Recognizing and Responding to Mental Health Crises
A Resource for Pastors in Virginia
Dear Pastor,
We recognize the profound role you play in the lives of those you shepherd. As a trusted leader, you are often the first person someone turns to in moments of crisis, especially when struggling with mental health challenges. We understand that every church approaches these topics differently. Our goal is simply to provide information that may be helpful when individuals in your congregation come to you for support.
Recognizing a Mental Health Crisis
A mental health crisis can take many forms. It may present as:
Severe Anxiety: Persistent, excessive worry that is difficult to control, often accompanied by physical symptoms such as rapid heartbeat, sweating, dizziness, restlessness, and difficulty concentrating. Someone experiencing severe anxiety may appear constantly on edge, have trouble engaging in conversation, or express irrational fears.
Depression: A prolonged state of sadness, hopelessness, or emptiness. Signs may include fatigue, loss of interest in activities once enjoyed, changes in appetite or sleep patterns, difficulty concentrating, feelings of worthlessness, or talk of death or suicide.
Suicidal Thoughts or Behaviors: Expressions of hopelessness, talking about wanting to die, self-harming behaviors, or making plans to end their life.
Psychosis (Hallucinations, Paranoia, or Delusions): Seeing, hearing, or believing things that are not real, exhibiting extreme suspicion of others, or holding onto fixed false beliefs even when presented with contrary evidence. A person experiencing psychosis may have disorganized speech, erratic behavior, or appear disconnected from reality.
Extreme Mood Swings or Erratic Behavior: Rapid shifts in mood, from euphoria to deep sadness, impulsivity, reckless decision-making, or aggression. These may indicate bipolar disorder or another mood-related condition.
Substance Abuse Spiraling Out of Control: Using drugs or alcohol as a coping mechanism, increased consumption over time, and inability to stop despite negative consequences.
Uncharacteristic Withdrawal: Isolating from family, friends, work, or faith activities, showing a lack of motivation, and disengaging from responsibilities.
How You Can Help
1. Provide a Listening Ear
Your presence and willingness to listen can be deeply meaningful to someone in distress. Creating a space where people feel heard, without pressure to disclose more than they’re comfortable with, can help them feel less isolated. It can be tempting to immediately share advice, scripture, or encouragement, but sometimes, listening first is the most powerful way to offer support. In moments of deep pain, people may need to feel heard and understood before they are ready to receive guidance. A compassionate ear can lay the foundation for meaningful pastoral guidance.
2. Know When to Refer
While prayer and pastoral counseling can offer immense comfort, there may be times when professional support is necessary. Certain mental health challenges require an additional partnership of specialized care to help work through biological, mental, and emotional roadblocks to recovery. Consider referring someone to a licensed mental health professional in the following situations:
Suicidal/Homicidal Ideation or Self-Harm: If an individual expresses thoughts of harming themselves or others, further assessment is needed. If the individual has no plan or intention to act on their suicidal/homicidal thoughts, a referral to an outpatient therapist may be sufficient. However, if the individual has a plan and intention to harm themselves or others, immediate crisis intervention is necessary. (A list of resources is listed below.)
Severe Depression or Anxiety: When symptoms persist despite pastoral support, or when they interfere with daily functioning, professional therapy can provide additional tools and strategies.
Substance Abuse and Addiction: If someone is struggling with addiction, they may need medical detox, rehabilitation, or structured counseling beyond what a pastoral setting can offer.
Psychotic Symptoms: If an individual is experiencing hallucinations, delusions, or extreme paranoia, they require psychiatric care to ensure safety and stability.
Trauma and Abuse Survivors: Individuals who have experienced significant trauma, including physical or sexual abuse, may benefit from trauma-informed therapy to work through their experiences safely.
Severe Mood Swings or Unstable Behavior: Those exhibiting patterns of extreme emotional highs and lows, aggression, or impulsivity may need clinical evaluation for conditions such as bipolar disorder or personality disorders.
Chronic or Unresolved Emotional Pain: If someone repeatedly seeks help for the same emotional distress without improvement, professional counseling may offer new strategies for healing.
Guiding individuals toward professional care in these cases is not a failure of pastoral leadership but rather an act of wisdom and compassion. Recognizing when to refer can help ensure the best possible support for those in need.
Integrity Counseling Collective is happy to offer faith-integrated counseling throughout the state of Virginia, as well as educational resources and support for churches. The Center for Apostolic Counseling and Psychology Today are additional resources for locating professional therapy near you.
3. Emergency Protocols for Crisis Situations
If there is an immediate threat of harm, such as plan and intent to harm oneself or others, or an inability to keep oneself or others safe, call 911 and request a crisis intervention team (CIT)-trained officer. You can also search to see if your city/county has a 24/7 mobile crisis intervention team that can assess the situation.
For 24/7 mental health crisis support, encourage congregants to call or text 988, the National Suicide and Crisis Lifeline. An additional hotline is Christians in Crisis (1-844-472-9687).
For local mental health support in Virginia, contact your Community Services Board (CSB). CSBs provide crisis response, counseling, and mental health services tailored to your region. To find your nearest CSB and other emergency resources, visit https://dbhds.virginia.gov/contact/need-help/ or call the Virginia Mental Health Access Program at (804) 298-3300.
If substance abuse is involved, reach out to the Virginia Department of Behavioral Health’s Addiction Helpline at (804) 786-3906.
Caring for Yourself as a Pastor
Supporting others through crisis can be emotionally taxing. Pastoral burnout is real, and your well-being matters. Seeking guidance, building your own support network, and making space for rest are important steps in maintaining your ability to serve effectively.
We’re Here to Support You
Our agency is available as a resource should you need information, training, or consultation. If you have questions about navigating difficult conversations or connecting someone with help, please don’t hesitate to reach out at 757-895-7953 or info@integritycollective.org. You do not have to handle these situations alone.
With gratitude for your service,
Integrity Counseling Collective PLLC
This resource was created by Integrity Counseling Collective PLLC, dedicated to supporting faith communities in addressing mental health with compassion and care.
