Partnerships Between Faith Communities and the Mental Health Sector: A Scoping Review

Abstract

Objective:

Faith communities are increasingly providing services to address the mental health needs of their congregations and communities. However, many feel limited in their capacity to address serious illness and experience challenges to collaborating with the mental health sector. To inform the development of faith community–mental health sector partnerships, the authors conducted a scoping review to assess the characteristics and evidence base of partnership approaches to addressing mental health needs.

Methods:

A search of four databases identified peer-reviewed articles published between 2010 and 2023 on faith community–mental health sector partnerships in the United States.

Results:

In total, 37 articles representing 32 unique partnerships were reviewed. Most partnerships (N=19) used multicomponent approaches, particularly involving training the faith community (N=18), mental health education for the broader community (N=14), and direct counseling (N=11). Most partnerships (N=14) focused on African American communities. Partnerships that included an evaluation component (N=20) showed promising findings for improving mental health symptoms, mental health literacy, stigma, and referrals, among other outcomes. Several articles reported facilitators (e.g., support from faith leaders, reciprocal relationships and equal power) and barriers (e.g., limited time and funding, differing interests and attitudes) to developing partnerships.

Conclusions:

The findings highlight how faith communities can be a critical partner in providing services across the continuum of mental health care and reveal the need for more rigorous evaluations of the effectiveness, feasibility, and sustainability of these partnerships. The results also identify strategies that may facilitate the development and strengthening of future faith community and mental health partnerships.

Trends from the past two decades indicate worsening mental health among adults and youths in the United States (1), despite implementation of policies aimed at improving access to mental health treatment, such as the Affordable Care Act in 2010. One key resource that is gaining attention for its role in addressing gaps in mental health care is the faith community, including faith leaders (e.g., priests, imams, rabbis, and other clergy) and lay leaders or groups (e.g., volunteers and ministries) that are affiliated with a congregation (e.g., in a church, mosque, or synagogue) or other religious organization (e.g., seminary), across any denomination or nondenominational faith (2). A growing body of evidence has indicated the general medical and mental health benefits of religiosity and of belonging to a faith community (3, 4). Religiosity in the United States has declined slightly in the past two decades but remains high, with about 80% of adults reporting a religious affiliation, 69% attending religious services at least once a month, and 77% stating that religion is an important part of daily life (5, 6). Religiosity is particularly high in populations that experience disproportionate barriers to mental health care and utilization, including minoritized racial-ethnic groups (e.g., Latinos and African Americans) and in immigrant populations (4, 6, 7). Faith communities often provide services that extend beyond spiritual guidance, including assistance with social, economic, legal, and general medical and mental health concerns (8). In one national study, nearly one-quarter of adults who experienced a mental disorder reported seeking help and counsel from clergy (9). Therefore, faith communities may be key partners for improving mental health for a significant portion of the U.S. population, but their services remain underutilized.

Religion can play an important role in coping with life challenges and health conditions as well as in the treatment-seeking process (10). For instance, studies suggest that a high percentage of individuals with mental health needs rely on religious beliefs and practices (e.g., prayer) to cope with symptoms (11, 12). Furthermore, a high levels of religiosity is associated with seeking mental health support from both clergy and mental health professionals (13). However, this relationship is complex. One study reported that seriously distressed individuals were less likely to use mental health services if religious beliefs influenced their decision making (14), potentially because of a lack of trust that the mental health system would take their religious coping beliefs and practices into account during treatment (15). Hence, some individuals may seek help from faith communities because these groups may be better equipped than mental health professionals to support religious beliefs and forms of coping (16).

Faith communities may not be fully prepared to address the full range of mental health challenges because formal mental health training and the capacity to handle clinically significant mental disorders are often very limited (8, 17, 18). Although faith communities can encounter the same type and severity of mental disorders as seen in formal systems of care, they face challenges in referring to, consulting with, and collaborating with mental health professionals (9, 19).

The factors underlying the lack of collaboration between faith communities and the mental health sector are multifaceted. For example, differences in conceptualization of the causes, nature, and treatment of mental disorders may impede collaboration (20). Although some faith communities conceptualize mental illness and treatment in accordance with traditional medical models (21), others may use a more spiritually oriented framework (22). Mental health professionals are typically less religious than the general U.S. population and are trained in traditional scientific models, which can dismiss or overlook the important role of religion and spirituality (23). Consequently, faith communities may be hesitant to collaborate with mental health providers because of fear that these professionals may undermine or devalue the religious beliefs and values of individuals who seek assistance (24).

Other potential barriers are the lack of training in mental health care in faith communities and the lack of training in religious or spiritual concepts among mental health professionals. Faith communities may feel limited in their ability to recognize when an individual is at risk for a clinically significant mental disorder, in part because they do not have the capacity to conduct screenings (18, 21). Among faith communities that can identify clinically significant mental disorders, many are unfamiliar with standard referral procedures and available mental health services (25, 26). On the other hand, mental health professionals may not be adequately prepared to address patients’ religious beliefs and spiritual needs. A survey of 89 directors of clinical psychology programs accredited by the American Psychological Association revealed that only about one-quarter of these programs offered a course on religion and spirituality (27). Most mental health professionals view religion as beneficial, rather than harmful, to mental health (23), yet they seldom initiate discussions on religiosity, even though many clients engage in religious forms of coping and view religion as an important topic for treatment (28, 29). Even among psychologists with an expressed interest in religious issues (e.g., those in the American Psychological Association’s Psychology of Religion Division), collaboration with faith communities has been limited (30).

