An invitation to our readers to brainstorm about God’s purposes in mental illness

I’m working on a project over the next week or two and I’d like to extend an invitation to our readers to lend your ideas and input.

I’ve been invited to teach during the Sunday morning worship services on October 21st at Fredericktown United Methodist Church in Fredericktown, Ohio. A group of leaders at the church have been working through our ministry’s book on mental health inclusion as part of their strategy to better serve persons with disabilities. I’m planning to tie together their study by addressing the topic – Discovering God’s Purposes in Mental Illness. I’m planning to start by using John 9:1-3 as Scripture text and supplementing with other references.

What teaching or reading have you come across that’s been helpful to you in better understanding the topic? Are there sermons or blog posts that have been particularly impactful that you’d like to share? If you’re an individual with mental illness, or a parent or spouse of someone with mental illness, what do you think the people of the church need to hear on this subject?

Please post your ideas, links and references in the comments section below so that all of our readers might benefit.

I’m planning to share my teaching on the blog as an extended post on the evening of the 21st. Fredericktown is approximately 50 miles northeast of Columbus. I’d be delighted to see you in person.

Are you a pastor or ministry leader searching for resources to better understand how to support children, adults or families affected by mental illness in your church or in your community? Check out Key Ministry’s Mental Health Resources page, containing links to video, articles and topical blog series designed to help you minister with persons with common mental health conditions. Also available through the website are a free, downloadable mental health ministry planning tool designed to accompany Mental Health and the Church, along with links to recommended books, like-minded mental health ministry organizations, relevant research, sermons addressing mental illness, social media resources and a compilation of stories from families affected by mental illness.

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Should I teach them the right way to care for patients?

Allow me to digress today and share from one of my “tent-making” jobs that provides my family with the financial support necessary for me to spend some of my time serving in the leadership of our ministry.

In addition to my unpaid work with Key, I have three jobs for which I receive financial compensation. One is my child and adolescent psychiatry practice. Another is the teaching position I hold at the medical school from which I graduated. The third is a consulting position I hold with a large child and adolescent community mental health agency in a county approximately an hour from where I live.

In my position with the mental health center, I’m implementing a redesign of the system through which families of children and teens with mental health conditions access psychiatric care. The plan utilizes available child and adolescent psychiatry resources to expand the capacity of primary care practices to identify and treat youth with serious mental health conditions, and emphasizes interdisciplinary training of early-career mental health professionals.

My work with the mental health center has probably been the most gratifying of my three paying jobs over the past year. We’ve hired a wonderful new medical director with board certifications in three different specialties, including child and adolescent psychiatry along with four bright and highly motivated nurse practitioners newly licensed over the last year. We’ve more than doubled the number of kids seen by the agency’s medical department over the last year and plan to quadruple our service capacity by next summer.

A large part of my job involves providing training to the medical and psychological staff of the agency and the legally required collaboration with our nurse practitioners. The training and collaboration is essential to the success of the plan. We want to train our clinicians in the most current, evidence-based practices before they’ve developed bad habits or experienced a work situation in which they were required to cut corners. The kids served by our mental health agency are incredibly complicated. Those who are referred to medical services more often than not have experienced significant trauma. Very few come from intact families. Their families of origin are often characterized by multigenerational histories of serious mental illness and substance use.

This past Wednesday, a very experienced nurse who helps provide care coordination for kids served by our clinic pulled me aside and told me she had to counsel one of our nurse practitioners to “don’t listen to Dr. Steve.” Here’s what happened…

I’d explained the process we use to initiate treatment with ADHD medication. We typically start children on the lowest dose of medication available and increase the dose on a weekly basis (the American Academy of Pediatrics practice guidelines suggest every three to seven days) in the absence of significant side effects until the child’s symptoms have resolved. By following the recommended procedure, our clinician was creating an administrative nightmare for themselves and for our agency.

Our care coordinator arrived that day to eight “prior authorization” requests from the insurance companies responsible for managing benefits for kids enrolled in Ohio Medicaid and private insurance. Basically, the insurance companies demand a review process that can take an hour or longer to complete in which a staff person from our agency has to justify the need for the prescription written by their psychiatrist or prescriber before the family is permitted to get the medication. The prior authorization process can take longer than the standard amount of time some insurance companies allocate for the child’s complete evaluation. The process is likely required whenever a new patient is seen, when medications are changed, or in some instances, when the dose of a medication is adjusted.

By following the proper procedure, our clinician was generating an unsustainable volume of prior authorization requests, most of which represent an exercise in futility. From what our staff explained to me, the typical procedure among the insurance companies that cover the kids seen in our clinic is to approve one prescription every thirty days for thirty pills from a highly restricted medication formulary. Spending the time on a prior authorization or appeal represents a waste of limited resources. Increasing the dose after a week means the family will run out of medicine ten days early with no recourse to get more.

Another conversation overheard in the hallway later in the morning. One of our prescribers wanted to conservatively increase the dose of a serotonin reuptake inhibitor by half a pill per day for a child they were treating for anxiety. Conservative dosing is especially important in our kids because those with trauma or other conditions impacting self-control are very susceptible to problems with impulsivity as the dose of these medications are increased. They were informed the dosing strategy would be impossible because their patient’s insurance company would refuse to pay for more than thirty pills per month for a product that would typically cost less than $10/month at a local pharmacy.

I found myself wondering whether the day represented a sign from God that it might be time for me to move on to a different type of work. I’ve found myself exhibiting truly unhealthy displays of anger when some pharmacy benefit manager gets in the way of a kid under my care getting access to medication that I think they need. I said a few things this past Wednesday that were unbecoming of an elder and ministry leader  (use your imagination!) that would have likely earned me a one way ticket to anger management class if I were working in a big, bureaucratic system. Later in the day, I was looking up a research paper for one of our clinicians on an older drug that hasn’t been used in any significant way for the last ten years for which he struggled to find information online. This older drug was the only covered alternative to two earlier generic forms of Concerta that had already been found by the FDA to be inferior to the original drug, but hadn’t been removed from the market because they weren’t clearly unsafe.

