Powerful forces have brought it about that neighbours are unlikely to want close informal involvement with others ... Nevertheless, a potential pool of neighbourly help exists amoung the 'exceptional' categories of residents; ... committed churchgoers and community activists, for example - who are likely to have an interest in 'political' movements and/or voluntary associations of various kinds organised on a neighbourhood basis.¹

This quote gives us the launching pad to examine the role of the church in the 'community care' of the 'mentally ill'. Community, though a much loved and cuddly word, is, in reality, evaporating down into a residue of the immediate family². Virtually every church, however, makes an effort to create community³. Churches therefore have a role to play in community care which is worthy of investigation. Before proceeding with a direct examination of the role of the church a brief summary of what is meant by mental illness will be useful. What is mental illness? This is the first of many questions on mental health which cannot be answered conclusively⁴.

Even a book such as Gibbs', here quoted, which seeks to be a 'straightforward' guide to mental illness is aware that the subject is far from being clearly defined. David Ingelby⁵ is more questioning. He doubts if we are any nearer a definition of mental illness than we were 50 years ago and radical critics even argue that mental illness is caused by the structures of society⁶. Barham⁷ shows how our society turns people into illnesses and so deprives sufferers of human rights, excluding them from us. Particularly in the inner city one might reasonably ask if mental illness isn't a reasonable response to intolerable living conditions. Previously we shut people away in asylums, now we release them into the community where they sink, inadequately supported, into wretched poverty⁸. The medical profession, with its traditionally positivist philosophy, which treats human beings as complex machines⁹ , has drifted into reliance on drugs for containing the symptoms of mental distress. Furthermore people are stigmatized as having a disease, like diabetes, which they must live with, even though it has no physical symptom. In this context, community care, although, at root, driven by genuine concern¹⁰, perpetuates the old problems. The mentally ill are marginalised and poorly cared for, because, in our minds, we exclude them from our society. We need to hear the remark of an ex-patient "You are not your illness! Find another role besides mental patient!"¹¹.

The church we will be considering is located within the zone of the West Battersea Mental Health Team, which is one of the areas of Wandsworth Health Authority. A brief look at the services they provide will provide a necessary context for our discussions¹². The team consists of: 

Access to these workers is through referral from GPs or Social Services. Self-referral is difficult as workers are worried at being overwhelmed by the 'less unwell'. Defining boundaries of who to work with, and who not is clearly a key issue. The new appointment of the Intensive Outreach Workers illustrates the emphasis on trying to provide care in the community for the severely ill. This is, perhaps, influenced by the Christopher Clunis case where care broke down to such an extent that Clunis murdered an innocent bystander. Those that can cope, or be coped with by family, are more or less left alone¹³. There isn't even a drop-in in the area. The workers are aware of the problems this causes, especially in inner city areas where the environment can cause and exacerbate stress. It is clear that Mental Health services are in a period of transition, the hospital provision is being cut down to the bare bones, resettlement strategies are being implemented and community care plans adopted¹⁴. All this is in the context of the fundamental shift to the purchaser/provider system and, in Wandsworth, the amalgamation of the Health Authority with Merton and Sutton. What is particular worrying in this time of shift to community care are the antics of groups like SANE who have been playing on our fear of the 'lunatic, madman and schizophrenic' released into the community, with lurid advertising¹⁵

HE THINKS HE'S JESUS

YOU THINK HE'S A KILLER

THEY THINK HE'S FINE

The change to 'community care' is a passing issue. Our stigmatization of 'the other, the different, the not-normal' remains unchanged. Mental health services are ill-equipped to deal with this issue as they focus on caring for the exceptionally distressed.

What role, then, might a church community have to play in this complex situation?

Battersea Chapel is a fairly typical inner city Baptist church situated in the middle of high-rise estates to the north of Clapham Junction. The area is regularly reckoned to be one of the most deprived areas in the borough¹⁶, healthcare professionals reckon that up to « of all residents would suffer some form of mental illness¹⁷. The membership of the chapel is around 60, 50% of these are women over 60, racially it reflects the area: about 40% are black. There is a group of older members who live in other parts of Battersea but most live within walking distance. The chapel is able to pay a full time minister but financial only just about keeps its head above water. It is, therefore, a fairly typical estate church: elderly, cautious, with enough vitality to struggle on but a little afraid of the future¹⁸.

The pastor of the church identifies 9 members (out of 61) as having a long history of mental illness, without mentioning non-members who drift in and out¹⁹. He goes once a week to Springfield hospital and identifies mental illness as a major issue. He makes six points:

i   The unavoidability of the issue in the area.

ii  The impact mental illness has on others in the church.

iii Mental illnesss is essentially about being unable to make relationships.

iv  The high levels of care ill people require and the unpreparedness of the church to take this on.

v   What is the churches healing ministry in this context?

vi  What partnership with statutory authorities should the church attempt?

