Mental health is fast becoming a critical area of British public policy. Over the past two years, few issues (with the inevitable exception of Brexit—the political fallout from the United Kingdom's decision to leave the European Union) have commanded such attention as the promotion of mental health and well‐being as a political issue.

The former UK Prime Minister David Cameron certainly maintained a significant interest in the area, making it a key commitment of the Department of Health, with several ministerial appointments and a promise (that would go as yet unfulfilled) to oversee “a revolution in mental health treatment” (Prime Minister's Office ). He also took seriously, at least for a while, measures of national happiness and well‐being (these have been recorded by the Office for National Statistics since 2012). He took some flak (in terms of press coverage and mockery) for that decision, but it was in many ways quite a bold and interesting counter political cultural move to prioritize markers of performance that were not simply economic in nature. Over time, the importance placed by the government on that measure seemed to decline. That notwithstanding, the policy importance attached to mental health and well‐being has continued to increase.

This interest among policy makers has led to my own organization, the United Kingdom religion and society think tank Theos, to engage in two separate research projects. Theos is a think tank which provides research, comment, and events analyzing religion and society, primarily in a British context. Our first intervention was a report called Religion and Well‐Being: Assessing the Evidence (Spencer et al. ) which was a study of 139 academic studies into the relationship between “religion” and “well‐being” (recognizing the significant breadth in the way both of those terms are understood and evaluated).

The second, which was published in 2017, was Christianity and Mental Health: Theology, Activities, Potential (Ryan ). This second project was a scoping study; it was not intended to be the final word on anything. It was instead designed to scope out the field of what British Christians are doing in response to mental health, so far as an initial study could identify, and to raise questions for future research.

This article draws out some of those questions and themes. First, it will tentatively point to the evidence of what is widely regarded as being anecdotally true—namely that, in the United Kingdom, Christians are increasing their involvement and producing more and more services, interventions, resources, and responses to mental health issues.

That development raises a number of questions, but this article will look at two in particular: First is how to measure the extent of the activity, and who has ownership of it? Second is how Christian is it? Or, to ask it another way, what is the particular Christian theological or value structure, if any, which underpins that work?

That in turn raises the specter of whether that latter issue matters: Does it matter whether or not there is an authentic Christian approach to the issue of mental health? The answer, I would suggest, is yes, but that conclusion is not necessarily widespread within the sector.

Finally, this article will conclude by exploring some particular theological and theoretical issues in forming a Christian response, both anthropological and explicitly theological, from which we might begin to form the building blocks of an authentically Christian response to mental health. Within the broader context of religion and science, this connects to wider debates about the use of spirituality and religion within medical science (e.g., Wood et al. , and the work of Harold Koenig in the American context), and into theological debate about the extent to which Christianity has adequately wrestled with the growing medical literature (e.g., Beer and Pocock ).

THE GROWTH OF CHRISTIAN ACTIVITY

Anecdotally, there seems to be a pretty broad consensus that a lot of Christian groups are springing up each year with a particular focus on mental health issues. Over the course of interviews conducted for the Theos project on mental health (Ryan ), this was regularly stated as the case by practitioners within the field. This ought not to be surprising—in fact, it merely mirrors the reality that society more broadly (and the Church within that) has shown a significant increase in interest in, and awareness of, mental health and the need for additional services over recent years.

Certainly, the public visibility of mental health is growing. It is no longer staggering, though it is still unusual, to see public figures—politicians, athletes, musicians, actors, and prominently over recent months the royal family, open up about their personal experiences of mental health. It does remain a curiosity that that trend is not nearly so widespread among religious leaders (though here too there are signs of change). That does not mean that all mental health issues are popularly well understood or recognized (by any means!), yet the growth of public understanding of some issues has increased dramatically. With that increased understanding comes a natural response. It is only when something is widely recognized as a problem (or at least as being important) that responses start to be formed. There is little money or volunteer resources to be found for issues that are not considered of public importance.

More contentious is the claim that not only public understanding but actual instances of mental illness have increased over recent years. This is the claim that something about the modern world particularly lends itself to poor mental health. Dozens of articles and studies have been produced in the past few years about how, for example, work‐life balance (Guest ), or particular careers (Michalak ), or changing patterns of family life (Centre for Social Justice ), or countless other facets of modern life are linked to particular issues of poor mental health or well‐being.