Faith communities and mental health professionals may have different expectations about the roles and conditions that would be important for collaboration to occur. For example, faith communities have emphasized shared values as a more important condition for collaboration than have mental health professionals (24, 31). Faith communities and mental health professionals may also differ in how they define a collaborative relationship. For example, mental health professionals may place high importance on referrals, but this process is often unidirectional, with faith communities making referrals to the mental health sector but rarely does the mental health sector provide referrals to faith communities, even though some faith communities are interested in being more involved in the treatment process (32, 33). Faith communities and mental health professionals may also differ in their approaches to caring for individuals with mental disorders, which may contribute to distrust and hinder collaboration (34).

Partnerships between faith communities and the mental health sector that are rooted in mutual collaboration, a shared framework, and trust could yield powerful and significant benefits for religious individuals with mental health challenges. Despite being recognized as de facto providers of mental health care and as gatekeepers to the formal mental health care system, faith communities remain a relatively underutilized resource in facilitating access to needed mental health services (22). There is growing recognition within the mental health sector of the potential benefits of involving or consulting with faith leaders and communities (30, 35), as highlighted by the American Psychiatric Association’s Mental Health and Faith Community Partnerships collaboration between psychiatrists and clergy (https://www.psychiatry.org/psychiatrists/diversity/mental-health-and-faith-community-partnership). Faith communities can provide support before, during, and after treatment and often possess greater familiarity and understanding of an individual’s life history and context, which, in collaboration with mental health professionals, could enable continuous and better-informed care (16, 33).

Despite the acknowledged importance and promise of fortifying partnerships between faith communities and the mental health sector, there is limited understanding of the overall evidence base of past partnerships, how those collaborations worked, and their impacts. To inform future partnerships between faith communities and the mental health sector, in this scoping review, we aimed to describe partnership approaches to addressing mental health needs (e.g., intervention components), assess their associated impacts, and summarize the characteristics of these partnerships, including the types of partners involved from the faith community (e.g., clergy, leaders, and congregants) and mental health sector (e.g., mental health providers and health departments), partnership frameworks, stage of partnership (development to sustainment), partnership roles and responsibilities, and partnership barriers and facilitators.

Methods

Article Search Strategy

The literature search was conducted in July 2023, following the checklist of the PRISMA Extension for Scoping Reviews (PRISMA-ScR) (36). The scoping review protocol was registered with the Open Science Framework (https://osf.io/rdm6w). To develop a search strategy, we worked with a research librarian at the RAND Corporation with a master’s of science in library and information science who specialized in conducting systematic reviews across a range of health topics. We applied the search strategy to four databases: PubMed, PsycInfo, Web of Science, and ERIC (Education Resources Information Center). We used the PICOTS (population, intervention, comparator, outcome, timing, and setting) framework to guide our selection of search terms.

The population terms related to faith communities (reflecting faith leaders, groups, institutions, or religious denominations) and the mental health sector (reflecting individual providers and mental health service settings). We also included terms related to partnerships, both broadly and specific to faith community and mental health collaborations. For the intervention component, we included terms for relevant services, such as counseling, therapy, screening, and referrals. To allow for inclusion of real-world programs (i.e., those not in a research context) or pilot studies, we did not require a comparator group. For the outcome variable, we included terms for mental health outcomes, such as depression and posttraumatic stress disorder. For timing, we limited the search to articles published between 2010 and 2023 to balance resource constraints with comprehensiveness. For setting, we included terms related to the United States and the 50 U.S. states. Reviews and multicountry studies that included U.S.-based studies were included.

We included only articles published in English. After initial deduplication, the search yielded 1,385 articles. We dropped 20 additional duplicates and two articles with insufficient information (e.g., missing authors or titles), resulting in 1,363 articles for screening.

Eligibility Criteria

All four authors independently screened subsets of the articles. Two reviewers were graduate students (C.C., T.B.), and the other two were Ph.D.-level researchers (L.G.P., E.C.W.) who had conducted faith-based health promotion interventions and had experience leading literature reviews (e.g., scoping and systematic). Two reviewers (L.G.P., C.C.) had personal affiliations with Catholic parishes, and one (E.C.W.) had an affiliation with a Protestant congregation. When the article titles and abstracts did not have sufficient information to complete the screening process, reviewers read the full text. One reviewer (L.G.P.) reviewed all screened entries and contacted the other reviewers to resolve disagreements with the entered information.

First, we screened for the article type to include original peer-reviewed research articles (N=1,022), short or brief reports (N=14), reviews (N=46), and commentaries (N=158). We excluded theses and dissertations, protocol papers, opinion pieces, editorials, and other gray literature (N=123). We further screened the commentaries to confirm whether they described findings from an evaluation of a faith community and mental health partnership, such as outcomes or lessons learned about the partnership’s impacts, implementation, or elements (e.g., trust) (N=12); if this information was not available, the commentary was excluded (N=146). Second, we screened to include only partnerships with both a faith community and mental health partner (N=58 of 1,094). A partner could be an individual, group, or institution. Included articles were required to provide clear information about the partner’s role in the partnership (e.g., codesigning the approach); articles without these details were excluded. If the mental health entity primarily worked in an evaluator role and was not involved in the design or implementation of an intervention, we excluded the study (e.g., psychology researchers conducting surveys with faith leaders). Third, we included only studies conducted in the United States (N=41). We downloaded the full texts of these 41 articles.

