Thematic qualitative analysis of rural Southern faith-based leaders identified that church leaders are unprepared to address mental health stigma but believe they can support congregants through relationship-building, listening, and discernment.
Key Findings
Results
Faith-based leaders in the rural South view mental health as a broad topic connected to a person's overall well-being rather than a narrowly defined clinical concept.
This was identified as the first of three major themes from thematic qualitative analysis.
Participants were pastors and ministers (N = 10) recruited from 3 rural Southern counties.
The study used purposeful sampling to recruit participants.
Participants shared perspectives after viewing a minidocumentary featuring faith-based leaders discussing mental health issues in the church.
Results
Church and faith-based leaders reported feeling unprepared to address mental health stigma among church congregants.
This was identified as the second of three major themes from thematic qualitative analysis.
The finding highlights a gap between faith-based leaders' front-line role and their readiness to handle mental health issues.
Faith-based leaders are often the first people contacted by people in rural areas experiencing mental health crises, yet some may delay referrals.
The study was conducted in the rural South, a region where access to mental health services may be particularly limited.
Results
Faith-based leaders expressed belief that they could address mental health needs by building relationships with congregants through listening and exercising a spirit of discernment.
This was identified as the third of three major themes from thematic qualitative analysis.
Participants saw relationship-building and listening as key mechanisms through which they could support congregants with mental health needs.
The concept of 'spirit of discernment' reflects a faith-based framing of recognizing and responding to congregants' mental health challenges.
Authors suggest integrated spiritual-based and mental health prevention approaches may be beneficial to support faith-based leaders in their referral role.
Methods
Focus groups with rural Southern pastors and ministers were conducted using a minidocumentary as a stimulus to elicit perceptions about mental health and the church's role.
A total of 10 pastors and ministers participated, recruited from 3 rural Southern counties using purposeful sampling.
Participants viewed a minidocumentary featuring faith-based leaders discussing their role in addressing mental health issues in the church before participating in focus groups.
Thematic qualitative analysis was used to identify patterns across focus group discussions.
The small sample size (N = 10) and geographic and religious specificity are noted as limitations, with future studies recommended to include larger samples from different religious backgrounds.
Conclusions
The authors conclude that integrated spiritual-based and mental health prevention approaches may be beneficial to support faith-based leaders in referring people to treatment.
Public health professionals and mental health providers are specifically identified as stakeholders who should understand faith-based leaders' perspectives.
The authors note that some faith-based leaders may delay referrals despite being first points of contact during mental health crises.
Future studies with larger samples and different religious backgrounds are recommended to build on these findings.
The rural Southern context is highlighted as a distinct setting relevant to understanding these dynamics.
What This Means
This research suggests that in rural areas of the American South, pastors and ministers frequently serve as the first point of contact for people experiencing mental health crises — yet these leaders often feel ill-equipped to handle mental health stigma within their congregations. The study involved focus groups with 10 faith-based leaders from three rural Southern counties who watched a short documentary about mental health and the church before sharing their perspectives. Researchers identified three recurring themes: that mental health is seen as broadly connected to overall well-being, that church leaders feel unprepared to tackle stigma, and that leaders believe they can help by listening carefully and building trusting relationships with their congregants.
The findings highlight a meaningful gap: faith-based leaders occupy a trusted, accessible role in communities where formal mental health services may be scarce, but they lack the tools and training to fully address mental health stigma and facilitate referrals to professional care. This research suggests that when some leaders feel unprepared, people in need may experience delays in getting appropriate help.
The researchers suggest that programs combining spiritual and mental health approaches could help bridge this gap — supporting faith-based leaders in their natural community role while also connecting people to professional mental health treatment. Because this was a small qualitative study in a specific region, the authors caution that future research should include larger and more religiously diverse groups of faith-based leaders to better understand how these dynamics play out across different communities.
Cody S, Sanchez S, Burton W, Bradley L, Foster P, Newman S. (2026). Faith, Hope, and Therapy: A Qualitative Study to Explore Faith-Based Leaders' Perceptions of Mental Illness in the Rural South.. Preventing chronic disease. https://doi.org/10.5888/pcd23.260031