This article is an excerpt transcribed from an interview recorded for a CMDA Matters podcast episode released in September 2024 with CMDA CEO Mike Chupp, MD, FACS; CMDA Senior Vice President of Bioethics and Public Policy Jeff Barrows, DO, MA (Ethics); and Stephen Grcevich, MD. During the conversation, they discussed mental health and the church, as well as how mental health relates to gender and identity. To listen to the full episode, visit cmda.org/cmdamatters.

 

                                                                                                                                                           

 

Mike Chupp, MD, FACS: We’re discussing the impact of kids with mental health disorders and their families who genuinely want to be involved in their churches, as well as how mental health relates to gender and identity. Let’s talk about the ministry you founded some time ago.

 

Stephen Grcevich, MD: Key Ministry has been in existence now for over 20 years, and our focus is working with churches to help them welcome, serve, include and share the gospel with families who have children with disabilities with a unique focus on “hidden disabilities”—any emotional, behavioral, developmental or neurologic conditions where there aren’t outwardly apparent physical symptoms. Part of how this got started was, I was serving on the elder board at our church, and we had a large cohort of families in the mid to late 1990s, after the fall of the Iron Curtain, who went to Russia and Bulgaria and adopted kids with complex medical, neurological, emotional and behavioral issues. These were stalwart families in the church who had been involved in leadership and in serving.

 

I’m sitting in an elder board one night and the woman who, at the time, was leading our family ministry efforts was talking about some of the challenges these families were having staying involved with church, because the issues they were having with their kids were getting in the way of them being able to attend worship, to stay involved with their small groups or to serve in the capacities they’d been serving. At the time I was running a large multidisciplinary child psychiatry group in suburban Cleveland, Ohio, and I’m thinking, “I wonder how much of an issue this is for the kinds of kids and families who are coming through a practice like ours.”

 

At the time, the most common things we were dealing with were kids with anxiety, kids with ADHD, kids with mood disorders like depression or bipolar disorder and kids on the high end of the autism spectrum. In an informal way, over the next few months, as families cycled through our practice for follow up, we asked each of them one question: “Did the problems that led you to come to our practice significantly impact your family’s ability to attend church or your place of worship?”

 

I was floored by the stories I started hearing from folks. I was spending a lot of time traveling around doing grand rounds or doing other lectures for healthcare professionals, and wherever I would go, I would start talking about some of the work our church was doing trying to support families in situations like these. The church started getting inundated with requests from around the country. That’s how Key Ministry got started. It’s helping churches be able to recognize the needs in terms of sharing the gospel and the imperative need for supporting families in being fully engaged and involved in Bible-believing churches where they can hear the gospel preached, come to faith and grow in faith and use their gifts and talents to serve other people.

 

Jeffrey Barrows, DO, MA (Ethics): You’ve also written a book entitled Mental Health and the Church: A Ministry Handbook for Including Children and Adults with ADHD, Anxiety, Mood Disorders, and Other Common Mental Health Conditions. The title implies you believe the church has not done a good job in addressing mental health problems; is that your perspective? If so, can you talk to us about the premise of the book?

 

Dr. Grcevich: It’s not just that I believe the church has a role here, it’s that we have an overwhelming amount of evidence that argues, in my belief, families who are impacted by mental illness may in fact be the largest underserved population by the church in North America. There was a study published about six years ago based upon over a quarter million interviews conducted as part of the National Children’s Health Survey. One of the questions they asked as part of that survey was, “Has your family attended a church or place of worship at any point in the last year?”

 

Andrew Whitehead, a sociologist and father of two sons with autism, did a deep dive looking at the data and at the relationship between the presence in the home of a child with a disability and family church attempts. To nobody’s surprise who operates in my world, having a child with an autism spectrum disorder decreases the likelihood a family will set foot in church by 84 percent; 73 percent if you have a kid with depression; 55 percent if you have a kid with a disruptive behavior disorder, oppositional defiant disorder or conduct disorder; 45 percent if you have a child with an anxiety disorder; and around 20 percent if you have a child with ADD or ADHD.

 

Data from the 2011 Baylor Study of Religion suggests when you look at adults who have symptoms of anxiety or depression on any given Sunday, they’re somewhere between 50 to 60 percent less likely than their peers in the community to be at church. One of the things we’re hearing more of in the church, given the mental health crisis our society is experiencing, is the need to do more to care for and support people who are in the church. Almost the entire thrust of what we’re doing in mental health ministry is associated with care and support of people who are already coming to church. The burden the Lord has given me is to try to help the church recognize the need for the gospel among individuals and families who are impacted by these conditions and aren’t currently attending church.