Three of the 41 articles (37–39) were reviews of mental health interventions. We dropped these reviews after examining the included studies and references, which yielded only one study (40) that met our criteria and was therefore added to our review. We further excluded three studies because one used the term “parishes” to refer to counties in Louisiana and not faith communities (41), one provided insufficient information about the faith partner’s role (42), and the third discussed a software used in a faith-based intervention that was described in another article in our review (43). Finally, an online search for one study (44), which focused on partnership insights, revealed an additional article showing effectiveness outcomes of the same intervention (45); we therefore included the additional article.

The final review included 37 articles, representing 32 unique interventions or partnerships. We reviewed the reference lists of all 37 articles and did not find any additional articles that met our inclusion criteria.

Data Extraction

Three reviewers (L.G.P., C.C., T.B.) read the final 37 articles to extract information related to each of this review’s aims. To describe the partnership approaches to addressing mental health, we extracted the following information, where available: intervention components (e.g., education, counseling) and theory or framework; characteristics (e.g., race-ethnicity, age, gender, health status) of the population with mental health needs (in the case of training for the faith community to deliver mental health services, we extracted data on characteristics of the congregants or community served); intervention evaluation, study design, and methods; and relevant outcomes assessed and main findings.

To characterize the nature of the reviewed partnerships, we extracted the following information, where available: faith partner and denomination; mental health sector partner; partnership framework; stage of partnership, from development to sustainability; partnership roles and responsibilities; and a brief summary of key findings or lessons reported about the partnership (e.g., barriers and facilitators).

Articles that reported on the same intervention or an extension of an intervention (i.e., randomized controlled trial [RCT] after a pilot) were summarized together. Of note, five articles by McCabe and colleagues (46, 47, 72–74) had some overlap in terms of the interventions examined, but the articles discussed different combinations of those interventions and involved different partners. We reviewed those articles separately, with the exception of two articles (46, 47) that described the same study but provided different insights, which we reviewed together.

To facilitate comparisons and interpretation of findings or insights, the articles were categorized into four categories, by the stage of the partnership: partnership and intervention development, which included articles describing the identification and initial engagement of partners, a needs assessment, or other initial steps to inform an intervention; intervention implementation, which included articles describing how partners implemented an intervention, with a focus on implementation (e.g., feasibility or acceptability) or process indicators (e.g., attendance) rather than individual-level outcomes; intervention evaluation, which included articles describing the effectiveness of interventions on individual-level outcomes as well as implementation or process indicators, if applicable; and intervention sustainability, which included articles describing longer-term interventions and discussion about the sustainability of the partnership or intervention. Articles were categorized according to the stage for which findings were reported (e.g., an article focused on partnership insights from an intervention that was implemented would be categorized as partnership or intervention development if implementation or process indicators were not provided).

Results

Of the 32 unique mental health and faith community partnerships examined (described across the 37 reviewed articles), six focused on partnership and intervention development (20, 48–54), five on intervention implementation (55–59), 19 on intervention evaluation (40, 44–47, 60–75), and only two on a sustained program or partnership (76–78) (Table 1). Most partnerships (44%) focused on African American or Black populations, whereas few focused on Latino (6%) or Asian American populations (3%) (Table 2). Some partnerships focused on specific populations, such as individuals with mental disorder symptoms (22%), immigrants or refugees (16%), Muslims (6%), or couples (6%).

TABLE 1.

Intervention and study details of research assessing faith community and mental health sector partnerships, by partnership stage^a

