Clergy-Provided Mental Health Services

A Strategy for Addressing Disparities in Scale-up Efforts




Health disparities, underserved populations, mental health services, scale-up, task-shifting, clergy


Most individuals with mental health needs do not receive professional care. One strategy to narrow this service provision gap is task-shifting, a process where certain responsibilities are shifted to less specialized workers. Approximately 25% of those who seek mental health care turn to clergy. This study investigated the suitability of using clergy to scale-up mental health service provision by assessing perceptions of satisfaction and helpfulness with clergy-delivered services. Using data from the National Comorbidity Survey Replication (2003), we found most respondents (n=204) who went to clergy reported satisfaction with their care (92%) and that the services were helpful (94%). Ordered logit regression revealed that racial/ethnic minorities and individuals for whom religion was more salient were disproportionately likely to find clergy-delivered mental health services satisfying and helpful, while older adults were more likely to report the services were helpful. The results suggest incorporating clergy in mental health scale-up plans via task-shifting may be a viable option, particularly for addressing the mental health needs of underserved racial and ethnic minorities, as well as older adults. Social workers—at least in theory—are well-positioned to collaborate with clergy in the process of implementing task-shifting.

Author Biographies

Cole Hooley, Brigham Young University

Assistant Professor

School of Social Work

Yi Wang, The University of Iowa

Assistant Professor

School of Social Work

David Hodge, Arizona State University


School of Social Work


Ahmad, F., Jhajj, A. K., Stewart, D. E., Burghardt, M., & Bierman, A. S. (2014). Single item measures of self-rated mental health: A scoping review. BMC Health Services Research, 1-11, 398.

Alang, S. M., & McAlpine, D. (2020). Treatment modalities and perceived effectiveness of treatment among adults with depression. Health Services Insights, 13, 1-7.

Alang, S. M., & McAlpine, D. D. (2019). Pathways to mental health services and perceptions about the effectiveness of treatment. Society and Mental Health, 9(3), 388-407.

Alegria, M., Jackson, J. S., Kessler, R. C., & Takeuchi, D. (2016). Collaborative psychiatric epidemiology surveys (CPES), 2001-2003 [United States]. Inter-university Consortium for Political and Social Research [distributor].

Ali, O. M., & Milstein, G. (2012). Mental illness recognition and referral practices among imams in the United States. Journal of Muslim Mental Health, 6(2), 3-13.

Association of Religion Data Archives. (2000). The 2000 American rabbi study.

Aten, J. D., & Worthington, E. L. (2009). Next steps for clinicians in religious and spiritual therapy: An endpiece. Journal of Clinical Psychology, 65(2), 224-229.

Babbie, E. (2016). The practice of social research (14th ed.). Cengage.

Boorstin, B., & Schlachter, E. (2000). American association of pastoral counselors and Samaritan Institute Report. Greenberg Quinlan Research, Inc., M., Dolan, S. L., Padilla, J. I., & Stanford, M. S. (2014). Psychologists and clergy working together: A collaborative treatment approach for religious clients. Journal of Spirituality in Mental Health, 16(3), 149-170.

Boorstin, B., & Schlachter, E. (2000). American association of pastoral counselors and Samaritan Institute Report. Greenberg Quinlan Research, Inc.

Brown, J. Y., & McCreary, M. L. (2014). Pastors’ counseling practices and perceptions of mental health services: Implications for African American mental health. Journal of Pastoral Care & Counseling, 68(1-2), 1-14.

Byers, A. L., Arean, P. A., & Yaffe, K. (2012). Low use of mental health services among older Americans with mood and anxiety disorders. Psychiatric Services, 63(1), 66-72.

Chalfant, H. P., Heller, P. L., Roberts, A., Briones, D., Aguirre-Hochbaum, S., & Farr, W. (1990). The clergy as a resource for those encountering psychological distress. Review of Religious Research, 31(3), 305-313.