I could never work as a clinician at the mental health center I described. I need far more time than the insurance companies allow to do a thorough and complete evaluation, especially with complicated kids. The burden of having to collect clinically irrelevant information required by the electronic record and the distraction of having to type answers into a computer while talking to patients wouldn’t leave me with the cognitive capacity to do my best for my patients. But the biggest problem I’d face is knowing that the kids I’d be treating would be getting a lower standard of care than they could. They’d wait longer to get better, and they might be exposed to a greater risk of side effects in the process. Our agency doesn’t have the money to hire the staff necessary to fight the system. Following the redesign of our state’s public mental health system, we get paid less per hour for providing psychiatric care than we did when I served as the agency’s Medical Director twenty years ago.

I need to get to work on the core of the training we’ll be giving our young clinicians over the course of this year, and I have a dilemma. Do I train them in the best way I know how to take care of the kids in their care, or do I tell them what they’ll need to know to give kids the level of care their insurance company is willing to pay for and to go home at night with a clear conscience?

It’s getting harder and harder to sustain the level of care we offer through our practice. We’ve declined contracts with any insurance companies for many years because the terms of those contracts would essentially necessitate us to provide “assembly-line” care. Doctors are compensated very well under insurance for seeing three, four or more patients per hour and very poorly for longer appointments with their patients. Much to the surprise of my residents and fellows, I don’t get “rich” running a practice like ours. I made less money last year than I did in my first year out of training in 1991. Given the huge increases in in durance premiums and deductibles in recent years, fewer and fewer families have the resources to access our services outside their insurance plans, and we don’t have the resources to have a staff person available six days per week to run interference with their pharmacy benefit managers. It’s becoming impossible for a small practice like ours to survive that seeks to provide thoughtful and personalized care while hiring the army of support staff necessary for dealing with pharmacy benefit managers and the record-keeping demands resulting from billing regulations.

I wonder if there’s any correlation between the rise in suicide rates and the decline in access and availability of mental health care in this country and the rise of insurance companies and pharmacy benefit managers empowered by all levels of government to hire high school graduates to micromanage the work of medical professionals with many years of training and experience?
Are you a pastor or ministry leader searching for resources to better understand how to support children, adults or families affected by mental illness in your church or in your community? Check out Key Ministry’s Mental Health Resources page, containing links to video, articles and topical blog series designed to help you minister with persons with common mental health conditions. Also available through the website are a free, downloadable mental health ministry planning tool designed to accompany Mental Health and the Church, along with links to recommended books, like-minded mental health ministry organizations, relevant research, sermons addressing mental illness, social media resources and a compilation of stories from families affected by mental illness.


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Redefine Grace: A Simple Christ-Centered Approach for Students

It is without question that many of us wonder where WE as individuals fit in to our ever-changing society. We may enter into each day with confusion, doubt and uncertainty and cannot help but search for our place. Regardless of our age, stage of life or financial status, we all grapple with these fundamental questions in one way or another: “Who am I?” “Where is my place?” “How can I possibly make a difference in this world?” For the youth and adolescent population, these questions are not only ever-present, but they are magnified. Now add depression, anxiety and the multitude of challenges young adults and adolescents face to the mix. These questions move from magnified to incredibly intense!

When intense and magnified questions are present, there is an even greater need for answers and resources, especially ones that provide a simple, Christ-centered approach. At the Grace Alliance, we believe in a collaborative effort when answering these questions and are grateful for the opportunity to point individuals to partnering organizations with deep insight and expertise, like Key Ministry. Along with our collaborative partnerships, the multitude of requests for a young adult and student focused curriculum prompted us to dream about a resource that would meet a new need.

After a year of research, dreaming and constructing, we finally created a simple, Christ-centered resource, Redefine Grace! This is far more than just a workbook or comprehensive set of tools to “fix” some of the fundamental problems that exist for today’s youth and young adults. Rather, Redefine Grace is an invitation to explore these aforementioned questions and a roadmap to help rediscover, redesign and redefine God’s presence in the midst of a challenging stage of life.

Here are four key points as to why this project was so special for us and how we designed Redefine Grace to impact young people.

1) Why Does Redefine Grace Exist?

It doesn’t take much for us to witness the changing reality of mental health within our society today, specifically for youth and adolescents. Maybe this reality even hits close to home for you. Research published by the National Institute of Mental Health now demonstrates that 1 in 5 youth between the ages of 13 and 18 years old are living with a diagnosable, serious mental illness and 75% of all lifetime cases of mental illness begin by the age of 24. Unfortunately, a 10-year delay between onset and intervention still remains. Our hope is for Redefine Grace to exist as a tangible and accessible resource that plays a critical role in decreasing the time it takes for these individuals to receive the care that they truly need.

2) What Makes Redefine Grace Unique?

In an attempt to remain accessible, inviting and relevant to the adolescent and young adult population, Redefine Grace takes on a unique language, structure and format with three main sections that make up each chapter: Rediscover, Redesign and Redefine. As youth and adolescents arrive with uncertainty, doubt and questions, longing for genuine answers and a freedom to explore, this curriculum invites readers to encounter the reality that they are not alone. They are invited to rediscover characters from the bible who also navigated through various trials and life obstacles, demonstrating the resiliency and hope that is accessible to each and every one of us today. Redefine Grace incorporates compelling facts and tools that are not only written in a non-intimidating language but also tools that touch on relevant topics such as identity, life balance, expectations, purpose, social media and community. Finally, Redefine Grace leaves students with a tangible “next step” and a knowledge that each and every week is an opportunity to redefine their stories with the confidence that they are no longer defined by the challenges that they have experienced or will continue to experience.

3) How is Redefine Grace Used? 

