John Fikkert: 0:00

Church officers have more ability than they maybe even appreciate to create the environment within the church that is loving and safe. And just being a little more intentional about thinking through how do we do that and how are we, as Lindsay mentioned, how are we going to track if somebody tells us that they had a problem or a prayer request? In what ways are we going to follow up with that and care for this person over time?

David Nakhla: 0:26

Welcome to the Reformed Deacon, a casual conversation with topics specifically designed to help local Reformed Deacons. There are nearly a thousand deacons in the OPC alone, so let's take this opportunity to learn from and encourage one another. We're so glad you could join us. Let's jump into our next episode. Hi, my name is Adrian.

Adrian Crum: 0:45

Crum. I'm a pastor at Harvest Orthodox Presbyterian Church in the one another. We're so glad you could join us. Let's jump into our next episode. Hi, my name is Adrian Crum. I'm a pastor at Harvest Orthodox Presbyterian Church in the greater Grand Rapids, michigan area and I serve on the OPC's Committee on Diaconal Ministries. Today, on the Reformed Deacon Podcast, I'm joined by Reverend John Fickert and his wife, dr Lindsay Fickert. John serves as director of the OPC's Committee on Ministerial Care, supporting ministers through counseling, financial planning, sabbatical funding. It seems like you do a lot of things, john. He also works alongside Lindsay at Pella Counseling in Iowa. Lindsay has been a counselor since 2005 and brings a wealth of experience in therapy, psychological assessments and mental health training. I have to say, john and Lindsay, as a pastor who often tries to think through how much is my counseling going to be able to connect with people that are struggling through mental health difficulties and trials, I'm so excited to get to talk to you guys today. Thank you so much for coming on the podcast.

John Fikkert: 1:41

Yes, well, thank you for having us. We're looking forward to the conversation.

Lindsay Fikkert: 1:44

Yeah, good to be here.

Adrian Crum: 1:46

Excellent. So we're going to approach this kind of first from the angle of understanding mental health and then we'll dive into how do we recognize different needs for support and professional care? So I'll just open up with a general question what are some common mental health challenges people face today?

John Fikkert: 2:02

I would say, just to begin, the two most general categories to think about mental health struggles that people have are probably anxiety and depression, and those can be fairly common. Then a little bit more acute versions, like a higher anxiety than just general anxiety disorder, would be things like a panic disorder, or sometimes we talk about OCD obsessive compulsive disorder. A lesser known one would be trichotillomania hair pulling, which is also a form of an anxiety disorder. And then depression is likewise where there can be more acute versions of depression. One we often talk about, that I'll just throw in there is bipolar one and two disorders. They're much less common than depression but affect a significant number of people as well.

Adrian Crum: 2:48

Yeah, I saw my first case of cutting as a youth pastor this year. I had to kind of do some counseling, I had to do some reading and learning about it. I'd never observed it before, but from your perspective, lindsay, any general statements about things that are common?

Lindsay Fikkert: 3:04

Sure, I guess one thing that I would note too is that trauma is such a prevalent experience when you think about incidences of abuse and things like that that trauma can often form kind of like the underlying foundation for depression and anxiety. So you know, sometimes when we encounter people we encounter the symptoms that are consistent with depression and anxiety. But you know, there's a lot of underlying issues like trauma that can be the foundation for which those other symptoms emerge.

John Fikkert: 3:36

I can just add to that. In addition, if somebody seems like they're having a longer time recovering from a mental health struggle often there's trauma in the background that's leading to a slower recovery time.

Adrian Crum: 3:50

So this is a podcast specifically targeted for deacons. There's a thousand deacons in the OPC. I'm really excited for them to benefit from your insight. Why do you think it's really important that deacons specifically keep in mind that there are often mental health dynamics at work in their labor with people?

John Fikkert: 4:08

I think I would say one way to think about it as a deacon is when it rains, it pours, and if somebody's having one kind of a problem that you're trying to work with in mercy ministry, it's worth asking the question what else is happening in this person's life that might lead to these conditions? And considering someone's mental health would be part of a full assessment of all the needs that a person might have at a particular time.

Lindsay Fikkert: 4:32

And I would add to that, you know, mental health diagnosis, just by definition they must have a negative effect on daily functioning for them to even reach the threshold of a mental health diagnosis. And so you know, deacons are in a unique position in many ways to hear about or observe daily functioning right of the people within the congregation. So somebody struggling to complete tasks or go to work or struggling to pay bills or just manage the demands of life which are often the outcome of mental health issues. Not always, I mean sometimes those things exist separate from mental health, but because impairment in functioning is intrinsic to mental health difficulties, deacons have a very helpful vantage point on that.

Adrian Crum: 5:21

Excellent. So you take up our next question and topic there on recognizing a need for support and professional care. So how would you recommend that church leaders I'm a pastor, a youth pastor and I work in evangelism here at Harvest in Grand Rapids how would you recommend that we go about recognizing that there is a need, an individual mental health need, and that they are deteriorating over time?

John Fikkert: 5:44

I would say some of it is self-report, Like just by the words that they're using you can observe by what they're saying about themselves that this person sounds really anxious from the words they're using or really depressed. But then there's those other ways markers to notice, like Lindsay was just mentioning, those daily life tasks Like are they eating well? Are they sleeping? Are they getting eating well? Are they sleeping? Are they getting to work? Are they paying their bills? How is their house kept up? Some of those things are markers to say if that's not working out, what else might be going on in their life.

Adrian Crum: 6:16

So when do you think it is necessary or appropriate to seek professional care, and how should deacons go about facilitating that process? Is kind of a tricky question.

John Fikkert: 6:26

That is a tricky question, I think, when the problems you're noticing seem persistent and they're not improving quickly, and perhaps even you're noticing in the person you're trying to help I'm not sure they have the resources to pull out of this. You know, somebody could tell you they're sad and you might pray with them or be concerned for them. But if you're noticing their mood is really low and this has been sad like this for a while, and you might ask them, you know, is this a sadness that you're able to manage, or is this something you might need help with, and even how they might view themselves like no, I'm really stuck and being sad right now? Those would be some of the markers I'd be looking for.

Adrian Crum: 7:12

Excellent. I'll pitch this question to Lindsay. So most of our deacons at Harvest will not be trained, like the two of you are, as professional counselors. If a deacon meets up with their own limitation, how should we view the intersection of faith and deeds of mercy? Which deacons are equipped and trained to do with this question of professional mental health care, how do you view the three of them working together? Maybe you have a concrete example where you saw the church kind of working in this way.

Lindsay Fikkert: 7:42

That's a great question, you know, as somebody who's working with people in a professional setting maybe I'm seeing them one hour a week, right, and we're working on something related to depression and anxiety, and what I often find in that is that I actually have limits as a professional too. So, whereas you know, I have some training and skills to be able to offer someone who, say, suffering from depression at the end of the day, when the hour is up, because of the professional boundaries, there are things I can't do, Like I long to maybe, if they don't have a great support network, go and help them, you know, sort out their, you know mess in their kitchen so life feels less chaotic. Or I long to help somebody who's struggling with agoraphobia or difficulty leaving the home to go take a walk. But I have some constraints around what I can do, and so this is where partnership is so important.

Lindsay Fikkert: 8:38

You know, I have to stay in my lane, as it were, professionally, and I can't replace the things that deacons can do or the body of Christ can do to come alongside somebody in need, and so for me to be able to apply those skills but then to know that there are deacons or brothers and sisters in the Lord who are able to help with those kinds of operationalized, concrete helps and cares. That's really significant right, and I feel kind of handicapped in a way when I know that somebody doesn't have that kind of support because I can help them for that hour. But what can be done in the practical issues of their daily life? Who's going to come alongside them then? And so this is where that kind of partnering becomes really important and helpful.

John Fikkert: 9:32

If I could add to that, some of those partnerships might require a well-crafted release of information that the person you're trying to help agrees to, and then there can be communication, even between somebody who needs help and their pastor or elder or deacon.

Adrian Crum: 9:48

So a question that comes up, because this has happened quite a bit recently for us here at Harvest if a person is really nervous to release their information as a counselor, what would you tell them to say? This will really help you for your deacons or your pastors to know more about the counseling I'm offering to you.

Lindsay Fikkert: 10:05

You know, I actually have a very sort of present experience with that very thing right now, because I know someone who I work with, who's in a very good church, who I think has those resources available to them but has a lot of fear about those needs and maybe feels her particular needs are not as significant or not significant enough to ask for help.

