The Church and Mental Health-Hipaa and Referring, Part 2 and 3

written by Amber Fuller, LMFT and owner of Fuller Living


I belong to several different social media groups specifically for therapists. The following question comes up often in these groups, “To what extent should a pastor, priest, clergy member, and church leader be doing counseling?”. Honestly, it’s a hard question to answer because there are so many factors to take into consideration. Does the person have a masters in counseling and they’ve chosen to be a pastor? Are they prepare/enrich certified? Do they have a degree in social work but chose to go down the path of pastoral care? All of these are important questions to be asking. Despite all of these questions though, there is one factor that still remains and it is a big difference between providing counsel via the church vs. a licensed mental health professional, and that factor is Hipaa.

When I was in my early days of my mental health career, I experienced myself thinking often, “Man! my job would be SO much easier if I didn’t have to get a release of information”. It’s a hassle to get them to the client, sometimes work to get them signed, and sometimes very scary to not be able to talk to an emergency contact if the situation doesn’t allow for it. However, I very quickly developed a love for hipaa that I never thought was possible. Quite a few years ago I went through a situation where some very uncool and unkind things had happened to me by a person who was in a leadership position within a church.

When I look back on the situation now I realize that if Hipaa laws, rules, and violations existed within the church, none of what I went through would have happened and if it had there would have been some serious consequences for that person breaching hipaa(if it existed in the church). The situation had me at the lowest point of my life that I had ever been in. I healed through EMDR and am incredibly thankful for such a powerful therapeutic tool.

To be frank, what hipaa asks of people to do is to not talk about people (can’t even confirm whether or not one is a client) unless you have their permission to do so; sound familiar? It’s because to do the opposite is called gossip. If the Church was bound to hipaa, so much could be done that isn’t being done currently. People would feel safe knowing that their problems weren’t going to be talked about with other church leaders. Also, have you ever noticed that most church leaders are friends with each other? So the excuse of, “Well I talked to the other church leader about it so that they could ‘pray’ (which is another issue of it’s own) for you” only goes so far because when you walk into the Fuller Living practice we aren’t allowed to talk about clients between us colleagues unless we have a release of information to do so, and the same thing should be happening within a church, in my professional opinion (and hopefully that’s worth something! lol).

Do you know what happens to a mental health professional if they talk about a client without that client’s permission? They could potentially lose their license/their whole livelihood, their reputation would suffer, and they can be fined tens of thousands of dollars. The reason this is a reality is because it can be incredibly damaging, like I stated earlier, because a couple of people within a church decided to talk about me without my permission, I was in the lowest place I had ever been in my life.

So, because hipaa doesn’t exist within the church in the same capacity as it does within the counseling setting(there are some exceptions to this), the church is limited in some capacity to be a private and safe space for counseling to occur.


If you’re wondering if a Church leader should be providing counseling, I’d like to pose this question: If a church member came in to my office and asked me “what does the Bible say about the issue of X?” Should I answer? Or is it better for me to allow a pastor the gift of purpose in their life by allowing them the opportunity to answer having been given the specific giftings of that nature? I certainly can answer( and I actually ESPECIALLY can because I also have a degree in Biblical principles and theology), and maybe my answer would be just fine, but I’m still taking away another person’s area of ministry by jumping in, and just because I can, doesn’t mean I should, and I’m taking away the gift of purpose for that person’s pastor if I choose to answer. What I would do in this situation in order to be most helpful is talk with them about who they have in their life as a spiritual mentor and guide them in that direction while figuring out barriers that they may have to overcome in order to talk to that mentor and helping them get over those barriers.

Now turn the exact situation around. If a church member goes to a Church leader and asks them what they should do about a mental health issue, I think it serves in everybody best interest for the church to refer the person to a mental health professional. They can talk with them about the barriers that may exist to accessing the mental health support that they need and they can help them overcome those barriers whether it be financial, shyness, childcare, etc. Please, allow us mental health professionals the opportunity to have purpose in their life. Allow us that gift. We are trained in it and for it and we would do the same thing for you in your gifting.

I’d also like to add that in ANY situation I think that it’s important for pastors to listen to the prompting of the Holy Spirit because really, at the end of the day, that prompting will never steer a pastor in the wrong direction when working with somebody in a mental health crisis.

Do you know what is required in order to become a Licensed Marriage and Family Therapist? It requires 4 years in an undergrad psychology specific program, then 2-4 years in a masters degree program in a counseling specific program where you have to complete 2,000 hours training while in your masters program along with a master’s thesis project, THEN after graduating with your masters degree you have to spend 4,000 hours in the counseling setting training (we refer to this as an internship and can easily be compared to the idea of residency for a doctor), months worth of studying in order to pass the state written exam, and then more months worth of studying in order to pass the oral exam. It’s a lot. As a Church leader, would you feel that you could give accurate medical advice to somebody with a medical condition? We literally spend the same amount of years on training and education, it’s just done in the mental health world and not the physical health world. Would you give legal advice to church member, as a church leader? We have to study just as hard as an attorney does in order to pass our board exams.

One of the reasons we do all of this training is so that we are able to remain neutral with clients or families when meeting with them. In order to get to a place where we can be neutral, we have to experience lots and lots of different situations so that we can see all sides. We also have to do our own work through going through our own counseling so that we can heal up any unhealed trauma so that it doesn’t ooze out onto the clients we work with. Neutrality and doing unbiased work is often something that is taken for granted by many, but it literally is what allows us to do what we do. I had somebody say to me once, “Oh Amber, I could be a counselor. It’s literally just sitting there listening to people talk about their problems”…and the person was saying this with the agenda of one-upping me, which this person had a problem with doing, and this is literally the very reason this person couldn’t do the work, because 1. They don’t comprehend the work we do at all, and 2. the statement they made showed that they hadn’t done their own healing work. There is absolutely no space in the therapeutic setting to be emotionally selfish with clients, because if a therapist is being emotionally selfish then they are very likely acting in an unethical manner.

This might leave one asking, “Well Amber, if we should be referring people out to mental health professionals then HOW exactly can we be helpful to church goers and their mental health?” and to that I would point them back to my Part 1 of this blog and tell them, “That’s how”. I also would tell you that you can be helpful by providing practical and tangible things for those in mental health crisis because when a person’s practical and tangible needs are taken care of, they are in a realistic place to start to be able to change their mental health. I also know for a fact that a person’s spiritual health heavily affects their mental health, so focus on that. Focus on feeding a person’s spiritual health.

Stay tuned for Part 4. I will be addressing “secondary abuse”, what it is, and how the church can better handle when a church member is the victim of emotional abuse by their spouse or family member.