Mental Illness Recognition and Referral by Catholic Priests in North Carolina

Deinstitutionalization ushered in an era of community-based care in which early recognition and treatment of mental illness is emphasized. Identifying individuals with mental illness or substance abuse problems and getting them into treatment is a persistent difficulty. Some persons seek treatment directly from health care professionals, but researchers have found that many turn first to clergy (1–3). Clergy have been described as a kind of “gateway” to the health care system, particularly for persons from ethnic minority groups, who may be impeded by financial difficulties, be unfamiliar with local resources, or have concerns about stigma (2).

However, little is still known about what clergy do when they encounter people with psychiatric problems. They may feel uncomfortable or inadequately trained to recognize mental illness (1,4). They may also feel disinclined to refer people to mental health providers who do not have a similar religious worldview or if they believe that providers might undermine a person's religious faith (1,2,5). These factors could delay or preclude treatment.

Because Catholics constitute a quarter of the U.S. population and represent the largest single religious denomination in the country, we conducted an online survey of Catholic priests in North Carolina to better understand how comfortable and capable they are with identifying and responding to individuals with mental illness. We also wanted to understand the importance that priests place on a shared worldview with providers. A 16-question survey was distributed to all Catholic priests (approximately 300) in North Carolina via diocesan Listservs. It included a questionnaire eliciting demographic information (age, years as a priest, level of mental health training, and parish setting) and information about the respondent's comfort level with identifying and responding to mental illness. Four vignettes described cases of mania, major depression, domestic abuse, and moderate alcohol use. Respondents chose to handle cases themselves or refer to a fellow priest, family or friends, a mental health professional, a primary care physician, or other. Data were collected between October and November 2011. The study was granted exemption by the institutional review board of the University of North Carolina at Chapel Hill.

Forty-eight priests completed the survey (response rate of 15%–20%). Most (87%) felt comfortable recognizing mental illness, and most (87%–92%) sent vignette patients for additional services when circumstances were severe (for example, mania, domestic abuse, and suicide risk). Most (85%) felt that it was either “critical” or “important” that providers have a similar religious or philosophical worldview, which suggests that although priests may have concerns about providers' handling of specific matters of faith or morals, most understood the need to involve other providers in a crisis.

Although the low response rate limits generalizability, Catholic priests appeared to understand and feel comfortable with their role in the caregiving system. Future research could explore the types of people and problems that priests encounter and the referral process and identify areas of common ground to facilitate collaboration. Nonetheless, priests can be seen as able and willing partners in community mental health providers' efforts to identify and treat people with mental illness, domestic abuse, or substance abuse problems.