Lindsay Fikkert: 10:27

And so part of counseling sometimes is just helping people think through their objections to the things that might be helpful to them. And you know, where does that belief come from? Are there any sort of distortions that might be making it difficult for you to ask for help, sometimes even reframing, you know, and saying this is a season where you need help, but there might be other seasons where you are the one providing help to someone and you know you being able to access and receive help is an important piece of communicating that you are willing to give it later. So you know, those kinds of conversations can prime the pump, as it were, for people to be more willing to reach out and ask for help. You know, I'm obviously going to respect their decision on that, but I can be just someone who maybe presents it slightly differently or helps them challenge some beliefs or distortions that might be getting in the way.

John Fikkert: 11:22

At the heart of therapy, as well as at the heart of a deacon's work, is consent.

John Fikkert: 11:28

You need consent on the part of the person that needs the help, and if they're not willing to offer consent, part of honoring them is to honor their agency in that, and to just violate it or push against it too hard can harm them as well. So that's just something to keep in mind. And then one specific detail, just as an application if a deacon were to know there was no release of information, but a deacon were to know that somebody was meeting for therapy with a particular therapist, they could call the therapist. The therapist could not confirm or deny that they have that person as a client. But it can still be a one-way communication where I just want to let you know this information about client X, that such and such a thing are happening in their home and we have these concerns about the way they're living their lives, and the professional can receive that information and just take it can receive that information and just take it, and that's, I'll say, from the perspective of a pastor.

Adrian Crum: 12:28

That's often one of the weaknesses is on our part, we don't take the initiative, we're too afraid to kind of start those partnerships and stuff like that. So there is too much of a wall between professional caregivers and the church, and so deacons don't reach out or pastors don't reach out and just take the initiative and say, hey, this is what I can share right now. So I think in an optimum situation, all those people are in the same congregation, agreed, great. But unfortunately it doesn't often seem to be that way. So you guys have observed many, many different cases, which I think is the most helpful thing. With experience, what are signs in your mind that there is need for more intensive care, including immediate intervention, or someone needs to be referred to professionals? And then I'll tag on another question If you see that in someone, how would you recommend a deacon who's maybe embarrassed or doesn't know how to actually broach that topic with someone? How would you recommend actually going about having a conversation saying, hey, I'm concerned for you.

Lindsay Fikkert: 13:26

I think probably the most immediate thing that comes to mind is anytime somebody is endorsing suicidal thoughts. You know, with some plan and means and intent, that's an immediate let's get this person to the emergency room kind of scenario, and I can speak more to that in a moment. But other situations that might demonstrate that there's a heightening crisis or need for more intensive care would be situations like someone who has a significant mental health issue, like bipolar disorder or schizophrenia, and they stop taking their medication. Behaviors start to become erratic. Other situations, especially with bipolar, you might see people engaging in risky behavior, more dangerous behavior, spending a lot online gambling, promiscuous behavior that's out of character for them. Those would be indications that it's time to take a more intensive approach. You know even things like people's physical presentation. You know when they're not showering and they're not maybe eating well or things like that, and you can see a very visible manifestation even in their home. Sometimes you know something that represents a significant change from previous functioning. I think is a signal that there's something that might require more immediate attention. I think is a signal that there's something that might require more immediate attention. To your second question you know how do you respond to that potentially as a deacon. I think if it's something like a matter of personal danger, like suicidal ideation, or if somebody is expressing thoughts of wanting to harm someone else, that's just an immediate trip to the emergency room. Else, that's just an immediate trip to the emergency room, like hey, we need to go get you assessed. And you know the deacon doesn't need to be in the place of making that assessment, whether or not someone's actually a danger to themselves or someone else. There are professional social workers that work in hospital settings that do that assessment. So it's really about you know communicating. Hey, I think you're in a place where we just might need another person to come alongside and we just need to make sure you're safe and I'll come with you, or you know we'll take you there.

Lindsay Fikkert: 15:30

For other situations it can be a little delicate, right, like how do you observe with someone that you know their physical appearance has changed or their home is in disrepair? And I think just some wisdom in the way that it's said, like coming from a humble posture you know we're all subject to weakness and to difficulties and times of struggle and kind of that posture of you know, but for the grace of God, go I. So it starts with that kind of a posture and then, I think, maybe even listening, asking some questions and then you know, eventually having, I think, resources on hand. So this is maybe a little beyond what you've asked, but I think it can be really helpful for churches, deacons, elders and pastors to get to know the resources in their area so that when a crisis comes up it's not like a scramble. For where do we go? What do we do, but who do we trust? Right? What medical providers have we gotten to? What do we do, but who do we trust, right?

Lindsay Fikkert: 16:25

What medical providers have we gotten to know in our community? What counselors have we vetted and, you know, already done the work? You know what is our nearest emergency room or is there, you know, a crisis unit that comes to someone's home? You know some communities have those. So kind of getting to know those resources so that in that moment you can gently say to the person you know some communities have those so kind of getting to know those resources, so that in that moment you can gently say to the person you know I care about you. And it seems like things are really hard right now and I wonder if we could help you get connected with some people who have the tools and the skills to work through this, and it's not a handoff. I'm going to walk with you through it, too, in the ways that I can, but I want to invite some other people to be able to help you out right now.

John Fikkert: 17:13

I want to comment on one specific part agreeing with everything that Lindsay just said, and that would be how does a deacon broach the subject? And this is just a basic communication suggestion. But if you use an I statement rather than a you statement, that can be a really big deal. So a you statement would be like you know you look terrible or you look depressed or something's wrong with you. You know it's all those you things and it's you giving your assessment to that person of what you think is wrong. Versus, if you start with an, indicate something about you that you're sad and you might want some help, and I think that's a more humble way to approach it if you use some sort of an I statement rather than a you statement an I statement rather than a you statement.

Adrian Crum: 18:26

That's really wise. Yeah, that's helpful to frame it. I think one thing that can happen if deacons are not recognizing really big waves of anxiety in someone or someone who's really crippled with depression, is to draw a kind of connection between bad deeds and bad consequences and like, hey, you're really messing up in different ways and we want to teach you responsibility. How do you recommend people slow down maybe in that value judgment and say, hey, there's more going on than just what you see, kind of on the surface?

John Fikkert: 18:54

Yeah, and that's where you know if you go in and you're a firefighter and you got to crash down the house and start spraying water everywhere, that's absolute emergency time. But most of the work as a helper or as a deacon is being a listener, not a firefighter, and so, like I'm still gathering information, I'm still trying to understand something, and being slow to judgment and quick to listen is always a good approach.

Lindsay Fikkert: 19:24

Yeah, I tend to think of that in terms of like, there's the stuff we see on the outside and sometimes you know you can think about that as the fruit. But I want to usually try to help get to the root of what's happening so as to understand what's needed right. And that is a matter of listening, of humility, of approaching things with gentleness and, you know, not just at the level of behavior and compliance, but really at the level of who is this person, what do they need, and you know what might be going on under the surface.

John Fikkert: 20:03

Really helpful. Yeah, can I add one more thing to that? Yeah, can I add one more thing to that? Yeah, this is just a habit that I've seen in pastors, elders, deacons. We like to do the quick fix, like the thing that if I can just go in and say something and get this person this resource, and then I can check the box and just having a disposition towards a longer view of people and getting to know them and seeing them as part of your lives, and not assuming that this problem is going to get fixed right away if I just do this one thing or get them this one resource.

Adrian Crum: 20:40

Yeah, we often on the committee on Diaconal Ministries speak about a ministry of presence, which is? This person just spent time with me, they listened to me, they wept with me, they struggled through this thing. That was complicated and difficult to understand, but they gave me themselves and really practiced the love of Christ in that. Well, that's where I want to take this conversation to next. I think everything that we do is shaped and oriented by scripture. So I'm sure that you guys, as Christians who are counselors, have thought through some biblical categories, biblical foundations for caring with people with mental health struggles. Can you share some places in scripture or other categories that you have found helpful?

Lindsay Fikkert: 21:17

Sure, yeah, you know what? Last November I gave a presentation on mental health and wellness for Redemption OPC in Gainesville, florida, for their women's retreat, and I had an opportunity to really dig into some biblical foundations for mental health. So one of the things we discussed there was just how theology and anthropology are the anchors and the categorical roadmaps when we're talking about mental health, and you know what do I mean by that. Well, whenever we're approaching mental health or considering how to walk alongside people who are struggling with it, we really have to start with who God is. We have to start with His characteristics, his attributes, and that matters a lot for how we approach this. And I had a seminary professor. We had a seminary professor, dr Bill Richardson.