Chatters, L. M., Mattis, J. S., Woodward, A. T., Taylor, R. J., Neighbors, H. W., & Grayman, N. A. (2011). Use of ministers for a serious personal problem among African Americans: Findings from the national survey of American life. American Journal of Orthopsychiatry, 81(1), 118-127.

Chevalier, L., Goldfarb, E., Miller, J., Hoeppner, B., Gorrindo, T., & Birnbaum, R. J. (2015). Gaps in preparedness of clergy and healthcare providers to address mental health needs of returning service members. Journal of Religion and Health, 54(1), 327-338.

Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: A global return on investment analysis. Lancet Psychiatry, 3(5), 415-424.

Corley, N. A., & Young, S. M. (2018). Is social work still racist? A content analysis of recent literature. Social Work, 63(4), 317-326.

Covino, N. A. (2019). Developing the behavioral health workforce: Lessons from the states. Administration and Policy in Mental Health and Mental Health Services Research, 46(6), 689-695.

Dalencour, M., Wong, E. C., Tang, L., Dixon, E., Lucas-Wright, A., Wells, K., & Miranda, J. (2017). The role of faith-based organizations in the depression care of African Americans and Hispanics in Los Angeles. Psychiatric Services, 68(4), 368-374.

Deimling Johns, L., Power, J., & MacLachlan, M. (2018). Community-based mental health intervention skills: Task shifting in low- and middle-income settings. International Perspectives in Psychology: Research, Practice, Consultation, 7(4), 205-230.

Dorsey, S., Gray, C. L., Wasonga, A. I., Amanya, C., Weiner, B. J., Belden, C. M., Martin, P., Meza, R. D., Weinhold, A. K., Soi, C., Murray, L. K., Lucid, L., Turner, E. L., Mildon, R., & Whetten, K. (2020). Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): Protocol for a stepped wedge cluster randomized trial. BMC Psychiatry, 20(10), 1-14.

Doyle, C., Lennox, L., & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open, 3(1), 1-18.

Ellison, C. G., Valler, M., Flannelly, K. J., & Weaver, A. J. (2006). The clergy as a source of mental health assistance: What Americans believe. Review of Religious Research, 48(2), 190-211.

Farrell, J. L., & Goebert, D. A. (2008). Collaboration between psychiatrists and clergy in recognizing and treating serious mental illness. Psychiatric Services, 59(4), 437-440.

Fortin, M., Cao, Z., & Fleury, M.-J. (2018). A typology of satisfaction with mental health services based on Andersen’s behavioral model. Social Psychiatry and Psychiatric Epidemiology, 53(6), 587-595.

Garland & Yancey (2014)

Garland, D. R., & Yancey, G. I. (2014). Congregational social work: Christian perspectives. North American Association of Christians in Social Work.

Gonçalves, J. P. B., Lucchetti, G., Menezes, P. R., & Vallada, H. (2015). Religious and spiritual interventions in mental health care: A systematic review and meta-analysis of randomized controlled clinical trials. Psychological Medicine, 45(14), 2937-2949.

Gottlieb, M. (2020). The case for a cultural humility framework in social work practice. Journal of Ethnic & Cultural Diversity in Social Work, 2020, 1-19.

Grant, K. L., Simmons, M. B., & Davey, C. G. (2018). Three nontraditional approaches to improving the capacity, accessibility, and quality of mental health services: An overview. Psychiatric Services, 69(5), 508-516.

Harris, M. G., Kazdin, A. E., Chiu, W. T., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Altwaijri, Y., Andrade, L. H., Cardoso, G., Cía, A., Florescu, S., Gureje, O., Hu, C., Karam, E. G., Karam, G., Mneimneh, Z., Navarro-Mateu, F., Oladeji, B. D., … Kessler, R. C. (2020). Findings from World Mental Health Surveys of the perceived helpfulness of treatment for patients with Major Depressive Disorder. JAMA Psychiatry, 77(8), 830-841.

Health Resources and Services Administration [HRSA]. (2016). National projections of supply and demand for selected behavioral health practitioners: 2013-2025.