As many of us can recall from our own youth, the way we approach adolescents and young adults cannot be done with a “one size fits all” mentality – each individual is unique in their physical, mental, spiritual, emotional and relational needs and therefore requires a resource that has the flexibility to meet these needs. Redefine Grace is specifically designed with this idea in mind and has the ability to be used individually, one-on-one in a mentorship relationship and as a small group.Our desire is to meet adolescents and young adults right where they are, whether on their mountaintop or in their deepest and darkest valley.  This is exactly what we witnessed with the Redefine pilot group that launched at Baylor University:

“As a public health major, masters in counseling grad student, and Redefine facilitator, I have observed and studied the impact mental health difficulties have on young adults. Ultimately, what I have found is that everyone needs to be heard, supported, and given hope. Redefine groups do just that by providing a community in which individuals can explore spiritual truths, psycho-educational facts, thought-provoking questions and empowering tools. When faith and mental health insight come together in a group setting, one is able to identify their challenges and the grace and hope needed to move forward and live out their God-given calling. I am so excited about the new Redefine curriculum and the impact it will have on our current & future generation of young adults!”

 -Faith Badders, Redefine Facilitator 

4) What is the hope for Redefine Grace?

Redefine Grace provides real faith, real facts and real opportunities to love and care for our body, mind and spirit, as well as the relationships that flow from a balanced, whole-health lifestyle. Adolescents and young adults often assume that they have to “get it all together” in order to seek whole-health care and a fruitful relationship with God. Our hope is that Redefine Grace offers an invitation for students to come as they are and explore what it looks like to experience God’s grace and peace through a process of redefining their story.

Overall, we see Redefine Grace as a simple resource that can be used in collaboration with Key Ministry and other incredible organizations. We know and believe that it takes all of us working together to see a great impact for students.



Natalie Franks M.A., OTR/L serves as Executive Director of Programs for The Grace Alliance. To reach Natalie, learn more about the Redefine Grace curriculum, or to view all of the Grace Alliance’s offerings to support individuals and families affected by mental illness, check out their website,

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Advancing the cause of disability ministry

I’m pleased to announce to our readers that Barb Dittrich will be taking on an expanded role with our Key Ministry team. In addition to continuing the ministry she’s established to train and support parent mentors for families impacted by disability, Barb will become  our ministry’s Director of Advancement, effective immediately.

When we discuss advancement in the context of our ministry, we’re referring to the process of identifying people with the available time, talent and treasure to support the mission to which we’ve been called…connecting families of kids with disabilities to local churches for the purpose of making disciples of Jesus Christ.

Prior to joining our team, Barb served as the Executive Director of SNAPPIN’ Ministries, an organization that provided outreach to help parents of children with every sort of special need, from learning and emotional disabilities to physical disabilities and chronic diseases. She was very successful over many years in procuring the volunteers and resources necessary for sustaining their ministry with families touched by disability.

I want to share with our readers why we’re asking Barb to assume this expanded role. The scope and impact of our ministry – along with the ministry done by other like-minded organizations is exploding.

  • Our network of churches prepared to welcome families of kids with disabilities has more than doubled in size since the first of the year!

  • We received 101 requests from churches for consultation or training from January – July 2018 compared with 112 requests for all of 2017.
  • We’ve received over 160 requests for mental health ministry training or resources since releasing Mental Health and the Church this past February.
  • The Facebook group we provide for for providing resources and support for special needs and disability ministry leaders now has over 1,300 members and continues to grow weekly.

  • Our Inclusion Fusion Live disability ministry conference attracted more than 250 disability ministry leaders and family members. The main stage sessions made available through our Facebook page have been viewed more than 40,000 times!

Why did we need to ask Barb to take on an expanded role – for no additional pay? To borrow a term from the football training camps that have opened across our home region over the last two weeks, we’re “outkicking our coverage” -meaning that we’re providing far more ministry resources than we’re able to pay for. And we require significant help just to sustain the level of ministry training and support we’re already providing, much less to continue to grow in response to the need. We’re averaging around 20,000 unique visitors to our website per month, and approximately 40,000 page views per month across our blogs and platforms, not counting the approximately 5,000 church leaders and family members who subscribe to our blogs by e-mail.

We’re trying to do our work on a budget of roughly $7,000/month…and we brought in a little over $5,000/month for the first half of this year. We’re currently operating with a core staff of five, including two (your humble blogger and Catherine Boyle, our Mental Health Ministry Director) who volunteer all of their time to our ministry. Our team of approximately two dozen volunteer writers who create the content for churches and families also volunteer their services. We had no money to pay the speakers who came to our conference, and most had to pay their travel expenses as well to attend. We’re frugal!

Finding the money to support our ministry has been an ongoing challenge. Our two target audiences (pastors/church staff and families of kids with disabilities) are not noted for their discretionary income. I HATE bringing up the issue of finances or doing anything that makes it harder for churches with limited budgets to access the resources they need to help families. We can’t sustain what we’re doing much beyond the end of this year at our current pace. And that’s why we need to ask Barb to reallocate some of her time to help ensure we’ll have the resources we need to go forward.

We understand that many of the churches and families we serve don’t have any financial resources to share. We very much appreciate your prayers and encouragement! If you do have the ability to help us financially, your support would obviously be a great blessing! We’re also looking for a few “angels”…an individual, family, foundation, corporation or church that could help with a few very large needs…

  1. We’d like to put on another large disability ministry conference in 2019 for church leaders and families from throughout the Eastern U.S. and Canada. We could host an excellent conference with a larger audience and broader impact than this past year’s Inclusion Fusion Live for $15,000 while making the conference available to church leaders and families for a nominal cost.
  2. Outside of our personnel costs, the largest ongoing expense for our ministry involves the cost of getting our resources to church leaders and families through the use of social media advertising and e-mail. We spend close to $1,000 per month between social media and e-mail distribution. An angel who could cover those costs would be a great blessing! $2,000 per month would like allow us to more than double the current reach of our ministry.
  3. We’d like to produce a series of high quality, brief, “on-demand” training videos for church staff and volunteers addressing the most common questions and challenges they’re likely to encounter in the course of disability ministry. The videos would be made freely available through our website and social media platforms. We would film this in conjunction with next year’s Inclusion Fusion Live conference and invite the broad range of speakers in attendance to contribute. If an “angel” would be interested in funding this project, we’ll reach out to local videographers for cost estimates.

Any “angels” interested in helping to meet our need can feel free to contact me ( or Barb ( with any questions or ideas.

