Breaking the silence: the mental health of our clergy.

The sign outside an Ontario church read, "We're too blessed to be depressed." The author of the sentiment almost certainly meant to encourage gratitude, but the truth is the message betrayed a sad fact about many of our congregations: we do not understand mental illness and we do not appreciate how deeply it is affecting the life of the church. Not only are people in the pew suffering, but our clergy show alarming statistics of depression and anxiety disorders.

Mental illness in Canada is on the rise, and according to the Canadian Mental Health Association, one in five Canadians will develop a mental illness in their lifetime. Among the most common are depression and anxiety disorders, and the World Health Organization estimates that by the year 2020, depression will be second only to heart disease as the leading global cause of disability and mortality. This is no small matter to be kept under wraps; the economic, personal and social costs of mental health problems are immense. It has been estimated that the cost of lost productivity due to workplace mental illness in Canada is in excess of $30 billion per year. Mental health issues can also lead to strained relationships at work and at home, erosion of self-esteem, and for some, even suicide.

While many Christians struggling with mental illness turn to their minister for comfort and help, our clergy themselves are suffering. A recent survey conducted by the Centre for Clergy Care on Clergy Well-Being (led by Rev. Andrew Irvine of Knox College, Toronto) revealed some disturbing trends. In their survey of more than 300 ministers from six Canadian denominations, they found that the number of those who had been diagnosed with clinical depression was double the national average. Almost 40 per cent sought the care of a clinical counsellor and 45 per cent sought advice from their family doctor regarding stress and anxiety issues. What is worse, these statistics likely underestimate the extent of clergy suffering, since studies show that only about half of those with major depression seek help. Clearly, the mental health of our clergy is in need of attention.

The Clergy Well-Being study revealed a number of factors that are compromising the overall health of our ministers. The average work week of respondents was reported to be 50 hours, although a quarter of them work in excess of 55 hours. Almost 40 per cent take fewer than three days off per month because, like others in care giving professions, ministers are taught to pay attention to the needs of others, and in the process rarely pay attention to their own need for rest or healing. Surrounded by the constant needs of a faith community, many ministers are neglecting regular exercise, personal devotions, and relaxation in order to find additional time for serving or simply to avoid feeling guilty. In the Canadian clergy study, for example, reading scripture was listed as one of the most important sources of spiritual renewal for ministers. What is startling is that 94 per cent of those same respondents noted that although they read scripture in preparation for sermons, it rarely nourishes them personally.

Few would disagree that the work of ministry is increasingly complex. As the size of many Presbyterian congregations across the country decline, there is tremendous pressure to not only shepherd a congregation but also balance budgets and increase membership. Meanwhile, traditional social supports for ministers are eroding. As with most Canadian families, both spouses are likely working. This means both women and men in ministry are now juggling the demands of children's activities, aging parents, and household responsibilities alongside their working spouse. And all of this happens within the calling of ministry that demands long, unconventional and unpredictable hours. These all have an impact on mental health and leave ministers at risk for significant problems.

Frank (pseudonym), a Presbyterian minister who has experienced several bouts of depression, says depression, anxiety disorders and plain old burn-out are "endemic" among clergy, in part because ministry is an endless job, often a bottomless pit. "As I visualize my weekly clergy peer-group meeting, going around the room," says Frank, "I can't see one who has not been, or isn't now, in treatment for a chronic illness, high blood pressure, digestive problems, or depression. Among my closest friends and colleagues in ministry there are only two who haven't had serious health problems directly related to the stress of ministry."

Despite the prevalence of mental illness in the general population, the issue is often hidden. Many people living with a mental illness report that the associated stigma causes them more suffering than the disease itself. One woman in our parish who is suffering from depression remarked that she does not want to tell others about her disease because "they see it as a weakness, not an illness." In an American study, 80 per cent of mental health consumers indicated that they heard people in the workplace making hurtful or offensive comments about mental illness. Another 70 per cent noted that others had sometimes treated them as less competent once their illness was known.