Hedman, A. S. (2014). Perceptions of depression, counseling and referral practices, and self-efficacy reported by Minnesota clergy. Pastoral Psychology, 63(3), 291-306.

Hodge, D. R. (2007). Progressing toward inclusion? Exploring the state of religious diversity. Social Work Research, 31(1), 55-63.

Hoeft, T. J., Fortney, J. C., Patel, V., & Unützer, J. (2018). Task-sharing approaches to improve mental health care in rural and other low-resource settings: A systematic review. Journal of Rural Health, 34(1), 48-62.

Hoge, M. A., Stuart, G. W., Morris, J. A., Huey, L. Y., Flaherty, M. T., & Paris, M. (2017). Behavioral health workforce development in the United States. In Workforce development theory and practice in the mental health sector (pp. 433-455). IGI Global Publications.

Hoge, M. A., Stuart, G. W., Morris, J., Flaherty, M. T., Paris, M., & Goplerud, E. (2013). Mental health and addiction workforce development: Federal leadership is needed to address the growing crisis. Health Affairs, 32(11), 2005-2012.

Hook, J. N., Worthington, E. L., Davis, D. E., Jennings, D. J., Gartner, A. L., & Hook, J. P. (2010). Empirically supported religious and spiritual therapies. Journal of Clinical Psychology, 66(1), 46-72.

HRSA. (2018). State-level projections of supply and demand for behavioral health occupations: 2016-2030 (p. 51). National Center for Health Workforce Analysis.

Institute of Medicine. (2015). Psychosocial interventions for mental and substance use disorders: A framework for establishing evidence-based standards. The National Academies Press.

Jackson-Jordan, E. A. (2013). Clergy burnout and resilience: A review of the literature. Journal of Pastoral Care & Counseling, 67(1), 1-5.

Jameson, M. T., & Naugle, A. (2013). Attitudes toward empirically-supported treatments among pastoral mental health care providers: Exploratory findings and future directions. Journal of Pastoral Care & Counseling, 67(3), 1-12.

Javadi, D., Feldhaus, I., Mancuso, A., & Ghaffar, A. (2017). Applying systems thinking to task shifting for mental health using lay providers: A review of the evidence. Global Mental Health, 4(e14), 1-32.

John, D. A., & Williams, D. R. (2013). Mental health service use from a religious or spiritual advisor among Asian Americans. Asian Journal of Psychiatry, 6(6), 599-605.

Kessler, R. C., & Merikangas, K. R. (2004). The National Comorbidity Survey Replication (NCS-R): Background and aims. International Journal of Methods in Psychiatric Research, 13(2), 60-68.

Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa, S., Hiripi, E., Jin, R., Pennell, B.-E., Walters, E. E., Zaslavsky, A., & Zheng, H. (2004). The US National Comorbidity Survey Replication (NCS-R): Design and field procedures. International Journal of Methods in Psychiatric Research, 13(2), 69-92.

Kolla, B. P., He, J. P., Mansukhani, M. P., Frye, M. A., & Merikangas, K. (2020). Excessive sleepiness and associated symptoms in the U.S. adult population: Prevalence, correlates, and comorbidity. Sleep Health, 6(1), 79-87.

Kovess-Masfety, V., Dezetter, A., de Graaf, R., Haro, J. M., Bruffaerts, R., Briffault, X., Gilbert, F., Codony, M., Alonso, J., & ESEMeD/MHEDEA 2000 Investigators. (2010). Religious advisors’ role in mental health care in the European Study of the Epidemiology of Mental Disorders survey. Social Psychiatry and Psychiatric Epidemiology, 45(10), 989-998.

Kuramoto-Crawford, S., Han, B., Jacobus-Kantor, L., & Mojtabai, R. (2015). Differences in patients’ perceived helpfulness of depression treatment provided by general medical providers and specialty mental health providers. Psychiatric Medical Comorbidity, 37(4), 340-346.

Kutner, M. H., Nachtsheim, C. J., & Neter, J. (2004). Applied linear regression models (4th ed.). McGraw-Hill/Irwin.