Lindsay Fikkert: 22:05

He pointed out that, you know, god is both speaker and listener par excellence. He observed our God by name and nature, as a revealer and a self-discloser, and what he discloses about himself has significant impact on how we treat mental health and as, speaking through the Word, he reveals Himself to be compassionate, tender, acquainted with grief, our Creator and Sustainer, sovereign over our suffering, gracious in regards to our suffering, such that you know our suffering isn't karma or punishment, because Christ has already received all the punishment for our sin Suffering is not administered according to merit. There are so many different reasons why we suffer, so all of those attributes are significant, relevant and foundational for how we approach mental health. We need the truth of God's character if we're going to take our thoughts captive and progressively work through our distorted thoughts or distorted feelings or our dark nights of the soul, so to speak. Distorted thoughts or distorted feelings, or our dark nights of the soul, so to speak. But then you know also, when we think about, who God is he's the great listener. I mean, you can't get a better listener than the Lord. He invites us to pray. You know, in the Bible he's referred to as Shema. You know as the God who hears in Psalm 65 too, or the one who sees in Genesis 16, 13. So we're instructed to pray to God, who is our attender here.

Lindsay Fikkert: 23:26

So our theology and our beliefs about God are really important for how we think about and work through mental health challenges. And there's some very direct stories that demonstrate God's gentleness. You know, with Jonah and Elijah, in the midst of what I would say is spiritual, mental and emotional distress right, and even in response to their distorted thinking, we see His gentleness and care. But then. So that's theology. But then there's also anthropology, right, and so what Scripture tells us about who we are? And I think it's really important to consider this when we're trying to have right thinking about mental health struggles. So let me just give a couple of examples.

Lindsay Fikkert: 24:03

Our anthropology is of huge significance when we wonder why Christians have mental health difficulties, right, so we can become really judgmental of those who are suffering. If we don't take the scriptures that demonstrate that our bodies are fallen and have a trajectory of decay, if we don't take that seriously, you know, our culture wants to deny this sometimes, sometimes errant theological circles want to deny this, and sometimes even in our own hearts, we want to reject the truth that we are embodied. But that is such an important anthropological reality that our bodies are affected by the fall, and so we need to really take that into consideration when we're thinking about why people might be suffering. So that would be one thing, but you know, another anthropological reason why people struggle with mental health is because of other people's sin, right, and so we have to kind of think through that. And a friend, a mentor of mine, john Cox he's observed that our hearts and beliefs and habits are shaped in a fallen world, surrounded by fallen people. So, because we're developmental in nature, you know, we encounter people in situations that sometimes wrongly, inform us about things such as am I worth loving, is it safe to fail? Can I trust people? So thinking through those anthropological realities I think is really important when we think about mental health.

Lindsay Fikkert: 25:27

There are other things too, like you know, realities like we are finite and we are limited. Those are realities we have to face that the scripture is very clear about. We're limited, even before the fall. So the fact that we're limited means we can't take on everything. We can't say yes to everything. We have to honor the fact that we are affected by stress, and so things like that are really important. These are big categories, though you know, a lot of times when people want to approach scripture with regard to mental health, they want to approach it from just like a verse perspective, like what verse says this about that? And these are big biblical categories that we're thinking about, not just which proof texts you know we can point to about depression or anxiety.

John Fikkert: 26:14

So I think I would add to that there are books written on the theological and biblical foundations of counseling. So, trying to summarize it, I think Lindsay did a pretty good job of hitting some key points just there, and the only thing I would add is just to have a theology of suffering as part of the foundation and just understanding that in a fallen world it's not just that suffering accidentally happens to us, but the Lord appoints suffering of various kinds, including mental health struggles, for us and to receive that as the thorn in the flesh in 2 Corinthians as it speaks about that in 2 Corinthians 12, that those are appointed things that help make us more reliant and see the sufficiency of Christ's grace in our lives, things that help make us more reliant and see the sufficiency of Christ's grace in our lives, and so that's a more narrow point on that. But you can probably tell we could probably do three more podcasts on the foundations for counseling, so we should probably pause here and see if you have any follow-up questions or comments.

Adrian Crum: 27:19

No, that's really, really helpful. I really appreciated Lindsay's statement about just the reality of our humanity being a good thing. That God made us. Body and soul is not a bug, it's a feature. The Lord has made us as embodied creatures. And then what you said, john, about the. I think maybe 30 or 40 years ago there was a tendency to want to have a proof text approach to counseling and mental health and things like that, like I'll give you a passage, pray about this and by next week it should be kind of you know, worked out in your life. And the scriptures are more complex. They're not un-understandable, but humans don't work that way in terms of change, where you just give someone a verse and it sort of unlocks something and everything is fixed for them. How do you rely upon scripture in terms of giving people hope If someone says I know this about myself, I'm a really anxious person or I'm caught in really deep, dark aspects of depression.

Lindsay Fikkert: 28:12

There are so many ways that scripture is an encouragement and a help to us in our struggles with mental health, and something that immediately comes to mind are just the Psalms of Lament. You know, this is not the reason why people have mental health issues, but sometimes, when we don't process pain very well, when we don't metabolize our sadness or our worry in helpful ways, it can leave us vulnerable to mental health struggles right? So depression doesn't equal sadness and anxiety as a disorder doesn't equal worry. They're different. You know, anxiety and depression are more like conglomerations of symptoms, conglomerations of symptoms. But when we don't process pain, when we don't process sadness or worry in helpful ways, we are more vulnerable. So the Psalms of Lament, I think, are instructive in the sense that we see that we can cry out in a raw and transparent way to the Lord and we can come to Him with our pain and bring those things before Him. But then also, you know, the structure of the Psalms of Lament at the end of almost all of them is a remembrance of who God is and what he has done. And so I think working through those Psalms can sometimes be really helpful for people who maybe are struggling to be real with God about what they're going through. They're afraid that if they bring their complaints that there's something you know wrong about that, and so we can say, look, this is Scripture. It even gives some words, you know, I think sometimes we don't even have the words, and so it gives us some language to use for when we're, you know, trying to bring our concerns before the Lord. And then you know, there are so many other practical scripture verses and passages. I just think about things like, you know, romans 12, 18, when Paul instructs you know, if possible, so far as it depends on you, live peaceably with all.

Lindsay Fikkert: 30:19

I encounter many clients who, when there's conflict in a relationship, they're either over-responsible for it or under-responsible for it. Right, and so, thinking through what a verse like that means, you know, so far as it depends on you, that means two people are required for reconciliation. So what are you doing to promote that, you know, and what are the limits in your ability to promote that? And then you know, working through things like unwanted thoughts, you know, depression and anxiety. It distorts our thinking, and so, trying to help people, think about passages like Philippians 4, 8, you know.

Lindsay Fikkert: 30:56

Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable. If there's any excellence, anything worthy of praise, think about these things. So what? You know, what does it look like to take every thought captive? Well, it doesn't just look like stop thinking this thing, you know, we have to walk that out with people. Sometimes it's observing that I'm having that thought, trying to create a little distance from it and not take it so literally. Just because I had a thought doesn't make it true, and then trying to think on things that actually are true. And so there's lots of scripture for what we ought to be thinking on and what might be helpful to think on when we're faced with distortions in our thinking.

John Fikkert: 31:38

One thing that I do is I have some go-to scriptures that I like to use, but sometimes I actually try to reverse engineer it, and what I mean by that is start with a passage that's very meaningful to the person that's struggling, and so you know often Romans 8 or Psalm 23 or some like passage and it's just a matter of all right, let's this passage is really meaningful to you.

John Fikkert: 32:04

Let's work out what that means. If we apply this passage that you care about, I think it can really impact and help their thinking, because often what happens is is we know what's true, we can read scripture and we say, yes, that's true, but we haven't worked out fully the implications of what that scripture actually means in our lives. And really that's the outworking of the gospel, right? It's like we can believe that Christ died for our sins, he's raised from the dead, and we rejoice in this promised hope. And then a mental health struggle is often like an incomplete working out of what that actually means in my life. Like an incomplete working out of what that actually means in my life. So helping them work through a truth that they already have and cling to is a way I commonly go at it with someone.

