The Possibility of Clergy Cooperating with Mental Health Professionals: Factors Associated with Clergy Willingness to Refer Congregants to Mental Health Services

Abstract

Background: With the increasing need for mental health support in the United States, the role of clergy is one that has the potential of identifying and connecting congregants in need with professional mental health services. However, little is known about the factors related to clergy’s mental health referral-making behavior. Objective: This study aims to examine the overall patterns of mental health referrals made by United Methodist Church (UMC) clergy and to explore the factors associated with referral behavior. Clergy’s personal experience with mental health service use is hypothesized as a key predictor, while additional covariates, including mental health status, occupational well-being, spiritual well-being, church characteristics, and general demographics, are analyzed as exploratory variables. Method: Secondary data analysis of the 2023 wave of the Clergy Health Initiative Longitudinal Survey, a biennial survey to which all United Methodist clergy with appointments in North Carolina are invited, was conducted. Clergy who was appointed to a church and who received a survey item on their frequency of referring congregants to mental health services were included in the analysis (n = 454). Multivariate regression analysis was performed in which the frequency of mental health referral-making was regressed on the participant’s personal mental health service use, several mental health variables including three components of burnout (emotional exhaustion, depersonalization, and personal accomplishment), and several demographic variables including church size and urban/rural church status. Results: A large majority of clergy (81.7%) in this study reported having referred congregants to mental health services. In terms of frequency, 37% reported referring once or twice in the past year, 32.2% reported referring more than twice but less than monthly, while 12.6% reported making referrals monthly or more often. Clergy with current or past mental health service use were significantly associated with a higher frequency of referring congregants to mental health services. Higher personal accomplishment and higher depersonalization were associated with greater reported frequency of making mental health referrals. Additionally, clergy serving in medium-sized churches and those located in more urban areas reported greater frequency of referrals. Conclusion: This study’s findings suggest that clergy are actively engaged in referring congregants to mental health services, with the majority having made at least one referral in the past year. Clergy with personal experience of mental health treatment were more likely to refer, indicating that those without such experience may benefit from greater exposure to mental health services to build positive attitude in making referrals. Professional well-being like feelings of personal accomplishment and depersonalization, and contextual factors like church size and geographic location were also related to referral behavior. These results imply that both a strong sense of occupational fulfillment and the awareness of personal stress may support referral practices through different yet reinforcing pathways. As these findings are limited to United Methodist clergy in North Carolina, future studies should examine referral practices across other denominations, faith communities, and regions.