The validity of those various claims and reports are beyond the scope of this article, and it is at any rate a moot point as to whether the United Kingdom in 2017 is less conducive to good mental health then Britain in the 1930s, or at any other historical point. What does seem to be to be incontestable, however, is that diagnoses for many mental illnesses and disorders are on the rise (McManus et al. ). Whether the causes for that increase lie in the flaws of the modern world, or in our increased medical knowledge and willingness to make such diagnoses, either way mental health is becoming a growing concern of public health and policy.

The effect is that mental health is moving up the agenda of public issues in the United Kingdom, and with that comes increased attention from medical and social services, media and the public, and, of course, policy makers. Under such circumstances it is no surprise to see an increase in charities and third sector bodies (nongovernmental organizations and nonprofits) springing up to confront particular issues—particularly at a time when austerity economics has seen an increased role for the third sector in healthcare and social services. At the same time, since a large percentage of the UK population is Christian, and since the Church has a history of and, in so far as these trends can be detected, a growing contemporary involvement in, social action and providing welfare services (Spencer ), it is no surprise to see Christian groups increasing in this space.

Nevertheless, it is interesting to see the spread of activity in the sector. It is very difficult to accurately map everything that is going on for at least three reasons:

• (1)

  The definition of mental health is contested. Differing definitions (and indeed projects and organizations), for example, may or may not include dementia as a mental health issue. Some might consider loneliness to be a mental health issue—where others might see it only as a causal factor of bad mental health. It is difficult to adequately group together clinical issues that would have a sufferer detained under a section of the Mental Health Act, with issues which are not treated medically. Since there is little consensus, it is difficult to map everything that is going on.

• (2)

  A second issue is the extent to which it is possible to keep accurate records of such activity. For example, it has been demonstrated that people who regularly attend some sort of social activity better resist the effects of dementia (see among others Pargament et al. ; Koenig ; Spencer et al. )—but few would consider it sensible to include every church service or bingo activity as a Christian intervention on mental health. Other research has demonstrated the positive effects associated with ceremonies that provide closure after the death of a loved one (Romanoff )—but again counting all religious funerals would inflate the number of Christian mental health projects considerably, and beyond what most people would understand as a mental health intervention.

• (3)

  So much of what is going on is grass roots level, small‐scale work. Such work is notoriously difficult to track. In other research projects with the faith charity sector (Ryan ), I have previously explored the difficulty of keeping track of volunteers, the exact hours they put in, and evaluating how effective that work is. Volunteers, staff, and indeed whole faith‐based charities, have a tendency to come and go—a particular volunteer or leader will get a project going, but when he or she retires or moves on the project may stop. This makes keeping accurate records notoriously difficult.

Given those difficulties, what the Theos research on mental health tried to do was to look at a series of particular mental health issues and identify what was going on in each case. As a base we used the list of mental health problems identified by the mental health charity Mind (Mind ), though some were added where existing categories failed to really encapsulate the issues being addressed by some Christian charities (e.g., projects looking specifically at clergy mental health).

What that exercise reveals is that, as would broadly be expected for largely volunteer‐based programs, in social action projects a lot of the activity is focused at a “softer” end of the spectrum. Christian groups were producing a great number of “resources”—including awareness‐raising campaigns, guides to dealing with particular issues, and how‐to guides for churches.

Some particular mental health problems had greater provision than others. For example, a lot of work was being done on loneliness (some of it extremely innovative). This included a number of projects focused on the well‐being of the elderly and other groups (e.g., refugees or the disabled) who, for a variety of reasons, were unable to fully participate in communities. These projects crossed a range of denominations. In one case, a small Catholic charity was operating a phone line staffed by volunteers who called local elderly residents simply to chat with them to help alleviate loneliness. The Cinnamon Network, which resources and funds churches to run a local social action network, has partnered with a Baptist charity called the Link Visiting Scheme to franchise a model for befriending that began in Berkshire and now works through nineteen churches and has more than four hundred beneficiaries.

