remarks at the conference, Saint John Paul II responded unambiguously, stating, “The Church is deeply convinced of the truth of the Imago Dei, even when one’s mental faculties are severely limited and even impeded by a pathological process.” In some sense, he dismisses the theological question as addressed elsewhere, then flips it on its head. “That question—Always?—must spur both the personal and the collective conscience to a sincere reflection on our behavior towards those persons who are suffering from mental illness. Is it not true that all too often these persons encounter indifference and neglect, when not also exploited and abused?”
In principle, we profess the human dignity of all people, but in practice, we often fail to embody this truth in the care of people with mental illness, and especially those with serious mental illness. Father Jofre’s sermon could just as easily have been preached in my hometown of Cleveland, Ohio in 2026—it captures the needs of people with serious mental illness and the consequences of inadequate treatment and care.
In summary, the Church’s call to address mental illness is rooted in the healing ministry of Christ, a ministry extended through the centuries by the work of the Church, including in the domain of psychiatric care, as Father Jofre showed us, in response to the truth of the Imago Dei, a truth we often fail to embrace in practice.
Before I turn to the practical side of this topic, I want to offer a brief reflection on mental illness through the lens of the Catholic imagination. The Catholic imagination is a way of seeing the world as shot through with the glory of God. It asks the question, “How do I understand this if Catholicism is true?” I spend a lot of time thinking about the meaning of mental illness and those who bear its weight in this way. As I mentioned earlier, I see patients with mental illness every day. Like many physicians across specialties, this brings me into intimate contact with the suffering of others. My patients grace me with their stories. They ask me, “Why is this happening?” and I am often left with just mystery. My patients seek joy, persevere through suffering with hope, and make incarnate the reality of the Imago Dei. This is truly a gift.
Now, I could talk for hours about the opportunities for the Church to address mental health and mental illness, but I will limit my remarks to several domains that will be most relevant. A simple question I am often asked—what should I do when I encounter someone with a mental illness or a mental health challenge in my work as an educator or minister? After all, ministers and educators are often on the front line of this issue—I want you to be prepared to respond accordingly. In the moment, do what Christ did and enter into an encounter with that person. That is the first step in healing. More explicitly:
- Shut your mouth and listen—doctors are notorious for interrupting their patients within seconds of meeting them, and it is a good reminder for all of us.
- Express gratitude—thank the person for sharing.
- Take a page out of Pope Benedict’s book and tell them, “It is good that you exist.”
- Focus on accompaniment (“I’m here with you”) over action (“I’m here for you”)—although both are important.
- Support agency—ask for concrete ways that you can support this person.
- And of course, do not hesitate to ask about safety concerns, such as whether someone might be having thoughts of self-harm or harming others, experiencing hallucinations or delusions, or having difficulty tending to their basic needs. These are circumstances in which a higher level of care or more acute intervention may be needed.
- I cannot tell you exactly how to respond in every situation, and you should collaborate with your organization to define management of crisis situations, but this is a good starting framework.
It is one thing to encounter someone suffering with a mental illness in a particular moment. It is another, often more challenging thing to accompany someone over time through the ups and downs of a mental illness. Remember that, as educators and ministers, you are not expected to be mental health professionals. You are an important part of this person’s support system, but you are not and should not be the entire support system. It is important to be attentive to your own well-being, as this sort of accompaniment can lead to feelings of frustration or weariness.
As you accompany someone suffering from mental illness, keep in mind that people with mental illness may experience impairment in concentration, motivation, insight, and other key faculties necessary to get the help they need. Saint John Paul II understood this, recognizing that given “the effort it costs a depressed person to do something which to others appears simple and spontaneous, one must endeavor to help him with patience and sensitivity, remembering the observation of St. Theresa of the Child Jesus—little ones take little steps.” It is well within your purview, and the purview of any loved one, to offer assistance with connecting someone with resources and treatment. For particularly severe illness, when there is a risk of harm to self or others, when basic self-care is impaired, or when insight is absent, most states have laws that permit involuntary assessment and treatment.
Educators: young people can experience a wide range of challenges, from the normal ups and downs of childhood, and especially adolescence, to severe, impairing anxiety disorders, OCD, depression, and more, and suicide remains a serious consequence in an increasing percentage of children and adolescents. In some ways, it is more difficult to sort through what is “normal” for young people, in part because their brains are still developing—and there are risks to over-pathologizing. There are some studies that actually show negative effects of introducing universal therapeutic interventions in school settings. For this reason, I will focus my remarks on a more general approach that I believe will be beneficial to all young people, regardless of where they may fall on the spectra of mental health and mental illness.
Catholic schools from grade school to college have an opportunity to cultivate a particular culture oriented toward flourishing and can in this way serve as an antidote to the mental health crisis among young people today. Practical opportunities include:
- Banning phones from schools. This is a hot topic right now, and hot topics always give me pause because the scientific literature can evolve rapidly. That said, there are significant correlations between poor adolescent mental health and use of smartphones and digital media. A recent Norwegian study assessed the effect of banning smartphones from school and found improvements in educational performance, reduction in bullying, and a significant decline in the number of mental health referrals. In a Catholic anthropology, we already know that engaging with human beings in person is crucial for human flourishing, and we should encourage this however we can.
- Next, emphasize play, wonder, curiosity, and independence. We know that kids (and sometimes their parents) are experiencing high levels of anxiety these days. New research observes that the large decline in children’s opportunities for independent activities (such as biking or walking to school alone) may account for some worsening mental health in youth, and argues that this can be addressed by increasing opportunities for independent activities. To learn more, check out the organization, “Let Grow.”
