Mental illness in your church is not an isolated problem. Current research highlights that one in five adults in the United States struggles with some form of mental-health issue each year. One in twenty adults experiences a serious psychiatric disorder. These suffering brothers and sisters are no doubt part of the flock you are called to shepherd.

Joel is one such congregant. He was recently arrested high on crystal meth, engaging the services of a prostitute. In fact, this is the third time this kind of behavior has happened in the last two years. What does pastoral care look like for him? What is the role of church discipline in his life? Should it make a difference that Joel has been diagnosed with bipolar disorder and ran out of his medications again, potentially precipitating the manic episode in which he stayed up all night using meth and engaging in illicit sex?

There are no easy answers here. In thinking about the juxtaposition of mental-health issues and church discipline, we want to be wary of two extremes. First, we don’t want to avoid corrective pastoral care out of fear that we will “add insult to injury” for those struggling with mental affliction. Second, we don’t want to care for someone with mental illness exactly as we would care for someone without such a struggle. We want biblical truth and love to guide us.

What Is Mental Illness?

Mental (or psychiatric) disorders are significant disturbances of thought, emotion, or behavior that cause distress to the person and often significant impairment in day-to-day functioning. Many struggles fall under the umbrella of mental illness, including schizophrenia, bipolar disorder, obsessive-compulsive disorder, major depression, and also problems such as substance abuse, autism, and dementia.¹

Because there is such heterogeneity in what is understood as mental illness (not to mention the potentially myriad causes of such struggles), we must be careful of any one-size-fits-all approach. Each struggling person is different. A mental-health diagnosis is a starting point, not an endpoint, for understanding a person’s experience.

Much mental suffering is hidden, including among Christians. Many who bear a psychiatric label feel ashamed and stigmatized. They may already feel disconnected from the church body and even from Christ. In my experience, they are much more often “fainthearted” and “weak” rather than “idle” or disorderly (1 Thessalonians 5:14).

Mental illness always involves suffering. Church leaders, therefore, are wise to slow down, taking the time to draw near to the brokenhearted as the Lord himself does (Psalm 34:18). But suffering isn’t the only category to consider. All believers simultaneously live as saints, sufferers, and sinners this side of glory.² When people struggle with mental-health problems, the battle with their sinful nature continues, and this battle may have significant consequences for self or others.

Sinful behavior can be particularly prominent in some mental-health struggles, such as manic excesses, multiple relapses associated with substance abuse, the relational harm associated with certain personality disorders, or angry and abusive outbursts associated with PTSD. In such cases, it becomes even more challenging to discern the priorities of pastoral care for this sister or brother who is both a sufferer and sinner.³

What Is Church Discipline?

Now that we have some general ideas about mental illness, what about church discipline? Jonathan Leeman highlights,

Church discipline is the process of correcting sin in the congregation and its members. Church discipline typically starts privately and informally, growing to include the whole church only when necessary. In its final, formal, and public stage, church discipline involves removing someone from membership in the church and participation in the Lord’s Table.

We see this process most clearly in Matthew 18:15–17. For the person under discipline, the goal is always restorative, not punitive. We want to see unrepentant sinners return to Jesus!

It’s helpful to think of church discipline on a spectrum. In one sense, all believers sit under the autocorrect function of God’s word (2 Timothy 3:16; Hebrews 4:12). As we read and hear Scripture, we are personally convicted — disciplined — by God’s indwelling Spirit to live in line with biblical truth.⁴

But God also grows us through community. When a friend approaches us and says, “Hey, I’m concerned about your harsh interactions at small group,” God, in his mercy, is using this person to help us see where we have sinned (Matthew 18:15). This broader practice of discipline is an utterly normal part of the Christian life. Informal but intentional conversations focused on what living for Jesus looks like should characterize our body life and our pastoral oversight.

More formal steps of discipline (Matthew 18:16–17) are not carried out simply for those who sin (we all do this!), but for those who sin in significant, high-handed ways and do not repent despite multiple entreaties to return to the safety and beauty of God’s law.⁵

Seven Guiding Principles

For helpers and church leaders, seeing sin in the lives of fellow believers should prompt the question, “What is most wise and loving at this juncture to help this particular person with these particular patterns of sin?” Answering that question, however, is often more complicated when the person involved deals with mental illness. So, how might we bring together our understanding of mental illness and church discipline?

The following general guidelines are certainly not exhaustive. In any given situation, what is wisest pastorally is prayerfully discerned by a team of thoughtful and compassionate shepherds who know their people well.

1. Personalize mental illness.

Familiarize yourself with the general contours of the psychiatric disorders that you know members of your congregation struggle with, endeavoring to think biblically and theologically about such issues.⁶ Then personalize that growing awareness by having conversations with those brothers and sisters, along with their family members, counselors, and physicians. Get a sense of their daily lives. Where do they struggle to live out their faith? Where do they experience joy and contentment? How can the church better care for them? You don’t have to be a mental-health professional to know a person deeply, but the more complex the struggle, the greater the importance of broadening your understanding.