Study	Intervention detailb	Study detailc
Partnership and intervention development
Ali et al. (48); Awaad et al. (49)	Project: na; population: Muslim population; setting: San Francisco; purpose: to create a community advisory board (CAB) to guide focus groups to explore and address determinants of mental health service utilization in the community; intervention framework: na; components: training for faith community and counseling	Design: na; method: mixed or multimethod; participants: CAB members (N=14); outcomes: none evaluated
Oppenheim et al. (50)	Project: Health and Mental Health Education and Awareness for Africans in Lowell (HEAAL) Project; population: African immigrant and refugee community; setting: Lowell, Massachusetts; purpose: to create a CAB to guide a needs assessment of mental health in the community; intervention framework: na; components: training for faith community	Design: needs assessment; method: qualitative; participants: CAB members (N=11); outcomes: none evaluated
Hankerson et al. (51)	Project: Mental Health First Aid (MHFA); population: Black or African American youths and adults; setting: Harlem, New York City; purpose: training faith leaders to deliver evidence-based practices for depression; intervention framework: na; components: training for faith community and education on mental health	Design: na; method: none; outcomes: none evaluated
Milstein et al. (52)	Project: Lives Well Lived conference; population: consumers of mental health care; setting: Denver; purpose: to connect consumers, clergy, and clinicians to discuss collaboration; intervention framework: na; components: education on mental health and “other” (i.e., panel and roundtable discussions on collaboration)	Design: conference evaluation; method: mixed or multimethod; participants: conference attendees (N=90); outcomes: treatment appropriateness for promoting collaboration__
Sullivan et al. (53); Sullivan et al. (20)	Project: Mental Health–Clergy Partnership Program (MHCPP); population: veterans; setting: rural communities in Arkansas; purpose: to train clergy as first responders to veteran mental health problems and to help veterans gain access to care; intervention framework: na; components: bidirectional referrals, education on mental health, education on faith or spiritual concepts, counseling, other (i.e., community events)	Design: pilot; method: quantitative; participants: local advisory board members (N=3), institutional partners (N=3); outcomes: none evaluated
Wong et al. (54)	Project: Restoration Center Los Angeles (RCLA); population: Blacks or African Americans with unmet mental health and substance use needs; setting: Los Angeles; purpose: to bring together partners in planning effort to develop recommendations for creation of restoration centers; intervention framework: na; components: na	Design: na; method: qualitative; participants: RCLA members (N=11); outcomes: none evaluated
Intervention implementation
Lampe et al. (55)	Project: African American Alzheimer’s Caregiver Training and Support Project 2 (ACTS 2); population: Black or African American adults; setting: Florida; purpose: a faith-integrated, skills-training and support program (based on cognitive-behavioral therapy (CBT) for depression) for family caregivers of persons with dementia; intervention framework: na; components: education on mental health and training for faith community	Design: na; method: qualitative; participants: facilitators (N=9); outcomes: acceptability, appropriateness
Thompkins et al. (56)	Project: Project Trust (PT); population: Black or African American population; setting: San Francisco; purpose: culturally specific resources for pastors to support mental health during pandemic; intervention framework: n/a; components: education on mental health	Design: na; outcomes: reach into churches
Caplan and Cordero (57)	Project: El Buen Consejo; population: Hispanic or Latino immigrant adults; setting: two communities in New York and Maine; purpose: to improve mental health literacy; intervention framework: na; components: education on mental health and training for faith community	Design: pilot; method: mixed or multimethods; participants: congregants (N not reported); outcomes: acceptability, appropriateness
Williams et al. (58)	Project: Promoting Emotional Wellness and Spirituality (PEWS) program; population: Black or African American population; setting: urban areas in New Jersey; purpose: to expand health ministries to include mental health or develop a mental health ministry; intervention framework: na; components: referral (from faith community to mental health partner), education on mental health, training for mental health providers, training for faith community	Design: na; method: quantitative; outcomes: treatment attendance
Kirchner et al. (59)	Project: na; population: veteran adults with mental health needs; setting: rural community in Arkansas; purpose: to enhance access to care for returning veterans; intervention framework: rural de facto mental health services model; components: referral (from faith community to mental health partner) and training for faith community	Design: na; method: quantitative; participants: clergy trainees (N=23); outcomes: acceptability
Intervention evaluation
Mitchell et al. (60)	Project: Prevention and Relationship Enhancement Program (PREP); population: heterosexual couples; setting: Tennessee; purpose: to improve relationship communication and conflict management, expectations, and commitment; intervention framework: na; components: training for faith community and counseling	Design: pre-post test; method: mixed or multimethods; participants: couples (N=97); outcomes: mental health symptoms or conditions, acceptability
Ali et al. (61)	Project: Creating Healthy Culture (CHC); population: Black or African American adults; setting: Bronx, New York City; purpose: to implement virtual sessions to improve mental health among Black congregants by using a holistic, spirituality-based approach; intervention framework: na; components: training for faith community and counseling	Design: pilot, pre-post test; method: mixed or multimethods; participants: congregants (N=84); outcomes: mental health symptoms or conditions, mental health literacy, feasibility
Nogueira and Schmidt (62)	Project: Project Esperanza; population: Hispanic or Latino immigrant adults with low socioeconomic status; setting: Santa Paula, California; purpose: to improve mental health literacy among parents and guardians; intervention framework: social constructivism, intersectionality framework; components: education on mental health	Design: na; method: mixed or multimethods; participants: mothers (N=5); outcomes: mental health literacy, mental health stigma, help-seeking behaviors, referral rates, number of program activities delivered
Weaver et al. (63)	Project: Raising Our Spirits Together (ROST); population: adults with mild depressive symptoms; setting: rural community in Michigan; purpose: technology-assisted CBT; intervention framework: na; components: training for the faith community and counseling	Design: pilot, single-group pre- post test; method: quantitative; participants: program participants (N=9); outcomes: mental health symptoms or conditions, fidelity, treatment attendance
Ormond et al. (64)	Project: Tabernacle Mental Health Awareness Conference; population: Black or African American youths and adults; setting: Wichita, Kansas; purpose: to reduce mental health stigma; intervention framework: na; components: education on mental health	Design: conference evaluation; method: quantitative; participants: attendees (N=74); outcomes: mental health literacy, mental health stigma, treatment attendance, satisfaction with treatment
Pandya (65)	Project: na; population: Asian or Asian American immigrant adults; setting: multiple U.S, cities; purpose: online spiritual counseling; intervention framework: na; components: counseling	Design: RCT; method: quantitative; participants: couples (N=144); outcomes: mental health symptoms or conditions, treatment attendance
