Engaging African American Clergy and Community Members to Increase Access to Evidence-Based Practices for Depression

This case study illustrates perspectives associated with training clergy in interpersonal counseling (IPC). IPC is an evidence-based, three- to six-session therapy that was derived directly from interpersonal psychotherapy. IPC is designed to be delivered by non–mental health professionals, such as clergy members (7). IPC was selected as the study’s proposed training intervention because it explicitly addresses risk factors for depression (e.g., death of a loved one, relational disputes) that clergy members are most likely to encounter when providing informal counseling.

The demographic characteristics of clergy (N=2) and community members (N=25) were as follows. The two clergy members were a 42-year-old woman and a 27-year-old man. Both self-identified as Black or African American, had a master’s degree or above, had a total household income of ≥$75,000, worked for pay, and had health insurance.

The mean±SD age of community members was 53.2±11.1 years, and most self-identified as Black or African American (N=21, 84%). A majority were women (N=21, 84%), had an education level of some college or technical school (N=10, 40%), had a total household income of $0–$29,999 (N=11, 44%), worked for pay (N=11, 44%), and had health insurance (N=21, 84%).

For this column, we highlight three pertinent themes: mistrust of institutions, depression stigma, and feasibility of training clergy in IPC.

This case study assessed clergy and community members’ perspectives on training clergy in IPC in one African American church. Church-based mental health services may address sociocultural barriers that contribute to treatment disparities. Given the small sample size and single study location, we interpret the results cautiously and discuss potential next steps.

Our results underscore some African Americans’ distrust of health care settings. Psychiatrists in clinical practice could build trust with church leaders by providing a brief church-based workshop on depression or by serving as a referral source for clergy. This type of two-way resource sharing could lay the foundation for a more long-term partnership. We encourage psychiatrists to embrace cultural humility when seeking to engage church leaders and to learn about the historical factors that may contribute to mental health disparities in their local community (9).

Participants in our study described stigma as both an internal and a community-level process. African Americans with depression have intersecting, highly stigmatized identities (e.g., racial minority group, mental illness) that highlight the importance of culturally tailoring anti-stigma interventions for this population. Contact is an anti-stigma intervention that involves planned communicative interactions between people with mental illness and key groups (10). These narrative approaches may include stories, drama, personal experience, and others’ experiences. Given the strong tradition of oral history in Black churches, future studies could evaluate the impact of church-based contact interventions on attitudes toward depression help seeking.

Participants in the clergy were eager to receive training in IPC. This is an important finding because, in other studies, clergy members have resisted mental health training because of perceived philosophical conflicts between psychological constructs and religious doctrine (2). However, because of multiple competing demands, the clergy in our study were not interested in counseling more people. Thus, training clergy in IPC at this church was not a feasible approach by which to reduce racial disparities in depression care. An alternative task-shifting approach is to train community health workers (CHWs) in EBPs for depression. CHWs are trusted, culturally concordant lay health personnel from the local community who have been trained to provide health literacy and evidence-based interventions for chronic medical conditions (11). Exploring the feasibility of training CHWs to deliver mental health literacy programs and depression-focused interventions would be a novel way to address the limited number of providers available in churches.

Community members had positive views about the prospects of clergy being trained in IPC. Before seeking depression services from clergy, however, community members wanted clergy members to have certification that they had completed IPC training. A clergy member’s outward display of IPC certification may alleviate community members’ cultural mistrust when seeking mental health services. However, despite a strong evidence base and established fidelity measures, no standardized national certification process for training in IPC currently exists. Alternatively, proof of certification may be a way for community members to differentiate the clergy’s role as spiritual leaders from their role as mental health providers.

Our small aggregate sample size and recruitment from a single church in New York City limited the generalizability of our findings. The findings may not translate to small- or medium-sized churches, those in rural communities, or different denominations. Because views about a specific depression intervention (i.e., IPC) were assessed, we cannot comment on participants’ perceptions of other interventions. Another limitation was that community members’ positive views of training clergy in IPC may be influenced by the church’s preexisting ministry programs that address mental health conditions (i.e., substance use disorders). Thus, our results may not translate to other places of worship that do not provide these types of ministry opportunities. Last, because the lead author (S.H.H.) facilitated all focus groups, participants’ responses may have been affected by social desirability bias. However, our team decided that the risk of desirability bias would be outweighed by visibility and engagement with community members, leading to a more trusting long-term relationship.

This case study highlights how cultural mistrust and depression stigma impede the use of traditional psychiatric services among African Americans. Clergy in our study were interested in learning the skills of IPC but did not want to increase their counseling caseloads. Implementing mental health literacy interventions for church members may be a more feasible and scalable approach to promoting help seeking for depression in African American communities.

This study was supported by grants from the National Institute of Mental Health (K23 MH102540) and the New York State Office of Mental Health (to Dr. Hankerson).

The authors report no financial relationships with commercial interests.