During my Chaplain Residency, I served for 6 months in a psychiatric ward.  My work involved ongoing spiritual assessments of new patients (referred to as “residents” in the VA Medical Center), providing appropriate resources such as Bibles, and engaging people in countless conversations.  Depending on the situation, those who were admitted to the ward progressed through a variety of care processes with the ultimate goal of a discharge to their next phase of recovery. 

People sometimes ask me, “What was it like serving in a psychiatric ward?”  My response is, “Incredibly rich and fulfilling”.  I am going to spend a few paragraphs here fleshing out why.

However, before I continue, I feel a need to clarify the nature of psychiatric care in most hospital settings.  Years ago, psychiatric patients were admitted for an extended period of time, with the goal of not only stabilizing their condition, but also delving deeper into the underlying causes of their struggles and providing the counsel they needed to return to their daily lives.  This still happens, but to a lesser extent.  The primary objective in modern psychiatric care in a hospital is stabilization.  There are many reasons for this shift in emphasis, not the least of which are advancements in medications, the availability of outpatient treatments, inpatient treatment programs and cost considerations.  This reality places more responsibility on the patient, families and numerous entities outside of the hospital environment.  This presents pros and cons, but the bottom line is that chaplains and other care professionals have less time to engage patients in the healing process during their hospital stay.  

My first contact with patients was often in their rooms where they were under close supervision or in a common area where they were waiting for the care team to complete initial evaluations and admission paperwork.  Most came with some level of depression and suicidal ideation which some had attempted to carry to completion.  On several occasions my ability to communicate with patients was limited for a few hours as they moved through a process of detoxification.    

I introduced myself to patients with a brief statement expressing my desire to care for them.  It was not uncommon for patients to tell me they weren’t interested, but a high percentage welcomed me into conversation, if not at the moment, at a later time after they had adjusted to their surroundings.    

Following these initial exchanges, I recorded notes in the hospital charting system and rehearsed my experiences in the form of “verbatims” (a word-for-word account of the encounter with a thorough evaluation of my work) with my chaplain peer group.  In the latter case, I used fictitious names for the sake of confidentiality. 

Additional visits usually lasted longer.  As a chaplain I was taught to live “in the moment” of every encounter, which means I did not lead with information from a former visit.  Nevertheless, patients usually remembered me, and our relationship developed as time progressed. 

Not all encounters were individual.  Some of my best conversations occurred as groups gathered to watch TV, eat meals, participate in spirituality groups or play cards.  I once asked a patient if he thought it was healthy for people in acute psychiatric care to watch westerns where gunslingers and lawmen were constantly killing each other.  He said, “Chap, we know it isn’t real”.  Don’t ever think psychiatric patients lack a sense of humor.    

As I look back on this season in my ministry, I have embraced some wonderful lessons I will take with me for the rest of my life.  I offer them in tribute to the patients I met, and to encourage you to draw close to those under psychiatric care. 

First, acute mental distress usually involves a break in a relationship, through estrangement, death (even pets), relocation or other events resulting in significant change.  Relationships hold our hopes and dreams, and provide stability in the face of difficult circumstances.  Perhaps this is why it is so important to provide a listening ear to those who are hurting.  Care is communicated through our willingness to give others our time.  Our goal is not to replace lost relationships, but to do what we can to remind others they are not alone.  This is also one reason a loving and accepting church is so valuable for those who are suffering.  Community can bring hope in the midst of pain and comfort those who inaccurately perceive God has abandoned them. 

Secondly, during my time in the psychiatric care unit, I had to overcome the fear I would say or do something that would make matters worse for the patient.  It is true we must be careful in our interactions with people who are receiving acute care, remembering that others don’t need us to fix or judge them.  People also need to reclaim personal agency, which means we should respect their space.  But it is hard to hurt people by listening and being present.  We should not let the fear of making a mistake keep us from reaching out to people in mental distress.

Third, there was a time in my life when I hesitated to discuss psychiatric issues with those receiving care, regardless of where I encountered them.  I thought I should pretend everything was “fine” unless I was invited to say more.  I still respect confidentiality, and proceed with great care when I encounter someone outside of a clinical setting who has been struggling with mental issues.  However, I am much more aggressive in pursuing a conversation.  While providing a safe environment, I will delicately inquire about their circumstances.  I am prepared to step back and disengage if I sense any anxiety, but I remain present and alert to the possibility others might wish to share their burdens. 

Finally, I now operate with the understanding mental distress is multi-faceted, and usually runs deeper than the presenting condition.  People with diagnosed mental diseases and disorders are unique in their family history, social context and personal challenges.  I may not be the one to prescribe a medication, but I can show them they are loved.  I have heard the three greatest needs that people have are to love and be loved, to belong and to find meaning.   Even in the most acute mental cases, people will usually respond on some level to others who meet these needs.

Primarily, during my time in the psychiatric unit, I did a lot of listening.  I heard words of confusion, heartache, resentment and regret.  I sensed fear, anxiety and hopelessness, sometimes through the expressions of a patient who was largely unexpressive, and other times through tears of anguish.  

If I have learned anything I can pass along, it is to strive to overcome any fears we might have of caring for those receiving psychiatric treatment.  We are not with them to fix what they are facing, and we will often come away wondering if we made a difference.  But most anytime we listen with concern, we are making an impact.  And in the context of the church, the love of community can have a profound influence on the healing process.  This is true for all of us since we all need healing. 

We serve the One who has placed us as His hands and feet in the midst of a hurting world.  Jesus is the Healer and we are His ambassadors applying grace in the lives of others.