"I HAVE had enough, Lord. Take my life; I am no better than my ancestors," Elijah says, in the first book of Kings. Elijah's depressive lament is just one from several biblical characters that show depression is not a modern malaise, especially among people of faith.

Sad moods, physical exhaustion, a sense of hopelessness, and a loss of perspective are some of the symptoms of a devastating illness whose worst outcome can be suicide. For some, it is triggered by life events: trauma, stress, loss, or burnout. For others, depression can be what is known as "endogenous" - it is a biological vulnerability.

The Mental Health Foundation says that one in four adults experience at least one diagnosable mental-health problem in any one year. Anxiety and depression is the most common mental disorder in the UK: between eight and 12 per cent of the population are depressed in any one year (The Office for National Statistics Psychiatric Morbidity Report, 2001).

As scripture shows, people of faith are not immune to depression. And at a General Synod fringe-meeting on mental health in February 2012, the former Archbishop of Canterbury Lord Williams signed the "Time to Change" pledge, a campaign run by Mind, and Rethink Mental Illness, to end the discrimination and stigma against people with mental-health illness.

The Ven. Arthur Hawes, Archdeacon Emeritus of Lincoln and Canon of Lincoln Cathedral, has held various senior and advisory positions on mental health in the Church of England and the NHS. He says that the stigma arises out of fear. "People are afraid, particularly of what they can't see. Unless you're a professional, and you know what you're looking for, you can't see mental illness."

In the Church, there can be an added problem, he says. "There are still some Christians who see it as linked to sin in one way or another. And even if they don't do that, they can be made to feel guilty about it."

A senior consultant in psychiatry, spirituality, and ethics at a Christian clinic in Switzerland, Dr Samuel Pfeifer has written widely on Christianity and depression. He says that stigma concerning depression among Christians often comes down to a wrong understanding of faith: that Christians should be happy all the time.

"It is very hard when we think that faith just means enjoying the Lord, enjoying prayer, enjoying praise, to come into a situation or mood where this isn't possible any longer," he says.

"Then people think that this is antagonistic to their faith, because it is antagonistic to their emotion. . . [They can think] it's also antagonistic to God's plan for their lives. I think that's a wrong connection."

Sue Atkinson, a Christian author, wrote Climbing out of Depression in 1993. More than 20 years later, misconceptions about depression are still prevalent, she says. "Some people are clearly more up to date, but there's still a huge number of people who think that real Christians don't have these kind of problems."

Not understanding depression can lead to simplistic responses that require the sufferer to try harder, or pray harder, to beat their symptoms. "When you have a significant bereavement, most people wouldn't dream of saying 'Pull yourself together.' But they do with depression."

And, she says, among some wings of the Church, "there tends to be the attitude: 'If you just pray, you'll be fine; so clearly it's your fault,' -which, of course, it isn't."

Mrs Atkinson has found the best support outside the Church, through the charity Depression Alliance. "It's a lot of people who are depressed, supporting each other. I've found that hugely helpful - sometimes more than the church community. There's no blame, no shame."
 

CLERGY are not immune from depression. Figures quoted by St Luke's Healthcare for the Clergy show that 30 per cent of clergy say that they have suffered from depression since becoming an ordained priest, and 18 to 25 per cent of all clergy are depressed at any one time.

The Anglican Association of Advisors in Pastoral Care and Counselling (AAAPC) is a network of pastoral-care advisers and other professionals for the dioceses, providing training, counselling, and support for clergy. Last year, it surveyed all of its advisers to determine what the key pressures were for clergy. Stress, relationships, depression, and having to be a financial manager, came out on top.

"Clergy often feel that they have to be on duty 24/7, and that they live in something of a goldfish bowl," the secretary of AAAPC, Heather Vernon, says. "The expectations that people have of them can be huge."

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Sue Clements-Jewery is a consultant to the Churches' Ministerial Counselling Service (CMCS), and chairs its steering group. The CMCS is an ecumenical counselling service that also provides counselling to clergy in Southwark diocese. She says that conflict can be a significant source of stress for clergy.

"Congregations are declining, so change is very necessary, and that's stressful and threatening for everybody," she says. "Often the person who is the initiator of change is a target for negative feelings, and that leads to clergy getting stressed and depressed."

The Revd Paul Brown (not his real name) took early retirement at the age of 45, after three breakdowns while in ministry. He feels that his situation could have been avoided if he had had more support earlier.

"It was only after my breakdown that a mentor was put in place for me. This was a retired, experienced member of the clergy, who gave me his card. Had this been in place from when I was made vicar, rather than after the horse had bolted from the stable, things may have been different" (see panel, opposite).