We know God has the resources to meet the need. We appreciate your prayers for Barb in her new role and for our ministry as a whole…that we’d honor God while remaining faithful to our mission and carrying out the plans he has for us!
Are you a pastor or ministry leader searching for resources to better understand how to support children, adults or families affected by mental illness in your church or in your community? Check out Key Ministry’s Mental Health Resources page, containing links to video, articles and topical blog series designed to help you minister with persons with common mental health conditions. Also available through the website are a free, downloadable mental health ministry planning tool designed to accompany Mental Health and the Church, along with links to recommended books, like-minded mental health ministry organizations, relevant research, sermons addressing mental illness, social media resources and a compilation of stories from families affected by mental illness.

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It’s the hidden disabilities that keep kids out of church

A landmark study in the disability ministry field was published by Dr. Andrew Whitehead of Clemson University in this month’s Journal for the Scientific Study of Religion examining the impact of a variety of physical, developmental and mental health disabilities upon church attendance using data generated from the National Survey of Children’s Health (NSCH).

What makes this study a “game changer” is the suggestion that the kids who are least likely to attend church aren’t necessarily those who have been the traditional focus of the disability ministry field – kids with intellectual or physical disabilities. The study found that the children most likely to be excluded from church are those with autism spectrum disorders and common mental health conditions – anxiety, depression, Oppositional Defiant Disorder, Conduct Disorder and ADHD.

For the purpose of this study, Dr. Whitehead accessed data from three waves of the NSCH (2003, 2007, 2010-11) and compared the reported rates of children never having attended a religious service in the past year among kids with no identified disability to rates among children with twenty different chronic health conditions included in the survey. The large sample size of the survey – 95,677 phone interviews were conducted for the 2010-11 wave – allows for meaningful statistical comparisons.

Dr. Whitehead noted that children with no reported chronic health condition were significantly less likely to report never attending church services compared to the population as a whole. In contrast, kids with the following health conditions were significantly more likely to report never having attended church

  • Children with autism spectrum disorders are 1.84 times more likely to never attend church.
  • Children with depression are 1.73 times more likely to never attend church.
  • Children with traumatic brain injury are 1.71 times more likely to never attend church.
  • Children with Oppositional Defiant Disorder are 1.48 times more likely to never attend church.
  • Children with anxiety are 1.45 times more likely to never attend church.
  • Children with speech problems were 1.42 times more likely to never attend church.
  • Children with learning disabilities were 1.36 times more likely to never attend church.
  • Kids with ADD/ADHD were 1.19 times more likely to never attend church.
  • Kids with bone, joint and muscle problems were 1.15 times more likely to never attend church.

The study also noted a number of other chronic health conditions that had no effect on church attendance. Those conditions included:

  • Tourette Syndrome
  • Epilepsy
  • Hearing problems
  • Vision Problems
  • Intellectual disability (2010-11 wave)
  • Cerebral palsy (2010-11 wave)

Dr. Whitehead’s interpretation of the study results was that conditions that negatively impact upon social interaction or communication are those that result in the greatest impact upon church attendance.

It appears that across a range of chronic health conditions, those that areprimarily characterized by deficiencies in social interaction or might impede communication are most consistently andsignificantly associated with disengagement with attendance at religious worship services. Furthermore, these results strongly suggest that the higher probability of children with particular health conditions never attending religious services has been stable over time. Prior research signals that thisis likely due to factors attributable to barriers within congregations as well asthe characteristics of the children’s disability. As Ault, Collins, and Carter point out, the behavioral characteristics of children with various chronic health conditions play an important role in structuring if and how they will be integrated into congregational life. Children with autismspectrum disorders, developmental delays, and conduct disorders allmanifest a range of social and behavioral characteristics that routinely resultin strained social encounters and interactions. Likewise, children with speech problems might not be able to communicate as easily as their peers. The particular behavioral characteristics or physical limitations associated with these health conditions appear to limit these children’s ability to attend religious services.

Dr. Whitehead’s analysis didn’t include data examining the frequency of church attendance among kids with the chronic health conditions identified in the study. My hypothesis is that not only is it less likely that families of kids with autism, mental health concerns and other hidden disabilities will ever attend church, but those who do attend church are able to attend less frequently than families unaffected by those disabilities.

The findings of his study are consistent with the hypotheses that underlie the inclusion model our team developed for churches seeking to become more intentional about welcoming families affected by mental illness. I’d add to his observations about social communication and interaction that conditions impacting a child’s capacity for emotional regulation and self-control also appear to cause great challenges at church. The highly significant association reported between church attendance, depression and anxiety likely results from the impact those conditions have upon the ability or willingness to enter into social interactions and relationships at church.


If your church is prepared to act, our team is prepared to help!

We have a simple and flexible model for mental health inclusion ministry that we believe is useful for churches of all sizes, denominations and organizational styles.

We have a complete library of free training videos to help pastors, church staff and volunteers to understand and implement our mental health inclusion model.

We have trained and experienced staff and volunteers available to help address questions and challenges that arise as your church seeks to develop a mental health inclusion strategy. Your inclusion team can use this link to contact our ministry team for help.

Dr. Whitehead’s study is a clear call to pastors and ministry leaders that it’s time we do more to ensure that there’s a welcoming church available for every child and every family!

Are you a pastor or ministry leader searching for resources to better understand how to support children, adults or families affected by mental illness in your church or in your community? Check out Key Ministry’s Mental Health Resources page, containing links to video, articles and topical blog series designed to help you minister with persons with common mental health conditions. Also available through the website are a free, downloadable mental health ministry planning tool designed to accompany Mental Health and the Church, along with links to recommended books, like-minded mental health ministry organizations, relevant research, sermons addressing mental illness, social media resources and a compilation of stories from families affected by mental illness.