Adrian Crum: 32:51

Yeah, that's wonderful, yeah. Taking, for instance, the way that kids are catechized with principles and memorized phrases but then letting the truth and the reality actually function in someone's life. Yeah, I often think about the story where the waves are crashing in on the boat and Jesus has taken them into the sea of Galilee and he's like what have you forgotten about me? Basically, I mean, I'm the master and Lord of the universe. What do you not believe right now about me? To believe that I can actually bring you through this and overcome this? So I think it's often just gospel forgetfulness that we need to work through. So it's not just like some principle they've never heard before, but something that we need to rediscover. So, from your perspective, I think the word healing is probably very complex word because people can expect like they want to get over something and close it and put it in their past. How do you think about the concept of healing from a spiritual perspective?

John Fikkert: 34:04

What does it look like for someone with mental health struggles that we face that don't have a definitive endpoint the way you might get your tonsils taken out. So I'm more thinking about how does this become manageable? How do the symptoms get to a place where I can be okay? How do the symptoms get to a place where I can be okay? Somebody that struggles with severe anxiety it would be unlikely to have a goal that they will get to a point where they never have anxiety anymore. But how does that anxiety get in check and how, through spiritual and physical and mental efforts, can I live as a Christian with this thorn in the flesh?

Lindsay Fikkert: 34:45

Yeah, I would agree with that in the sense that a lot of mental health issues are either episodic or chronic, right. So episodic, well, I could have one episode of depression, or I could have multiple episodes over the course of my lifetime, and we don't know, we aren't able to predict right and so healing because it has sort of that connotation to it that we get to a place where there's no more suffering in this particular way anymore is a difficult word. I agree with John. I tend to think of it as management. You know, can I live meaningfully in the presence of diabetes? Can I live meaningfully, in accordance with my values, in accordance with the Bible, in the presence of asthma? Can I live meaningfully with anything that is either chronic or episodic? Yes, I can, and sometimes we just need help, no matter what. Our difficulty is learning how to live meaningfully and to, like John said, have those symptoms managed well enough that we can still fulfill our callings, that we can still show up for other people and live faithfully.

John Fikkert: 35:54

And perhaps this one verse reference will help. Psalm 103, you know, bless the Lord, O my soul, and one of the things that we bless the Lord. It says he heals all of our diseases. Well, if we see people dying of cancer and having different maladies in their life, how do we understand that verse? It's that sometimes the way that we're healed of our diseases will be in the eschaton. It won't all happen in this world and at this time. Disease as it will be in the eschaton. It won't all happen in this world and at this time. And that's part of our faith journey and our sojourn that sometimes we will not see a final relief from a problem until Christ returns.

Adrian Crum: 36:32

Very good, yeah, so one maybe temptation could be then to rush or try to put pressure on someone who is anxious or depressed from a diaconal perspective. Have you seen maybe the other tendency as well, where someone so identifies with their diagnosis that they sort of abandon responsibility? And how would you help a deacon have that conversation with someone where they are? You know their house is falling into disrepair. There's other physical demonstrations of where they're struggling and they've maybe too much said this is the way it's always going to be, they're resigned to it too much.

John Fikkert: 37:09

Yes, I've definitely seen that happen and there's plenty of good verses about that, about how we're called to work at our sanctification. We're called to work out with fear and trembling before the Lord, out with fear and trembling before the Lord. So I think we're very much called to not resign ourselves in any way, especially if we're struggling and it's impairing ourselves or others around us. I think that contentment with the circumstances we're given and yet a willingness to work and work at our sanctification and seek the Lord's grace in it.

Lindsay Fikkert: 37:42

Medical analogies can be really good here, and obviously mental health issues aren't just medical in nature. There's spiritual components and other things too. But I like medical analogies when confronted with this issue because it helps illustrate, like, if I have an autoimmune disorder and I can't help that, that's nothing that I did to create, that it's just something that's part of my fallen body. But I actually have a responsibility to be the best steward of what the body that I have, right? So if I know certain things create inflammation because of my autoimmune disorder, I probably ought to avoid those things, right? I probably ought to make sure that I'm doing everything I can to steward the body I've been given and the circumstance I've been given.

Lindsay Fikkert: 38:30

So when I'm working with someone who seems to be over-identifying with their you know mental health issue, first of all I'm wondering what the function of that is. You know, as a clinician, that's one of the things I'm wondering. What's the function of this? You know, behavior. But also trying to get at that idea of stewardship you know I'm still responsible to steward myself. What does that look like?

Adrian Crum: 38:54

Excellent. Thank you so much. So this is a very controversial topic. It's medicine and how we think through whether or not it's appropriate to take a prescription. I think I remember as a child, maybe a season of time where Christians were saying things like it's not right to take any medicine for things like anxiety or depression. I think I saw the opposite direction now, where almost every kid in high school might seek out a prescription. How do you work through that question from your professional experience, and how do you think deacons should take medicine into account?

John Fikkert: 39:30

I would just say there's a lot of misunderstandings about medicine assumptions that people have.

John Fikkert: 39:36

Most medicines for mental health are not addictive and habit-forming.

John Fikkert: 39:41

Some are like like sleep medications and some anxiety medications.

John Fikkert: 39:45

But just to be fully informed about the type of thing that you're being asked to take or you might be asked to take is really important, and whether you're the person that has to consider taking it or a deacon could potentially help with just working through the cost benefits of a particular medication. So if someone doesn't take their medication for bipolar, there's some significant costs or schizophrenia, or even severe depression, and it impacts not only themselves but others around them. And so just working through some of the costs and benefits there are important, but I think it's important to say, like in the technological world in which we live, that there are amazing things that we have for everything from cancer treatment to diabetes to things that can help people with a mental health diagnosis, and I would just want to think through with anybody is there a barrier to a medication for a mental health problem that you're not willing to take but you would be willing to take if it were for diabetes or some other? What would be viewed as a purely physical?

Lindsay Fikkert: 40:55

problem somewhat depends on the situation too, right, like you know schizophrenia bipolar there's already a brain imbalance there, so we're just correcting an imbalance with medication. In those situations, depression is a little harder, in part because there are lots of depressions. In other words, depression can occur for a lot of different reasons. Right, sometimes those reasons are very much chemical. But one thing as a clinician I should say I mean I agree with what John said about medication and its usefulness, but I also know that there are lifestyle changes that can be as impactful, if not more impactful, than medication, especially for depression and anxiety.

Lindsay Fikkert: 41:39

And in our current culture it feels like we are so inclined towards immediate relief that we want to just take a pill for something. And certain things like exercise, watching what we eat, eating whole foods and less processed foods, decreasing caffeine, making sure that we have good sleep hygiene all of these things are tremendously impactful. They're not cures, and that doesn't mean that we shouldn't consider medication for depression and anxiety. We certainly should. But sometimes it's really also important to educate people about the fact that those lifestyle changes are as efficacious in some cases as medication without the side effects. So you know, you want to present a whole balanced, nuanced discussion about medication when you're considering that with people and, like John said, get at you know what are the facts, what are the myths, and try to get at some of those things too.

John Fikkert: 42:42

You know what are the facts, what are the myths, and try to get at some of those things too. To add one more thing to that it would be convenient for a lot of us if it was just a law, like a biblical rule, you know, like we should take medication, we shouldn't take medication, and then it's decided and we can move on. And this is medication for mental health is really more of a wisdom issue, and that's where you're in this middle ground, where you're trying to weigh lots of different things about a particular person and their case and their needs, and the costs and benefits for one person that has moderate depression might be completely different from the next person that a deacon might meet with depression. So just appreciating that it's a wisdom issue rather than just a biblical law one way or the other.

Adrian Crum: 43:28

So I oftentimes describe it to people when they ask me you know, pastor, is it okay if I take medication? I describe it as like noise in your environment. So if you were wrestling to try to figure something out in your life and you could just turn the volume down, it wouldn't fix the problem you're working on, but you could maybe give your attention more to it. Right, and so there are medications that can normalize the situation in your life. Right, that you can then focus on the actual thing. And oftentimes that is kind of more of a straightforward spiritual struggle. But like you say, john, it's not as simple as just reducing it to yes or no. I think that's helpful.