Among the other areas which seemed to receive significant Christian attention was suicide; we found a significant number of projects and charities working on suicide prevention and supporting the friends and families of those who were suicidal. This included a growing number of groups concerned with clergy mental health—an issue which is only beginning to come fully to light. Perhaps most interestingly the secular Northern Irish suicide prevention charity Lighthouse was running a scheme called Flourish which worked with clergy on their mental health needs, with financial support from the Northern Irish government.

We also found a lot of work with children and teenagers. This has long historic roots and makes sense given that a very large number of mental health symptoms emerge in adolescence. Accordingly, it makes sense to focus attention on early identification and intervention. Ally that to the fact that Christian groups have always tended to invest a lot of time and energy into children and education (there are still a vast number of faith schools, scouts clubs, and youth clubs) and it is little surprise to be seeing so much work in that area. Some of this work has been extremely innovative particularly around issues of self‐esteem and body image in teenage girls, and in confronting bereavement in children.

Unsurprisingly the other, “harder,” end of the spectrum—including clinical issues such as personality disorders, saw fewer Christian interventions. That is hardly surprising—it reflects the fact that some work in this area is primarily medical and the rest is increasingly left to civil society. The interesting feature here is that it was the sense of several interviewees that more and more extreme cases are being moved into the charity sector. For example, there was one interviewee who worked for a children's charity that worked very closely with the local council, social services, and the National Health Service (NHS) trust. All work with children was put into four tiers, with level 1 being the least serious, and level 4 being something highly serious requiring the immediate intervention of the police or social services. Throughout the 1990s, the charity only worked with category 1 cases, and the rest were referred to the council. In the 2000s, it moved to all level 1 and 2 cases. Now they deal with everyone level 3 and below, plus a small group of level 4 cases. This transition has been driven almost entirely by the underfunding of council services. In fact, it was proving impossible to get social workers even to assess possible level 4 cases, so overstretched were such social workers who were still employed. This trend of increasingly severe mental health issues being outsourced is one which looks set to continue, despite increasing government funding and demands.

So, to summarize the initial point—it appears that there is a real and significant growth in Christian responses to the issue of mental health. It is very difficult to map them precisely, but every indicator is of increased interest and spread, and it is likely that this is a trend which will have to continue to meet the demands of wider society.

CHALLENGES STEMMING FROM INCREASED CHRISTIAN INVOLVEMENT

All sorts of challenges are raised by this increased Christian involvement in the mental health sphere, many of them practical and political. For example—who's going to pay for it? Should faith‐based charities and churches be bailing out the state at all? Who if anyone is responsible for inspections, training, and standards? There are also a range of questions around what impact looks like in this space—that is, how do we evaluate these bodies to determine who is doing a good and effective job? What measures need to be recorded and how reliable are the results likely to be?

Those practical questions are extremely important, but largely beyond the scope of this article. Instead, the issue for the rest of this piece is the question of whether there is anything distinctively Christian about these projects. This a familiar question from a number of different projects commissioned by Theos and others on the faith charity sector (Bickley ; Ryan , b). There is a spectrum of “faith” that ranges through work done by churches, through work done by explicitly Christian charities with a strong and prominent Christian ethos, through to those with a fuzzier ethos and history—perhaps only a Christian inspiration, or just a historic link. For the latter consider something like the YMCAs, originally quite an explicitly Christian charitable organization, but where the vast majority of staff are now simply secular.

Aside from that issue, there is also a spectrum within charitable activity itself. A classic example here is the food bank. There is nothing distinctly Christian about the activity of a food bank. The ethos may be driven by a Christian motivation to serve the poor and be alongside people, but the work itself is not substantially different from any secular agency performing the same role in most cases. This contrasts with activities that are explicitly religious in nature—praying with people, taking communion, providing religious services, and the like. Both who is doing it and the work itself can, therefore, define something about whether the operation is Christian.

When we look at mental health initiatives there is plenty of evidence of Christians getting involved in providing something, as was explored above. The question is how Christian is the theory and practice behind what they're actually doing? Across the faith charity sector there is a perceived pressure on Christian ethos (Bickley ). There are several reasons behind this. One is an issue of Christianity's own making—namely, that there are not as many Christians as there used to be. So, for example, not so long ago a Catholic school in England would not employ any teacher who was not a Catholic. Now the rule is only applied to head teachers, and many schools are struggling to fulfill even that criterion. When the personnel who make up an organization changes from those who have a common (default) faith ethos, to a more plural space, it is inevitably harder to keep that ethos at the heart of the operation.