2. Deal patiently and gently.

Patience and gentleness are key (1 Thessalonians 5:14; Galatians 6:1–2). Notice that there is no specific timeline associated with the process of church discipline in Matthew 18. In general, apart from the clearest cases, we might expect there to be several or even many conversations while moving along the spectrum from informal to formal church discipline. The administration of church discipline is not on a hair trigger. Godly shepherds model the description of Israel’s high priest in Hebrews 5:2: “He can deal gently with the ignorant and wayward, since he himself is beset with weakness.”

“You don’t have to be a mental-health professional to know a person deeply.”

Along the way, seek the input of the mental-health professionals who are working with the affected person (assuming consent is given). Decisions about formal church discipline are always momentous, even when seemingly clear-cut. How much more so when there are additional factors to weigh in the case of someone with a psychiatric diagnosis.

3. Form wise expectations.

Prayerfully consider how the weaknesses of the person might temper your expectations for obedience. A parenting analogy may help explain what I mean. In parenting, the age and developmental stage of our children matter in terms of our specific expectations for obedience, and the way we discipline should align with those differences. “Honor your father and your mother” holds equally for both the three-year-old and the twelve-year-old, but we have more robust expectations for our twelve-year-old. Additional factors in the child — such as hunger, pain, illness, or sleeplessness — may also warrant an adjustment in expectations. For example, we may not correct our three-year-old who has had a meltdown during a fever and strep throat.

How might this look for someone with both mental-health and recurring sin issues? Years ago, I was consulted about a middle-aged single man who was undergoing formal discipline for laziness and failure to honor his parents. After having a string of part-time jobs for many years, he hadn’t worked for several years and was living with his elderly parents.

As I got to know him, I indeed noticed places where his fleshly propensities for ease and comfort led to laziness. But more was going on. He struggled with incapacitating anxiety in social settings. Further, I observed some impaired interpersonal and cognitive capabilities that no doubt made it difficult for him to hold a job. The elders and I ultimately crafted a shepherding plan that took into account this man’s true weaknesses and inabilities while at the same time exhorting him to take more proactive care of his parents. However, given the full picture, the process of formal church discipline no longer seemed appropriate.

4. Care for everyone involved.

At the same time, it is also important to consider the impact of the person’s struggle on family members and the broader body of Christ. The severity and chronicity of these harmful offenses factor into the extent and time course of church discipline. A wife raising concerns about her husband’s apathy and passivity amid his serious depression is one thing. A depressed husband who has become verbally or physically abusive to his wife is a different matter and requires more urgent pastoral intervention. Or consider the difference between a person with fluctuating psychosis who sometimes disrupts church gatherings and the same person who is also making unwanted sexual advances toward another church member.

You are simultaneously trying to recognize and address the harm done to others while also bringing hope, encouragement, and correction to the suffering sinner. Put another way, you are seeking to love multiple people at once: the person with mental illness, those impacted negatively by his struggle, and the wider body of Christ.

5. Prayerfully assess repentance.

Prayerfully assess the person’s level of repentance (2 Corinthians 7:10–11). Remember, Scripture reserves the most serious manifestations of church discipline for church members who refuse to repent of clear-cut, significant sin. Questions to consider include the following (I’ll use he as a generic pronoun):

• Does the person understand what he has done?
• Is he grieved by this sin before God and others?
• Has he asked forgiveness from those he has sinned against?
• Is he doing the hard work of rebuilding trust with others?
• Is he availing himself of all reasonable help, including counseling and/or medical care?
• Is he compliant with prescribed medications?
• Does he welcome greater pastoral oversight and accountability?

The more concern these questions raise, the more reason we may have for continuing a process of formal church discipline.

6. Remain open to change.

Be ready to change direction. Sometimes a decision regarding discipline needs rethinking. In many cases, this is not being wishy-washy but being wise and humble stewards of additional information and insights as they become apparent. No doubt, it is difficult to discern the difference between can’t and won’t in a struggling person. Sometimes, we will realize later that we erred on either side — being too lenient when greater accountability would have been wiser, or being too quick to advance formal discipline when greater patience and mercy would have been appropriate.

7. Love beyond discipline.

What about those (hopefully infrequent) instances where a congregant with a mental-health diagnosis requires removal from membership and the Lord’s Supper for serious and unrepentant sin — despite a prayerful, thoughtful process and multiple entreaties of love and warning? We do it with gentleness and tears, continuing to acknowledge the person’s real suffering as well as the sins that have harmed others and brought the gospel into disrepute.

If possible, communicate well with those outside the church who are involved in the person’s care (like counselors and physicians), as the discipline process may impact the person’s emotional state, and caregivers may need increased vigilance. Be prepared that taking such a step may incite anger and/or self-harm in the person. Ideally, family members and friends understand the need for this final step of church discipline and can offer ongoing support to the person.

Excommunication doesn’t mean that the person is barred from attending your church (a potential exception being harm done to others in the congregation by his continued presence). But it does mean that this person’s profession of faith is no longer seen as credible, and he is therefore viewed as an unbeliever. What does that look like? The person is welcomed and encouraged to attend the gathering but not partake of the Lord’s Supper, and leaders and members continue to urge him toward repentance and faith in Christ.

While this article cannot fully address the complexity involved in the exercise of church discipline in cases of mental illness, I hope these reflections provide biblical perspective and guidance as you, together with your fellow pastors, seek to wisely love those God has called you to shepherd.