John Fikkert: 44:03

One more avenue, and this relates specifically to anxiety, an analogy I often use for somebody that's really moderate to severely anxious. That noise comment that you made reminded me that for somebody that's really anxious it's like trying to make contact with like a hundred mile an hour fastball. It's just really hard to do that, but an anxiety medication can reduce the speed to like 50 or 60 miles an hour, so then you're able to actually do some of the other things that would help you reduce anxiety. So it really depends on the severity of the symptoms sometimes, but treating a medication as part of a solution rather than all of the solution is another way of thinking about it.

Lindsay Fikkert: 44:50

I was just going to add. You know I've seen it both ways right, where people have made significant lifestyle changes that have had significant impact on their symptoms. But I've also seen it, you know, I was doing marital therapy with a couple for a long time and we were just really bumping up against some perpetual issues. And after a while psychological assessment training in me started kicking in a little bit and I started to realize I actually think that this husband might have undiagnosed ADHD and had him assessed, went through a whole psychological testing process and he got on a low dose of a medication for ADHD and it turned around the marital issues that this couple was facing I mean night and day. And so you know, I think just kind of having an open mind, if you will, about some of these things.

Lindsay Fikkert: 45:40

And the other part of that is like that medication, if it hadn't made a significant impact we could have just gone off of it, right. So these decisions aren't once for all. You know it takes time sometimes to titrate off of a medication and you know it has side effects and things like that. But people can try them and then if they're not making significant progress with medication, it's not like written in stone that we have to stay on it forever and ever Excellent, very good.

Adrian Crum: 46:07

So let's shift gears, then, toward some more practical questions helping someone working with particular mental health crises. What have you seen helpful in your own churches, as deacons can rally together either themselves, or maybe in coordinating other congregants to provide meals, transportation, financial assistance? How would you recommend helping someone practically?

Lindsay Fikkert: 46:30

I would say the first thing is something I already said already, so I'll just briefly mention it in the context of this question, and that is access to mental health care is a very big barrier these days. Clinicians have long waiting lists and sometimes it's hard to know who to go to if you're a Christian. And so first practical thing to me is having those relationships built with other people in the community, for the churches to have those relationships and to know what those resources are.

John Fikkert: 46:55

I would also add just to be cautious about when helping hurts principle of doing everything for somebody. There are times where somebody is in a severe crisis where they need 100% help. But if somebody is struggling with depression, for instance, what they need is to start getting active and exercising. So maybe it would be hard for them to clean their home or do their yard work or whatever. But instead of just doing it for them, is there a way that the deacon could do it with them and then it actually helps the person that needs to get activated, like, oh, there's this person that's coming over and I want them to help me and they can come over and do it with me and that's an encouragement to them. And then I just think there's some ways that you can think through. How is the person with the struggle of practical care should be viewed as?

Adrian Crum: 48:03

just as important as spiritual care in supporting mental health. Sometimes you can say in essence, go and be well, but not step in to love a person well. So how does practically caring for people demonstrate integrity to your desire to help?

John Fikkert: 48:20

them. I think in a way the question almost answers itself right, like there's just so many ways that we're called to not just love in thought, but the good Samaritan that actually practically does things. That demonstrates care, not just that he thought theoretically, oh I care that the Samaritan is hurt, but does practical things to help the Samaritan. And I think that's just a built-in biblical principle that we bear one another's burdens together, not only theoretically or in principle, but in actual acts where word and deed ministry is matching together.

Lindsay Fikkert: 48:59

Along those lines, I think, because mental health difficulties are whole person experiences.

Lindsay Fikkert: 49:10

You know it's not just I've got a trial, you know, let's say a spiritual trial, and you know what we're talking about are things that affect body, soul, spirit, mind, everything.

Lindsay Fikkert: 49:16

And so being able to meet that with whole person intervention and help makes sense, right. And then you know, along the lines of what John was saying, if you think about what are some of our most costly things that we give to people, well, time is one of them, and what does it communicate to someone when we give our time to come alongside them to help them out, not just to quickly spout off something that we want them to think about or do, but also like we are giving them some of our most costly resources, right, and I think that communicates a lot to people. And that's true of listening too. Listening is such a need. I think we are desperate to have good listeners in our lives, and not everybody knows how to do that well, and it requires a lot of self-discipline and holding oneself back and giving time and patience and perspective. So I think listening is a big part of that too, in terms of what we can offer people when they're struggling.

Adrian Crum: 50:25

If I were to see someone in a service visibly shaken or not seeming like themselves or just really, really emotional, I think a tendency for me is to kind of withdraw and not want to engage. What would be something about Christ, Christ's disposition and his compassion that would give a motivation for a deacon to actually step into the situation and say, hey, how can I help you in this moment?

John Fikkert: 50:48

If I'm understanding your question correctly, the motivation would be this is an opportunity to step into somebody's life and we can feel pressure to say something right away, but maybe you don't have to say too much. Maybe you just have to be present with them and say, hey, you look like you might be upset, is everything okay? And just be prepared to listen and hear what they have to say. I think that would be a really good step forward, like if a spiritual problem comes up to say this might be something I need to refer to an elder or my pastor as well, so that we're doing this in partnership and it's not just a deacon bearing the burden of whatever crisis they've discovered in somebody in the congregation.

Adrian Crum: 51:34

I'm very struck with Christ's disposition, particularly toward people who had demonic oppression. Obviously, the relation between demons and mental health is complex Try to figure out what that is but he had such a deep love. I think of the man who was around the tombs and kept on hurting himself in different ways and Christ very intentionally pursued him and moved toward him and wanted to see him made whole again, which is a beautiful image of what mercy and other gospel ministry can look like. So I care for young people. I'm a pastor for youth in our congregation. They may, I think, be some of the ones that struggle the most. I often tell parents who are maybe not being compassionate toward their kids I would not wish the high school years on any of you. It's because they're difficult years. I remember being a high schooler and having tons of identity crises and other intense, intense struggles. How can deacons give good care to that age group? There are kids that would have a lot of these particular mental health struggles. How can a deacon give good care to that age?

John Fikkert: 52:36

A lot of thoughts come to mind, but the first one that comes most immediately to mind is maybe more general than just the one with the mental health challenge. But if there are ways that the youth in the church can be engaged in helping others or engaged in service projects and community projects, or hey, we're going to do this. That's what creates bridges and opportunities. If you see a young person or a teenager engaged in ministry and then if they have a struggle, there's more context for actually having a conversation with them, that's the first thing that comes to mind.

Adrian Crum: 53:13

That's excellent. Yeah, so one of the things I say often to older people in our congregation is, if you have an hour that you could just give your time to a young person struggling through different things, that will be, I think, so much more beneficial than trying to give them something or do something else. I think our time is often the best resource we can give. What about the complexity of a parent? Who is the authority? You know the person is underage, so they're not 18 years old and maybe a parent's not taking the severity of someone's mental health seriously? How should deacons weigh the different spheres of responsibility in that sense and how do they navigate the complexity of that?

Lindsay Fikkert: 53:52

Very carefully. I mean, I think, when you're talking about any of us approaching a parent, I think we have to be very careful, right, because we only have a snapshot too, and they're living life with their child. I think we're coming often. We need to be coming from a place of compassion and curiosity. You know, there are reasons why even you know trained professionals don't necessarily want to see things in their families because it's scary, right.

Lindsay Fikkert: 54:25

If I take something seriously instead of just sort of writing it off, it's frightening to think that my child could be struggling that much. I'd rather think that, oh, it's no big deal, you know they're just being teenagers, or this is just angst, right, or whatever. You know they're just being teenagers, or this is just angst, right, or whatever. Most parents are not dismissing or writing off those kinds of things because they're unloving, it's because they're fearful, and so I think starting from that understanding helps us to maybe be a little bit careful how we walk into those situations and how we communicate, and allows us to maybe have some empathy for why the parent is potentially overlooking something or dismissing or minimizing something that might be more significant. So that's not a mechanical how, but that's just kind of a posture, I think, to take as you walk into difficult conversations with parents.

John Fikkert: 55:20

And some of the how would be something we touched on a little bit earlier. I would be leading, not with analysis like this is what I think is happening in your child's life but leading with data. Here are some things that I've noticed. I wonder if you've noticed those things too. And as you share that data with the parents, then that sets the context for what they want to do about it. And if there were to be a situation in which the deacon's like I'm not sure the parent's seen this accurately and I'm still concerned for this child that's the point at which I'm talking to someone on the session about that concern.

Adrian Crum: 55:58

Excellent. One of the things that I'm most concerned with in my congregation is the growing epidemic of loneliness. How many hours people spend just by themselves and without real connection and community. How would you help a widower or a widow that is pretty depressed because of loneliness if you were a deacon in a congregation?