One minister, who asked to have his name withheld, told the story of a presbytery in which a minister required a short-term health leave from his congregation. "The pastoral care committee reacted to his depression and anxiety with distaste and discomfort," he says. "Not only did they fail to offer any support at all, but they concluded that the man must lack essential gifts and should never have become a minister in the first place." Privately, many ministers acknowledge that the public admission of mental illness will virtually put an end to peer respect and future ministry opportunities. "You can never, ever tell," said one. "You will be labelled for life."

FOR SOME CLERGY, mental health problems may lead to increased sick days or time off work. Many others, however, continue to work despite their mental health issues. Unlike a broken leg or other physical illness, issues of mental health are often invisible, poorly understood, and build gradually over time, making it difficult to recognize when they are occurring. "Presenteeism" (as opposed to absenteeism) is a new buzzword in today's business community, referring to individuals who continue to go to work despite illness. Although the individual is at work, he or she is not as productive. Studies have shown that rates of presenteeism are particularly high among physicians and other service providers, where it is difficult to find a replacement to cover the work. This is likely to be true of clergy, especially when they are the sole minister in a charge where there is no one to share their responsibilities. By not taking the time to rest and recover, however, this could lead to a longer duration of sick leave down the road.

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For those ministers who experience mental health problems, the Presbyterian Church offers almost no financial support. The pension and benefit plan for 2008 allows only $300 a year to provide for professional counselling or the services of a social worker. This support falls well short of the funding needed for effective treatment. Research shows that a series of 10 to 14 sessions of cognitive-behavioural therapy can be effective for a range of mental health problems. Current funding provided by the church, however, would only cover approximately two visits per year. The cost of additional visits, often more than $100 each, could lead to significant financial burden on ministers who are already going through a difficult time.

THE FINANCIAL COST for congregations and to the presbytery for a minister who is on sick leave is high. While the minister is on leave, they must continue to provide housing, utilities, and stipend. In addition, the congregation must pay for weekly pulpit supply and any additional staffing needs. When the leave is for more than a few weeks, an interim moderator must also be appointed, and be given an honorarium. Presbyteries vary in their guidelines for such payment, but many suggest 10 per cent of the minister's stipend. These costs, for many congregations across the country, would be difficult to bear.

Although it is limited, some support is available through the denomination's benefit program. "Each situation is unique; each medical leave is unique," says Judy Haas, senior administrator for the church's pension and benefits board. "A congregation may apply to this office for pulpit supply insurance if their minister is away from the pulpit more than two weeks." When a leave must extend beyond three months, employment insurance benefits become available, but congregations must then face other practical questions about how to continue their ministry in the midst of pastoral uncertainty.

Leaders in the business community are starting to recognize the financial and moral imperative for addressing mental health issues in the workplace. The Global Business and Economic Roundtable on Addiction and Mental Health, for example, is a collection of CEOs from the business community who have come together to tackle this growing problem. Canada Post recently identified mental health in the workplace as its cause of choice. As former senator Michael Kirby explains, there is "a strong and compelling business case to be made for making the workplace an environment that is conducive to mental health--the payback in greater productivity will outweigh any costs that may be incurred." The newly formed Mental Health Commission of Canada has identified the elimination of stigma and the reduction of discrimination as a top priority to be addressed as part of its federal framework for mental health.

In the Christian community, vision and leadership is also needed. In other denominations, clergy wellness has begun to receive attention. In 2006, the United Church of Canada began a Sabbatical Policy for Ministry Personnel in Pastoral Relationships, which mandates a paid sabbatical of at least three months after five or more years of service. This time for study, rest, retreat, and prayer is offered with the explanation that Jesus sought occasional respite from the demands of ministry. In the Anglican Church, the General Synod Pensions and Benefits Committee raised concerns about the rise in both short-term and long-term disability claims in 2002, prompting the denomination to begin a variety of clergy wellness studies and initiatives.