- Finally, lean on the wisdom of the Catholic tradition to teach young people how to live the good life. Frame discussions about the future as discernment of vocation; help your students identify their gifts and explore how they might give them away to the world in love. The Church’s enduring wisdom about how to achieve human flourishing is coming into focus through a scientific lens—research increasingly supports the value of things like forgiveness, engaging in relationships, marriage, acts of kindness, and the virtues.
Saint John Paul II summarized the value of the Church’s wisdom in the healthy development of young people. He said,
The phenomenon of depression reminds the Church and all society how important it is to provide people, and especially youth, with examples and experiences that can help them to grow on the human, psychological, moral, and spiritual levels. In fact, the absence of reference points can only contribute to making persons more fragile, inducing them to believe that all forms of behavior are the same. In this perspective, the role of the family, of schools, of youth movements, and of parish associations is very important because of the effect that these realities can have on the person’s formation. Indeed, the public institutions have a significant role in guaranteeing standard of living, especially to abandoned, sick and elderly people. Equally necessary are policies for youth aimed at offering the young generations motives for hope to protect them from emptiness or from dangerous fillers.
In addition, I would encourage you to instruct your students about mental illness, particularly serious mental illness, as a life issue, a matter of human dignity. Applying the spiritual and corporal works of mercy to caring for those with mental illness offers practical opportunities in this regard.
Ministers: this concept of promoting flourishing certainly applies to your work as well. I encourage you to recognize and embrace the critical role of the Church in absorbing suffering, especially for those experiencing suffering outside of the framework of “bona fide mental illness.” In many cases, those who are grieving, lonely, or suffering other human trials and tribulations benefit greatly from the ministry of the church. Psychiatrists and other mental health professionals play only a small role in the grand work of human flourishing. I should also note that research continues to identify positive associations between religiosity and well-being. Although we cannot say if this is causal, public religious practice is strongly associated with reduced mortality, better mental health, better social relationships, life satisfaction, as well as virtuous and prosocial behavior. We also know that religion is a protective factor against suicide.
Other practical opportunities for ministers include:
- Demonstrating support for people with mental illness publicly and visibly:
- Host speakers on this issue at your parish
- Incorporate explicit prayers for people with mental illness into the prayers of the faithful
- Offer the Sacrament of Anointing of the Sick and emphasize inclusion of people with mental illness
- Inquire about opportunities to bring the Eucharist to those in psychiatric hospitals
- Celebrate the feast of Saint Dymphna, the patron saint of mental illness
- Develop a meal ministry for families impacted by mental illness; Deacon Tom Lambert, a strong advocate for addressing mental illness in the Catholic Church, says that mental illness is not a casserole illness—we are quick to support those facing illnesses like cancer, but less so for people with mental illness and their families.
- Explicitly accompany those with serious mental illness to church if they desire this and have barriers to attending. Many people with serious mental illness live in group homes with limited access to transportation. There are actually high rates of spirituality and religiousness in the lives of people with serious mental illness, yet how often do we make a special effort to include them?
- Be aware of the services available in your community and help connect people with mental illness to treatment and other resources; most Catholic Charities have at least some relevant services, and they may be able to connect you with other community resources as well. For those looking for clinicians who share a faith background, some dioceses will maintain a list of Catholic clinicians that can be accessed by the public.
- There are also several important evidence-based interventions for people with serious mental illness that are worth reviewing.
- Assertive Community Treatment teams, or ACT teams, are an evidence-based model of care that delivers comprehensive community-based treatment, support, and rehabilitation services to people with serious mental illness. The multidisciplinary team takes responsibility for an abundance of services individualized to the needs of the patient. Team members are typically available twenty-four hours a day, seven days a week, and care is provided in the patient’s home and in their world. Randomized controlled trials demonstrate that patients on ACT teams use significantly fewer psychiatric inpatient days and have fewer ED visits. They also spend more days in stable community housing and have less justice-involvement.
- The second intervention is known as Clubhouse. A Clubhouse is a “community-based service dedicated to supporting and empowering people living with mental illness.” People with mental illness, and especially those with serious mental illness, are welcome to participate in Clubhouse as members. The first Clubhouse began in New York in 1948; today, there are over 370 Clubhouses in 32 countries. South Bend, Indiana has the Clubhouse of St. Joseph County. Clubhouses have key elements, including a work-ordered day, in which the Clubhouses are operated by members and staff working side-by-side; unique employment and educational programs; evening, weekend, and holidays activities; and regular outreach when members do not attend Clubhouse. Randomized-controlled trial results also support the efficacy of Clubhouse for improving quality of life, promoting employment, and reducing hospitalization.
Beyond your day-to-day work of accompaniment and formation, you can also advocate for the Church to respond to the clinical and care needs of people with mental illness, and especially serious mental illness. Today, the United States has twelve psychiatric beds per 100,000 population, far below the fifty beds per 100,000 recommended by some institutions. Just as Father Jofre was moved to action by his encounter with a man who was suffering, the Catholic Church, one of the largest providers of healthcare in the world, must respond to this great need impacting the sickest among us.
Saint John Paul II writes that Christ took all human suffering on himself, even mental illness. There is so much that is mysterious about mental illness, but I take great comfort in the idea that our Savior knows something about the misery of mental illness. In the light of the Catholic tradition, young people can be formed for flourishing; those suffering with mental illness and their families can be accompanied with tenderness and patience; and the unmet needs of those with serious mental illness can be embraced as a calling and a responsibility for the Church.
