When I (Carey) was a lead pastor, I had a hard enough time keeping up with a rapidly growing church. Caring for everyone\u2019s needs could topple me over the edge, and as a friend once told me, the problem with human need is that there\u2019s no end to human need.<\/p>\n\n\n\n
Initially, as the leader of a small church, I took the approach of most pastors who are wired as shepherds: Scheduled as many counseling appointments and pastoral care visits as I could.<\/p>\n\n\n\n
As the church grew, I started to refer most needs to the groups ministry or to a professional outside our church. Given my personality, my lack of training in counseling, and our church size, it was the best I could do.<\/p>\n\n\n\n
Chances are you\u2019ve embraced one of these two approaches and know that neither works well for you\u2014or the church.<\/p>\n\n\n\n
Pastoral care has always been the ethos of the church. Pastors aren\u2019t only preparing sermons or running programs; they\u2019re sitting with people in grief and confusion. The weight of unmet need becomes part of their exhaustion\u2014something invisible, but constantly pressing.<\/p>\n\n\n\n
I (Jim) see pastors embrace the approach that Carey took as his church grew\u2014referring emotional and mental care of congregants to outside professionals.<\/p>\n\n\n\n
While those partnerships are essential for complex concerns, the pendulum has swung too far. The result is a dilution of the presence of Jesus\u2014experienced through the church\u2014to care for the suffering.<\/p>\n\n\n\n
As a licensed psychologist, I (Jim) receive referrals from pastors. I embrace the opportunity, but I see a gap between what pastors hope for their people and what I can deliver. I address anxiety, depression, and relational conflict; I can provide tools and help relieve symptoms.<\/p>\n\n\n\n
But my license means I can\u2019t be a friend. I am not part of the church\u2019s emotional and relational community. The relief of symptoms without community will mean the return of symptoms.<\/p>\n\n\n\n
We have a holy opportunity to return to our roots\u2014a chance to recover the kind of care that once marked every aspect of the early church. This moment asks us to see with old eyes\u2014and step into a new vision.<\/p>\n\n\n\n
Historically, care was reserved for family, or tribe, but Jesus redefined the scope of care. The parable of the Good Samaritan was not just about kindness\u2014it was a cultural and theological revolution: Attend to your enemy, the overlooked, and the vulnerable.<\/p>\n\n\n\n
The church understood this through exhortations to care: \u201cBe joyful in hope, patient in affliction, faithful in prayer. Share with the Lord\u2019s people who are in need. . . . Rejoice with those who rejoice; mourn with those who mourn\u201d (Rom. 12:12\u201315).<\/p>\n\n\n\n
This selfless, sacrificial, presence-driven care is in our DNA as the body of Christ. It\u2019s not just compassion. It\u2019s a calling.<\/p>\n\n\n\n
In recent years, we lived through a pandemic\u2014but today our pandemic is no longer a virus. It is loneliness, anxiety, and emotional overload fueled in part by social media, which likely will accelerate as AI becomes further entrenched in culture.<\/p>\n\n\n\n
People with mental health diagnoses are more likely to seek help from clergy than from psychologists and psychiatrists combined. This isn\u2019t because clergy are better equipped\u2014it\u2019s because churches are accessible. This leads to a care structure where almost every need funnels through the pastor, who refers to a professional. That can be a crucial step in getting specialized attention, but we need both the transformative life of those in the church caring for one another and professional clinicians (see Fig. 1).<\/p>\n\n\n\n
Most needs in a church today are heard by the leadership before referring a person out to a clinician. In fact, in our survey for When Hurting People Come to Church<\/em> (see sidebar), 88 percent of pastors believe to some degree that referring out should be the church\u2019s primary mental health service.<\/p>\n\n\n\n And certainly, referrals are necessary. Clinicians treat severe symptoms and stabilize crises. But there are serious limitations to a church care model based primarily on referrals.<\/p>\n\n\n\n First, clinicians have ethical boundaries. As part of licensure, therapists cannot have coffee with clients. They don\u2019t sit in someone\u2019s house during grief. Clinicians can be costly and have waiting lists. More than a third of the US population lives in geographic areas termed \u201cmental health deserts\u201d with few clinicians to meet the demand.<\/p>\n\n\n\n Also, the mandate of clinicians is temporary. They care deeply for their clients, but their job is to reduce symptoms and terminate treatment. The job of the church is to care for a lifetime.<\/p>\n\n\n\n Therapy can reduce symptoms and address complex issues that require specialized care. But it cannot heal the soul or provide lasting reconciliation with God or community. For that, we have the church.<\/p>\n\n\n\n The responsibility rests with too few. Exhausted pastors can\u2019t address the multiplicity of issues that people face, and most don\u2019t have the capacity to provide consistent emotional support. This isn\u2019t merely a matter of pastoral burnout, although that\u2019s a key concern. It\u2019s also a concern for church growth. One reason most churches don\u2019t see growth is because they struggle to scale pastoral care.<\/p>\n\n\n\n Instead of referring out, what if churches referred within? Imagine a model where churches train volunteers to help meet basic emotional needs. Someone grieving hears, \u201cPete will call you. He\u2019s on our care team and will walk with you.\u201d In another instance, a new mom facing postpartum depression is connected to a therapist and a group of other moms who\u2019ve been there. Such a model of care could be represented like Fig. 2.<\/p>\n\n\n\n The top tier of the pyramid are those who experience serious mental illness and other critical issues and who should see licensed professionals. A woman with acute postpartum depression needs specialized care. Her husband might need pastoral support.<\/p>\n\n\n\n The middle tier is composed of people who know loss, addiction, or marriage crises. They can be served by trained lay counselors or specialized ministries like ReBoot, Celebrate Recovery, Stephen Ministries, or GriefShare. In the base tier is everyone else\u2014who experience discouragement, anger, fear, worry, and isolation. Trained listeners who know how to sit with suffering can meet these needs. This new (old) idea might seem unsettling given how much we have leaned into professional care. But we must face two profound realities.<\/p>\n\n\n\n First, it is not possible for pastors and clinicians to provide enough behavioral, emotional, and relational support for the millions in need. That would require training hundreds of thousands of new clinicians and cost billions. The current system of mental health care\u2014though effective\u2014is not scalable to meet the need. Only 32 percent of pastors felt their church was effective in addressing mental health needs.<\/p>\n\n\n\n Second, there is no realistic way to address the mental health crisis without the church. There are, on average, eight churches in every ZIP code\u2014each filled with people capable of showing up with empathy, compassion, and grace. Ninety-six percent of pastors believed that this type of Christian support was among the best ways to foster good mental health.<\/p>\n\n\n\n This kind of church engagement creates a solution to a cultural crisis and opens the door for discipleship, evangelism, and transformation through the power of the Holy Spirit.<\/p>\n\n\n\n We can see the need and the solution differently through a minimal cultural shift.Most churches successfully made this shift with five steps:<\/p>\n\n\n\nA New Old Vision<\/h2>\n\n\n\n
The Current Realities<\/h2>\n\n\n\n
A Simple, Powerful Path Forward: The Five Steps<\/h2>\n\n\n\n