John Fikkert: 56:27

in a car. Personally, I would be trying to figure out ways to involve them in either going to visit them with somebody else, like you're taking something to them, or you're asking them to do something. If there's ways that you can initiate and say, hey, we really need somebody to get name tags organized and handed out at VBS, would you be willing to do that, rather than just waiting and seeing who volunteers and whichever of the 20% of the people that always volunteer for stuff in your church and they hand out the name tags. But if there's ways that you can structurally think through, what would this person maybe enjoy doing? That's not going to require too much of them but it gets them engaged back in the congregation and the community of the church. I think there's a lot of ways that you can either ask people to serve or you bring a service to them that helps them engage.

Lindsay Fikkert: 57:15

This is a topic I feel really strongly about as well and have lots of thoughts and feelings about. But some of the things that we know about loneliness is that people need connection and multiple levels. So having a friendly interaction with someone at the grocery store is actually meaningful when people are lonely is actually meaningful when people are lonely. But that can't just be it. We also need deep relationships, intentional relationships. But I say that to point out that sometimes we can put a lot of pressure on ourselves, you know, to have somebody, let's say, in our home every night of the week or something like that. And it's what we really need as a church is those little interactions that are meaningful, as well as the big, more sustained, longer ones. So it's not just you know, how do we plug this person in for hours and hours on end and get them in deep, meaningful conversations, or just how do we be more friendly with them in passing at church? It's both right.

Lindsay Fikkert: 58:18

We actually to sort of combat our loneliness, we improve in our sense of connectedness when we have both kinds of interactions, and I just really think we have to be really intentional about engaging with people, about hospitality and just sharing life together, you know, and making that more the culture that we have.

Lindsay Fikkert: 58:40

You know, and it doesn't have to look formal. I can just be like hey, you want to go grocery shopping together. I have to go grocery shopping on Saturday, you want to go too? Or come over, I have to fold laundry and probably helping kids with homework, but you want to just come over for the day and just kind of sit in my living room we can have some coffee, you know, in between some of those things, and so being very intentional about hospitality is a big piece of this. Loneliness is also a huge problem among our youth. So, you know, increasingly, as youth are behind screens and their social interactions are disconnected more or connected only through social media, there's a profound sense of loneliness. So creating embodied activities and spaces where kids can come and be physically present with other people, I think is a really important way to combat some of that too.

Adrian Crum: 59:31

Excellent. Thank you so much. Yeah, we did a study at our church, somewhat prompted by Jonathan Haidt's book Anxious Generation. I just started reading a lot of books on the effects of technology and social media on children. So there's a stigma, at least at our church still about mental health illness, like if I were to admit in the pulpit that I was a depressed pastor, for instance, or if I were to say last year I struggled we'll talk more about that later but struggled significantly with intense anxiety. I think there's a sense in which it's like you really shouldn't talk about that. If deacons perceive that, how would you help get a conversation started so people are more open to speak about anxiety and depression and mental health struggles. Just, you know, being able to say this is real, this is a real factor in life and we don't need to kind of be ashamed of it.

Lindsay Fikkert: 1:00:20

I think transparency is really important here. You know like there, I think, are places where we can model a willingness to be open without oversharing, and you know, we don't have to tell everyone our whole life story. But the incidences of depression and anxiety, if you just look at prevalence, would suggest that there's a decent number of people in and outside of the church that are struggling, and so having more transparent conversations about that, being willing to bring it up in different contexts and just speaking about it, I think becomes an important way of sort of getting at stigma and also when. So mental health kind of a distinct category, but to some degree we're all working on our wellness and our soul care and our self-stewardship.

Lindsay Fikkert: 1:01:10

So sometimes breaking down the divide yes, there are discrete categories for mental health diagnoses, but also that doesn't mean that that has nothing to do with me. If I've never had a mental health diagnosis, I've been subject to chronic stress or I've had family members with whom I had conflict or things like that. And so trying to break down the divide between diagnoses and our human experience I think is important too, which is like when I went to Gainesville we got to talk about mental health diagnoses but we were also just talking about prevention, wellness, soul care, stewardship. Those are all mental health constructs, even if I don't reach the threshold of a diagnosis.

John Fikkert: 1:01:52

So Lindsay's going to Gainesville was an example of the session, sponsoring that and reviewing what she's going to be talking to the women in Gainesville about, and so that would say there's a Christian education piece to this that I think can help remove the stigma and so, in part, if the deacons could work with the session, I'm like, hey, we'd really like to host a conference on this, or maybe it's a Sunday school class taught by the pastor or something to that effect. I think that education piece at least introduces the topic and can reduce stigma in that way.

Adrian Crum: 1:02:27

So this is sort of a connected question. Then, how can deacons grow and nurture a church environment where there's a safety, a sense of safety for people to say I am struggling or I need?

John Fikkert: 1:02:38

help. Safety is one of the hardest things to achieve in a community, so in a way that's a much broader question. Usually when we say safety it's like, well, how do we make sure we don't have an active shooter come into our congregation? And so everybody asks that safety question. But how is there relational safety in our congregation? How is there relational safety in our congregation and I think that's a really good question for any combined church officer project to ask how are the elders and deacons of this church going to think through, how do we make sure that this is not just a community where the love of Christ is expressed from the pulpit, but truly have a safe community in which people can be themselves, talk about real problems and we hear each other and care for each other. So in a sense I think the question is tapping into an important and much larger question.

Lindsay Fikkert: 1:03:34

If I could just speak to that too. I think being seen, having people be intentional over time, creates relational safety. So you know, not just that one time meeting where we talked about this issue, but somebody who remembers a deacon and elder who says, you know, two months later, hey, I've been thinking about this, praying about this. How is that going? Or are you getting what you need out of those resources that we connected you with? And you know I was thinking about what you were saying about youth.

Lindsay Fikkert: 1:04:06

My daughter has commented how significant it was to her in her early adolescence that one of our elders and his wife remembered things about her and would ask her about them.

Lindsay Fikkert: 1:04:19

Right, and it just left her feeling like they knew her, that she was seen, and I think if she had a struggle, she would feel like these are people she could go to because they sort of in a preventative kind of way, if you will let her know that they remembered things about her and they asked her about them, they made eye contact with her. You know she wasn't just a kid running around church, right? So I think some of that we build in on the front end by seeing people, by remembering things about them, and I have a terrible memory. So I would be somebody who would I need to go home and like, jot that down and then put it in my planner to ask so-and-so. But that's okay, right, like if that's what we need in order to be intentional, in order to create relational safety, that's what we need to do so that we get past, like how's the weather and what do you think of the game last night?

John Fikkert: 1:05:07

Just to add a couple more comments about that. One would be that church officers have more ability than they maybe even appreciate to create the environment within the church that is loving and safe and just being a little more intentional about thinking through. How do we do that and how are we, as lindsey mentioned, how are we going to track if somebody tells us that they had a problem or a prayer request? In what ways are we going to follow up with that and care for this person over time, not just in this one instance? The other thing I just briefly add and this may be coming up in some of the books that you're reading, but I heard a researcher on a podcast recently say our closest relationships are still in a strong place, like our closest family members and so forth, and our most distant relationships are still good.

John Fikkert: 1:05:59

But all those middle spaces that we used to have, like bowling alleys and, to some degree, coffee shops, but other places, those middle places, they just don't exist the way that they used to, just to create a vision. The church has this unique place where here's not just any middle space between your family and a stranger. This is like the best possible middle space. People are starving for this middle community between just their direct family and the common neighbor. So the church has an opportunity in this culture to create an amazing place for people to feel loved and cared for.

Adrian Crum: 1:06:38

Excellent. I think one of the things that we've recognized here is there's the difference between crisis care and then long-term structures that assist people. We've been trying to put together care teams where there's someone sort of running point on the care team and there's a variety of different members working together with a church member. That needs a lot more time. What are some ways that deacons can help build some strong systems like this? Maybe? What kind of people would you look for for care teams for someone wrestling through mental health?

John Fikkert: 1:07:07

What are some giftings that you're looking for in the body as you gather together a care team or a structure like that, I would say, first of all, some sort of structure begins with writing things down or having you know some sort of confidential spreadsheet or database where you're, as a deacon board tracking what people have. So that's one part of it, is that structure. But then the second part about the care team would be observing, yeah, In your congregation who are the good listeners? Who are people that other people seem to go to anyway good listeners? Who are people that other people seem to go to anyway?