Pyne et al. (66)	Project: Mental Health Clinician Community Chaplain Collaboration (MC4); population: veterans with posttraumatic stress disorder; setting: mid-South region of the United States; purpose: a manual-guided intervention to address moral injury symptoms; intervention framework: na; components: training for faith community and counseling	Design: single-group pre-post test; method: mixed or multimethods; participants: veterans (N=13), clergy (N=12), clinicians (N=5); outcomes: mental health symptoms or conditions, acceptability, feasibility
Garner and Kunkel (67)	Project: na; population: Black or African American adults; setting: southeastern United States; purpose: a quality improvement training for ministerial team; intervention framework: health promotion model; components: education on mental health, screening for mental health symptoms, and referral (from faith community to mental health partner)	Design: pre-post test; method: quantitative; participants: ministerial team (N=28) and congregants (N=9); outcomes: mental health literacy, mental health stigma, mental health symptoms or conditions, referral rates, care utilization
Lynch et al. (68)	Project: na; population: Black or African American adults of with low socioeconomic status; setting: West Side Chicago; purpose: a health assessment of churches and surrounding communities; intervention framework: na; components: screening for mental health symptoms; counseling; referral (from faith community to mental health partner)	Design: health assessment; method: quantitative; participants: screened individuals (N=1,106); outcomes: mental health symptoms or conditions, referral rates
Scribner et al. (69)	Project: Bridges to Care and Recovery (BCR); population: Black or African American population with low socioeconomic status; setting: St. Louis; purpose: to support behavioral health through three strategies (help churches become friendly toward behavioral health, improve access to services, and create opportunities for ongoing collaboration); intervention framework: na; components: training for faith community, education on mental health, referral (from faith community to mental health partner), and counseling	Design: pre-post test; method: mixed or multimethods; participants: clients (N=11), wellness champions and congregants (N not reported), churches (N=4); outcomes: mental health literacy, mental health stigma, referral rates, care utilization, number of churches trained, number of people trained
Syed et al. (70)	Project: Muslim Mental Health First Responder Training (FRT) program; population: Muslim population; setting: Chicago; Washington, D.C.; Tempe, Arizona; Hartford, Connecticut; San Francisco; East Lansing, Michigan; Passaic, New Jersey; and Toronto; purpose: to equip imams and community leaders to address mental disorders; intervention framework: na; components: training for faith community, screening for mental health symptoms, referral (from faith community to mental health partner)	Design: post-test; method: quantitative; participants: trainees (N=128); outcomes: mental health literacy, appropriateness of the intervention
Kelley et al. (71)	Project: na; population: Black or African American patients; setting: Pittsburgh; purpose: to improve psychiatric residents’ attitudes toward role of religion in mental health and enhance willingness to collaborate with clergy; intervention framework: na; components: training for mental health providers	Design: pre-post test; method: mixed or multimethods; participants: psychiatric residents (N=38); outcomes: attitudes, acceptability
Baird et al. (40)	Project: Healthy Sudanese Families; population: South Sudanese refugee women; setting: urban community in U.S. midwestern region; purpose: a culturally tailored intervention to address stressors relevant to resettlement; intervention framework: na; components: education on mental health	Design: pilot, pre-post test; method: mixed or multimethods; participants: women (N=9); outcomes: mental health symptoms or conditions, mental health literacy, mental health stigma, acceptability, feasibility, treatment attendance
Jameson et al. (44); Stanley et al. (45)	Project: Calmer Life project (CL); population: predominantly older African American adults with low socioeconomic status experiencing late-life anxiety; setting: Houston; purpose: to address barriers to accessing mental health services and provide treatment for late-life anxiety; intervention framework: na; components: education on mental health, training for mental health providers, counseling, other (i.e., linkages to community resources and coaching)	Design: RCT; method: quantitative; outcomes: worry, anxiety, depression, satisfaction with treatment, treatment attendance
McCabe et al. (46); McCabe et al. (47)	Project: Psychological First Aid (PFA) and Guided Preparedness Planning (GPP); population: adults; setting: urban and rural communities in eastern and midwestern regions of the United States; purpose: to train lay paraprofessional, disaster mental health extenders; intervention framework: na; components: training for faith community	Design: pre-post test; method: mixed or multimethods; participants: trainees (N=391); outcomes: knowledge, self-efficacy, mental health literacy, appropriateness, feasibility
McCabe et al. (72)	Project: Guided Preparedness Planning (GPP); population: adults; setting: rural communities in Maryland; purpose: to train academic, faith, and health department leaders in disaster mental health preparedness planning; intervention framework: na; components: training for faith community	Design: one-group, quasi-experimental, post-test; method: quantitative; participants: residents (N=178); outcomes: knowledge, self-efficacy
McCabe et al. (73)	Project: PFA and Community Disaster Planning (CDP); population: adults; setting: urban communities in Maryland; purpose: to train faith-based organization leaders to train community members in psychological first aid and disaster planning; intervention framework: na; components: training for faith community	Design: pilot, post-test; method: quantitative; participants: trainees (N=72); outcomes: knowledge, self-efficacy
McCabe et al. (74)	Project: Motivational Preparedness Training (MPT)/PFA; population: adults; setting: rural communities in Maryland; purpose: to train community members in assisting with mental health care after a natural disaster; intervention framework: na; components: training for faith community	Design: one-group, quasi-experimental, post-test; method: quantitative; participants: community members (N=178); outcomes: knowledge, self-efficacy, feasibility, treatment attendance
Stuck et al. (75)	Project: na; population: na; setting: South Carolina; purpose: to train psychiatric residents, psychology interns, and seminary students to enhance collaboration; intervention framework: na; components: training for mental health providers and faith leaders and staff, and bidirectional referrals	Design: pilot; pre-post test; method: mixed or multimethods; participants: trainees (N=84); outcomes: knowledge
Intervention sustainability
Moore et al. (76); Pearson et al. (77)	Project: Congregational Social Work Education Initiative (CSWEI); population: diverse populations with low socioeconomic status; setting: urban and rural communities in Guilford and Rockingham County, North Carolina; purpose: to connect social work students and congregational nurses in order to provide free behavioral health services; intervention framework: na; components: screening for mental health symptoms, education on mental health, training for mental health providers, counseling, other (i.e., advocacy, referrals to community resources)	Design: na; method: none; outcomes: referral rates, number of clients served, treatment attendance, satisfaction with services and the student
Aten et al. (78)	Project: Clergy, academic, and mental health partnership (CAMP) model; population: individuals with low socioeconomic status; setting: South Mississippi; purpose: respond to emotional and spiritual needs after a natural disaster; intervention framework: na; components: training for mental health providers, training for faith community, counseling, other (self-care for clergy and mental health professionals)	Design: na; method: none; outcomes: none