We can take note of the assumption of an active community which has a responsibility to do something. The problem is framed in terms of a community struggling to include those who want to be part of it, but who find it difficult. This would appear to be a common scenario for churches²⁰. There is a de-emphasis on severe/violent illness and a focus on the more mundane concerns of including everyone in an effective community. It is possible for churches to operate in this way because they create organised systems of care. They vary greatly in their form: some are clergy dominated; others run by lay members through a house group system; some are highly structured, others informal. Pastoral care is expected. People make sure it happens²¹.

This reminds us that community care doesn't just happen. Churches reveal a multiplicity of ways it can be made to happen. This alone, however, would leave us with a shallow understanding. Churches are not just Friendly Societies, they are driven by a faith commitment. It is this shared commitment which creates both the community and the desire to care²². This makes some feel uncomfortable with churches. It is difficult to be involved in a church and not feel under pressure to adopt the church's beliefs. This presents a problem for secular bodies such as Local Authorities. They might appreciate the caring churches can provide but don't want to promote the 'proselytising' of churches²³. The churches caring, however, is most effective when it incorporates people in the community, which means including people within the community's worldview²⁴. Mentally ill people are no different than anyone else, they are equally incorporated as members of the community. This, perhaps, challenges contemporary views of caring which provide care with no strings attached at all. Is this not ultimately paternalistic? The cared for is always 'other', different from the carer. Christian caring depends on community²⁵. In the community people hold common beliefs, do common things, they are 'members, one of another': caring is caused by this community not altruism or paid labour. By saying this I would not want to imply that churches are perfect communities, who are always perfectly caring. Far from it! Certain churches have a tendency to associate illness with sin, which is an easy way to marginalise uncomfortable distress and pain. A more common problem is respectability: "You can't join us, you don't behave properly, you aren't like us". This is one of the risks of forming a community: it becomes happy with itself and doesn't want to let anyone in. Even 'good' communities have their limits. Most churches seem to hold a certain number of the mentally distressed almost irrespective of size²⁶. This means there is a limit to what can be coped with, if this limit is exceeded the community ceases to be caring as it suffers overload and burnout. This may well be what is happening in the area as well as in the church²⁷.

An interesting area is the role of spirituality in mental health. The mentally distressed often have a strong religious awareness²⁸. My experience suggests that religion can be a remarkable liberation for some: as for my friend who has been free from anxiety attacks since he saw a vision of Jesus. On the other hand another friend has developed an obsessive interest in religion which makes him extraordinarily difficult to relate to. Generally, in the rather grimly medical and positivist world of mental illness it would seem that the church can provide an alternative world view: visions and voices don't have to be schizophrenic delusions, but can, when acknowledged by the church community, be genuine words from God²⁹. Life does not have to be judged by what people think of you and how successful you are but in terms of a spiritual awareness of life's value in God's eyes. On the other hand one visitor to the chapel often says something along the lines of.

 I don't come here to hear about all this Jesus nonsense. I only come for companionship and a cup of tea. And anyway, I'm not a Baptist, I'm Anglican, but it's so boring there: everyone so grim and serious. At least you can have a laugh here.

 How might a typical inner city church, like Battersea Chapel, develop its caring?

One thing a church appears to offer people is a clearly defined structure. It is always there. People are able to make us of it as and when they want³⁰. These more 'boring', traditional dimensions of church life: it's always been there, it does the same thing week after week etc, can be valuable for people who are distressed. What often needs development is not so much the structures as the attitudes. As I've tried to point out above churches care because they are communities organised to care, not because they are necessarily full of wonderfully caring people. There are dangers with such structured caring. It can become wooden and restricted. A church caring in itself, can ignore those not perceived as being the church. This can be seen in the case of the visitor quoted above who is often disruptive. In which case people almost will him to leave them in peace. The church should be challenged by its tradition³¹ and values to overcome the barriers between us and them and so create a truly caring community.

The church needs to be aware of mental health services in the area so as to be able to access professional help both in severe cases and when carers get overloaded. An advocacy role may also be appropriate³², although it can be a problem for professionals to accept the role a church plays. Both the Director of Social Services and Director of Public Health expressed surprise at extent of churches caring role when presented with reports³³ .

One way churches can progress is by developing some project work. A good example is St Pauls, Lorrimore Square in Camberwell. They developed a drop-in for the mentally ill run by volunteers which has evolved into a larger, more professionalised centre that has sparked housing developments and other drop-ins. In so doing churches can operate more like a traditional voluntary organisation and avoid some of the problems discussed above. Yet at the same time they may lose something of their community nature. The priest at St Pauls does give voice to some regrets in this regard. Some caution about church projects for the mentally ill might therefore be expressed. For a start only a small minority of churches will be able to run one³⁴. They might also be in danger of stigmatizing and marginalising sufferers in the very process of befriending them. Grainger reports an ex-patient as saying "People don't want their whole lives dominated by 'mental health activities'." The church's core work is the integration of people into the church community. The chapel has made some strides in this, as for instance, the friend who saw the vision above, is now a leader in the church and responsible for evangelism - yet he is still on medication. Small, struggling churches like the chapel may well be in a better position to achieve this than big, thriving ones overflowing with the confident and super-capable.