Lehmacher, 1997

Lehmacher, E.K. (1997). The parish or church social worker’s counseling role. Social Work & Christianity, 24(1), 34-57.

Lippens, T., & Mackenzie, C. S. (2011). Treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services. Journal of Clinical Psychology, 67(12), 1197-1209.

Long, J. S., & Freese, J. (2014). Regression models for categorical dependent variables using Stata (3rd ed.). Stata Press.

Lukachko, A., Myer, I., & Hankerson, S. (2015). Religiosity and mental health service utilization among African-Americans. Journal of Nervous and Mental Disease, 203(8), 578-582.

McGuire, T. G., & Miranda, J. (2008). Racial and ethnic disparities in mental health care: Evidence and policy implications. Health Affairs, 27(2), 393-403.

Milstein, G., Manierre, A., Susman, V. L., & Bruce, M. L. (2008). Implementation of a program to improve the continuity of mental health care through Clergy Outreach and Professional Engagement (C.O.P.E.). Professional Psychology: Research and Practice, 39(2), 218-228.

Muehlhausen, B. L. (2010). Dual degree programs in social work and divinity: Graduates’ experiences of "journey companions [Unpublished doctoral dissertation]. Indiana University.

National Academies of Sciences, Engineering, and Medicine. (2017). Training the future child health care workforce to improve the behavioral health of children, youth, and families: Proceedings of a workshop. National Academies Press.

Neighbors, H. W., Musick, M. A., & Williams, D. R. (1998). The African American minister as a source of help for serious personal crises: Bridge or barrier to mental health care? Health Education & Behavior, 25(6), 759-777.

Newport, F. (2012). God is alive and well: The future of religion in America. Gallup Press.

Nguyen, A. W., Taylor, R. J., Chatters, L. M., Taylor, H. O., & Woodward, A. T. (2020). Professional service use among older African Americans, Black Caribbeans, and Non-Hispanic Whites for serious health and emotional problems. Social Work in Health Care, 59(3), 199-217.

Nortje, G., Oladeji, B., Gureje, O., & Seedat, S. (2016). Effectiveness of traditional healers in treating mental disorders: A systematic review. Lancet Psychiatry, 3(2), 154-170.

O’Connell, B., Young, J., & Twigg, D. (1999). Patient satisfaction with nursing care: A measurement conundrum. International Journal of Nursing Practice, 5(2), 72-77.

Olfson, M. (2016). Building the mental health workforce capacity needed to treat adults with serious mental illnesses. Health Affairs, 35(6), 983-990.

Oppenheimer, J. E., Flannelly, K. J., & Weaver, A. J. (2004). A comparative analysis of the psychological literature on collaboration between clergy and mental-health professionals—perspectives from secular and religious journals: 1970-1999. Pastoral Psychology, 53(2), 153-162.

Oxhandler, H. K., Parrish, D. E., Torres, L. R., & Achenbaum, W. A. (2015). The integration of clients' religion and spirituality in social work practice: A national survey. Social Work, 60(3), 228-237.

Payne, J. S. (2009). Variations in pastors’ perceptions of the etiology of depression by race and religious affiliation. Community Mental Health Journal, 45(5), 355-365.

Payne, J. S. (2014). The influence of secular and theological education on pastors’ depression intervention decisions. Journal of Religion and Health, 53(5), 1398-1413.

Pew Research Center. (2014). Religious landscape study.

Pew Research Center. (2019). In U.S., decline of Christianity continues at rapid pace: An update on America’s changing religious landscape.

Pillion, T., Reed, R., & Shetiman, B. (2012). Mental illness recognition and referral by Catholic priests in North Carolina. Psychiatric Services, 63(5), 510-511.

Puyat, J. H., Kazanjian, A., Goldner, E. M., & Wong, H. (2016). How often do individuals with major depression receive minimally adequate treatment? A population-based, data linkage study. Canadian Journal of Psychiatry, 61(7), 394-404.