Unlike the business community, however, none of these church initiatives have addressed mental illness directly. They allude to the need for rest, healing, and life balance, but fall short of recognizing the current high rate of depression among clergy. The church, which is to be a place of rest for the weary, and which seeks to be good stewards of all its gifts, must also take steps to erase the stigma and support those who suffer. Mental illness needs to be brought out of the shadows and identified as a common problem that deserves a compassionate response. Concrete supports need to be put in place to ensure that churches are mental-health friendly, and accepting of individuals, including clergy, who have a range of needs and abilities.

IN THE CURRENT ENVIRONMENT, clergy who are open about their mental health issues take a risk in exposing their vulnerability. "Some colleagues and church members have been offended by my openness about my personal issues," says Frank. "Most, by far, have appreciated my honesty. There is such a stigma associated with depression. My sharing has given several members of my congregation permission to tell the hard truth about their own experiences, and the struggles of family members. Among colleagues, it has been a great help just to know none of us is unique or crazy." Frank's openness, however, seems to be the exception rather than the rule.

In order to create a church community that is conducive to mental health, there are a number of practical strategies outlined in international workplace literature that could be adopted, including primary prevention of mental health problems, early intervention, and treatment. If the church is to create a comprehensive approach to meeting the needs of clergy, strategies within each of these categories should be considered.

Primary prevention: High job demands and work overload, for example, are significant risk factors. For clergy, it may be important to review explicit and implicit job descriptions, as well as hours of work and planned Sabbath time for prayer and spiritual renewal. Sessions can offer support by identifying sources of stress within each unique ministry (such as conflict or financial strain) and providing appropriate resources to address these stressors.

Presbyteries could begin to create a healthy workplace strategy that includes supports for clergy training and development (for example, mental health information, or funding for sabbatical initiatives). This government website provides policy examples: http://www.hrsdc.gc.ca/ en/lp/spila/wlb/imt/05sample_policies_forms.shtml

Early intervention: It can be difficult to acknowledge symptoms of anxiety or depression and the need for treatment. In some cases, it may be a colleague or congregational elder who first notice the changes (see sidebar for a outline of red flags that may signal the importance of seeking professional support). An easily accessible, confidential, online self-assessment screening tool may also be useful (see examples at: www.checkupfromtheneckup.ca and www.healthyplace.com/index.asp). Studies show that if problems are caught early enough, recovery is faster with fewer negative social and financial consequences.

Treatment: The majority of mental health problems are highly treatable, and early access to treatment can not only prevent problems from getting worse but may lead to a faster recovery as well. The church would do well to learn from the many organizations that offer confidential employee assistance programs that provide mental health screening, support and referrals when they are needed. Adequate coverage for professional counselling should be viewed as an essential part of the benefits package since it is very effective either in conjunction with, or as an alternative to, psychiatric medication. In Canada, all employers are required by law to make reasonable accommodations for employees who have a disability. Presbyteries have a responsibility to assist an individual to return to ministry by gradually increasing hours of work, modifying duties, or offering additional on-the-job support. Accommodations are not expensive; more than 90 per cent of the accommodations for mental health problems cost less than $90.

It is possible to create a supportive mental-health * environment in every congregation and at every level of the church. To begin, however, we must combat the stigma of mental illness by bringing it out of the darkness, and acknowledging its prevalence in the life of all of members of the church, from parishioners to pastors. As followers of a compassionate Healer, surely we are well equipped for this task. And as a church who strives to be the hands and feet of Christ in the world, surely we are called to greet vulnerability with mercy and offer love to the suffering among us.

Red Flags for Mental Health Problems

Signs and symptoms to watch for in yourself and others (adapted from Conference Board of Canada and CMHA Mental Health Works)

Poor Work Performance

* Consistent late arrivals or frequent absences/sick days

* Decreased productivity

* Lower quality of work

* Increase in errors

* Decline in dependability (e.g., not meeting deadlines or completing work tasks)

* Decreased interest or involvement in work

* May work longer hours, but performance still poor

Personal Changes

* Difficulty concentrating, making decisions, or remembering things

* Speech slowed down (or speeded up)