John Fikkert: 1:07:43

There are some things where it might be a challenge for a deacon to meet with someone a female or whatever or they have a really uncomfortable situation. So is there a group of women in the church that I have as a go-to group, that I know that they could come with me and help with the conversation and, depending on how far you want to go with it you were talking about care teams it sounds like, I mean, you could really plan it out in a useful way and have not just the idea or the resource people available that you've identified, but organize it even further into ways that we're caring for others, perhaps even showing hospitality to each other and in other ways as well.

Lindsay Fikkert: 1:08:19

Oh, another thing I would say about that is I think sometimes, because it seems so common sense, we don't think about actually training people. Things like how to be an effective listener. We just, oh, she seems like a good listener, he seems like a good listener, or be a good listener. It's like, well, what does that actually look like?

Lindsay Fikkert: 1:08:38

There are ways to improve our capacity to be good at some things that we just take for granted or we think are character traits, but we can actually get better at those things. And so when you're thinking about putting together care teams or getting sort of formalized in our care for people, we can think skillfully about some of these things and break them down into bite-sized pieces and practice them right. Like I can sit here with John and practice a good active listening dialogue and get better at it. And it seems kind of silly and mechanical, I guess, at first, but just thinking through, like what would that look like to actually train ourselves to be more effective people you know, to be more effective family members and the family of God, right?

Adrian Crum: 1:09:34

Excellent, yeah, james. 1. I mean, I think that's sort of just ordinary necessity for all relationships, but care teams that care for people with mental health struggles. I think really, really essential that people be able to be trained to listen well, and I think we've all had the experience of someone listening attentively to something hard that we were going through and just how encouraging that is, but it's hard to know, okay. Well, how do I then move toward growing in that skill? It takes a lot of patience. How can you help people who are struggling get paired up and helped with someone they already know and trust, rather than being forced to walk to talk to an officer they don't know? So how do you make connections in the body with people that they're already dependent on, rather than I think sometimes we may be overly officially like?

Lindsay Fikkert: 1:10:24

oh, go talk to this deacon, go talk to an elder. Yeah, I like to think of that as not so much an either or, but a both and like, because you know, deacons and elders have certain roles and resources. So, and what I find sometimes is, in order to not burn out in our care for other people, we need to make sure we're not an island trying to help someone. And I find that when it comes to like what we sometimes call compassion fatigue or burnout, if we're not working alongside other people, especially for those long walks that we're going to take with people who need help for a long time, we're going to burn out. So I think pairing elders and deacons alongside people that someone who's struggling already feel comfortable around makes a lot of sense.

Lindsay Fikkert: 1:11:05

And I think especially we have to be especially careful around trauma, especially sexual abuse, because and I've had this happen before I had a female client who had been horrifically sexually abused by more than one male and she could not sit alone in a room with a man without just feeling completely unsafe, and so I happened to work at that time in a clinic where her psychiatrist was a male and he worked down the hall for me so I could go sit with her as her counselor, I could go sit with her in her psychiatric appointment and create safety, and that worked for her and that worked for the psychiatrist and that worked for me. But kind of having that mindset that we have to be sensitive to the fact that, especially for females who have gone through trauma, one-on-one work with an elder or a deacon who's a man can be very difficult, and so you know we need to create that safety by bringing along people with whom they feel safe.

John Fikkert: 1:12:03

Presumed in some of the questions that we've been covering, but just to call it out in the open. You know the deacons are to lead in mercy ministry, but they don't have to do it all on their own. So just to be clear, we agree very much. So how do we lead but help others in the church, be involved in the mercy of ministry in our congregation?

Adrian Crum: 1:12:24

Yeah, excellent. I think our book of church order speaks about deacons as stewards of gifts in the congregation. So I think, knowing who has gifts and abilities and distributing it, it would actually be so much better if the deacons did very little work but distributed. So the whole church, the whole body, is working together to serve each other. That's great. What are some common misconceptions? You probably have hours and hours also of funny misconceptions that Christians have about mental health. What are some maybe common pitfalls or misconceptions that people in the church have and how would you address some of those biblically?

Lindsay Fikkert: 1:12:58

Well, I'll start with one. I already alluded to that mental health issues are synonymous with emotion, in other words, like sadness is bad, right, it's not a pleasant emotion, and you know, I think this is changing. But what's not changing is perhaps like a general mismanagement of our internal experience. It is our emotions and thoughts. And so you know, in the past, maybe past generations, have kind of had that more stoic approach among Christians to emotions and you know, we should just feel happy all the time and those sorts of things, happy all the time and those sorts of things.

Lindsay Fikkert: 1:13:41

And it's funny, I stumbled upon a quote by John Calvin where he just really calls out the Stoics for sort of having that mentality, that we should not be sorrowful ever. I think he even uses a little sarcasm in that quote. But so I think that's one misconception. But the other that seems to be gaining in popularity and maybe is more sort of a newer generation, is my experience and my emotion is what matters, it is the only thing that defines my truth, right, and so really having a right understanding of the place of emotion in the Christian life is of utmost importance, I think right now, the place of emotion, the place of internal experiences, my thoughts about myself, my sense of self. How do we understand that when our truest identity is in Christ right? And so teaching people how to think rightly about their emotions and not falling on one ditch or the other is really important?

John Fikkert: 1:14:39

Another topic would be sin and its relation to a mental health problem. There are some times where a person's personal choices are very much involved, or their thoughts are very much involved with a mental health problem, sometimes less so. Sometimes it's something that's happened to them or it's just the basic fallenness of our world and rather than feeling the pressure to come to an immediate conclusion about to what degree does this person sin involved in this problem, being just a little more cautious about it, and even for the person themselves like it may take a little while to figure out how sin is involved or how my response to this mental health problem may have sin in it. But we all admit we sin daily and thought, word and deed. So we should assume that in some way our sin is certainly going to be involved, but it's not an all or nothing venture when we think about mental health problems.

Adrian Crum: 1:15:33

One of the CCF books is it Ed Welch or Dave Paulson is called Saints, sufferers and Sinners. I appreciate that threefold, you know, and asking the question am I seeing someone who's suffering something? Am I seeing someone who is just sinning in a particular way but maybe not reducing it to just how are they guilty and how do they need to respond? Yeah, excellent. Do you have any creative ideas or things that you've found helpful for a whole body, the whole church we talked about this earlier, but the whole church coming together to offer prayer or create support groups or educate the congregation. Are there ways that the whole church can work better together to support people walking through mental illness crises?

John Fikkert: 1:16:14

I think for me it just begins with the considering if you would be willing to do a conference and just have an education piece on it, and it could be education on mental health, it could be education on how to be a better helper. Here are some listening skills. Here are some other things that would be helpful for you to do. If somebody tells you a problem, write it down so you know to follow it up with them and just doing some training things. I think that is a beginning point for encouraging it.

Lindsay Fikkert: 1:16:40

Yeah, we, you know, I think a couple of years ago we did a couple of youth group lessons, even on thinking biblically about our emotions and how to take care of ourselves. You know how to do that self-stewardship piece, and so you know, I think, being intentional with those kinds of teaching opportunities that allow for those kinds of conversations, so that would be one thing as well is bipolar or this person needs to be taken to the ER.

Adrian Crum: 1:17:21

but it becomes a long road and going for the long haul, how would you encourage a deacon who is just feeling fatigued and worn down because they've been caring for someone for a long time?

Lindsay Fikkert: 1:17:29

Yeah, I'll kind of jump back into that because I think I brought it up a little bit earlier. But compassion fatigue is a very real experience. It's real for anybody who's willing to come and walk alongside people. And so if we really want to be in it for the long haul and be sustaining in our care for other people, I think we have to take seriously our own limits and not try to be, in essence, kind of like little saviors for people. We have to really be honest about what we can and can't do in the lives of another person. It kind of starts there because sometimes we have expectations of ourselves as helpers that we can do more than we actually can do, because we're always having to respect somebody's autonomy right, and we can't control other people, and so they stand alone before the Lord, right, and they have't control other people, and so they stand alone before the Lord, right, and they have to kind of work through some of these things in the timing that they're willing and able to. So it starts with probably that.

Lindsay Fikkert: 1:18:28

But I think, as this has come up in my own life as a counselor, but also in other people in ministry, for me there's also a piece of am I doing my own self-care well, because if I'm not, I'm going to have much less to give people for the long haul.