There are other factors, however. One is pressure from secular bodies. There are countless examples of charities softening their faith ethos because it was proving too difficult to get local government money or help. Accusations of being exclusivist, or of proselytizing (though the term is never actually defined), of perceptions of homophobia, sexism, and so on have led to many faith charities abandoning, or at least softening their public faith ethos. A number of local government agencies as a matter of policy will not work with organizations of a single faith. That same pressure also comes from funders. Charity funding is currently infamously stretched—local government money has fallen through the floor, and trusts and foundations have their own criteria, and we are witnessing an increased trend of resistance to those more explicitly religious operations (Ryan ).

When it comes to mental health there are particular pressures in this regard. There is a perception among some that medicine/healthcare and religion are two arenas which ought to be entirely separate. That perception is one to which Christians have contributed in some sense. A lot of Christians have accepted this dualism of science/medicine as entirely separate from the spiritual. At its worst, the danger is an “overspiritualizing” of issues. A complaint from some in the medical profession was of Christian groups rejecting medical diagnosis and urging sufferers to pray harder, or see their problem as one of relationship with spiritual powers (Wood ). At its most extreme this is seen in the contentious issue of exorcisms. This is not to necessarily discount the possibility of demonic possession, or of a subject being spoken to by spiritual forces, or angels, but when the first step taken by churches is to reach for spiritual warfare there is a potential for serious harm.

That dualism exposes part of the issue about the question of how extensive the Christian content of this activity really is. The language of mental health is medical and scientific. Well‐being, as a term, interestingly does not quite suffer from the same issue—because it has come to incorporate a softer and more spiritual set of elements, including mindfulness.

Mental health language is new; it has its own jargon and its own medical terminology; and little of it has much theological resonance or biblical basis. The sorts of terms used to describe particular medical illnesses have only been invented in the past few decades. So when Christians try to engage in this space there is a language problem. The words are foreign to the resources on which Christians (and indeed other faith groups) usually draw. There is a lack of a shared register by which issues can be discussed, analyzed, and processed.

This is part of what sits behind that problem of “overspiritualizing” mentioned above. Because the language is not familiar—and the usual sources for theological and Christian engagement seem to be in a different language—there is a tendency to reject or ignore the medical terminology and, sometimes even, diagnosis.

There are cultural issues here too. For example, you are disproportionately likely to be sectioned if you are from a West African or Caribbean immigrant background (Sainsbury Centre for Mental Health ). Plenty of possible factors have been suggested for that trend, including institutional racism, and the fact that migrants generally seem to be more susceptible to particular issues, perhaps as a result of upheaval and loneliness (refugees, of course, often have particularly traumatic pasts). Another factor which is often suggested is that members of that community are disproportionately likely to express what they are experiencing through a language of spiritual conflict. The same experience of inner turmoil might be expressed very differently by someone of a different background—but what seems to be the case is that when West Africans (particularly but exclusively those drawn from Pentecostal religious backgrounds) phrase their experiences in those terms this tends to prompt a particularly strong reaction from the medical profession.

There is a known phenomenon, though anecdotally there is evidence that it seems to be shifting in recent years, that the psychiatric medical branch is among the most atheist and hostile to spirituality of any profession (De Beer ). The result of this is that when confronted with someone presenting themselves as having some sort of spiritual battle, often diagnosis is more severe than it might otherwise be had the same experience been differently expressed.

The problem, therefore, comes from two poles. One is a hard medical, clinical approach that can often prioritize quite a materialist, rationalist mindset (this is obviously a generalization—but it is the extreme expression of one pole), and the other is a faith mindset that views everything through a prism of spiritual conflict, in which mental health can be dismissed or devalued (again, this is not necessarily, or even likely to be, typical, but is the extreme pole).

WHY SHOULD THE CHRISTIAN FOUNDATION MATTER?

With all that in mind, the question of what motivates and theoretically underpins these Christian projects is an important question. Their value structures and language for what they are doing is significant in navigating between the two poles.