Churches as active communities have a role to play as places where a mentally ill person can find friendship and spiritual values, as one amongst many. This is the heart of their calling. The pastoral skills of clergy³⁵, central roles in some ethnic communities³⁶ and, particularly, the caring for carers³⁷ are areas I have no time to explore. Yet none should distract from the need to get beyond the us and them mentality towards something, at least approximating, to the early Christian vision of us all being 'members one of another'.

Notes  1 Ray Snaith in Joanna Bornat ed. Community Care: A Reader. OUP: 1993. p58  2 Anthology: the breadth of community compiled by Charmaine Pereira in Joanna Bornat ed. Community Care: A Reader. OUP: 1993.   3 James Ashdown. Church Community Care Survey. Bright the Vision: 1993. Survey of 30 Churches in Wandsworth.  James Ashdown. Healthcare and Wandsworth Churches. Bright the Vision: 1994. Survey of 6 churches.   4 Angelina Gibbs. Understanding Mental Health. Which Books: 1986.  5 David Ingelby. "Understanding Mental Illness" Critical Psychiatry. Penguin: 1981.  6 Starting with the 'Freudo-Marxists' in the 1920s.  7 Peter Barham. Closing the Asylum. Penguin: 1992.  8 Peter Barham. Closing the Asylum. Penguin: 1992.  9 David Ingelby. "Understanding Mental Illness" Critical Psychiatry. Penguin: 1981.  10 Joan Busfield "Managing Madness" in Joanna Bornat ed. Community Care: A Reader. OUP: 1993.  11 Peter Barham. Closing the Asylum. Penguin: 1992. p96  12 Lent Group led by Occupational Therapist and Social Worker from West Battersea Mental Health Team at St Peter's, Battersea. 2 March 1994.   13 A friend of mine, caring, for her husband during a change in medication which caused severe mood changes was told by her GP "I'm sorry you're on your own, there's nothing we can do".  14 Wandsworth Community Care Plan 1994/5  15 Peter Barham. Closing the Asylum. Penguin: 1992. p151  16 Jane Charlton. The York Rd 1 and Winstanley estate survey. Safer Cities: 1993.   17 Alison Pollack, Assitant Director for Public Health, WHA.  18 James Ashdown. Battersea Chapel 1993: A Snapshot.  19 Julian Gotobed: Minister Battersea Chapel. Personal Interview. Mar 7 1994.  20 Association for the Pastoral Care of the Mentally Ill. Day Conference "A Friend in Need". All Saints Church, Battersea 5th March 1994.  21 James Ashdown. Healthcare and Wandsworth Churches. Bright the Vision: 1994.  22 The classic text is the first six chapters of Acts.  23 cf Conflicts between councils and churches over Equal Opportunities and non-Christian festivals in Newham and Southwark - ironically led by commited evangelical christians.  24 This is particularly so for gathered churches like the chapel. Anglicans working on a parish model may have a different approach.  25 This is true of non-Christian communities also.  26 James Ashdown. Healthcare and Wandsworth Churches. Bright the Vision: 1994.  27 The local policeman identifies the key characteristic of the estates as being a tendency for domestic and neighbourhood disputes to turn violent. Surely an indicator of an overheated community. See Julian Gotobed's point iv above.  28 Julian Gotobed: Minister Battersea Chapel. Personal Interview. Mar 7 1994.  29 1 Thessalonians 4:19-21  30 Roger Grainger. Strangers in the Pews. Epworth: 1993. p18-20  31 Hebrews 13:1-2 and more contemporarily Roger Grainger. Strangers in the Pews. Epworth: 1993.  32 cf Janice Price ed. Travelling Together ... towards mental health. Southwark Diocesan BSR Mental Health Working Group: 1993 p25  33 James Ashdown. Healthcare and Wandsworth Churches. Bright the Vision: 1994. James Ashdown. Church Community Care Survey. Bright the Vision: 1993. Survey of 30 Churches in Wandsworth.  34 The Wandsworth survey indicated only 16% of church projects catered for the mentally ill, whereas 100% churches had mentally ill members.  35 Roger Grainger. Strangers in the Pews. Epworth: 1993.  36 Janice Price ed. Travelling Together ... towards mental health. Southwark Diocesan BSR Mental Health Working Group: 1993 p34  37 Janice Price ed. Travelling Together ... towards mental health. Southwark Diocesan BSR Mental Health Working Group: 1993 p39