Mental Health Needs of Urban Communities

Presentation Given at May 4, 2022 Colloquium
Part of Educating Urban Ministers in Philadelphia After 2020 project

Presentation Question: What are the mental health needs of urban communities, and how do Christian congregations shift to address them?

Mental health is a hot topic. Can you feel the heaviness? The weight of the pandemic on our family, friends, and congregants? Is the heaviness personal? We’ve all experienced trauma throughout this pandemic. We have lost our routines, coping skills, jobs, income, and we are mourning the loss of life. If you ignored mental health before the pandemic, it is hard to ignore it now. The bride of Christ, the church, is a beautiful expression of God’s love for the world. It has built educational institutions, hospitals, orphanages, and numerous social organizations. It lives out Matthew 5:14, “You are the light of the world. A city that is set on a hill cannot be hidden.” Right now, we, the church can’t hide in or from this mental health crisis. We must shine all the more brightly.

While serving at a church, I saw the light of the world when leadership spent a great deal of time, energy, and money planning for a new elevator addition to the church to improve mobility for its seniors and physically handicapped members. While the elevator was being built and the old lift didn’t work, I saw the men work together to assist each person up the stairs into the sanctuary, making space for wheelchairs, walkers, and oxygen tanks. The church leadership cleans their houses, cuts their lawns, and shops for them. They’re a light in the community. This is a lovely expression of serving the physical needs of the body of Christ.

The pandemic has brought on higher levels of stress from food insecurities, job loss, and health concerns. And added to those factors is a sharp increase in murder rates. How can the church respond to the mental needs of congregants? We will examine the mental health needs within the urban community and deliberate on how the church should shift to address them. Our findings are based on six interviews with four pastors and two Christian school principals.

The urban community is defined by the density of the population. People live closer together. This denseness leads to a higher level of COVID-19 exposure, violence, Adverse Childhood Experiences, and mental illness. Adverse Childhood Experiences (ACEs) is a study conducted in Philadelphia that examines people’s exposure and experiences of the following: physical, emotional, and sexual abuse; being raised in a household with domestic violence, substance abuse, mental illness, divorce, incarcerated relatives; exposure to adverse neighborhood experiences, bullying, living in foster care, and witnessing violence. A high level of ACEs connects to high levels of stress and traumatic responses. “Forty percent of Philadelphians had experienced four or more expanded community-level ACEs.”1

So, how does this impact the church? We asked four pastors to share their perspectives on the mental health needs of the urban community. One of the pastors, a denominational leader, focused on church leaders. He reported that pastors and associate pastors feel overwhelmed, anxious, stressed out, and they struggle with family issues and a desire to quit. He noted that many senior pastors have high anxiety over live stream preaching because it opens them to scrutiny. Many feel resentful for the time investment made in people who have since left to view online churches through social media. This pastor is deeply concerned about the mental health of fellow pastors.

Another pastor stated similar concerns. She reports that church leaders are tired and resentful that other leaders are staying home instead of serving the body of Christ. Many are facing the reality that the church is starting over while they are feeling burnt out. This is leading many leaders into depression and anxiety. A Barna Group survey reports that 38% of U.S. pastors have thought about quitting full-time ministry in the past year.2 According to a previous Barna poll in 2016, 85 percent of pastors rated their mental wellbeing as good or excellent. In the October 2021 poll, it was down to 60 percent.3 Our pastor’s mental health needs to be addressed.

Regarding parishioners, all the pastors describe high anxiety levels from the pandemic and gun violence. Many congregants don’t want to leave their homes. One pastor raised concerns about the increase in alcohol consumption, weight gain, sleeplessness, and irritability. Some of the pastors are worried about a rise in conflict within the home between marital and parent-child relationships, thus leading to sexual, physical, and emotional abuse in the home. Outside the home, the world isn’t feeling safe with the increase in gun violence, carjackings, and fear of catching COVID. One pastor reported that a youth in the church told her she gets panic attacks every time she leaves her home.

An additional high stressor conveyed by all the pastors was food insecurity. Several pastors with food banks report an increase in people seeking food distribution, which is causing anxiety. One pastor expressed the magnitude of the need, and that the shortfall is not limited to food. He has received multiple requests from members for the church to pay rent, mortgage, health care, and utility bills. His church is too small to handle the financial requests. He stated that several members had left the church because it was unable to help them. He also felt that the parishioners wanted to be handheld through the social service or referral process. With all the demands, the pastor felt overwhelmed and wanted to quit several times throughout the pandemic.

Another major report from all the pastors is the high level of grief. The pastors describe leading many funerals where typical ways of grieving couldn’t be displayed, how loved ones couldn’t attend the funeral, or were not allowed to see loved ones in their last moments due to COVID restrictions. Many people lost jobs, health insurance, and savings. We all lost our coping skills like going to a coffee shop, attending praise and worship events, and visiting close friends and family.