^ana, not available; RCT, randomized controlled trial.

^bTarget populations were those with mental health needs that the intervention aimed to benefit.

^cStudy details focus on effectiveness, implementation, or process outcomes and findings.

TABLE 2.

Populations and intervention components of faith community–mental health sector partnerships (N=32)^a

Characteristicb	N	%
Race-ethnicity of population
African American or Black	14	44
Latino	2	6
Asian	1	3
Specific population
Patients or individuals with mental disorder symptoms	7	22
Immigrants or refugees	5	16
Low socioeconomic status	6	19
Rural	5	16
Veterans	3	9
Muslims	2	6
Couples	2	6
Not specified	3	9
Intervention componentb
Training for faith community (e.g., leaders, staff, congregants)	18	56
Training for mental health providers	6	19
Education on mental health for broader faith community	14	44
Education on faith and spirituality for providers or broader community	2	6
Direct counseling	11	34
Screening for mental disorder symptoms	4	13
Referrals from faith community to mental health sector	6	19
Referrals from mental health sector to faith community	0	—
Bidirectional referrals	2	6
Otherc	5	16
N of componentsd
One	12	38
Multiple	19	59

^aPopulation comprised individuals with mental health needs who could benefit from the intervention. N=32 partnerships, N=37 reviewed articles.

^bCategories or subcategories were not mutually exclusive.

^cIncludes roundtable discussions, community events, community advocacy, referrals to community resources (e.g., housing assistance), and self-care for faith and mental health professionals.

^dExcludes one partnership that did not have intervention components (54).

Partnership Approach to Address Mental Health Needs

Across the 32 partnerships, the most common intervention components involved training the faith community (e.g., leaders, congregants, and staff) (56%), mental health education for the broader faith community (44%), and direct counseling (34%) (Table 2). About one-fifth (19%) of partnerships involved referrals from the faith community to the mental health sector, none involved referrals from the mental health sector to the faith community, and only 6% involved bidirectional referrals. Less common intervention components included training for mental health providers (19%), education on faith- or spirituality-related concepts for mental health providers or the broader community (6%), and screening for symptoms of mental disorders (13%). Most partnerships (59%) involved two or more intervention components (Table 2). The Mental Health–Clergy Partnership Program (MHCPP) (20, 53) and the Congregational Social Work Education Initiative (CSWEI) (76, 77) had the most components, with five each (Table 1). (The components are described in detail in the online supplement to this review.)

Only three partnerships used a theory or framework to inform or guide the intervention (Table 1). The rural de facto mental health services model informed an initiative to improve behavioral health care access for returning veterans in a rural community (59). The health promotion model informed a training program for ministerial team members serving an African American community (67). The social constructivism and intersectionality frameworks informed Project Esperanza, which aimed to improve mental health literacy among Latino immigrant parents (62).

Among the 22 partnerships that reported a study design, all but two (45, 65) had weak designs (e.g., pre-post, post only, or no comparison group) (Table 1). With respect to evaluation, 20 of 32 partnerships (63%) assessed effectiveness outcomes, 14 (44%) assessed implementation outcomes, and 10 (31%) assessed process outcomes (these assessment were not mutually exclusive). Among the effectiveness studies (N=20), findings were overall promising with respect to improving mental health symptoms, mental health literacy, stigma, and referrals, among other individual-level outcomes (see the online supplement).

Partnership Characteristics and Insights

Most partnerships (91%) involved congregations as the faith partner, and about half had a Christian affiliation (including Catholic and Protestant) (44%) (Table 3). The most common mental health partners were academic experts (47%) and individual providers (47%). Details about partner roles and responsibilities are summarized in Table 4.

TABLE 3.

Characteristics of faith community–mental health sector partnerships (N=32)

Characteristica	N	%
Faith partner
Congregation (faith leaders, group, or congregants)	29	91
Otherb	4	13
Mental health partner
Academic experts	15	47
Individual providers	15	47
Health department (local or state)	6	19
Community-based organization	5	16
Clinical organization	3	9
Otherc	1	3
Faith partner denomination
Christian	14	44
Nondenominational	5	16
Muslim	4	13
Baptist	4	13
Methodist	3	9
Jewish	2	6
Otherd	6	19
Not reported	9	28
N of denominations in partnership
One	24	75
Multiple	8	25

^aCategories are not mutually exclusive.