 

One of the things Key Ministry is doing on an annual basis is to hold an event called Disability in the Church, which is the largest disability ministry conference in North America. This year we held our first Mental Health in the Church conference in suburban Cleveland, specifically to blend these two ideas to help people in the church integrate the need for better care and support of folks who have these struggles who already identify as Christian with the urgent need for evangelism and outreach to folks who are outside of the church. Part of Mental Health and the Church was an attempt to lay out a model for churches to pursue and develop a mental health outreach and inclusion strategy in the communities they serve.

 

Dr. Chupp: Are you still seeing a reticence in the church today to get engaged in doing ministry with those who are suffering with mental health?

 

Dr. Grcevich: There’s clearly a reticence. When I look at the whole mental health ministry movement, we’re about 15 years behind. Part of where we have struggled is this notion about the extent of some of the struggles people have associated with mental health. Is this something that is neurobiological or is this something that is indicative, for example, of someone’s skin condition or indicative of a lack of faith? One of the struggles we’ve had is that having a mental health condition is very much stigmatized in the church.

 

A Lifeway study surveyed several unchurched adults. 55 percent of them disagreed with the statement that if they had a mental health issue, they would be welcome at church. In the book, we look at some of the things that get in the way of individuals and families who have struggles being part of church. Part of the model is helping churches think about this in terms of seven different barriers using a cultural model of disability.

 

Certain attributes about church culture make it more difficult for folks who have some of these mental health struggles to fit in. The first one is stigma. In that same Lifeway survey, they surveyed adult family members of other adults who had serious mental illness, and when they asked those families what their churches could do that would be most helpful to them, the number one answer was for their pastors to talk about these issues from the pulpit. In doing so, it then gave them permission to share their struggles within the context of their relationships in the church and their small groups. A lot of folks perceive this to be not something people who are in the church are necessarily comfortable talking about with other church members.

 

Dr. Barrows: We do hear a great deal about the negative impact of social media, especially on our children and adolescents today. I am thinking about a recent book by Dr. Jonathan Haidt called The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness. Do you agree social media is causing an epidemic in our children?

 

Dr. Grcevich: Absolutely. I think the evidence is incontrovertible if you look at the United States and Western culture and some of the things Haidt presents in his book. He makes several arguments for why we’ve seen the mental health crisis in kids over the last 10 years, particularly the advent of smartphones. We’ve reached a sort of a tipping point where the majority of teenagers have smartphones. He makes a compelling argument in the book and traces data, again, not just in the U.S. but across all other Western cultures, showing a significant spike in rates of anxiety after smartphones got in the hands of our kids. One of the other arguments he makes is we don’t give kids enough opportunity to take risks and explore the world, and that our society, beginning in about the 1990s, became very overprotective of kids. He’s an advocate for what some folks have described as free-range parenting—we need to let kids have the opportunity to play without adult supervision and to actively encourage kids to be more independent. One of the points I think he made that’s very compelling is many parents are concerned about predators in the world, but our kids are much more likely to encounter predators online than they are in the real world. Part of the argument he makes is in addition to the images kids are bombarded with and the way algorithms some apps use to feed information to kids, is combined with excessively protective attitudes we have about our kids that contributes to why we’ve seen the explosion and rates of anxiety we have in recent years.

 

Dr. Chupp: Sometimes as a parent, it is hard to avoid hypocrisy because we are so in tune with our smartphones. In terms of your recommendations to parents of children, teens or young adults, tell me what you’re telling these parents.

 

Dr. Grcevich: One of the things I tell parents is kids learn how to deal with their anxiety by watching how parents deal with anxiety. I think we have to be conscious of how to model for our kids how to deal with some of the challenges we’re all dealing with. Our kids learn from watching us. If we don’t want them using smartphones at dinner, we can’t be checking our smartphones at dinner ourselves.

 

Some of the recommendations I thought Haidt made in his book make sense based upon my read of the ever-expanding research literature dealing with this topic. He strongly recommends kids not be given smartphones with internet access until they enter high school and they not be allowed to sign up for social media apps until they’re, at a minimum, 16 years old. This is something folks can think about in our schools and in our churches, is that it’s very hard for individual parents to manage this issue alone. The reality is if their kid doesn’t have a way of connecting and staying in touch with other kids, that in and of itself is going to be a problem. The parents need to come together, and this can happen through a church or a Christian School. One of the arguments Haidt puts forward in the book is schools, regardless of whether they’re public or private, need to take a strong stand in this and eliminate the availability of smartphones and technology where kids can access social media during the school day. They need opportunities to be able to build the kinds of social skills they’re going to need to fully function and to reach their potential as adults. We need networks of parents to come together to be unified in taking a stand about safe and appropriate access of technology for kids, so then we have a greater opportunity to be successful in terms of setting healthy limits on kids.

 

Dr. Barrows: In previous conversations, we talked about your concern especially with the American Academy of Pediatrics’ and the American Psychiatric Association’s approach to gender dysphoria. I’d like you to elaborate on what those concerns are as a psychiatrist yourself.

