This statement began the testimony of a couple at my church’s inaugural Disability Ministry Sunday, describing their experience of looking for a church in suburban Cleveland with two young boys with moderate to severe attention-deficit/hyperactivity disorder (ADHD). 

From the early days of my now 30-year-old child and adolescent psychiatry practice, I have observed that the kids and families I serve are far less likely to be regularly engaged in a church or place of worship than is typical for our community. Research supports that observation. 

Noted sociologist, Andrew Whitehead, published a study examining the impact of physical and mental health and developmental disabilities on church attendance using data from nearly 100,000 phone interviews conducted in each of three waves of the National Survey of Children’s Health (NSCH). His findings on the effect of mental health on family church attendance were eye-opening.1

  • Families raising a child with depression were 73% less likely to have attended church in the past year.
  • Families of children with disruptive behavior disorders (Oppositional Defiant Disorder, Conduct Disorder) were 55% less likely to attend.
  • Families of children with anxiety disorders were 45% less likely to attend.
  • Families of children with ADHD were 19% less likely to attend.

The church attendance problem is not confined to families with children. According to the 2011 Baylor Study of Religion, adults who reported significant anxiety or depression were more than 50% less likely to attend weekend worship services.2

Why might the presence of common mental health conditions have such a dramatic impact on church attendance? One hypothesis suggests the attributes of common conditions make entry into “church culture” more difficult. Seven potential barriers to church attendance include:

  1. Stigma. In 2013, LifeWay Research conducted a telephone survey of 1,001 U.S. adults in which 55% of non-churchgoers disagreed with the statement: “If I had a mental health issue, I believe most churches would welcome me.”3 Outsiders may fear mental illness will be interpreted by churchgoers as evidence of a lack of faith or diligence in religious practice. 
  2. Anxiety. People with anxiety disorders are prone to misinterpret the risks associated with entering new or unfamiliar situations. Opportunities for intense anxiety are plentiful at church. First-time visitors may fear being singled out for attention. Children may fear they will not know anyone in Sunday school. A parent with social anxiety may be wary of scrutiny from everyone they interact with during an initial visit. Expectations for self-disclosure in small groups may cause extreme discomfort for teens or adults.
  3. Capacity for Self-control. Executive function deficits are characteristic of ADHD and are common in children and adults with mood disorders, anxiety disorders, and fetal exposure to alcohol, drugs, and other toxins. Executive functioning is adversely affected by stress hormones and neural pathways activated in response to trauma. The process of getting a child ready for church who struggles to self-regulate can leave parents exhausted. Children’s or student ministry programming may be too stimulating for kids with executive functioning deficits. Children may experience more difficulty sitting, standing, or kneeling during worship services designed for adults, especially when they become bored.
  4. Sensory Processing. Abnormal sensory processing impacts more than 5% of U.S. children and adults and commonly occurs along with autism, ADHD, and anxiety disorders.4 Families of children with sensory processing differences face multiple potential pitfalls when attending a worship service. Ambient noise levels and numerous conversations taking place at once near entrances and exits can produce distress. Physical proximity often results in lots of bumping and touching. Bright lights and loud music, common at contemporary services, may be experienced as aversive. 
  5. Social Communication. Social communication is often a significant source of functional impairment among children and adults with psychotic disorders, ADHD, anxiety disorders, and pragmatic language disorders. Many kids and adults with social communication challenges desire authentic friendships. They desperately want to belong to a church where they can be recognized for their gifts and talents, but casual conversation and participation in small groups may be difficult. 
  6. Social Isolation. Families impacted by mental illness are less likely to meet people who might invite them to church. Their options for childcare are often limited. It is also less likely that children with mental health conditions will attend Christian schools where they might connect with other families actively engaged at church or have friends who invite them to church activities.
  7. Family Experiences of Church. The multigenerational expression of mental illness suggests that many children and teens with no church experience are more likely to have parents whose church experience was disrupted by their own mental health issues. Serious mental illness (SMI) is highly heritable. A truly effective mental health inclusion strategy for kids and teens also needs to address the challenges parents experience at church resulting from their own mental health conditions.

