How Can I Be Helpful? A guide for providing pastoral care to young people in a mental health crisis
/Note: The Office of Youth and Young Adult Ministries is grateful to the Rev. Ed Cardoza, Eva Dalzell, Beth Graham LICSW, Brian Litzenberger PhD, Emily Sugg, the Rev.. Christopher Whiteman, and other members and friends of the Adolescent Mental Health Network for their help in creating this guide and its related resource lists.
This guide is designed to offer some ideas and things to consider for a clergy person or youth worker supporting a young person through a mental health crisis. We will cover the ways that an adolescent may arrive in your care, some things to consider while talking to adolescents in crisis, and tips for building supports in that relationship, offering further resources, and making plans to follow up.
Making Contact
There are different ways that a crisis might come to your attention. Each situation will be unique, and yet there are some patterns to be aware of, depending on the circumstances.
When a young person comes to you, it’s important for both you and the young person to have a clear sense of what you can and can’t do in a pastoral relationship. Early in the conversation, explain to the young person that this is confidential, sacred space, EXCEPT if you learn that they are going to harm themself OR if someone has harmed them. In these cases, it CAN’T be confidential.
Please also keep in mind that, when an adolescent has reached out to you, they are showing a great deal of trust and vulnerability. Try to honor that trust however you can.
Throughout the initial conversation, as you triage and assess, lead with open-ended questions such as “What is going on? What's up? What brings you to this conversation? How are you doing? How are you feeling?”, and How can I be helpful?”
If you already have a relationship with a young person and can tell something’s not right, don’t be “cagey.” Be honest, curious, and direct, without being threatening. Ask the young person to talk. You can create some space and give teenagers agency and control of their situation. Give them the sense that you are there for them. (For more on being direct, see “Ask the Hard Questions,” below.)
If someone else has reached out to you about this person, it may be because the young person told their parents that they’d like to talk to the clergy or youth leader. On the other hand, it could be the caretaker’s idea entirely, which makes it even more necessary to hold clear and firm boundaries. Clergy and youth leaders must be very careful about what is shared with parents. It is often tempting for us to share, and this may not be the right thing to do in a given situation. Again, explain to the young person: this is confidential, sacred space, EXCEPT if you’re going to harm yourself OR if someone has harmed you. In these cases, it CAN’T be confidential.
Having the talk
There are many things to keep in mind while talking to a young person in crisis. Some are outlined above— trust that they are the experts in their own experience and be honest about your role and the boundaries you are setting. Here are a few more things to consider.
Set boundaries:
Make sure you have appropriate boundaries and follow “Safe Church” guidelines. You can meet at a coffee shop, for example, and still have plenty of privacy. Or you could sit outside the church, if you know another adult is nearby in the building.
If you’re meeting virtually, please check out our suggestions for Safeguarding in Digital Space.
If you’re considering saying something to a young person’s parents, is saying something going to be helpful? Trust your instinct but check your impulse.
Define the relationship between yourself and the young person. Make it clear how often you are able to check in (is this a one-time meeting to get the young person connected with the resources they need, or will you meet again for ongoing pastoral support?). It may be helpful to clearly articulate here that pastoral care is NOT therapy, but that you are still here to listen and to help however you can.
Keep context in mind:
There are many things that could be impacting a young person’s life. This is by no means an exhaustive list, just a few things to keep in mind as possibilities.
Young people recognize (for the most part) that the stigma is starting to disappear and may already have a “scaffolding” system in place for help.
It’s important to remember that they are the expert regarding their own experience, especially if they hold identities different to yours. Black and Indigenous People of Color and LGBTQ+ people, in particular, have additional issues to cope with.
It’s tempting for young people to look up symptoms on the internet and, though self-diagnosis is not the last stop, a young person saying that something is wrong is usually a pretty good sign that something is, in fact, wrong, and a self-diagnosis can be an important first step to getting a professional diagnosis and help.
The young person in question have recently grown out of pediatric care and this may be a crisis inflection point.
There is particular complexity around addiction: more young adults – now freshmen and sophomores in college – are struggling with addiction and are looking for treatment. Clergy are always encouraged to refer out and not try to “fix it” in this and other such situations.
The youth may be self-harming, drinking or isolating, etc. Try to determine if this is a “boiling point,” a point at which it is necessary to involve professional help immediately.
Ask the hard question:
If you are concerned that the young person is at risk of hurting themselves or someone else, it is important to ask that question. Here are key questions to ask if you are concerned about suicide:
Do you feel like harming yourself?
Do you have the means to do this?
Do you have a plan?
Please note that if you assess that the level of lethality in that moment ((how likely someone is to harm themselves or someone else) is high, action needs to be taken to ensure safety at that moment. However, if lethality is not high but suicidal ideation is present, additional supports for the person have to be brought in. This is an important place to remind the young person you’re talking to that that you will have to let someone know if there is serious risk behavior going on and that there are certain things that you can't keep secret.
Widen the circle of care
As a clergy person or youth leader, you can be an ally by NOT “spiritualizing” a young person’s emotional pain. Assuring a young person in crisis, for example, by telling them that “God is holding them close to Her bosom” may be helpful but is not sufficient. Science and faith are not mutually exclusive, and it’s important to be there for pastoral care while also recognizing when it’s necessary to refer a young person to professional help.
Pastoral care is a powerful tool and should definitely not be the only thing in your toolkit. Clergy & youth leaders should build a list of mental health care providers to refer out to, including school counselors and local mental health care providers. We have compiled some hotline numbers that we hope will be helpful to get you started.
Peer support for caregivers can be stabilizing to those who are dealing with a particular kind of concern about their child. You might ask a caregiver if they’re aware of any parent support groups in the area and, if not, help them get connected with such a group. It’s important for both youth and parents to realize that there are many groups to help! Make sure that they aren’t isolated and that they have resources.
In the meantime, you can offer what you can: a listening ear, an outside perspective, and a companion in prayer. Pray with them, not for something but just for their awareness of God’s presence and love for them.
Thank you for taking the time to be an ally and a resource to the young people in your community and your ministry. There are resources out there to help you and the young people and families in your care. (Not enough, but there are some.) We’ve compiled some, but if you’d like to share some that you’ve found helpful, or get connected with more resources or other youth workers who are supporting young people in crisis, we’d love to hear from you!
