How sick is sick enough to get help?

Whether it is counseling, psychiatry, or group work, people make it when they are in crisis, when they feel out of control, when they know they need help. 

I have spoken to many pastors about mental health, and often they talk about one person who is struggling greatly. In a congregation of 300-500 people, they isolate the one person who is barely functioning to see if there is something we can do. That one person becomes the definition of mental illness for that pastor and for the congregation. 


The image of mental illness changes when we see the 1/4th of one percent worst case scenario as mental illness. And in doing so, I think there are unfortunate ramifications. 

People associate mental illness with a definition so tight that they miss most of what mental illness looks like. When we associate mental illness with only acute mental illness, like severe schizophrenia or bipolar, we miss so many disorders that affect people’s daily lives. 

According to the NIMH, about 4.2% of people will have a serious mental illness in any year. “Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.”[1] These mental illnesses make up less than 25% of mental illness in the United States. When we identify an even smaller subset, we push people to the margins. Their pain is somehow not deep enough to count. Their mental illness is not severe enough to warrant community or attention. 

When we label mental illness with such tight parameters, we miss the suffering in front of us. Does the mom with depression who can barely hold it together count as having mental illness? She is still functioning, but she feels like her mind is breaking apart. How about the kid with anxiety who fears the embarrassment of having a panic attack around his classmates? The CEO with bipolar? The deacon who was abused as a kid? The mom with OCD? The soldier with moral injury? We miss everyone who does not present as very sick, and in doing so, we miss most of the people who do have mental illness. 

I think we do not want people to experience mental health. We want people to avoid feelings and pain we associate with mental illness. And there is a huge difference. 

The mom with depression is not suffering enough that the rest of the world would say she is too sick to function. She is pressing to drudge through, but she is still functional even is mental illness is consuming her life. She is not experiencing an integration of who God sees her as and who she believes she is. She is not experiencing hope and joy and life. She is just watching the calendar turn the tomorrows into todays into yesterdays. Society wants her not to be depressed, wants her to come back to normal, but does not actively want her to thrive. 

The conversation about mental health has been about mental illness for years. For me, as a person with bipolar disorder, the discussion has been about avoiding the symptoms of bipolar disorder and returning to a normal existence. I have been pretty stable for the last 17 years, but I was not experiencing mental health, just the absence of mental illness. I still had to process all the pain of my childhood and learn to understand why taking on risks was so hard for me when it seemed so easy for the people around me. I had to learn my own value and worth to discard all of the coping mechanisms that were ruining my life. I had to learn there was still hope for me. I had to learn how to disappoint people. I had to learn my strength. I had to learn I could lead. I had to fail and get up again to know I was resilient. And in learning all of those things, I learned not only how to not be sick, but how to be well. 

When we can rephrase this conversation away from the 1/4th of one percent, we have the chance to help people integrate themselves with Jesus. We have the chance to help those who we would have left in the dark. We have the chance to help people see themselves as God sees them. We can hear them and give the dignity of time. We can empower them and give them the blessing of voice. We can help them stop just existing and start thriving. 

As someone who still sees a counselor regularly myself, I do want to overcome the problems with severe mental illness, but I also want to learn to thrive and know that I am good. I want to experience deep and true mental health. 

So how sick is sick enough to get help? If you are asking the question, it is probably time.