Acute Mental Illness: What Can the Church Do?

Here are some further statistics from the Lifeway/Focus on the Family Study of Acute Mental Illness and Christian Faith I started summarizing last week. I hope to offer some commentary on these stats in the coming week, but have a read of them and maybe use them to start a discussion in your church or small fellowship group.

Pastor’s Experience with Acute Mental Illness

  • Most pastors indicate they personally know one or more people who have been diagnosed with clinical depression (74%), bipolar disorder (76%), and (45%)
  • 59% of pastors have counseled one or more people who were eventually diagnosed with an acute mental illness
  • 22% of pastors agree that they are reluctant to get involved with those with acute mental illness because previous experiences strained time and resources
  • 38% of pastors strongly agree they feel equipped to identify a person dealing with acute mental illness that may require a referral to a medical professional
  • The most frequently used learning resources for pastors have been reading books on counseling (66%) and personal experience with friends or family members (60%).
  • 23% of pastors indicate they have personally struggled with mental illness of some kind

How Well Churches Are Caring for those with Acute Mental Illness

  • The response of people in church to individuals’ mental illness caused 18% to break ties with a church and 5% to fail to find a church to attend
  • 17% of family members in a household of someone with acute mental illness say their family member’s mental illness impacted which church their family chose to attend
  • 53% of individuals with acute mental illness say their church has been supportive
  • Among individuals with acute mental illness who attended church regularly as an adult 67% say their church has been supportive
  • 75% of family members in a household of someone with acute mental illness say their church has been supportive
  • 39% of individuals with acute mental illness agree that their local church has specifically helped them think through and live out their faith in the context of their mental illness
  • Among individuals with acute mental illness who attended church regularly as an adult 57% agree that their local church has specifically helped them think through and live out their faith in the context of their mental illness.

Church’s Role in Caring for Acute Mental Illness

  • 56% of pastors, 46% of family members in a household of someone with acute mental illness, and 39% of individuals with acute mental illness strongly agree that local churches have a responsibility to provide resources and support to individuals with mental illness and their families
  • Top areas local churches should assist individuals with acute mental illness: 69% of individuals with acute mental illness indicate churches should help families find local resources for support
  • 68% of pastors but only 28% of family members in a household of someone with acute mental illness indicate their church provides care for the mentally ill or their families by maintaining lists of experts to refer people to
  • 65% of family members in a household of someone with acute mental illness believe local churches should do more in talking about mental illness openly so that the topic is not so taboo
  • 49% of pastors rarely or never speak to their church in sermons or large group messages about acute mental illness
  • 70% of individuals with acute mental illness would prefer to have relationships with people in a local church through individuals who get to know them as a friend

You can access the full report hereFocus on the Family have set up a helpful website with many resources to equip pastors and the church to better serve Christians who suffer in this way.

Two Searching Questions About Happiness

“Worldly people pretend to the joy they have not; but godly people conceal the joy they have.” Matthew Henry

Why do some unbelievers seem to be incredibly happy, while some believers seem to be incredibly sad? Matthew Henry’s explanation is that the unbelievers publicize pretend joy, whereas believers privatize real joy.

Pretend Happiness

But why would anyone in the world pretend to be happy?


Partly because happy people are popular people. Most people are sensible enough to run a mile from Mr Misery. That social pressure forces people to put a good face on, to pack up their troubles in their old kit bag and smile, smile, smile.


Others pretend to be happy not so much to deceive others but to deceive themselves. At times, albeit briefly, they see that their past is worthless, their present is meaningless, and their future is hopeless. But to honestly admit such to themselves is too painful, too challenging, too catastrophic. Better put a lid on it, dig a deeper mental hole, and cover such unwelcome thoughts with more layers of artificial happiness.


Then there are unbelievers who want to cover wrong choices in their lives. We know them don’t we? Maybe we’ve been there ourselves. We’ve made bad financial decision, bad vocational decisions, and bad relational decisions, and it’s all blown up in our face. But rather than admit we got it wrong, we’re like bomb survivors with blackened faces and shredded clothes, partying in the rubble of our lives.