To address the need for support, some dioceses, such as Salisbury, Worcester, and Exeter, are running "reflective practice" groups: confidential groups, facilitated by a pastoral-care adviser who is a qualified counsellor or therapist, where eight to ten clergy from a diocese meet monthly to provide peer support.

Pastoral-care advisers can also get involved in offering preventive support, such as resilience training, to help deal with stress and adversity. "Resilience is essentially helping clergy to reflect, become more self-aware, to recognise in themselves stress, negative thinking, and how to combat it. It's aimed to catch problems before they arrive," Mrs Vernon says.

St Luke's Healthcare for the Clergy is also offering help. Last autumn, it announced plans to offer a range of new "well-being" services. To help dioceses gain an accurate picture of clergy mental health,and then to plan appropriate support for dioceses, it is offering an anonymous online clergy questionnaire.

It has been used "in at least four dioceses so far", and there are "about half a dozen more" planning to use it, the chair of trustees, Edward Martineau, says.

St Luke's can also provide reflective-practice workshops and resilience training, and will part-fund these services if all three elements (questionnaire, reflective-practice groups, and resilience workshops) are taken together. "We are hoping to be at the forefront of mental well-being for the clergy," Mr Martineau says.
 

RACHAEL COSTA suffered from depression throughout her teens. She set up the charity Think Twice to challenge the stigma of depression and mental illness, and now runs courses for churches on mental-health awareness.

Miss Costa understands that it can be difficult to be open about depression in church. "There's a perception you have to be OK, because you have to be a good witness, and if you're crying all the time you're not being a good witness."

But this perception can be damaging, she says. "Not only does it force people to hide how they're feeling, but it can really push people away from church, because they can't be themselves. They can't say to people: 'Actually I'm having a really hard time today.' Depression is very isolating. Often it makes you somebody who is not very nice to be around."

It is just at this time of isolation, however, that church congregations can respond, and become places of healing, she says. "To have a community around you who are willing to sit with you when you can't be entertaining, and to help you do things that you can't do. We need to make it more normal to reach out in the same way that we would when someone's physically unwell."

Dr Christopher Findlay, who sits on the Executive of the Spirituality and Psychiatry Special Interest Group of the Royal College of Psychiatrists, says that relationship is essential in helping a depressed person out of his or her isolation.

"Mental ill-health and depression can be a change process whichcan lead to positive developments. Often, people can get caught in the pain - it's kind of a switching down, because it's too painful to face whatever the issues might be.

"Part of the therapeutic relationship, whether it's through a friend, a professional person, or clergy person, is to 'warm up' the distress so people can express it more freely. Then they can process it."

Churches that can foster openness and support can play a keypart in helping to support people with depression, an ordinand inthe Church of England, Haydon Spenceley, says (see panel opposite). Last year, he felt prompted, when leading worship at his church, to speak out about his own battle with depression and suicidal thoughts.

He was overwhelmed by the response from people, many of whom said afterwards: "It's amazing you said that, because I feel just like that."

In response to what he shared in the service, Mr Spenceley says that people began to come forward to pray. "There were people there who'd been depressed or suicidal for years, and had never mentioned it to people at church, and they were suddenly praying with each other, or offering to help each other, or offering to share meals.

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"I think there's been a shift in the Church: we're actually talking about stuff, now. One of the ways the Church can be Kingdom-focused, and show something alternative to the world, is by offering a welcome to people regardless."

The Revd Eva McIntyre is co-­ordinator of Mental Health Mat­ters, a new website set up for the Church of England to share re­­sources, best practice, and advice on how churches can deal with mental-health issues. She agrees that the Church is in a unique position to help remove stigma and offer sup­port.

"Time to Change's research shows that faith communities come out in a very good light, by and large, in terms of welcoming people. I think we could, potentially, be funded to be in the position of encouraging people towards self-referral and pre­venting escalation. Not doing huge amounts, but by being a welcoming, supporting community.

"We've got all these buildings; we've got people who care, and who are motivated. It would be quite simple to increase the input we have into making it less likely that people end up in A&E and secondary ser­vices."

Speaking out is the only way to take the fear and stigma out of
de­­pression, she says. "We must talk: we must gently say it's there, and find creative ways to allow other people to say 'This is me, is it OK, and can I have some help, please?'"

Other support structures may soon come into place. Mental Health Matters evolved out of fringe meet­ings at the Church of England General Synod, and is part of the work of the Committee of and among Deaf and Disabled People in Ministry Division. The Bishop of Salisbury, the Rt Revd Nicholas Holtam, who chairs the committee, acknowledges the work going on at national, diocesan, and congrega­tional level.

"The committee is well aware of the scale of need, and also of the diverse ways in which churches and individuals do amazing work in the area of mental health. It is at the heart of the concerns of any active congregation.