Posted in Autism, Hidden Disabilities, Inclusion, Key Ministry, Mental Health, Strategies | Tagged , , , , , , , , , , , , , , | Leave a comment

The sexual revolution, our kids and suicide…a new look

Two years ago in this space, we examined a study released by the U.S. Centers for Disease Control looking at the relationship between sexual identity, sexual activity and high-risk behaviors in teens, with a focus on the data examine the relationship between sexual activity and suicide. The CDC released updated data several weeks ago from the most recent Youth Risk Behavior Survey of approximately 15,000 teens, completed in December 2017. Results from the 2017 survey suggest that many high school students are engaged in health-risk behaviors associated with the leading causes of death among young people in the United States. During the 30 days before the survey…

  • 39.2% of high school students nationwide (among the 62.8% who drove a car or other vehicle during the 30 days before the survey) had texted or e-mailed while driving.
  • 29.8% reported current alcohol use, and 19.8% reported current marijuana use.
  • 14.0% of students had taken prescription pain medicine without a doctor’s prescription or differently than how a doctor told them to use it one or more times during their life.
  • During the 12 months before the survey, 7.4% had attempted suicide.
  • Nationwide, 39.5% of students had ever had sexual intercourse and 9.7% had had sexual intercourse with four or more persons during their life.
  • 8.8% of high school students had smoked cigarettes and 13.2% had used an electronic vapor product on at least 1 day during the 30 days before the survey.
  • Forty-three percent played video or computer games or used a computer for 3 or more hours per day on an average school day for something that was not school work.

The prevalence of many health-risk behaviors is significantly higher among sexual minority students compared with heterosexual students. The reasons for this difference aren’t completely clear, but trauma appears to be a significant factor.

According to the survey, sexual minority youth are four times more likely to have been physically forced to have sexual intercourse when they did not want tocompared to heterosexual youth, three times more likely to have experienced sexual violence in the last twelve months compared to the general population, and two to three times more likely to have experienced physical or sexual dating violence.

Suicidal thinking and the severity of suicidal behavior are HIGHLY correlated with sexual activity in teens. Students who experienced sexual contact with the same or both sexes are approximately 294% more likely to report having attempted suicide compared to students who had sexual contact with the opposite sex only and 567% more likely to report having attempted suicide than students with no sexual contact. Boys who experienced sexual contact with the opposite sex only were 232% more likely to report having attempted suicide compared to those with no sexual contact. Girls who experienced sexual contact with the opposite sex only were 188% more likely to report having attempted suicide than those with no sexual contact.

Since the time of our original post two years ago, I’ve continued to be struck by the association between early involvement in sexual activity and an increased risk for anxiety, depression, suicidal thoughts and suicidal behavior among the kids who pass through our practice. I wish parents, educators and church leaders would come to recognize that many teenagers aren’t remotely prepared to manage the intensity of emotions that results when relationships become sexualized. Those who ultimately commit suicide represent casualties of the sexual revolution.

There are lots of limitations to the conclusions that can few drawn from the study. We can’t tell from the way the data is presented whether suicidal behavior increases as the total number of sexual contacts increases. We don’t have a breakdown that shows suicide statistics comparing rates between heterosexual and sexual minority youth who have been victims of sexual violence. We don’t know whether rates of suicidal behavior “normalize” among teens with same-sex attraction who refrain from sexual activity.

Some thoughts that crossed my mind after reviewing this study…

Maybe we need to think about mental illness as a sexually transmitted disease, at least in the teen population? My guess as to why we don’t think of it that way is that there isn’t a way to make sex more safe from an emotional standpoint. Condoms don’t protect against emotional trauma.

Do our kids need to develop resilience and learn self-control more than they need “safe spaces?” When one in fourteen high schoolers reports having attempted suicide at least once during the preceding twelve months, clearly millions of kids are struggling to cope with the emotional challenges of adolescence. We’ve made significant strides in reducing smoking rates in teenagers by emphasizing the effects upon health and laws that make it more difficult to access cigarettes. Does our suicide crisis necessitate we make a similar effort to reduce sexual activity in teens?

We need a #MeToo movement to protect teens from sexual violence – especially teens who are members of sexual minorities. Maybe we need to consider raising the age of sexual consent? Maybe our more progressive churches led by members of sexual minorities could take the lead in changing attitudes regarding “coming of age” experiences between adults and LGBTQ youth? How is it acceptable in 2018 that a movie glorifying sexual predation and abuse can not only be nominated for, but win Academy awards?

I came away from this study impressed by the need for pastors and church leaders who work with youth to become more trauma-informed. One in fourteen high school students (and more than one in five sexual minority youth) have experienced forced intercourse, and one in ten (three in ten among sexual minority youth) have been victims of sexual violence.  The results of this study suggest that a better understanding of trauma is essential to those serving all kids – especially kids with same sex attraction– in youth ministry settings.

Finally, how is it still socially acceptable in this day and age for advertisers and social media platforms to promote sexual behavior in youth when a clear association exists between sexual behavior and suicide? Hats off to Abercrombie and Hollister for getting rid of their shirtless models. And how is it OK for parents to facilitate opportunities for their teens to engage in sexual contact with other teens? How are “coed sleepovers” for teens acceptable? How is it OK for the nation’s “paper of record” to celebrate the sexualized relationships of teens in the pages of its’ magazine?

In the midst of a culture that puts great pressure on teens and adults to define themselves through their sexual attractions and prowess, the church has the ability to introduce our youth to a better – and safer better way of discovering their true identity!.


shutterstock_138372947Know a family impacted by disability in need of help finding a local church? Encourage them to register for Key for Families. We can help connect families with local churches prepared to offer faith, friendship and support, while providing them with encouragement though our Facebook communities. Refer a friend today!

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Traditional churches and the mental health system…Irreconcilable differences?

Two weeks ago, I shared a post on the topic of Why the church and the mental health system should work together. Upon further reflection, I think a better question is: Can the church and the mental health system work together? And sadly, I’m coming to suspect the answer to that question is NO…so long as that church adheres to traditional teaching and Biblical interpretation addressing human sexuality.

Since my last post, I spoke at an event sponsored by a mental health board here in Ohio that serves a large and diverse population in a region of our state that most sociologists would describe as “culturally conservative.” The panel discussion that followed my talk on how the mental health system could help churches serve individuals and families affected by mental illness was dominated by LGBTQ-oriented questions and statements.