* Tired all the time or sleeping on the job

* Loss of interest/enjoyment in hobbies outside of work

* Frequent complaints of unexplained aches and pains, and insomnia 

* Feelings of hopelessness and sadness

* Pronounced mood swings

* Change in appetite, seen through substantial weight loss or gain

* Change in sleep patterns-employee talks about inability to sleep or sleeping too much

* Significant change in behavior or attire (e.g., disheveled)

* Talking about strange or "grandiose" ideas

* Evidence of alcohol or illicit drug use that interferes with work

Social Changes

* Lack of co-operation or a general inability to work with colleagues

* Tunes out what others say

* Irritability/hostility or blaming of others

* Resenting or even alienating parishioners

* Sudden outbursts at meetings

* Tearful when approached about tasks or performance issues

* Working at home to avoid the "negative energy" of the office

* Avoids eye contact when talking to others

* Withdrawal from, or extreme dependence on others

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Note: The "red flags" will vary from one person to the next. Many of the signs could be a reflection of an employee who is having a bad day or week, or who is going through a difficult time in their life. A pattern that continues over time, however, may indicate an underlying mental health problem.

Startling Numbers

Survey statistics reveal anxiety, spiritual burn-out.

The Centre for Clergy Care and Congregational Health conducted the study Clergy Well-Being: Seeking Wholeness with Integrity in June 2003 under the guidance of Rev. Dr. Andrew Irvine. In addition to focus groups, the study examined responses from 338 clergy from the six major protestant denominations in Ontario: United, Anglican, Presbyterian, Evangelical Lutheran, the Baptist Convention of Ontario and Quebec, and the Pentecostal Assemblies.

The report is available in the Current Research section of the Centre for Clergy Care and Congregational Health webpage: www.caringforclergy.ca.

* Ministers worked an average of 50 hours per week, but over 25 per cent worked in excess of 55 hours each week.

* In a 30-day period, almost 40 per cent of ministers took three or fewer days off.

* 80 per cent felt guilty if people saw them taking time off during the week.

* 78 per cent felt their position as a minister demanded perfection.

* 51 per cent indicated that they had suffered physically from stress-induced problems.

* 67 per cent said they sometimes projected job frustrations onto their families.

* 38 per cent sought the aid of a clinical councilor;

* 21 per cent a psychologist;

* 15 per cent a psychiatrist;

* 45 per cent the advice of a family doctor regarding stress and anxiety issues.

* 20 per cent had been diagnosed with an emotional condition;

* When asked to specify the condition, 16 per cent named depression.

* 62 per cent said they sometimes appeared outwardly happy while they were in emotional distress.

* 75 per cent were afraid to let their parishioners know how they really felt.

* Close to 49 per cent of ministers identified two or fewer close friends in their church or community.

* 60 per cent said evenings with friends usually involved 'church talk.'

* 55 per cent indicated that they sometimes feel very lonely.

* 81 per cent experienced a situation in which they required personal pastoral care in the past five years.

* Only 71 per cent sought and received such care.

* 40 per cent of ministers indicated that they had someone who was their personal pastor, but only 16 per cent indicated that they had a spiritual director.

* 80 per cent were sometimes jealous of the success of other ministers.

* 83 per cent believed ministry was a calling from God and the church.

* 91 per cent agreed that being a minister felt more like a job than a calling.

* 77 per cent felt more like CEOs than pastors.

* 83 per cent felt their churches wanted a CEO, not a pastor.

* 94 per cent said they read Scripture for sermon preparation, but it rarely spoke to them personally.

* 86 per cent prayed regularly with others but had little time for personal prayer.

* 71 per cent did not feel spiritually affected while leading worship.

* 89 per cent sometimes felt like they were simply going through a ritual when they led worship.

* 70 per cent felt unfulfilled in ministry.

* 33 per cent had considered leaving their denomination.

* 60 per cent indicated that they had at some time considered leaving ministry.

ILLUSTRATION BY MICHELLE THOMPSON

Sandra Moll is an Assistant Professor in the School of Rehabilitation Science at McMaster University and a PhD candidate in Public Health Sciences at the University of Toronto. The focus of her research is on mental illness in the workplace.

Kristine O'Brien is minister at Trafalgar, Oakville.