"There is a need to connect up the many excellent pieces of work and the many excellent individuals and groups who do them. The com­mittee is exploring ways of creating a stronger network to support them."

The Revd Susan Bull and the Revd Michael Preston are trustees of Love Me, Love My Mind, a small charity in Epsom that provides support for people with mental-health issues. Part of its work includes a weekly Monday drop-in at St Barnabas's, Epsom, for people with mental-health issues. 

"The drop-in was set up in 2006," Miss Bull says. "It's open to every­one, especially for people with mental-health issues, but we get semi-homeless people, people with drug and alcohol issues, and people struggling financially.

"Every week, we have tea, coffee, and chat, sharing the joys and sor­rows of life. Volunteers cook a freshly made meal, and we all sit down to eat together. We always celebrate birthdays.

"The ethos is that we are human beings together - it's not 'us and them' at all. We go on outings, and have speakers chosen by any mem­ber of the group on topics we find helpful. The church is open during the drop-in: people can go and pray if they want to, light a candle, or just sit in silence in church."

Miss Bull would like to see other churches run similar groups. "We are passionate that what we do
is not rocket science, but that it saves lives. We have no special training.

"We are all on a spectrum of men­tal health, and can all be kicked into touch in the blink of an eye. When we are in that place, what actually helps is people to sit alongside us, not to judge us, and even to sit in the mess with us."

THERE are good reasons for hope, Dr Pfeifer says. "Depression in most cases is a self-limiting disorder. It can be pre­vented and treated. With medica­tion, with talk therapy, we can really accomplish a very good improve­ment. Many, many people give witness to that." 

He says that churches can play a significant part in helping someone with depression. "The fellowship in a church can be very supportive. Also, there is comfort in one-to-one conversation; or even a sermon can be very helpful for the depressed in a church, especially when a pastor is thinking of the depressed people [there]." 

Mr Hawes says: "We shouldn't duck the healing mission of the Church, because the Church prays for people. Often, if I say to people, 'I'm thinking about you in my prayers,' they're usually very grate­ful - and people still are grateful, even in a secular society." 

Mental Health Matters, in con­junction with Inclusive Church, may soon be able to provide train­ing courses for churches on mental-health issues. And "Welcome Me As I Am", a not-for-profit community-interest company, has a pack avail­able, originally created for Roman Catholic churches.

"We want to make mental health an OK subject to talk about; and, secondly [provide] awareness train­ing of what is and isn't a mental-health issue," the charity's director, Ben Bano, says. "There's a differ­ence between normal loss and be­reave­ment, and something clinical called depression. We can make people aware of those boundaries." 

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Churches also need to be clear on when to suggest that someone seeks professional help, Mr Spence­ley warns. "Churches shouldn't try and completely solve the problem. . . If it becomes a thing where someone needs to talk to a trained counsellor, or take anti-depressants, or be sec­tioned, the Church has no place doing something else. Signposting is the best thing to do. 

"But the Church should be, in my view, a place where everyone has a welcome, regardless of anything. You can disciple people once they're in. . . But the first thing you should do is let them in."

cmincs.net

depressionalliance.org

inclusive-church.org.uk

time-to-change.org.uk

pastoralcare.org.uk

rcpsych.ac.uk/college

samuelpfeifer.com

stlukeshealthcare.org.uk

thinktwiceinfo.org

time-to-change.org.uk

mentalhealthmatters-cofe.org

welcomemeasiam.org.uk

1. Accept the depressive person in their illness and trouble, and show readiness to accompany them through this difficult time. 

2. Talk over the patient's life-history. Explore with them the experiences that triggered the depression. Give them the opportunity to empty their heart. 

3. Emphasise the outcome of the condition. Most depressions improve after a time. 

4. Explain treatment options, and send those with a severe depression to their GP. 

5. Encourage the person, and speak about God's love, even when he or she feels little of it. Use psalms, and scripture promises.

6. Prepare them for occasional mood-swings: the road out of depression is lined with potholes, but leads up to the light. 

7. Set one goal at a time. Depressed people are often so hemmed in that they can only take in a little at a time.

Demanding: 'pull yourself together'

Depressed people are already placing themselves under a massive burden of self-imposed obligations, and suffering as a result of their supposed failure. It is of little help to add to this pressure.

Sending them on holiday/leave

Even in familiar surroundings, it is difficult for depressed people to make contact with people, enjoy beauty, and fill their day on their own initiative, which is what will be required of them on holiday.

Allowing them to make big decisions

Often, a depressed person is not capable of properly evaluating his or her situation. Decisions taken during a depressive phase will often be recognised afterwards as wrong. 