During the panel discussion, one attendee strongly implied that the inclusion of statistics in my presentation from Lifeway Research and Focus on the Family and referencing organizations such as Saddleback Church and the ERLC represented an act of hostility toward the LGBT community. I’d think the reaction would’ve been pretty similar from any secular group of mental health professionals anywhere in the country.  I found myself very encouraged by the presence of a pastor on the panel involved in ministry with at-risk kids who also represented a more traditional Christian perspective pertaining to human sexuality.

The church’s teaching on sexuality is a big issue to a great many people in the mental health field. Let me try to summarize what I see as a prevailing view among many mental health professionals

Sexual minorities represent a vulnerable population. Their status as a sexual minority is largely immutable and an essential component of their identity. The increased prevalence of mental illness and suicidal behavior reported among sexual minorities is a function of the shame and condemnation of their lifestyle they experience from contact with the larger culture. Failure to accept and affirm them in the expression of their sexual identity (with sexual activity representing an integral component of such expression) is tantamount to assault upon their dignity. Any statements or teaching with the potential for causing guilt or distress increase their risk for suicide and a variety of mental health conditions.

Contrast that with what I would consider a traditional Christian view of sexuality…

God intended for sexual relationships between one man and one woman in the context of marriage. In Jesus’ words…

He answered, “Have you not read that he who created them from the beginning made them male and female, and said, ‘Therefore a man shall leave his father and his mother and hold fast to his wife, and the two shall become one flesh’?

Matthew 19:4-5  (ESV)

The Bible clearly teaches that alternative sexual relationships are sinful and disrupt our relationship with God. See Leviticus 18, Romans 1, or 1 Corinthians 6. In the final passage, Paul emphasizes that once we become Christians, our bodies are not our own – they – and everything we have belongs to God! In the next chapter, he expounds on this teaching by noting that husbands and wives are to give their bodies to one another – and one another only! The expectation for sexual expression outside of marriage is self-control.

Moreover, the Bible has very different thoughts than the larger culture on the source of our identity. Paul makes a point in Romans 6 that we take on a new identity when we come to faith in Christ…

We know that our old self was crucified with him in order that the body of sin might be brought to nothing, so that we would no longer be enslaved to sin. For one who has died has been set free from sin. Now if we have died with Christ, we believe that we will also live with him. We know that Christ, being raised from the dead, will never die again; death no longer has dominion over him. For the death he died he died to sin, once for all, but the life he lives he lives to God. So you also must consider yourselves dead to sin and alive to God in Christ Jesus.

Let not sin therefore reign in your mortal body, to make you obey its passions. Do not present your members to sin as instruments for unrighteousness, but present yourselves to God as those who have been brought from death to life, and your members to God as instruments for righteousness. For sin will have no dominion over you, since you are not under law but under grace.

Paul continues in Galatians 3

For as many of you as were baptized into Christ have put on Christ. There is neither Jew nor Greek, there is neither slave nor free, there is no male and female, for you are all one in Christ Jesus.

Throughout Romans 7, Paul describes the internal struggle on the struggle between our old and new identities…

For I do not understand my own actions. For I do not do what I want, but I do the very thing I hate. Now if I do what I do not want, I agree with the law, that it is good. So now it is no longer I who do it, but sin that dwells within me. For I know that nothing good dwells in me, that is, in my flesh. For I have the desire to do what is right, but not the ability to carry it out. For I do not do the good I want, but the evil I do not want is what I keep on doing. Now if I do what I do not want, it is no longer I who do it, but sin that dwells within me.

The traditional Christian view of sexuality and identity is radically countercultural and the teachings are essential to the faith and not easily dismissed as belonging to a different time and context. Life would certainly be easier for believers such as myself if they could be easily dismissed. But we don’t get to decide which of God’s commands we choose to honor and which we can easily dismiss. We put ourselves in the position of God when we assume we can do so. And when we do so, the Gospel loses its power and allure.

The reality is that the traditional Christian view of sexuality and identity is irreconcilable with very closely held values and beliefs of an influential majority of mental health practitioners. How do we work with folks who view our core beliefs as an assault on their dignity and the dignity of those we serve? Churches or individuals who support traditional marriage and expressions of sexuality are pariahs to them. Given the incompatibility of the prevailing views on sexual expression between churches and the mental health community, I think there will be little possibility for partnership unless at least one of the following conditions is met…

  • The church abandons traditional teaching on sexuality and marriage and seeks to affirm alternative definitions of marriage and avenues of sexual expression.
  • The church is predominantly composed of members of a protected class.
  • The church has an unimpeachable reputation in the community for work on behalf of social justice and downplays public pronouncements or teaching related to sexual expression.

I met a very kind and compassionate pastor at my recent presentation who started a church specifically to serve the LGBTQ community. When I asked her how the church was doing, she indicated they were struggling and explained her challenge by stating that gay and lesbian people aren’t in the habit of going to church on Sunday. What I wish I had said in the moment is that I can’t imagine why a watered down version of the faith that declares  our sexuality to be off-limits to God would be appealing to anyone. While I fervently hope that individuals with mental illness and their families come to be included in their larger family in Christ, we can’t compromise the integrity of the gospel message to bring about that goal.

When I first launched this blog eight years ago, my intent was to build a bridge between two worlds…the “church” world I inhabited as an attendee and a leader and my “work” world inhabited by kids and families impacted by mental illness or developmental disabilities. While I certainly see myself as qualified to serve as a guide to church leaders as they seek to understand the struggles of families impacted by those conditions, I no longer feel I belong in gatherings of my fellow mental health professionals. My values and beliefs are too incompatible with those of the vast majority of my peers.

The chasm between my two worlds is widening…making the need for the church to extend the love of Christ to kids and families on the other side of the chasm even more imperative.

Are you a pastor or ministry leader searching for resources to better understand how to support children, adults or families affected by mental illness in your church or in your community? Check out Key Ministry’s Mental Health Resources page, containing links to video, articles and topical blog series designed to help you minister with persons with common mental health conditions. Also available through the website are a free, downloadable mental health ministry planning tool designed to accompany Mental Health and the Church, along with links to recommended books, like-minded mental health ministry organizations, relevant research, sermons addressing mental illness, social media resources and a compilation of stories from families affected by mental illness.