With tears in her eyes, the Christian daycare and school principal stated, “I see little people carrying more than a child should be carrying. I don’t see happy children like I used to see. I see parents overwhelmed. We have to help them.” The National Association of Mental Illness states that suicide is the second leading cause of death among people aged 10-34.4 One in six U.S. youth aged 6-17 experience a mental health disorder each year.5 “Mental health challenges in children, adolescents, and young adults are real and widespread. Even before the pandemic, many young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade,” said Surgeon General Vivek Murthy.6

Youth lost education and milestones like graduation, school trips, and drivers’ education class and they experienced high anxiety and isolation. Many are experiencing conflicts within the family unit and are battling an unsafe home life and a dangerous world with a pandemic and gun violence. Parents are stressing over their children’s education. How will they make up for what they lost? One pastor described the situation as a “paralyzed sheep.” Another described it as “spiritual depression.”

How can the church be a light on the hill? How can the church lead the paralyzed sheep to the Good Shepherd? How can we help those walking through the valley of the shadow of death renew their souls and feel the comfort of the rod and staff on their valley journey? In short, how do congregations shift to address mental health needs? Our pastors and Christian school principals gave some insightful proposals.

Leadership Care

One pastor focused on church leadership in his response. He stated that leaders need to face their trauma and mental health needs by learning about mental health, genetics, and biology. Not all mental health is situational. We are often in denial of our own mental health needs. We need time to renew and heal. We set the tone. As we release things, we give God room to move through us. He had to admit to his depression, get counseling, learn the warning signs, set boundaries, and take care of himself. He said, “We experience both the ‘Garden of Eden and the Garden of Gethsemane.’ We often talk about the Garden of Eden and leave out the Garden of Gethsemane. We must educate our congregation on anxiety and depression by preaching, teaching, and leading trauma healing groups.” This pastor is also a trauma healing facilitator. He received basic training in listening skills, understanding the trauma symptoms, how to support people through traumatic experiences, grief, lamenting, helping people to take their pain to the cross, and assisting the participants in understanding principles of forgiveness.

Come Together and Come to God

One of the pastors focused on “creating ways people can come together and come to God.” She visits homes offering anointing prayer and directly asking how the church can pray for them and their family. This opened dialogue and opportunity for members to express their needs and reconnect with God and the church. She suggests staying connected with members through social media, reopening small group ministry, and developing ways to give leaders space and time to rest. The church went through an emotionally healthy spirituality curriculum through the pandemic, which helped. This pastor is also a trauma healing facilitator.

Another pastor gave great insight by saying that people are in a vulnerable state. We need to listen to them instead of responding in ways that are not helpful. We need to stop beating them up and instead communicate what the church can and can’t do graciously. We must evaluate our current ministries and programs and shift from traditional programming. It is a perfect time to do it. This pastor believes the church needs to refer outside the church for mental health needs. He is focusing on developing a referral source list for parishioners and learning to counsel better. He believes pastors should take counseling as a part of their training. He is currently taking counseling courses.

All the pastors agree that the church needs to acknowledge and address mental health needs. Each stated, “It feels like we are starting all over.” They all understood this was a perfect time to shift and address mental health needs in their congregations. All the interviewees gave us ground level personal insight into how the church could shift.

As a licensed professional counselor and ordained minister, I will build on the interviewees suggestions on how the church should shift to address mental health.

Pastors Support Groups and Modeling

Many of our pastors need counseling; according to a report, “Nearly 1 in 4 pastors (23 percent) acknowledge they have ‘personally struggled with mental illness,’ and half of those pastors said the illness had been diagnosed.”7 This reflects the national average of 21% of U.S. adults (52.9 million people) experienced mental illness in 2020.8 As one of the interviewees stated, pastors and church leaders set the tone. Therefore, they need to get counseling and provide leadership in guiding the congregants.

Seminaries and pastors’ networks need to address mental health for pastors by providing retreats, education on mental health, connection to agencies that specialize in counseling pastors, and raising money for sabbatical for urban churches that don’t have the resources or denominational support.

Change the Narrative about Mental Illness

The church needs to change the narrative that Christians can’t struggle with mental illness by holding conferences, implementing mental health small groups, preaching, teaching, and advocating for counseling. Ginger Robertson shares her story as a Christian experiencing mental illness in a National Association of Mental Illness (NAMI) article. She states,

In sermons, books by Christian leaders, and private conversations with preachers and churchgoers, I would often hear the following statements:

    • “You aren’t a good Christian if you can’t beat your depression.”
    • “You don’t have enough faith. You just need to trust in God.”
    • “You need to pray more.”
    • “You are letting the devil in. You are possessed.”

