Under a Harvard Medical School pilot program, they will work as interns before counseling on their own, referring more serious cases to medical providers.
After months of classes on counseling, Veron Blue got her chance to put what she has learned all year to work. Across from her was fellow trainee Deborah Johnson , who, as part of a lesson, assumed the role of a hypothetical client, who had come to Blue for help dealing with depression.
Remembering to focus first on the encounter’s positives, Blue, pastor at San Antonio’s Family Life International Ministries, began, addressing Johnson directly: “I am so proud of you for coming to this meeting.” By the end of the encounter taking place last month inside a local clinic, her fellow trainees and instructors broke into applause as Blue sighed in relief. “Having this knowledge with what we already know as pastors is powerful,” Blue told the group. Blue and Johnson are among 10 people from eight different Christian churches in San Antonio who have spent the year participating in a Harvard Medical School program called EMPOWER, a unique program to bring basic counseling skills to places of worship. The training is designed to help clergy, and its members become part of the mental health workforce, offering brief counseling sessions to community members. This program is not meant to handle severe mental illness beyond depression, and trainees are taught to refer cases beyond their scope to a clinical provider. “We know the people we are talking to in church, and there is already a built-up trust and dialogue,” said minister Greg Carter from Vertical Church in San Antonio. “It makes sense for us to use this program.” The free 12-month program is being sponsored by the Congregational Collective, a nonprofit organization founded by H.E. Butt Foundation in 2023 to help San Antonio faith communities support mental wellness. The organization’s executive director, Rebecca Brune, said the EMPOWER program draws on 25 years of research in India, which showed how community health workers and nonclinical providers could deliver mental health assistance as effectively, if not more effectively, than clinical providers. By the end of the year, this initial group of 10 clergy and church members will move on to an internship where they will do nine skills-building sessions at San Antonio’s New Opportunities for Wellness Clinic and three to five test cases under supervision. By November or December, they will be able to deliver services independently. Once they finish training, this first group will be tasked with helping train the next cohort of religious leaders. “With the workforce shortage struggle, we needed to figure out how to distribute mental health treatment from an equity perspective,” Brune said. “What better place to go to than faith communities, where Latinos and African Americans already have trust in.” When the Rev. David Murillo, lead pastor at St. Paul Lutheran Church in San Antonio for the past ten years, was approached by the Congregational Collective about participating in the EMPOWER program, he knew it was his calling to say yes. “This church has been intentional about outreach for centuries,” Murillo said. “I view this as the current iteration of the church serving the community.” Roxanna Johnson of St. Paul Lutheran Church, said their church has always looked to help those with mental illness, but they didn’t have the tools to address it until now. She said she already had seen the benefits of the training program when a couple from Honduras who were in the United States for asylum came into their church looking for help. “They had a hard time coming here. They told all kinds of stories. I assessed the woman using the training I had received, got her some help, and found her a program to get into,” said Johnson, who is now the church’s Congregational Collective coordinator. “I am sure we are doing the right thing now.” How the program works EMPOWER teaches people how to treat depression using positive emotions. This is the same training mental health providers receive to treat some depression. “We have learned that people may need to see a mental health clinician, but they are less likely to speak to someone in a white coat than somebody in the church,” the Rev. Murillo said. “This means the church needs to step up. If not us, then who?” This is the first time this training program has been used in the United States, but it has been implemented in countries such as India and various places in sub-Saharan Africa. Harvard Medical School’s Mental Health For All Lab has recently translated the program from Hindi to English and Spanish, and San Antonio is the first stop. “Leveraging faith leaders has been done all over the world,” said John Naslund, an instructor in Global Health and Social Medicine at Harvard who is helping implement the EMPOWER program in San Antonio. “America is actually behind in this regard.” Naslund believes the program fits perfectly with Texas due to its size and desperate need for more mental health providers. “San Antonio was perfect because there was already interest in collaboration between churches and clinical partners,” he said. “Also, there is a huge need in Texas, so there is a motivation to make it work.” The partnership with the NOW Clinic in San Antonio provides the EMPOWER program with ongoing clinical supervision and referrals, which Brune believes adds a layer of efficiency and integrity to their effort. “That is the exciting part. We will be able to measure it and track the referrals and the monetary value of this work,” Brune said. The Rev. Jaime Paniagua of St. Dominic Church in San Antonio, another EMPOWER trainee, said that when he referred people in the past, it might have taken weeks or months before they got help, and many people turned to their pastor before their mental health provider. “There are two reasons I believe this, and one is because we are a place of trust, and the second is that we don’t charge $200 an hour,” Paniagua said. “I never deny a call, and everybody who wants to call me can. We serve right away here, and people know they will be served.” He also said now is a perfect time for the EMPOWER training because a new generation is starting to return to religion. “God created us as good spiritual beings, and we are constantly pursuing things to make us feel spiritually good, but not many places provide it,” Paniagua said. “Sometimes, as a church, we mess up, but we need to give the people what they seek because deep inside, we all want to be happy.” Still, there are some concerns and questions about making the church a general provider of mental health services. “I think the biggest challenge is not to get emotional,” said Deborah Johnson. “You have to understand that we know these people personally, and when you hear about those challenges, you want to help immediately.” David Roberts, a psychologist at the NOW Clinic who is helping to supervise the program, said one of the biggest challenges for this pilot program is figuring out where the pastor’s role ends and the mental health provider’s begins. “It can be tough to be emotionally detached from people you personally care about, but you can use those emotions to affirm your client’s feelings,” Roberts told the classroom of religious leaders. Religious leaders hear all kinds of problems from their congregation, whether it be rent, divorce, spiritual conflict and more. Their natural reaction is to help their congregation immediately, but this training program focuses on not only helping the physical but also the mental. “You have to set boundaries. You can say right now is the behavioral activation session; outside of this, I will call you as a spiritual leader, but be honest about when you switch directions,” said Megan Fredrick, director of programs at the NOW Clinic. Another concern brought up by the group of trainees is what to do when someone is suicidal, and Fredrick quickly told them to refer those kinds of cases to mental health professionals. “You are going to meet people who you can’t help, but you can give them actionable items to find that help,” Frederick said. Naslund stressed that this program does not replace proper clinical counseling because the participants aren’t trained to diagnose or prescribe medication, and it’s primarily used to treat depression. “The current mental health care system isn’t working,” he said. “We had to find a different way. This is meant just to add additional help.” The relationship between mental health providers and the church can be viewed as mutually beneficial. Churches can use this program as a method of outreach during a time of declining membership, and providers can use regular people to address low-tier mental illness, freeing up time and space. “The church gets to help and serve people. The clinics can connect with clients they might have had difficulty getting a hold of. And the school can do their study,” Murillo said. “Everybody wins.” The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans about public policy, politics, government and statewide issues.
Harvard Medical School Veron Blue Texas Tribune Family Life International Ministries Vertical Church Butt Foundation NOW Clinic Deborah Johnson Rebecca Brune Blue Roxanna Johnson David Murillo John Naslund Jaime Paniagua David Roberts Greg Carter Megan Fredrick H.E. African Americans Latinos Fredrick Texans Frederick God San Antonio St. Paul Lutheran Church St. Dominic Church India Texas United States NOW Clinic Sub-Saharan Africa Honduras Spanish EMPOWER Mental Health For All Lab Global Health And Social Medicine Christian New Opportunities For Wellness English Hindi
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