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Why the church and the mental health system should work together

This coming Thursday, I’ve been invited to speak at an event sponsored by the Stark County Mental Health and Addiction Recovery Board as part of their Cultural Influence and Health Care series focusing on faith-based culture and community. The event will be held in the Johnson Center of Malone University in Canton, Ohio and is free and open to the public. Click here if you’re interested in attending.

My talk is titled Helping Churches Support Individuals and Families Affected by Mental Illness and is different from any other presentation I’ve done on this topic in that I’m speaking with clinicians working in the mental health system as opposed to church leaders. There are lots of reasons why churches and mental health service providers should work together. Whether these partnerships are possible in the current cultural climate is an entirely different question.

If I were an executive director of a local mental health board, I can think of lots of reasons why I’d be interested in building relationships with church leaders in the area I served. According to a study in the journal Health Services Research:

  • Approximately one quarter of persons seeking care turn to a member of the clergy before contacting a mental health service provider.
  • More people with mental health issues turn to clergy than psychiatrists.
  • One in six persons who approach clergy for help are experiencing serious mental illness.
  • The intensity of care and support provided by churches often doesn’t match the severity of illness.

Churches provide services and support to a large segment of the population who would otherwise increase demands on the mental health system. At the same time, mental health professionals and leaders have an interest in seeing that the care provided by churches is of high quality and meets the needs of those being served.

Churches have an incentive to partner with individual mental health practitioners and organizations in the communities they serve. According to the LifeWay Study of Acute Mental Illness and Christian Faith, among adults surveyed with acute mental illness:

  • 69% want churches to help families find local resources for support and dealing with the illness.
  • 59% want churches to talk about it openly so the topic is not so taboo.
  • 57% want churches to improve people’s understanding of mental illness.
  • 55% want churches to provide training for members to better understand mental illness.
  • 53% want churches to increase awareness of how prevalent mental illness is today.

Church members want help in finding mental health resources in their local communities. Such assistance may not be as available as church leaders believe. According to the LifeWay study, 68% of pastors believe their churches maintain mental health referral lists, compared to 28% of family members of adults with mental illness.

Church leaders also have a perception problem among outsiders as to whether persons with mental illness will feel welcomed.

Churches need assistance in understanding the needs of persons with mental illness and connecting them with appropriate services. Churches also provide lots free assistance and support to individuals and families served by the mental health system. Lots of low-cost and no-cost counseling. Respite care for families of kids with significant emotional and behavioral disorders. Emergency financial support. After-school programming or tutoring for at-risk kids. Safe and healthy peer group environments for kids who need more friends.  It makes too much sense for churches and the mental health system to form mutually beneficial partnerships

Here are four broad areas that appear ripe for collaboration…

  1. Facilitating referrals. One of the mental health supports church attendees desired according to the LifeWay study was assistance in accessing treatment when necessary. Pastors also need the ability to quickly connect attendees with severe mental illness to the appropriate level of care. Any mental health agency or clinic that depends upon a steady stream of referrals and serves large numbers of people covered by public or private insurance would be well-served from a business perspective to establish a simple and reliable referral process for churches.
  2. Educating pastors and church staff  on the mental health needs of the population they serve. Three specific training areas for which I see a significant need are Mental Health First Aid, assistance in becoming trauma-informed and training for pastors and church staff in evidence-based counseling approaches.
  3. Using churches to promote the availability of mental health supports. In this day and age, even churches of modest size often have substantial social media platforms. Churches can use both their facilities and social media tools to educate the communities they serve about the resources and supports available in the community.
  4. Innovation to serve families affected by mental illness. Churches can be a source of recruitment for therapeutic foster families – or respite for families serving in therapeutic foster care, as well as families to serve kids with mental illness in traditional foster homes. Many kids in faith-based schools have the same need for counseling or case management services that kids receive who are enrolled in public schools.  Churches with a long tradition of supporting development of low-income housing through organizations such as Habitat for Humanity would appear to be natural partners for local mental health boards with limited budgets seeking to provide housing for adults with chronic mental illness.

What if you’re a mental health professional? How can you use your gifts and talents to support your church in ministry with persons with mental health concerns?

Become an advocate for a mental health inclusion strategy in your church.

Volunteer to serve as a mental health liaison in your church. A mental health liaison is someone who can help connect persons in the church in needs of mental health services to appropriate resources in the community who also works with pastors and church leadership to include individuals with mental health issues into worship services and other church activities designed to promote spiritual growth.

Offer to start a mental health support group in your church. Possibilities include…

  • Grace Groups (Mental Health Grace Alliance)
  • Fresh Hope groups (Fresh Hope)
  • Celebrate Recovery (Saddleback Church)
  • NAMI groups

So…where do we start? And why hasn’t this happened already? I’ll look at that issue in more detail in next Sunday’s post.


In Mental Health and the Church: A Ministry Handbook for Including Children and Adults with ADHD, Anxiety, Mood Disorders, and Other Common Mental Health Conditions, Dr. Stephen Grcevich presents a simple and flexible model for mental health inclusion ministry for implementation by churches of all sizes, denominations, and organizational styles. The book is also designed to be a useful resource for parents, grandparents and spouses seeking to promote the spiritual growth of loved ones with mental illness. Available now at Amazon, Barnes and Noble, ChristianBook and other fine retailers everywhere.

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Eight things I think about the suicide epidemic

During a week in which we learned of the suicides of Kate Spade and Anthony Bourdain, the U.S. Centers for Disease Control announced that suicide rates in the U.S. have increased nearly 30%, and the rate of suicide increased in 49 of 50 states during that time.

There’s no one explanation for the explosion in suicide rates across the population. Here are eight thoughts for church leaders and my fellow Christians to consider in making sense  of the suicide epidemic.

Escalating suicide rates are another sign of the decreasing influence of Christianity in the larger culture. Twenty years ago, the fear of God was often cited by teens sitting in my office as a deterrent to acting upon suicidal thoughts. As fewer and fewer people believe in God, we’d expect less constraint on suicidal behavior resulting from fear of eternal consequences. We also know there’s an inverse relationship between church attendance and suicide. This study of middle-aged women demonstrated a five-fold decrease in suicide rates among weekly church attenders.