Why not give up the pretense and seek real and genuine happiness through Jesus Christ?

Hidden Happiness

But if an unbeliever pretending to be happy is madness, consider the second scenario, an even more ridiculous one – true believers hiding true joy! Why would anyone want to do that?


Some Christians hide happiness because it has strong associations with sinful pleasures. When people walk into a drug- or alcohol-fueled party they see lots of smiles and hear lots of laughter. Saturday Night Live, John Stewart, and other late night comedians have also given laughter a bad name, by linking it with bad language, innuendo, and humiliating mockery. Celebrities cannot risk being seen without their plastic smiles and who wants to be like that.


Others are scared off from public displays of happiness by the shallow superficiality of so much modern Christianity. They see through the fake smiles and emotional manipulation of the TV Evangelists and they want no part of it. “Better people think I’m deep and miserable than shallow and happy.”

False piety

Then there’s false piety, the idea that the more more morose, morbid, and mournful you are, the more spiritual you are. Yes, there are Christians who have been blessed with deep spiritual joy but who fight to contain and conceal it because they want to be known as hyper-spiritual. At heart, this is based on a wrong view of God, the idea that God is happiest when we are saddest. It’s also dangerous because science has demonstrated that our facial expressions, bodily posture, and words all combine to impact our emotional states as well.

Do you really want to risk losing spiritual joy just to make others happy with your sadness?

“You have put gladness in my heart, More than in the season that their grain and wine increased” (Psalm 4:7).

Top 10 Books for Elders

As I’m often asked for book recommendations on various subjects, I decided to put together an online list of my top ten books in various categories. Basically, if I was only allowed 10 books in my library on that subject, these are the ten I would choose. Previous posts include:

Following on from my articles on eldership (here and here), today I’m listing my Top 10 Books for Elders, with the recommendation that elders read at least one of these books on eldership every year. Why not do it together with fellow-elders? If you know of other good books on this topic please leave your suggestion in the comments and I’ll add them under “Reader Suggestions.”

Obviously there are various church polity models represented here, but I hope you’ll find much to learn about eldership from each of the various traditions.

1. The Shepherd Leader by Timothy Witmer

I agree with Pastor Al Martin that this book should be required reading for all elders/pastors. Crystalizes the elder’s work around four verbs: Knowing, leading, protecting, providing.

Also see Witmer’s The Shepherd Leader at Home for application of the same shepherding principles to family life.

2. The Elder and His Work by David Dickson

We’ve been studying this older Scottish work at our church. It’s a short and inspiring treatment of eldership that will elevate and expand your view of eldership as well as providing much practical advice on how to fulfil your duties. You can read my notes on the book here.

3. Biblical Eldership by Alexander Strauch

The most comprehensive, exegetical, and theological of the books on this list. It is also the best-selling book and for good reason. Like The Shepherd Leader this book also groups the elder’s duties under four categories: leading, feeding, caring, and protecting.

And here’s a condensed and simplified Booklet Version of Biblical Eldership, which can also serve as a helpful checklist for duties

4. Finding Faithful Elders and Deacons by Thabiti Anyabwile

The majority of the book is focused on eldership. It’s a simpler and more accessible alternative to Strauch’s Biblical Eldlership. Warm, exegetical, and practical, with challenging questions for both present and prospective elders.

5. Church Elders: How to Shepherd God’s People Like Jesus by Jeremie Rinne

A fresh, concise introduction to eldership from the IX Marks Building Healthy Churches series. Also a good book to give to non-elders in the church to help them understand the elders’ roles and their spiritual relationship to them.

6. The Elder’s Handbook: A Practical Guide for Church Leaders by Lester DeKoster

Practical, conversational, and with a Dutch Reformed flavor.

7. The Trellis and The Vine by Colin Marshall and Tony Payne

The helpful metaphor in the title of this book helps church leaders to discern if they are getting the right mix of vine work (preaching, teaching, discipleship) and trellis work (organization, administration, support work) and if the right people are doing each.

8. Conviction to Lead by Al Mohler

Although not aimed only at elders, this appears at #1 on my Top 10 Christian Leadership Books, and therefore strongly recommended for any Christian leadership position.