Superficially asserting: 'things are already better'

For a depressed person, things are the same, week after week. It is better to affirm that they are still going through the "valley of the shadows", and to affirm the presence of God in their darkness. 

Casting doubt on delusional ideas

Many people suffer from the delusions of guilt and failure. Be patient, and convince the sufferer they are valued. The promise in 1 John 3.19-20 is helpful: "We can set our hearts at rest in his presence, whenever our hearts condemn us. For God is greater than our hearts, and he knows everything." Close the conversation to give time to digest. 

Entering into the depressive condition

Avoid being drawn in and forgetting what they are still capable of, and what gives them security. The balance is in Psalms: time and again, the "nevertheless" breaks into the personal trouble of the praying person, and directs their gaze above. 

Making too many spiritual demands

Without reference to God's promises, pastoral care is reduced to idle talk. But an abundance of scripture, which lacks relationship to everyday life and to the depressed person's suffering, can leave the person unable to receive God's word and feeling condemned.

When studying the Bible intensively, a severe depressive will tend only to read the thoughts endorsed by their darkened perspective. I advise depressed people to read just one verse each day - preferably with an explanation in a devotional book.
 

Adapted, with permission, from Supporting the Weak: Christian counselling and contemporary psychiatry (Paternoster Press, 1994) by Samuel Pfeifer. www.samuealpfeifer.com

Haydon Spenceley will take up his first curacy this summer. He has cerebral palsy, and is a wheelchair user, which he links to his struggle with depression

WHEN I was 15, I woke up one day and thought: "I'm going to be disabled my whole life." It dawned on me that this wasn't the kind of condition you recover from. That started it for me, really.

I was in a conservative Evangelical church [which] kept talking about how when you sin it's killing Jesus. I'd basically been a good kid; it really messed with me for a while. It was like an existential crisis. Most of my twenties was like that, even though I did quite well academically, and I worked in churches and [did] a few other things.

With the variant of cerebral palsy I have, tiredness is an issue. I'd get tired, and spiral into negativity, thinking I wasn't any good. I'd focus on all my mistakes, and on things from the past that were long forgotten. It went unchecked because I thought everyone was like that.

Then, a couple of years ago, it dawned on me that maybe it wasn't necessary to be like that. I still sink occasionally, but I'm trying to slow my life down, trying to manage things better, and allow myself to be loved more. I think I'm still depressed, but I know what I'm doing with it.

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Between that, and being in a wheelchair, I have quite a clear picture of my reliance on God, the thorn-in-the-flesh stuff that Paul talks about. If I had everything together, and was able to physically get around, I'd be a lot more arrogant. I wouldn't feel like I needed anybody, and definitely not God.

[Having] grown up with lots of people helping me, I have a picture of God who sustains me, and has healed me many times. If you have a period when you want to die, basically, and you don't feel like life's worth living, then you don't have that feeling any more; that's kind of miraculous for me.

Paul Brown developed depression while he worked as a priest. Now that he works in the NHS, he feels that his condition can be a potential asset 

IN MY first parish as a vicar, I found myself in a united benefice of two parishes. They were very different. Rightly or wrongly, I felt a pressure to perform.

There were problems between the parishes. People looked to me to solve the problems. But any talk of change brought about such reactions from the congregation, and the wider community in one parish, that I now understand what went on as bullying. I experienced immense isolation as the only member of clergy.

After two years, I had my first breakdown. I was off work for about three months. I was to suffer again within 12 months, with, again, about three months off work.

Three years after my second breakdown, I moved into a team ministry. I was Team Vicar, with a Team Rector over the whole team. The church had very able people, a great PCC. It was very different. I had a curate as well. I enjoyed working with him, and training him.

But I had another breakdown after about 12 months. I then saw a psychiatrist through the NHS, and a community psychiatric nurse. They said: "You need to imagine yourself like an elastic band that's been stretched and under stress. Now you've come into this new job, and that stress isn't there. It's gone 'ba-doing' back into place. It's a reactive thing: your body has now just collapsed."

I resigned because I was asked to. The Bishop had no other means or tools to work with [me]. They recognised that stress was a major contributing factor, because they'd been told by a psychiatrist I had seen through St Luke's Hospital for the Clergy, after my first break­down.

It was said that: "We can't take the stress away from the job; so we'll need to take you away from the stress. The only way we have to do that is to offer you early retirement due to ill health," which felt like a big blow.

The Bishop said: "Think that we've just pushed the pause
button. . . At the moment this is the only thing we can do. We're releasing you to a new and creative ministry, free from the stress of the parish.'

I have since been diagnosed as having bipolar disorder, and now work two-and-a-half days a week as a hospital chaplain. Recently, I worked with someone who tried to commit suicide. I've shared part of my story with them, which they found very helpful.