Mental health programs Essay

Community health programs based in churches have been highly successful, although occasionally confusing and stressful for pastors to administer. However, it is not only physical health programs which have thrived; mental health and chemical dependency programs are an important supplement to church ministry and community service. Thompson and McRae argue that the Black church itself offers a positive therapeutic effect to its congregation, even without a formal mental health ministry in place. They discuss the historical basis for the Black church’s creation of community; the creation of the â€Å"we† group rather than the individual â€Å"I† and the need for belonging with a group, rather than to a group (41). They state â€Å"Embedded within the individual were past experiences, traditions, values, and norms for emotions, cognitions, and behaviors conducive to relatedness and â€Å"interpersonalness† that reflected a collective sense of belonging with rather than to, caring, similar others (Thompson & McRae, 41). † The Black church, in Thompson and McRae’s view, has created a bridge for the gap between the historic slave experience and the modern Black experience which helps ease the mental transition between worlds, and created a framework for dealing with hostility. They state â€Å"The Black church nurtures the survival of its members through providing a supportive, caring environment to facilitate an ever-widening upward spiral of positive cognitive, affective and behavioral outcomes for growth and change (Thompson & McRae, 46). † While the mere fact of church fellowship has a positive effect on its members, Black church involvement in formal mental health ministry programs has a significant impact on its members as well. Blank discussed the importance of mental health care within the church setting. They state that there are four areas of community care considered most effective in the church setting. These are primary care delivery, mental health, health promotion and disease promotion and health policy. Their review of studies underscored the importance of natural helpers (friends and extended family), lay helpers and most especially church leaders in the delivery of mental health care through an informal care system. Blank discussed the state of mental health care in the rural South in the 1970s; the population was discovered by researchers studying psychiatric utilization and morbidity in the area to be underserved, despite the general view that rural life was superior to urban. The problems contributing to low psychiatric utilization are complex; problems with service delivery, low quality of care (especially among minority patients) and lack of providers are entangled with social stigma surrounding psychiatric care, economic and social factors, geographic distance from providers, poverty, race and class issues to create a morass of issues a patient must slog through to acquire psychiatric care. Blank notes that at the time of the study, most counties lacked a single doctoral-level mental health professional; only 3% of licensed psychiatrists practice in the rural South, a number which has not changed significantly since the 1970s. In addition to the socioeconomic issues with receiving psychiatric care in the rural South, there are further problems relating to doctor-patient relations. Some theorists state that white mental health care providers cannot provide optimal care to Black patients because of their lack of knowledge and understanding of Black history and culture, as well as a lack of understanding of the difficulty of being Black in a white world; furthermore Black patients are less likely to trust white care providers due to racial tensions and differences in worldview (Blank , 1668). Instead, Black patients are considered to have a preference for Black care providers. While some studies have shown that Black patients do prefer Black care providers, stated reasons for this preference are a perception of greater professional competence and attitude, as well as racial and cultural compatibility (Blank , 1668). Blank emphasize the importance of sensitivity and cultural competence; it can lead to a greater understanding of non-normative minority behavior as well as an increase in trust levels between provider and patient which increase the possibility of a successful outcome. Blank discusses the cultural responsiveness hypothesis, which states that the effectiveness of psychotherapy is directly related to the therapist’s ability to communicate an understanding of the patient’s cultural background. Lack of this cultural responsiveness might account for some of the racial divide in diagnosis, treatment and premature termination of treatment observed between Black and white psychiatric patients (Blank, 1669). Blank hypothesized that rural churches provide fewer social and mental health services than urban churches, and that they have fewer links with the formal care system; furthermore, because of the importance of the church in the Black community and the historic exclusion of Black from formal care systems (schools, mental health services, etc), Black churches would provide more social and mental health services than white churches, but with fewer links to the formal care system (1669). Blank tested their theory using a phone survey of Black and white church leaders in both rural and urban areas in the South (defined in their study as Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Missisippi, North Carolina, South Carolina, Tennessee and Virginia (Blank, 1670)). A total of 2,867 churches were targeted, with a total of 269 completed interviews, or an overall participation rate of just under 10% (Blank, 1670). Rural Black churches, the targeted demographic, were actually least likely to participate in the study, with only a one in fourteen survey completion rate; the researchers cited lack of full-time staff creating difficulties reaching church leaders and a high rate of church leader refusal as factors in this low completion rate (Blank, 1670). The researchers discussed topics such as church demographics, including size and racial composition of the congregation, number of services held and attendance at the services, the church budget and founding date; problems the church’s congregants faced that the church leader considered to be most important; specific questions about mental health services provided by the church or church leader, including such issues as depression, paranoia, nervous breakdown, dementia and Alzheimer’s disease and attempted suicide; What type of support services were offered formally by the church to deal with these types of issues; and what links to the formal care system, including hospitals, care providers and support services like Alcoholics Anonymous existed, and if links existed to what level church leaders provided referrals to the formal care system (Blank, 1669). The researchers then constructed four different scales on which to rank the churches: Problems, which quantified the degree to which responding churches dealt with mental health problems over the previous two years; Programs for Adults, which quantified the number of mental health programs offered by the church, including those dealing with alcohol and substance abuse, marital counseling, sex education and counseling, domestic violence and sexual assault; Programs for Children, which quantified programs specifically aimed at support for children, including individual and family support services; and finally Programs for Teenagers, which quantified programs specifically aimed at support for teens. Referrals, both in and out, were also quantified (Blank, 1670). Statistical analysis using factorial analysis of variance (ANOVA) was performed to determine the correlation between the varying factors. The researchers found some surprising differences in funding – when adjusted for congregation size, rural white churches had substantially larger budgets than rural Black churches, and urban Black churches also had significantly larger budgets than the rural Black churches (Blank, 1670). However, both urban and rural Black churches were shown to offer significantly higher numbers of mental health programs overall than their white counterparts. There were no statistically significant variables in the study of links between referrals, but the modal response among churches overall was 0, indicating that all churches tend to lack links with the formal care system (Blank, 1671). Blank extrapolate concerning the possible reasons for lack of links between the formal care system and the informal care system provided by churches. They note that one of the difficulties may be historical in nature; because churches are often divided among racial and ethnic lines, there may be barriers to connection between the formal care system and churches precipitated by racial and ethnic tensions. Additionally, because churches have played a role as a political entity in the past, there may be lingering social tensions between churches and formal care systems which prevent these roles. (Blank, 1671). Another barrier may be the different paradigms of the formal care system and the church regarding the nature, causes and treatment of mental health problems.