9. Hospitality Commands by Alexander Strauch

1 Timothy 3 lists two of the elder’s duties – teaching and hospitality. As the latter is often neglected, the author of Biblical Eldership wants to put that right with this brief book on hospitality. A Meal With Jesus by Tim Chester is another book on hospitality. I’ve not read it but I’ve read many good reviews.

10. How Sermons Work by David Murray

Again not a specifically for elders, but as all elders are to be “able to teach,” this simple primer on the basics of putting a biblical message together might help elders get started on their first Sunday school lesson or sermon.

Honorable Mentions

The Warrant, Nature, and Duties, of the Office of the Ruling Elder, in the Presbyterian Church by Samuel Miller.

Elders in the Life of the Church by Phil Newton and Matt Schmucker

Reader Suggestions

With a Shepherd’s Heart by John Sittema.

The Work of the Pastor by William Still

The Cross and Christian Ministry by Don Carson

A Portrait of Paul by Jeremy Walker and Rob Ventura

An Elders’ Checklist

As I mentioned yesterday, with my fellow-elders, we’re making an ongoing study of the elder and his work. What better to study then, than a book of the same name The Elder and His Work by David Dickson (you can read it online free).

David Dickson was an elder in the Free Church of Scotland in the mid-late 1800′s and wrote this book for his fellow elders. The book was reprinted multiple times and he allowed later editions to be adapted to fit the American context also.

I made many notes on the book as I read it which you can access here (Word/PDF). But we’ve been using it at church, together with 1 Timothy 3:1-7, primarily to start putting together an elder’s checklist to guide us in our regular duties. Our aim has been to produce something that we can use to continually remind ourselves of the basics of our task and to keep one another accountable in our service. This is what we’ve come up with so far (also here in Word/PDF):


1. Visit each family in the district once every 18-24 months

Aim for one scheduled home visit every 3 weeks (our five districts have about 25 families/homes in each)

2. Review district list every week to identify specific needs including

  • New member
  • Bereavement
  • Birth
  • Marriage
  • Illness
  • Questions
  • Problems
  • Mentoring
  • Exam time
  • Old age

Depending on circumstances, specific needs may be met by:

  • Home visit
  • Hospital/Nursing home visit
  • Phone call
  • Coffee/lunch
  • Hospitality
  • Email
  • Social interaction at church

Aim for at least one of these “specific need contacts” every three weeks.

3. Aim to know the spiritual state and condition of each individual.


  • Private prayer for families and individuals on district list every month (average of one family per day)
  • Regular attendance at congregational prayer meetings


1. Attend monthly elder meetings and joint meetings with deacons.

2. Assist and advise fellow-elders in discussions and decisions.

3. Arrange for holy administration of the sacraments

4. Administer church discipline

  • Follow due biblical process especially Matthew 18:
  • Identify and admonish the disorderly
  • Act against the impenitent and receive the penitent

5. Help with administration


1. Watch the ministers of the Word

Using preaching review form, assess the doctrine and life of the ministers of the Word with a view to:

  • Encouragement
  • Correction

Identify where ministers of the Word may need help in delegating responsibilities to others so that they can give themselves more fully to the ministry of the Word and prayer.

2. Watch the congregation

Observe the congregation to see who is present/absent, active/passive, engaged/disengaged.

3. Watch the families

Ensure family worship is practiced and children are receiving Christian education.


The elder should be growing in:

  • Christian knowledge and wisdom
  • Teaching ability

In order that they may be equipped to teach in areas of special gifting, including:

  • Pulpit
  • Sunday School
  • Catechism Class
  • Fellowship evening
  • Bible Studies
  • Vacation Bible School
  • Church Camp
  • Evangelism
  • Book studies
  • Distribution of good books


Be on the look out for new families and individuals coming to church.

Offer hospitality to individuals/families/groups of families.


Pro-active rather than reactive leadership with a willingness to take on new responsibilities

  • Vision for future direction, role, and needs of the congregation.
  • Mission and evangelism
  • Identifying, encouraging, training future leaders and service opportunities.