The Reality of Mental Illness
 Those who serve the church as pastors, seminary, college, agency and congregation leaders, associates in ministry, deaconesses and diaconal ministers are not protected from such developments. Anxiety, depression, addiction, and serious mental illness can emerge among leaders with the same frequency as the general population in our society. Twenty-five to 50% of people may experience significant emotional illness in any given year (half of whom receive no treatment). Our church leaders assist the whole church when they are able to effectively tend to their own personal need for care as well as when they are equipped for proclaiming the message that the church will not ignore those whose lives are impacted by mental illness.
 The new social message on mental illness invites a conversation across the church regarding the needs of those among us who live with emotional pain that disrupts daily living. As we reflect on the implications for the body of Christ, we can begin to tell the stories of this reality and break through the isolation that can deepen the pain of emotional distress. The challenges we face are significant, as we confront secrecy, loneliness, confusion, shame, and alienation among us. Bringing visibility to mental illness is our unique opportunity as we extend compassion to those in distress.
 The ELCA needs to be particularly concerned about the health and well-being of its rostered leaders. Physical health and emotional wellness are closely connected, and both are vital to a church where faith is reflected in a vibrant and active life. Occupational risks are plentiful in the high demand, high stress situations of many of our diaconal ministers, associates in ministry, pastors and deaconesses. We must acknowledge as a church that our leaders are not exempt from common conditions in our society, such as high blood pressure, obesity, anxiety, depression, high cholesterol, substance abuse, and the more severe mental illnesses that can require skilled treatment and significant external support. Among ELCA rostered leaders who completed the 2012 Mayo Clinic EmbodyHealth Assessment, it was reported that the highest risk factors to health include Nutrition and Weight (with 72% reporting each of these risks), Emotional Health (62%) and Exercise (59%). In addition, the medical conditions they identified included depression (19%) and anxiety (11%). The occupational risks and hazards are everywhere for those who serve the church. We are no longer the predominantly happy and healthy civic leaders who thrived in previous times. Our public image has shifted in recent years, bringing diminished status and regard. A decline in congregational vitality and increase in workplace conflict has contributed to anxiety among leaders. Expectations for long hours and on-demand response to needs have left many leaders depleted and weary, leading some to question their call to public ministry. The resiliency of many church leaders has been undermined or compromised.
Resources for Mental Health
 There are a variety of resources that pastors, rostered lay, seminary and other leaders in the church can utilize for preventive as well as therapeutic support. These include spiritual direction and psychotherapy as part of a personal journey of transformation and healing. Healthy habits in fitness and nutrition deserve intentional effort as leaders establish personal goals or seek improvements to their lifestyle when they are off course. A personal life that involves social activities outside the church, along with a sustainable network of friendships can bring balance to the demands of congregational life. Establishing good boundaries encourages a lifestyle that can draw on resilience when the inevitable challenges or crises erupt.
 Adequate professional preparation of pastors and leaders in the art of referring congregational members and others to the most appropriate professionals will help avoid the risk of becoming enmeshed or overly attached to people in need. Learning how to provide appropriate pastoral care to those who seek it is essential, but it is also important to know the social and mental health services available in a community and to encourage access to professional help beyond the church when appropriate.
 Congregations and other ministry contexts can demonstrate an open and encouraging attitude about therapy, spiritual direction, domestic violence services, and safe and healthy practices for children and families. Identifying members who are part of a network of healthcare professionals is a helpful tool in building a collaborative approach to prevention and treatment. Worship can include mental health concerns through preaching, prayers, advocacy and education. Pastors and others can model an approach to seeking help by intentionally naming stress, mental illness, and addiction as a natural part of what many people face in their lives.
 Congregations must be a source of support to pastors themselves. Evidence is strong that seeking a healthy lifestyle that defends against burn out and exhaustion is essential for church leaders. Congregations can be intentional in providing fair compensation and benefits to staff. Best practices include regular days off (and encouragement to use those days for renewal), generous vacation time, prayers for the leaders and recognition when deserved, such as for anniversaries and other milestones. Sabbaticals are a way to offer rest and renewal to pastors as well as congregations. Advocacy when conflict arises is a way of mediating as well as preventing a decline in the vitality of congregations and their leaders. Strong allies can be life-giving partners even in difficult times.
 Other expressions of the church can also offer preventive care and appropriate response to the emotional health needs of those who serve. Synods can ease the alienation that can develop where conflict or stress undermines a healthy relationship between pastor or rostered lay leaders and congregational members. Intentional support can cut through the isolation that stresses pastors who are in difficult situations. Offering training, retreats, conferences, renewal, worship, and referrals all contribute to a sense of partnership for ministry. Seminaries provide resources for continuing education and can also offer opportunities for renewal and strengthening for the work of public ministry.
 Portico and social services of this church can develop initiatives in response to needs regarding the emotional health of our leaders and families. Wellness programs that build emotional resilience can offer real benefits as they encourage preventive health measures. Others will find it more valuable to use insurance benefits that are a resource for psychotherapy or medication treatments for psychological conditions such as bipolar disorder, anxiety disorder, depression and post-traumatic stress disorder. Establishing affordable co-pays and deductibles is important for many financially-stressed leaders.
 Confidence in those services will grow if they reflect a transparent awareness of specific needs and warning signs identified through study and evaluation of the health of our leaders. For example, access to services in rural areas can be difficult and must be addressed. Further limiting access is the reality that 45% of licensed mental health providers are not eligible to offer Medicare coverage (for older plan members) for behavioral health services. Advocacy for policies and legislation that respond to the increasing demand for mental health treatment will benefit the whole body of Christ.
 We must invite leaders of this church to be models as they reflect God’s healing power and compassion for the journey through the darkness of emotional pain. They can offer effective support and make the commitment to get help when they need it themselves. Leaders may consider their own psychological challenges and determine appropriate disclosure. Pastors and other leaders can name the realities associated with mental illness and help to break down the barriers of shame and secrecy.
Accompaniment as Ministry
 Accompaniment through the challenges of emotional illness can be a key component in healing and recovery. ELCA pastors and church leaders can tell their own stories. We can include mental illness as a public concern for the church, encouraging prevention and treatment. And we can be leaders who use the unique opportunity of congregational communities to educate so that the people of God may be nourished. It’s that simple, really.
 Nourish us, O God. May leaders take the ELCA social message on mental illness to heart: “We encourage you to treat your own mental health as essentially important in your life of baptismal vocation.”
Carol L. Schickel is an Associate in Ministry and works as a licensed psychotherapist in Chicago, Illinois.
© May/June 2013
Journal of Lutheran Ethics
Volume 13, Issue 3