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Working with People with Mental Illness
ConfidentialityIt is usual for a pastor to encounter some situations where a person with a mental illness divulges information which poses a threat to his/her own well-being or the welfare of others. Many of the problems persons in all the helping professions confront can result from the boundaries around confidentiality.
Being honest with the person is most important. For example a pastor can say:
"The information you have just told me, means that you may hurt yourself or someone else. It puts me in a difficult position. I am bound by law to prevent harm to you or anyone else. Therefore, it is not possible for me to keep this information confidential. Do you want to work with me on these feelings and threatening thoughts? How can I help you with your anger? What do you expect me to do now that you have told me this?"This might start a discussion of what are the limits of confidentiality.
Often people under emotional stress or with a mental illness, consciously and/or unconsciously, want to put the moral responsibility for their actions on the pastor. It is important to explain that this is not what ministry is about. Ministry is about helping people make decisions that are both moral and healthy. The pastor cannot prevent the person from doing wrong or even command them not to do wrong. However, the pastor can inform the person's conscience so that the person can be responsible for his/her actions.
When a person has already hurt someone or committed a crime, the pastor might be able to work with the person to move him/her toward identifying a course of action that leads the person to entrust him/herself to the justice system. In any case, informing the person of the fact that the pastor cannot condone the person making his/her guilt the pastor's problem, will, hopefully, lead him/her to find a meaningful way to deal with their own sense of guilt, shame or confusion. Offering the person the support needed to do the moral and healthy thing is what ministry is about. It separates information that is confidential from information that is potentially dangerous.
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