Queener, J. E., & Martin, J. K. (2001). Providing culturally relevant mental health services: Collaboration between psychology and the African American church. Journal of Black Psychology, 27(1), 112-122.

Stickley, A., Waldman, K., Sumiyoshi, T., Narita, Z., Shirama, A., Shin, J. I., & Oh, H. (2020). Childhood physical neglect and psychotic experiences: Findings from the National Comorbidity Survey Replication. Early Intervention in Psychiatry, 1-7.

Substance Abuse and Mental Health Services Administration. (2017). Behavioral health barometer: United States, volume 4.


Sullivan, S., Pyne, J. M., Cheney, A. M., Hunt, J., Haynes, T. F., & Sullivan, G. (2014). The pew versus the couch: Relationship between mental health and faith communities and lessons learned from a VA/clergy partnership project. Journal of Religion and Health, 53(4), 1267-1282.

Thyer, B. A., & Myers, L. L. (2009). Religious discrimination in social work academic programs: Whither social justice?. Journal of Religion & Spirituality in Social Work: Social Thought, 28(1-2), 144-160.

Trautmann, S., Rehm, J., & Wittchen, H. (2016). The economic costs of mental disorders. EMBO Reports, 17(9), 1245-1249.

United States Census Bureau. (2012). Statistical abstract of the United States.

van der Watt, A. S. J., van de Water, T., Nortje, G., Oladeji, B. D., Seedat, S., Gureje, O., & Partnership for Mental Health Development in Sub-Saharan Africa (PaM-D) Research Team. (2018). The perceived effectiveness of traditional and faith healing in the treatment of mental illness: A systematic review of qualitative studies. Social Psychiatry and Psychiatric Epidemiology, 53(6), 555-566.

VanderWaal, C. J., Hernandez, E. I., & Sandman, A. R. (2012). The gatekeepers: Involvement of Christian clergy in referrals and collaborations with Christian social workers and other helping professionals. Social Work & Christianity, 39(1), 27-51.

Vermaas, J. D., Green, J., Haley, M., & Haddock, L. (2017). Predicting the mental health literacy of clergy: An informational resource for counselors. Journal of Mental Health Counseling, 39(3), 225-241.

Veroff, J., Kulka, R. A., & Douvan, E. (1981). Mental health in America. Basic Books.

Wang, P. S., Berglund, P. A., & Kessler, R. C. (2003). Patterns and correlates of contacting clergy for mental disorders in the United States. Health Services Research, 38(2), 647-673.

Wang, P. S., Demler, O., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2006). Changing profiles of service sectors used for mental health care in the United States. American Journal of Psychiatry, 163(7), 1187-1198.

Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629-640.

Weaver, A. J., Flannelly, K. J., Flannelly, L. T., & Oppenheimer, J. E. (2003). Collaboration between clergy and mental health professionals: A review of professional health care journals from 1980 through 1999. Counseling and Values, 47(3), 162-171.

Williams, L., Gorman, R., & Hankerson, S. (2014). Implementing a mental health ministry committee in faith-based organizations: The Promoting Emotional Wellness and Spirituality Program. Social Work in Health Care, 53(4), 414-434.

Wong, E. C., Fulton, B. R., & Derose, K. P. (2018). Prevalence and predictors of mental health programming among U.S. religious congregations. Psychiatric Services, 69(2), 154-160.

World Health Organization. (2008). Task-shifting: Global recommendations and guidelines. Author.

Worthington, E. L., Hook, J. N., Davis, D. E., & McDaniel, M. A. (2011). Religion and spirituality. Journal of Clinical Psychology, 67(2), 204-214.

Wrzus, C., Hänel, M., Wagner, J., & Neyer, F. J. (2013). Social network changes and life events across the life span: A meta-analysis. Psychological Bulletin, 139(1), 53-80.

Young, J. L., Griffith, E. E. H., & Williams, D. R. (2003). The integral role of pastoral counseling by African-American clergy in community mental health. Psychiatric Services, 54(5), 688-692.