This is the seventh part of a IH Blog series, Global Mental Health: Burden, Initiatives and Special Topics.
Out of over 7 billion people on Earth, more than 80% identify with a religious group. The Pew-Templeton Global Religious Future Project reports that Christianity is the world’s largest religion, with approximately 2.4 billion individuals affiliating as Christian. The project estimates that 1.9 billion individuals affiliate as Islamic, 1.2 billion with Hinduism, 507 million with Buddhism and 15 million with Judaism. In most countries, a majority claim that God plays an important role in their daily lives.
As mentioned in the first part of this IH Blog Series, over one in three people will experience a mental health problem in their lifetime. Out of the total number of people who experience a mental health problem, 76-85% of people do not receive the treatment they need. With religion playing such a significant role in people’s lives and with mental illness being a global crisis, understanding the interplay between religion and mental health care seeking is of crucial importance.
Religion divides but it also unites us. All religions offer explanations for the meaning of life, purpose of life and rationalize human suffering. With religion being a source of individual growth, community strength, solidarity and resilience, it is clear that a person’s faith and spirituality has implications on their mental health. For example, in Hinduism, there is a broad view of life summed up in four aims (Purushartha): Dharma, Kama, Artha and Moksha. Each highlights harmony in different dimensions of life. Religious and spiritual beliefs and activities are commonly used to cope with stressful life events. Whether an individual lives in a high, middle or low-income country, people look to religious leaders and advisors for guidance in place of or before seeking out mental health treatment. In addition to poor access, stigma, a lack of understanding and religious insensitivity by mental healthcare professionals are just a few of the barriers religious people face in seeking out formal mental health services. We are discovering more about the role religion and spirituality play in mental health care seeking globally, but there are a number of gaps in our current knowledge on the subject. Most studies on religion and mental health treatment seeking have been done in the U.S. and Europe with religiosity garnering more attention than spirituality.
Elena: I first became interested in the relationship between religion and mental health when I interned at the National Alliance on Mental Illness’s (NAMI) national office in Arlington, Virginia five years ago. I remember exploring the NAMI website and discovering a page on faith and spirituality with a link to NAMI’s interfaith resource network, NAMI FaithNet. As a spiritual Jewish atheist, I found this perspective to mental health eye-opening. In the summer of 2019, at the start of my Master of Public Health program at Arcadia University, I began developing my capstone research project on the topic of Black clergy and their role in the mental health of their congregants. The aim of this research was to explore Black Protestant Philadelphia clergy’s perceived self-efficacy in the mental health gatekeeper role. From my background research, I discovered that Blacks are more likely to report serious psychological distress compared to Whites, but are less likely to utilize formal mental health services. Instead of utilizing these services, many Christian Blacks seek guidance from clergy, who are increasingly being called mental health gatekeepers. Philadelphia is a large, historical center of the Black Protestant community, but through a detailed literature review, I discovered that qualitative research was lacking on this topic within this population.
After conducting six semi-structured interviews with Philadelphia Black clergy, several themes emerged. The clergy I interviewed had differing mental health gatekeeper identities, with some considering themselves mental health gatekeepers and others not identifying with the title at all. Self-efficacy was high for clergy’s ability to recognize what was and was not within their scope of expertise, but self-efficacy varied for other skills, such as recognition of mental illness. Clergy acknowledged similar challenges in assisting congregants in need of mental health treatment and all admitted a need and desire to improve access to mental health resources. All respondents discussed interest in developing collaborations that may help them provide mental health assistance and connect congregants to mental health professionals in Philadelphia. Intervention and policy initiatives aimed at collaborating with Black Philadelphia Protestant clergy to address the perceived mental health needs of their congregations could strengthen their self-efficacy in the mental health gatekeeper role.
The role of religion in mental health and well-being is substantial. In a time when mental health outcomes globally are declining, exploring and understanding the mechanisms that shape our mental health is critical. This provides the foundation for developing effective strategies to prevent mental health issues as well as manage and treat these conditions. Further research is needed to fully elucidate the relationship between mental health and religion/spirituality in a range of populations and settings to inform intervention development and dissemination.
About the Authors:
Elena Schatell MPH (c) MMS (c)
Elena Schatell is a current student at Arcadia University enrolled in the Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. She aims to promote public health in underserved communities as a future physician assistant. Her current public health interests include access to mental health services, stigma surrounding mental illness, and the relationship between faith and mental health. She has interned at the National Alliance for Mental Illness (NAMI) national office in Arlington, Virginia, working closely with the Advocacy and Public Policy team on conducting research on service barriers and state mental health policy. During her time at NAMI, she also authored articles for the Advocate magazine and blog.
Dr. Heather F. McClintock PhD MSPH MSW
Dr. McClintock is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.