Lindsay Fikkert: 1:18:47

So I can't neglect being in the Word. I can't neglect my own physical movement and exercise, taking good care of my body, having rich and meaningful relationships in my life. As soon as I start neglecting that, I'm really going to run out of gas for helping other people. So I think those two places. But then also like, as you move on, even if you're doing those things, there are times where we're weary and it's hard to not grow weary and doing good right, and so we need other people and sometimes it's time to sort of tag team right, like bring alongside other deacons, as it were, in this situation, or other people who are doing diaconal care and say you know, this is a hard week, I have a lot going on. Do you think you could step in here and making sure that we have a wide enough network of people within you know the confines of confidentiality and consent, but a wide enough network that we can spread out some of those needs over time?

John Fikkert: 1:19:50

So that it doesn't come down to just one person.

Adrian Crum: 1:19:51

Yes, right, that's excellent.

John Fikkert: 1:19:55

If I could speak to an exception to the rule.

John Fikkert: 1:19:59

So generally, that's what you should do, you know look to others, seek support with your pastor, fellow deacons and so forth.

John Fikkert: 1:20:06

But on occasion a person might arrive at the church that appears to be exhausting all the resources not just of one person but of the entire deacon board and elders and pastor, and that would be a time to start asking what might be going on here. And it may just be a unique problem, but the reason I'm bringing it up is there are sometimes somebody with a particular personality disorder or something else going on where. That's how they're wired to interact and they will suck the life out of a situation. So if you're in a situation where you're noticing like everybody in the church is exhausted by this person's problems, that may be a time to seek an outside consultation with a mental health professional and you walk through. These are the things we're struggling with and we're all tired and this person isn't helped. I just think seeking out an even wider consultation about that. And again, this doesn't happen all the time, but I can think of more than a handful of churches that have had this sort of person arrive on their doorstep and they don't know what to do next.

Adrian Crum: 1:21:21

Yeah, that's so true, excellent. Well, some of our most popular episodes of the Reformed Deacon in the past have been real-world cases. So I wanted to pitch a real-world scenario. I'll just read this for you and then you can give some practical advice for deacons who see a situation like this.

Adrian Crum: 1:21:39

So a single member of your church comes to you asking for help with home repairs. She's older and somewhat disheveled in appearance. You've known her over the years as being eccentric and somewhat of a loner. As you run through with her usual list of information-gathering questions, you start to realize that she may be unrealistic about the severity of the problems. The next day you visit her home it takes only a minute for you to see the house is dilapidated well past repair. Her request for a fix would only at best be a band-aid. She insists it will just take a few minor repairs to get back in shape. But it's obvious to you she shouldn't be living there anymore. You suggest to her that she should find somewhere else to live, perhaps with family. But she is insistent. She stay put. You've noticed she often is caught in a faraway, stare and mumbles to herself and is agitated. How can you gently, lovingly and effectively help her?

John Fikkert: 1:22:27

I think the place to begin is to find out what she is willing to consent to. What does she identify as the problems in her life? Is she willing to talk to a doctor? Is she willing to go to a counselor? What is she willing to get changed in her home? And can we help with those things and maybe take an incremental approach of just like oh, since we did this, I wonder if we can. I just noticed this. What would it be like if I stopped by next Saturday and helped with this other thing? And over time, if you can build trust incrementally, it may give you a wider opportunity to step more deeply into her world and she might listen more as she experiences you in those ways.

John Fikkert: 1:23:08

The other question with that is the way it's framed. To me it sounds like this problem has been going on for a very long time. So applying what we said earlier rather than trying to get this to turn on a dime and say this is going to change next week, appreciate that it may take some time and effort. Over is dilapidated and we would never live in a house like that. But I think we have to make very sure that that's not just our own value for a house and what makes this house unlivable, or so forth, and just to try to be aware of our own biases as we enter that situation. Deacons are great for being at nuts and bolts and they're like. This house should be condemned, and maybe it should. If somebody was described like that, I would be thinking about Alzheimer's and memory care. Moving them from their house, the environments that they have, that's almost their only link to reality. So if you move them from a house to a facility, they may lose a lot more, as some of their links to reality might be gone.

Lindsay Fikkert: 1:24:23

Yeah, I would agree with all that and I would say that the place to begin, usually in a situation that's complex like that, is the place of least resistance. So even though it seems like a band-aid, it does build trust to respond to what's asked and then begin to work from there, kind of bringing up like hey, I've also noticed that maybe this seems hard or this is a difficulty for you. Is there you know a way that we can start building a plan to help out in these different ways, one that might have more lasting power or that kind of thing? The situation or scenario you gave it sounds like there may be underlying psychological issues there. So at that point you really are going to want to see if there's a willingness to reach out to a professional. You know how earlier you had talked about.

Lindsay Fikkert: 1:25:11

Sometimes medication can help with the noise.

Lindsay Fikkert: 1:25:14

This might be one of those kinds of scenarios where meeting with a doctor, you know someone is mumbling to themselves and agitated or sort of staring out, disassociative, like there might be something significant going on in a mental health sort of capacity and those kinds of symptoms are sometimes the kind that really do actually need medication. So just things like that if somebody is willing to go to the doctor as the next step and to begin that long road. It's tempting sometimes to see the like most outward sign and just want to like, let's get you to a new home, for example, or let's sell this property and get you into assisted living or something. And I found you know, sometimes with mental health the intentions are so good but like, let's just take somebody who has hoarding obsessive, compulsive hoarding we go in and we clean out and then two months later it's exactly back to the same state, right, and so if we don't get to the root issue, we're just going to have the problem reemerge in a different setting and in a different way.

Adrian Crum: 1:26:14

Excellent. Yeah, thank you. Well, I wanted to share a way that our Committee on Diaconal Ministries can heartily endorse the Committee on Ministerial Care that, john Fickert, you work on. Last year I had bouts of really, really intense, just waves of anxiousness and anxiety and honestly, I didn't know what to do with it and who to turn to.

Adrian Crum: 1:26:36

One of the difficult things for a pastor, an elder or a deacon is if you're going through some of that you don't know, can I share this with other people? Can I ask for help? What will happen if I stumble into the wrong situation in my own congregation? So I reached out to John and we had a set of consultations. The way I described it to my family is I felt like when I was disoriented, I didn't know what to do next. John could just kind of say hey, have you thought about this or taken the next step? And ultimately I got connected with a counselor in town and had a really, really helpful set of visits. So I think this is just my encouragement to elders or deacons or pastors who are listening to this to actually ask for help ourselves.

Adrian Crum: 1:27:15

I think we've said on the podcast already we will only be a benefit to others as ambassadors of Christ if we ourselves can ask for help and work through that. I just want to commend the Committee on Ministerial Care and also just seeking out resources in our areas for ourselves If we are the ones deeply depressed. I know pastors who have committed suicide. I've known pastors that have had really, really strong times of anxiousness and they don't really feel the freedom to share it. So just wanted to thank John for that and also just encourage people that are listening to this to take the next step towards seeking help. And if you guys have any encouragements about that for people that are listening, what would you say to someone that was kind of on the fence as to whether or not to seek help for themselves?

John Fikkert: 1:27:57

I think your testimony may have said it well. If you think about, I'll put it this way shame causes us to want to hide and withdraw, and if you really think through the gospel, it's to allow what's wrong or broken or weaken us to be exposed and to know the light of Christ, and we are as Christians. We are drawn to the light and so bringing things more to light. I would encourage that that will always be an opportunity for Christ's grace to shine through.

Adrian Crum: 1:28:27

Yeah, one of the things that you said to me I remember that stuck is instead of thinking of yourself as broken and unfixable, just have curiosity about this, just investigate things that don't make sense, think of yourself as sort of objective and just be curious about your own struggles. That was helpful for me to think through. Well, john and Lindsay, thank you so much for taking the time to talk today. I think this may be the longest Reformed Deacon ever, so we feel like we've put you through a lot of questions. We really, really appreciate you so much. We hope our listeners have gained some insight and feel in some way strengthened and encouraged as they minister to those in their congregations who are struggling with mental health concerns. Thanks for having us, thank you.

David Nakhla: 1:29:01

Thanks for joining us. Go to our website, thereformedeaconorg. There you will find all our episodes, program notes and other helpful resources, and please make plans to join us again for another episode of the Reformed Deacon Podcast.