 

Dr. Grcevich: Over the last couple of years, I have become so embarrassed and ashamed by some of the trends I see in our profession where we’ve lost the ability to look at data objectively. A lot of folks in leadership positions in our professional societies have essentially been hijacked by the sexual revolution and by a political agenda. This is probably most dramatized in terms of the approach folks are taking to what’s referred to as gender-affirming care in kids. Our colleagues across Europe are looking at the data and questioning our approach to what I would argue is probably one of the most vulnerable subsets of kids we see within the pediatric age group. At the same time they’re slamming the brakes on this and calling attention to the fact the data doesn’t support what we’ve been doing, the professional societies here in the United States are doubling down on these practices.

 

One of the reasons I recently joined CMDA is it’s important that healthcare professionals who are more evidence based have places to get together, resources and connection with one another to strengthen and support one another in terms of how we deal with issues like this.

 

Dr. Chupp: Would you talk about the association of mental health problems with those who identify as transgender, as well as neurodevelopmental disorders?

 

Dr. Grcevich: Let me start with the mental health disorder issue. One of the things we know is this is an extraordinarily vulnerable population. A 2022 study showed that, of the kids who presented or identified as having gender dysphoria, 70 percent of them met criteria for at least one anxiety disorder, and close to 60 percent of them met criteria for major depression. Nearly half of them met criteria for post-traumatic stress disorder, and 56 percent of these kids were involved in chronic self-injurious types of behavior. A study looked at the variance and mental health outcomes between kids with gender dysphoria and kids who identified as gay and lesbian, and nearly 20 percent of the variance specifically was attributed to the higher incidence of trauma among kids who have gender dysphoria. We’re exposing these kids to particularly risky and unproven treatments with serious long-term consequences in many instances, it appears, without doing the kind of careful diagnostic assessment necessary to separate that out from other neurodevelopmental conditions. This is scandalous.

 

Dr. Barrows: As a child and adolescent psychiatrist, why do you think it’s important for Christian healthcare professionals like yourself to get connected to organizations like CMDA?

 

Dr. Grcevich: Our professional societies have been captured by this ideology. For a number of years now, I don’t feel like I’ve belonged at the child psychiatry meetings. On a day-to-day basis, I’m running into more devoutly Christian colleagues who are afraid to speak up about stuff like this. As healthcare has shifted over time, it’s important for those of us of faith in the profession to network with one another, to be able to encourage one another and to support one another. One of the most important things I can do as a Christian physician is to represent truth. Jesus calls Himself the way, the truth and the life. Truth has been abdicated at the expense of pursuing a certain political agenda. We need to be connected with one another to strengthen and support one another in our faith and to share effective strategies for being able to continue to practice within the system in a way that is consistent with our faith and displays integrity with the teaching of the Bible. If we are going to be a positive force to bring about the change and restore certain things to the practice of healthcare that we’ve lost in the last several decades, we need to be networked together. We need to be collaborating with one another. We need to be encouraging one another, and we need to be platforming one another to amplify some of these voices within the profession. I’m grateful CMDA provides us an opportunity to do that.

 

Dr. Chupp: Those of us who have had a career behind us, we’re speaking out because we know those who are younger are at high risk. We know we’re in a war here for truth. In a war, we talk about a resistance. For our younger listeners, what are some ways they can be part of a resistance to this onslaught of truth in the area of gender identity?

 

Dr. Grcevich: One of the things we can do is make ourselves available to mentoring our younger colleagues. We have to model and be the change we desire to see in other people. It becomes easier to be brave when you see other people around you demonstrating bravery. When you think about the early church, they saw the leaders of the church being brave and bold and continuing with the power of the Holy Spirit to speak out while they were being persecuted. That was a period of time when the church experienced its most rapid growth. More than anything else, we have to model for our younger colleagues that we can speak out about these things, and we know in the end, Jesus wins. We have to keep all of that in perspective in speaking out and advocating for our patients and advocating for our profession at such a time as this.

 

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About the Author

Stephen Grcevich, MD (Northeast Ohio Medical University), is a child and adolescent psychiatrist serving as President and Founder of Key Ministry. Dr. Grcevich is the primary spokesperson and vision caster for Key, leads efforts to build collaborations with pastors, leaders and other ministry organizations, represents the ministry as a speaker at major conferences throughout the year and serves as Program Chair for Disability and the Church and Mental Health and the Church, Key’s national conferences. His writing has been featured by the ERLC, D6, Outreach Magazine, the American Association of Christian Counselors and the National Association of Evangelicals. His book, Mental Health and the Church (Zondervan, 2018), presents a strategy for evangelism and outreach with individuals and families impacted by mental illness. In addition to his work on behalf of Key Ministry, Dr. Grcevich is an experienced clinician, researcher and medical school professor with more than 35 presentations at major medical conferences. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI) and was a participant in the 2019 White House Summit on Mental Health.