Are they simply secular service providers using mental health language—but done by Christians? For many that would seem to be a reasonably fair descriptor, and potentially a significant missed opportunity.

No doubt for many people working in this sector and elsewhere this will all seem like an irrelevance. If people are being helped then it should not really matter whether there is a cohesive theoretical underpinning to the work. On one level of course that makes sense. The need for someone to run a social action project and help dozens of people ought to outweigh any concerns that they spend hours of time in introspection working out the theoretical principles for why they're doing it.

But on another level it does matter that we have an authentic Christian language with which to talk about these issues. There are two big reasons for that.

The first is authenticity. There is a reason that service users seek out faith‐based charities for help. There are, after all, secular charities and service providers. It is not simply a matter of having to go to faith charities because every other option is expended; on the contrary, many people's first port of call is to go to a religious group.

We know that clergy mental health is notoriously poor—but also the issues they are expected to confront are what one of our interviewees described as “the thick end of the wedge”—people show up to parishes seeking help with very serious issues. They go to the faith bodies because it matters to them—they choose a faith body because it provides something important to them that other groups do not.

Now with that in mind, they are expecting help which comes with a faith ethos. They want to be helped in their own language. They are seeking something more than just secular medicine. There is always the danger mentioned above about overspiritualizing, but there is nonetheless a demand for an authentic Christian response which embraces mental health.

Second, the sector as a whole is moving towards embracing approaches to spirituality and the importance of spiritual care—so we are faced with a possible irony of a secularizing faith charity sector just as the secular healthcare world is waking up to the importance of spirituality.

This can be overstated of course, but there is new guidance on spiritual care in the NHS (NHS England ), and there are a number of interesting ongoing research projects concerning spirituality in healthcare settings. The work of the Spirituality and Psychiatry Special Interest Group (SPSIG) at the Royal College of Psychiatrists was widely praised by interviewees. If ever there was a time to be exploring this and embracing the spiritual side of health it might be now.

There is plenty to build on. The majority of studies (not all) show a link between high subjective religiosity and positive mental health—that is, if you are religious and you take it seriously that is correlated with better health (Spencer et al. ). And conversely, if you have low subjective religiosity you are more correlated with depression.

Likewise, many studies suggest a really positive link between involvement in collective religious activities and mental health. Among others one study showed that “frequent churchgoers were about half as likely to be depressed” (Koenig et al. ).

So there is evidence that religion and participation makes an impact—if it makes an impact then it is incumbent upon faith groups to work through some of the questions that that raises.

WORKING TOWARD AN AUTHENTIC CHRISTIAN APPROACH

There are a number of possible elements on which we can draw to develop this distinctive Christian approach. The first is biblical—and is complicated by the fact that biblical approaches to mental health are hard to identify. The second is a Christian anthropology and is more promising as a starting point. The third is theological, looking at the three Rs—responsibility, redemption, and reconciliation, and raises the most difficult challenges for Christianity as it looks to the future in this space.

CONCLUSIONS

These discussions are not necessarily novel. Much of this has been debated for a long time—Carl Jung himself in the 1930s was concerned by issues of clergy who were “insufficiently equipped to cope with the urgent psychic needs of our age,” and that it was “high time for the clergyman and the psychotherapist to join forces to meet this great spiritual task” (Jung , 5218). It is not that mental health has come out of nowhere to suddenly exist as something for the church to confront.

And yet it does seem to me that we are witnessing a situation at a crossroads. On the one hand, faith groups are more engaged than they have ever been in these areas—with a great multiplicity of services and charities springing up. And yet, at the same time, though activity is increasing it is not clear that it is yet cohesive, or that the Church has yet developed its own authentic way of engaging in this space. This is surely a critical task for the future. Mental health is one of the great societal issues; it demands a response which is both pastorally motivated and theologically grounded.

Getting this discussion into the bloodstream of activity that is springing up in ever more settings is the great challenge to meet.

ACKNOWLEDGMENTS

A version of this article was presented at the annual Science and Religion Forum conference, held August 31 to September 2, 2017 at Bishop Grosseteste University, Lincoln, UK. The theme of the conference was “Mental Well‐Being, Neuroscience and Religion”; it was organized in partnership with The Guild of Health and St. Raphael.