Accusations like these, as one might expect, have the power to shame and derail anyone living with mental illness and hinder them from seeking necessary care.9

We must change the stigma, narrative, and theological messaging surrounding mental health. In 1 King 19, Elijah was neither full of the devil nor did he lack a relationship with God. He did need rest and food, which God provided for him.

Treat Mental Illness like Physical Illness

Churches will readily build a special elevator to meet the physical needs of its congregants yet struggle with supporting their mental health needs. The church should educate all participants on the signs and symptoms of mental health issues, as well as a trauma-informed approach to them. Instead of asking, “What is wrong with this person? What sin did they commit?” we need to start asking, “What happened to you? How were you sinned against? What resurrection power should the church live out to support you on your mental health journey?” The church care ministries must help congregants like they do physically ill; by visiting homes, cleaning houses, taking them to the doctor, etc. The challenge for care ministry and church leaders is learning to be emotionally healthy and mature so they can support others.

Build a Missional Trauma Healing Ministry

We must create safe spaces for people to release their pain and traumatic exposures and experiences. Also, our leadership boards need training on inappropriate responses to traumatic events within the congregation to decrease church trauma. These can be carried out through training care ministries and church leaders to lead trauma healing groups for children as young as 9, teens, and adults through a partnership with Quest Trauma Healing Centers. Other helpful programs include Celebrate Recovery, Grief Share, and Emotionally Healthy Spirituality.

Furthermore, we need to see the missional opportunity. Dr. Diane Langberg states, “Trauma is the new mission field,” in her book that each reader should read, Suffering and the Heart of God: How Trauma Destroys and Christ Restores.10 Lost and broken people can encounter Christ if the church does this correctly.

Care for the Entire Family

When a church member is struggling with mental illness, we must realize it is impacting everyone in the home. They may need family counseling. Therefore, we must have programs or referral supports for all ages and specialties when addressing mental health. Churches need to know that 50% of all mental illness begins by age 14, and 75% by age 24. Therefore, children’s and youth’s mental health is not optional for the church. Many of our youth who are struggling with a mental illness have wrap-around services. Our churches need to be educated on these services and possibly join the wraparound team if the family gives permission. We need to learn to walk alongside families—even if we refer them out. We must do more than pray for them, such as asking members how the church can support them or by attending team meetings or sessions. Like the Christian school principals, the church can implement Healing Heart Clubs for children 9-13 and Life Hurts Love Heals for teens 14-18. These 10-session trauma programs are done in partnership with Quest Trauma Healing Centers, a biblical trauma healing organization.11

Christian Counseling Referral List and Relationship Building

One of my close friends left the church after being in therapy for a year. She felt individual therapy was the answer and group therapy became her new church family. She felt accepted and a newfound sense of belonging that the church didn’t offer her after her diagnosis. We need to be supportive. Church leaders should get to know the agencies and build a relationship with referral sources with proper boundaries and expectations outlined. Church leaders need to be aware of and respect the confidential rules of all clients. The relationship-building helps both the church and the agency. The church receives a Christian mental health agency that provides consultation and training for the church. The agencies benefit by having a referral source. The church leaders and care ministries need to have basic training in understanding the various type of therapists, so they can make proper referrals.

I heard and felt the pain, pressure, and passion of the pastors and Christian school principals. They gave us frontline insight into mental health and provided suggestions on how the church could shift to meet those needs. I hope this paper gives the urban church a framework to better serve their communities, shine a light in the midst of darkness, and present Jesus Christ well to the world.


1 The Research and Evaluation Group, “Finding from the Philadelphia Urban ACE Survey,” The Philadelphia ACE Project, 2013 (Philadelphia: Public Health Management Corporation),
2 Barna Group, “38% of U.S. Pastors Have Thought About Quitting Full-Time Ministry in the Past Year,” November 16, 2021,
3 S. E. Zylstra, “1 in 4 Pastors Have Struggled with Mental Illness, Finds LifeWay and Focus on the Family,” Christianity Today, September 22, 2014,
4 “Suicide,” National Institute of Mental Health, accessed March 1, 2022,
<sup5 “Mental Health By the Numbers,” National Alliance on Mental Illness, accessed February 1, 2022,
6 U.S. Department of Health and Human Services, “U.S. Surgeon General Issues Advisory on Youth Mental Health Crisis Further Exposed by COVID-19 Pandemic,” December 7, 2021,
7 Zylstra, “1 in 4 Pastors.”
8 National Alliance of Mental Illness, “Mental Health.”
9 G. Robertson, “How I Dealt with Mental Health Discrimination in the Church,” National Alliance on Mental Illness (blog), October 15, 2021,
10 Diane Langberg, Suffering and the Heart of God: How Trauma Destroys and Christ Restores (Greensboro, NC: New Growth Press, 2015).
11 Quest Trauma Healing Centers, accessed February 1, 2022,

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