Being A Pastor to Those with Mental Health Struggles

I want to tell you the story of “Molly.” Her story is one I have heard and encountered many, many times. Nothing I am about to share has been exaggerated.

I met Molly when she was 15 years old. She lived with her grandparents due to the inability of her parents to care for her as they struggled with addiction. Molly had struggled with her thought life since she was 11 or 12. She was a victim of a sexual assault at 13 and had recently started self-harming. She wore black, did not like being called by her given name, and had panic attacks when people talked about her family situation. The legal, physical, and spiritual knot that needed to be undone was complex.

By the time I met her, she was living in a safe environment, she was away from her assailant, was on medication, and was seeing a therapist. So what was left for a pastor to do?

Be Present

One couple in the church decided they wanted Molly in their life. It started with offering to take her out to lunch. It was the first of many shoulder-to-shoulder activities they would do with her. They would, of course, show up at events, but most of the time it was car rides, watching a movie, or sitting next to her at the doctor's office that brought opportunity. She was an artist, and so there were even times when they would sit and draw together (Romans 12:15).

There were two contrasting responses to Molly. One was that some people made it clear they wanted her to find somewhere else to go. They found it uncomfortable that she had started coming to Youth Group. They claimed her self-harm was just for attention. They implied her morals were loose.

The other response came from those who texted, spoke, and posted on social media that they “were there if you need me” or “praying for you.” My point is not to assume that those comments were disingenuous; they just never resulted in any shoulder-to-shoulder care (1 John 3:18).

Years later, Molly would comment that the thing she loved about this couple is that they never wanted anything from her. They never asked her to change. They never looked for Molly to give them emotional feedback that they were good people. They didn’t flinch any of the times she stumbled and found herself institutionalized for short periods. It was as if they just loved her, and that was the way it was (1 Corinthians 13:7).

What Ifs

My time with Molly involved a lot of conversations around the word “if.”
If God really loved me...
If God knows...
What if the Bible isn’t true...
What if I have to take medicine my whole life?

The first thing Molly needed to know was that “if” questions are not real questions. That's not to say they don’t come from real thoughts or feelings, just that they, by their nature, can't be answered. They are like roundabouts with no exit. “If” questions can't be answered with positive information or negative information. The word “if” implies that there is data missing. At the same time, it dismisses any data given.

So what needed to happen is that we had to work together to figure out how to ask the question without the word “if.” For example:

Instead of, “What if I have to take medicine my whole life?”

We can use:

• Will I have to take medicine my whole life?

• Does the need to take medicine for my whole life say something about me as a person?

• Does it say something about my faith?

• Does it mean God doesn’t love me?

All of these are questions any pastor can answer (James 1:5).

After a while, she started to stop herself and figure out how to ask me the question. She not only grew more capable of being able to communicate what she really wanted to know, it also gave her a pathway to start studying the Bible for herself.

Non-Linear Care

Every pastor knows that sanctification is not a straightforward process. We, as pastors, have our own personal experience making the same mistake more than twice, and we have watched people repeat behaviors over and over as God worked in their lives. Even the mighty Apostle Paul announced that he had not arrived at perfection (Philippians 3:12).

This understanding seems to disappear when we talk about mental health.

In most cases, caring for someone is going to be very linear. There will be a starting point A—let's say someone falls off a ladder and breaks their foot—and then an ending point B, where they are walking normally again. We cannot bring this expectation with us when it comes to the care of the soul.

Someone with obsessive-compulsive disorder may have long streaks where they can resist urges and live relatively normal lives, but most of the time, there is an episode of regression. The same can be said of those struggling with all manner of mental health issues. This is what makes caring for people who live in these storms so difficult. They seem better on Monday and so much worse on Thursday. We minister with a goal in mind, and one day it seems to be very close, and then another, further away than it has ever been.

What was needed in Molly's life was an understanding that some of what she deals with may never go away. Molly is an adult now and still struggles with bouncing in and out of people’s lives for fear of getting hurt. She will start and stop communication suddenly because of unexpected emotions or out-of-the-blue panic attacks. These things are not her, but it appears that for the rest of her life, they will be happening to her.

Staying in her life requires both having compassion for her struggles and having enough confidence that the sanctification process is still happening, even when there is nothing tangible to see (Philippians 1:6).

Conclusion

Molly’s story reminds us that significant mental health struggles do not disqualify someone from being ministered to—they require a ministry of presence that refuses to flinch, retreat, or reduce the soul to symptoms. No degree in psychology is necessary; only a willingness to sit, see, and stay.

These three practices—being present, reframing despairing questions, and embracing non-linear care—form a radically Jesus-shaped framework for shepherding souls that feel storm-tossed by their own minds. When churches embrace this kind of care, we bear witness to something unmistakable:

“Truly God is among you.” (1 Corinthians 14:25)

Tim Lyzenga has served as a pastor for 20 years in Michigan, West Virginia, Ohio, and Nebraska. He currently serves as the Pastor of Discipleship at Fellowship Church in Hudsonville and as an adjunct professor for Kuyper College. He has been married for 19 years, has four children, and is finally finishing his doctorate in counseling.