Depression: Challenges in Serving Kids with an Episodic Disability
In today's segment of our series, Understanding Depression in Kids and Teens…A Primer for Pastors, Church Staff and Christian Parents, we’ll discuss one of the challenges in thinking about depression as a disability…the reality that for many kids and adults, depression tends to come and go over time. We’ll also talk about what a church staff member or volunteer might observe if a child or teen is experiencing depression.
Two big challenges that our team has faced in training church staff and volunteers in the concept of “hidden disabilities” involve our mental models of what constitutes a disability. One concept we’ve written of previously in this blog involve conditions that are disabling in some environments but not others. For example, separation anxiety in a school-age child might not be an impediment to church attendance in a Roman Catholic church where kids are expected to sit through the Mass with their families, but very well could be a barrier in a non-denominational church where kids proceed to a different area of the church campus for age-appropriate programming.
The other unique challenge involves conditions that can be very disabling during acute episodes, but partially or completely resolve either in response to effective treatment or spontaneously of their own accord. Mood disorders, including depression and manic episodes in a person with bipolar disorder are probably the two most common chronic conditions I see in children and adolescents that manifest episodically.
I’d certainly argue that depression constitutes a significant disability because it represents a mental disorder responsible for substantial limitations in major life activities. What’s different about depression from the perspective of inclusion at church is that in churches with established disability ministries, the staff and volunteers leading those ministries probably have no history with the child or their family unless other comorbid conditions that frequently accompany depression required accommodations in the past. The first people in a church likely to suspect a problem will be the youth pastor or a small group leader when they notice an often abrupt change in the pattern of involvement of a teen suffering from depression.
Unlike the other conditions, in the absence of another mental health condition or a parent with a disability, I’d hypothesize kids with depression wouldn’t be any less likely to start attending church…they’ll have difficulty staying involved with church once symptomatic.
What are some signs a pastor, group leader or volunteer might notice that would lead them to question whether a kid might be suffering from depression in a church setting? Keep in mind that these signs are not exclusive to depression and may be explained by a variety of medical, psychological or environmental conditions…
- Abrupt withdrawal from ministry programming they attended regularly and enjoyed
- Significant changes in weight in a relatively short time
- A marked increase in feelings of worthlessness or guilt
- Expressions of suicidal thinking or self-destructive behavior
- Acute onset of anxiety symptoms in kids who weren’t previously symptomatic. In my experience, it’s not unusual to see kids who develop panic attacks or anxiety in crowds only when they’re clinically depressed.
We’ll address the issue of seeking help for depression later on in the series, but it’s not the purview of a church staff member or volunteer to make a diagnosis of depression after observing a child or teen unless they have performed a formal assessment within the scope of their training or licensure. It is appropriate to pastors or volunteers to accurately and truthfully share observations with parents consistent with an emotionally “safe” ministry environment in which confidentiality rights are respected. It is appropriate to make a phone call or send an e-mail or a text to a student and/or their parents when they abruptly discontinue an ongoing ministry involvement to inquire if they’re OK and to identify ways in which the church may be supportive.
A brief statement on confidentiality…I tell kids in my office that everything they say to me stays confidential with two exceptions…if they have recurrent thoughts of suicide or a specific plan to commit suicide, or a plan to kill or seriously hurt someone else, I’m obligated to tell their parents and take immediate steps to protect them or others as the situation necessitates. If I discover they’re being physically or sexually abused or neglected, I’m obligated to tell their county officials.
Laws on confidentiality and duty to report vary by state to state…it’s important that pastors and church staff become familiar with the legal requirements and precedents in their home state. In Ohio (my home state), pastors and church staff have the same legal responsibility as educators and licensed health professionals to report suspected abuse.
With minors, acting in good faith, I’m going to err on the side of protecting the child.
Dr. Steve Grcevich is a physician specializing in child and adolescent psychiatry who serves as President and Founder of Key Ministry. He blogs at church4everychild.org and may be reached at email@example.com.