^bIncludes community-based organizations, lay pastoral care facilitators (faith community workers referred by clergy or self-nominated), seminaries, and congregational nurses.

^cIncludes referral specialists (community connector) selected from the community.

^dIncludes Presbyterian, Anglican, Mennonite, Sikh, Hindu, and Episcopal.

TABLE 4.

Roles and responsibilities in faith community–mental health sector partnerships, by partnership stage

Study	Partner role and responsibility
Partnership and intervention development
Ali et al. (48); Awaad et al. (49)	Collaboration between researchers at the Stanford Muslim Mental Health & Islamic Psychology (SMMHIP) lab and staff from the Muslim Community Association (MCA), which has the largest mosque in the area. The MCA liaison (licensed family and marriage counselor and coordinator for MCA social and counseling services) helped recruit Muslim community members for the community advisory board (CAB). Project principal investigators were part of the MCA community, and the SMMHIP team provided the CAB with research training. The CAB met monthly for 1 year, on a volunteer basis, to guide the design and implementation of focus groups with the Muslim community and to understand mental health needs and service utilization. The CAB built on existing mental health provider network and created additional partnerships (e.g., student associations).
Oppenheim et al. (50)	A CAB comprised 11 congregants, all of African descent, identified by the pastor and church health coordinator. A project team from the psychiatry department provided the CAB with research training. The CAB provided input on study procedures and study assessments for cultural appropriateness. Academic and faith partners plan to use data gathered to codesign and implement community-based health resources and mental health programming.
Hankerson et al. (51)	A project team from a medical university and senior pastors from 2 churches identified community members for a community coalition to learn about the project and participate in collaborative planning, which involved establishing values, selecting an intervention, developing a website, etc. The coalition comprised 14 members from faith, community, academic, and local government sectors. The coalition selected mental health first aid (MHFA) as the intervention, which was planned to take place in 2 churches, and would help recruit people. New York Department of Health and Mental Health offered MHFA training as part of a comprehensive initiative to improve population mental health.
Milstein et al. (52)	The director of faith and spiritual wellness at a mental health center organized a conference to bring together clergy and clinicians and consumers affiliated with the center. Clinicians from other community mental health organizations were invited to participate. Clergy were identified from denominations where the director of faith and spiritual wellness had conducted community outreach and training.
Sullivan et al. (53); Sullivan et al. (20)	The U.S. Department of Veterans Affairs (VA) South Central Veteran’s Integrated Service Network and Mental Illness Research, Education, and Clinical Center launched this partnership program. The VA partner worked with local clergy at 3 sites with many veterans. Aims of programming at each site were made in collaboration with local advisory boards comprising local clergy, veterans, and service providers. Chaplains and mental health professionals led various intervention components (e.g., education and mutual referrals).
Wong et al. (54)	Multiple partners with a history of collaborating were brought together in a planning effort to identify recommendations for restoration centers to address unmet behavioral health needs affecting the African American community. Initial leadership included representatives from community service providers, community- and faith-based organizations, and academia. Leadership created a larger planning committee that supported 3 workgroups charged with developing plans for mental health and substance abuse needs and services, wellness and resiliency programs, and policies and operations. Community forums were used to present and get approval of the final set of recommendations.
Intervention implementation
Lampe et al. (55)	The program was developed by a provider-researcher team. Training was led by lay pastoral care facilitators, who were faith community workers providing direct care and peer support services to their local congregations and communities. Facilitators were referred by faith community leaders (e.g., clergy) or self-nominated into the African American Alzheimer’s Caregiver Training and Support Project 2 (ACTS 2). Some facilitators were previous ACTS 2 participants. ACTS 2 staff-licensed providers (e.g., licensed clinical psychologists) provided support to facilitators.
Thompkins et al. (56)	The Justice and Peace Foundation invited pastors, public health officials, and mental health providers to give 15-minute video presentations about their COVID-19 experiences (e.g., explore ways to support one another, connect pastors to resources and best practices, and promote dialogue and collaboration). Videos were grounded in awareness of historical distrust of mental and public health services among African Americans.
Caplan and Cordero (57)	The researcher met with leaders at congregations to engage them in the development of the intervention. Adaptation of the program (i.e., integrating cultural values and religious beliefs) involved input from clergy, church lay leaders, a mental health services researcher, and a family nurse practitioner. Meetings were led by clergy and lay leaders and National Alliance on Mental Illness (NAMI) representatives.
Williams et al. (58)	The Promoting Emotional Wellness and Spirituality (PEWS) program was developed by a certified social worker. A community advisory committee, comprising ministers, consumers, lay community members, and mental health providers, created a manual on how to develop partnerships between faith and mental health providers. The committee sponsored a conference bringing together mental health professionals, faith leaders from various denominations, and community members, which led to the development of the PEWS training curriculum for clergy and community members. PEWS training was led by a clinical social worker, pastor, and certified substance abuse counselor.
Kirchner et al. (59)	A program was embedded in the Central Arkansas VA health care system. The clergy program arm included 3 VA employees to provide part-time support, a chaplain (who worked closely with clergy and the faith community), a psychiatrist (who worked with providers in the VA and community and provided resources and training sessions), and an administrative assistant (who helped find and organize resources). The intervention was delivered by a team of project staff, consultants, and clergy. The intervention was guided by an advisory board consisting of representatives from the military, VA, state government, criminal justice system, clergy, higher education, and advocacy groups. The clergy arm also formed a local advisory group in the rural community.