Christian counselors and mental health professionals have the expertise and influence to meaningfully impact these statistics. Six steps they might take to support church attendance and engagement for families affected by mental illness include:

  1. Meet with your pastor or church leadership to increase awareness of the problems children and adults with mental illness experience in attending church. Church leaders cannot respond to issues they do not know exist. 
  2. Offer to come alongside your church leadership in designing and implementing a strategy for welcoming and including individuals and families impacted by mental illness. Key Ministry offers free consultation to church teams interested in mental health outreach and inclusion and authored Mental Health and the Church, which presents a model for churchwide mental health inclusion sufficiently flexible for congregations of all sizes and denominations.
  3. Offer training to church leaders, staff, key volunteers, or small group leaders. A 2021 LifeWay study of 1,000 Protestant pastors reported only one church in five offers any formal training for pastors, staff, or key leaders on recognizing symptoms of mental illness, and fewer than one in five has a counselor on staff skilled in mental illness.5
  4. Encourage your pastors to talk about mental health concerns during worship services. The 2013 LifeWay study previously mentioned reported the most common request of churches from families of adults with serious mental illness was for pastors to talk about it from the pulpit because doing so enabled them to share their struggles with others openly.6 Pastors might address mental health-related topics in sermons or offer prayer for people impacted by mental illness. 
  5. Offer to start or promote church-based mental health support groups. Mental Health Grace Alliance and Fresh Hope are two Christian non-profits offering biblically-based mental health support models that have been successfully implemented in hundreds of churches in North America and beyond.
  6. Work with church staff to help accommodate clients with specific support needs. Consider asking clients about their church attendance and involvement during the intake process or initial assessment. Offer to speak with church staff if the problems they seek counseling for impact church participation or engagement.

Families raising children with common mental health conditions represent one of the largest underserved groups by the Church in North America. Christian counselors are uniquely positioned to help local churches with outreach to a population desperately in need of the love of Christ and care and support from a loving church family.

Stephen Grcevich, M.D., is a child and adolescent psychiatrist who serves as President and Founder of Key Ministry, a non-profit ministry that connects churches with families impacted by disabilities. He is an Associate Professor of Psychiatry at Northeast Ohio Medical University. Dr. Grcevich is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI) and a participant in the 2019 White House Summit on Mental Health. His book, Mental Health and the Church, was published in 2018 by Zondervan. 

Endnotes

1 Whitehead, A.L. (2018). Religion and disability: Variation in religious service attendance… Journal for the Scientific Study of Religion, 57(3). https://www.researchgate.net/publication/ 326003692_Religion_and_Disability_Variation _in_Religious_Service_Attendance_Rates_for_Children_with_Chronic_Health_Conditions_RELIGION_AND_DISABILITY.

2 The values and beliefs of the American public: Wave III Baylor religion survey. Baylor University. (2011, September). https://www.baylor.edu/baylorreligionsurvey/.

3 Acute mental illness and Christian faith research report. (2013). LifeWay. https://research.lifeway.com/wp-content/uploads/2014/09/Acute-Mental-Illness-and-Christian-Faith-Research-Report-1.pdf.

4 Grcevich, S. (2022, August 28). Ten thoughts about the new LifeWay study on pastors, mental health and the church. Key Ministry. https://www.keyministry.org/church4everychild/2022/8/13/ten-thoughts-about-the-new-lifeway-study-on-pastors-mental-health-and-the-church.

5 Earls, A. (2022, August 2). Pastors have congregational and, for some, personal experience with mental illness. Lifeway Research. https://research.lifeway.com/2022/08/02/pastors-have-congregational-and-for-some-personal-experience-with-mental-illness/.

6 Acute mental illness and Christian faith research report. (2013).