The increases in suicide rates represent a natural consequence of a culture beginning to embrace physician-assisted suicide. Is it any surprise that suicide raters are increasing as more states move to legalize physician-assisted suicide? We glamorize the lives of people like Brittany Maynard, a young, attractive woman with brain cancer who overdosed on medication prescribed by her doctor. Or the elderly couple in Toronto who were well enough to enjoy date night at their favorite restaurant two days before committing suicide together with the assistance of their physicians. Here’s a look at research showing the increases in suicide rates that result where physician-assisted suicide is legalized.

Suicide is a symptom of society’s emphasis on self-determination. Here’s a summary of the argument for the right to assisted suicide from a physician serving and transgender activist who bases their argument on the right to self-determination. Quoting from Dr. Dana Beyer’s argument…

Self-determination is intimately bound up with all three rights. An individual should be free to live her life as she sees fit, and not submit to her family, friends, physicians or religious community, and certainly not to the state. While there are profound ethical issues that touch upon this time of life, they do not trump the person’s right to live fully to the very end, and alleviate her own personal suffering – her final pursuit of happiness.

We have lots of people who commit suicide with serious, unidentified mental health issues. An interesting finding in the CDC data is that more than half of people who died by suicide (54%) did not have a known mental health condition.

Our mental health treatment isn’t particularly effective, especially when it comes to treating depression and anxiety that often contribute to suicide. Take a look at this data examining suicide rates in the U.S. population from 1950-present.

The first antidepressant medications came out in the 1950s and 1960s. The first SSRIs (Prozac and Zoloft) came out in 1988 and 1991, respectively. Over the next decade, we saw significant decreases in suicide rates, even though the effect sizes of antidepressants for depression are relatively small. The rates today are higher than those of seventy years ago, before we had any effective treatment for mental health conditions contributing to suicide risk.

Publicity around suicide lowers the threshold for other people to commit suicide. Here’s a summary from a national workshop held by the CDC on contagion associated with reporting of suicide. The problem is likely worse following the advent of online media dependent upon “clicks” resulting from attention-grabbing headlines.

We’re losing our ability to respond appropriately to adversity. Research suggests that resiliency following stressful events is in short supply. According to the CDC, four of the five most common factors associated with suicide include relationship problems, a crisis in the past or coming two weeks, a physical health problem or a job/financial problem. People who lack the resources to respond to stressful life events are at greater risk of suicide.

People are more socially isolated and lonely than ever before. A former surgeon general discussed the extent to which loneliness represents a public health crisis. One hypothesis behind the protective value of regular attendance at worship services is the social interaction that takes place at church.

To my church friends…We need to quit hiding our light under a bushel basket! We have a Gospel that provides a sense of meaning and purpose and hope for the future resulting from our faith in Christ. We can provide companionship and community to people who are lonely and isolated. To be “pro-life” includes taking an interest in the lives of the people around us who are hurting.

Interested in learning more about recognizing risk factors for suicide in the people around you? Check out this information from the folks at the CDC. If you need help for yourself or someone else, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or chat online at

Are you a pastor or ministry leader searching for resources to better understand how to support children, adults or families affected by mental illness in your church or in your community? Check out Key Ministry’s Mental Health Resources page, containing links to video, articles and topical blog series designed to help you minister with persons with common mental health conditions. Also available through the website are a free, downloadable mental health ministry planning tool designed to accompany Mental Health and the Church, along with links to recommended books, like-minded mental health ministry organizations, relevant research, sermons addressing mental illness, social media resources and a compilation of stories from families affected by mental illness.

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Meet Catherine Boyle…our new Director of Mental Health Ministry!

We’re delighted to welcome Catherine Boyle to our ministry team! Catherine will be assuming a key leadership role in overseeing our efforts to support churches in mental health outreach and inclusion. Her primary responsibilities will include…

  • Increasing awareness and implementation of mental health ministry in churches across the U.S. and beyond.
  • Developing strategies to connect families affected by mental illness with churches prepared to welcome and support them.
  • Developing funding streams to support Key Ministry-sponsored mental health ministry initiatives and operations.

Some specific projects Catherine will be working on will include…

a. Developing relationships between Key Ministry and individual churches, denominations and like-minded organizations with interest in mental health ministry.

b. Launching and facilitating  a Mental Health Ministry Video Roundtable – similar to the Disability Ministry Video Roundtable we host on a monthly basis for the special needs ministry community.

c. Providing consultation services to churches seeking to implement and/or improve mental health ministry. Catherine will serve as the initial point of contact for churches seeking training, consultation or resources from Key Ministry related to mental health ministry.

d. Developing resources for individuals called to serve as mental health liaisons in their local churches, along with resources for churches seeking to establish ministry positions for mental health liaisons.

Catherine has been impacted by mental health issues her entire life, having experienced her own struggles with anorexia, bulimia,anxiety and depression. She authored Hungry Souls: What the Bible Says About Eating Disorder, and helped launch a ministry home for women with eating disorders. In 2015, Catherine founded Outside In Ministries, focusing on how the church can minister to and with people with mental health issues.

Professionally, Catherine served as an executive at a large U.S. bank. She has led various church and community ministries, and has been interviewed for her ministry work on radio, television and in online magazines. She has a BBA in Accounting and an MBA from Virginia Commonwealth University. Catherine lives in Richmond, Virginia and has been married to Barney since 1994. They have two children (Jack, 21 and Natalie, 18). Catherine spends free time sewing or doing needlework and working out at the local YMCA.

Please join me in welcoming Catherine to our ministry team. She may be reached at


Are you a pastor or ministry leader searching for resources to better understand how to support children, adults or families affected by mental illness in your church or in your community? Check out Key Ministry’s Mental Health Resources page, containing links to video, articles and topical blog series designed to help you minister with persons with common mental health conditions. Also available through the website are a free, downloadable mental health ministry planning tool designed to accompany Mental Health and the Church, along with links to recommended books, like-minded mental health ministry organizations, relevant research, sermons addressing mental illness, social media resources and a compilation of stories from families affected by mental illness.

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