Intervention evaluation
Mitchell et al. (60)	A project team from the psychology department partnered with lay facilitators from local churches to deliver the intervention. Facilitators were identified by church leaders, trained by university staff, and supervised by a licensed marriage and family therapy supervisor, who was overseen by a clinical psychology professor. Workshop format and modules were left to the discretion of each church. Couples were recruited with advertisements through the churches.
Ali et al. (61)	Groundswell Group and the Network for Human Understanding, community-based organization (CBO) partners that aim to promote a stronger sense of community and spiritual awareness and sensitivity, developed a peer-led intervention to improve mental health using a spirituality-based approach. CBO partners helped recruit 9 congregations. Faith leaders identified 1–2 individuals to be trained as peer educators to deliver the intervention. Peer educators were trained by the CBOs.
Nogueira and Schmidt (62)	Workshops were facilitated by volunteer mental health clinicians and mental health advocates. A church provided space for the program.
Weaver et al. (63)	Researchers developed the intervention, housed on the “Entertain Me Well” online platform, and engaged faith partners to adapt it. Trained clergy facilitated the group activities. Licensed clinicians listened to all sessions and provided weekly supervision to the group leaders during treatment. Participants were recruited from food banks and churches.
Ormond et al. (64)	A congregation hosted a conference to reduce mental health stigma by providing mental health education and resources. The conference planning committee comprised pastoral counseling staff from local historically Black churches, church volunteers, community members, and doctoral students from a local university. Mental health providers and resources (e.g., NAMI) were invited to participate. Participant outreach was performed in historically Black churches, sororities, fraternities, and other historically Black organizations and professional associations.
Pandya (65)	Sessions were developed and delivered by 4 experts from transnational spiritual organizations and 4 family therapists based in the United States and South Asia. Sessions were culturally aligned to South Asian culture.
Pyne et al. (66)	Partnership involved 6 pastors, 3 chaplains, and 4 lay persons (community clergy). The intervention was developed with input from patients, mental health providers, chaplains, and clergy. Participants were recruited from the VA posttraumatic stress disorder clinic. Clergy received manual and weekly supervision with a VA chaplain, who mediated communication with VA mental health clinicians. Community action boards comprising clergy, VA and community mental health providers, returning veterans, law enforcement, and civic leaders guided the work.
Garner and Kunkel (67)	A project leader from academic institution designed the training and was available in person Wednesday nights from 6 to 9 p.m. and by cellular telephone for any questions or concerns from ministerial leaders during the project. Ministerial leaders participated in the training and provided feedback in an open forum. Community mental health providers were identified for referrals.
Lynch et al. (68)	West Side Alive (WSA), a research-community partnership, included pastors, church members, and researchers. The project involved a pastor advisory board made up of pastors from participating churches. Partners reviewed all study materials and provided feedback to make them more acceptable to participants; trusted pastors and community members led recruitment. Church coordinators were hired from each church and made up the WSA coordinators board. Coordinators completed a university training program to teach community research partners about protection of human subjects. Coordinators organized the screenings and recruited church volunteers to help, served as a liaison between WSA and churches, publicized WSA to church members, mobilized church members to participate in WSA activities, and provided input into research design and measures. Church pastors, paid staff and health volunteers (clinicians, social workers, students, faculty, and others) conducted the screenings and any follow-up activities (e.g., referrals).
Scribner et al. (69)	The program engaged wellness champions (church volunteers), clergy, and a community connector. Each church identified 2–3 wellness champions to be trained to serve as a personal mental health resource. Training for wellness champions was provided by community professionals, university personnel, behavioral health providers, and medical or clinical staff from hospitals. The community connector, who was from the community served as a resource and referral specialist, identified resources, maintained contact with people, and often accompanied people to their first mental health appointment. Staffing consisted of 3 full-time employed positions funded by the Missouri Department of Mental Health: program manager, program coordinator, and community connector.
Syed et al. (70)	An Islam-oriented Muslim mental health center developed the program. The center conducted the workshops, which were facilitated by mental health professionals trained in Islam-oriented models of care. Workshops were cofacilitated by licensed mental health professionals with formal Islamic studies backgrounds as well as an Islamic clergy member.
Kelley et al. (71)	Educational sessions were facilitated by African American clergy and mental health providers, hospital psychiatrists, and primary care physicians. Most facilitators were African American. Psychiatric residents were recruited from a clinic.
Baird et al. (40)	The research team and content experts from community agencies facilitated specific intervention sessions (e.g., an occupational therapist facilitated a session on yoga; a Catholic nun with expertise in psychotherapy with refugees with a history of torture or trauma led a session on psychotherapy). Church ministers from the South Sudanese Community Church endorsed the project and provided the space and resources to help deliver the intervention over 3 months. Session topics were selected by community members and were informed by prior research conducted by the first author.
Jameson et al. (44); Stanley et al. (45)	The academic partner worked in partnership with community organizations, including churches, faith-based mental health service organizations, and social service agencies serving older adults in the community. The project team connected with faculty from other academic institutions to identify community partners. Interested community organization leaders helped identify additional partners. A community advisory council, comprising representatives from community partners, provided recommendations for tailoring the intervention to make it more appropriate for the community.
McCabe et al. (46); McCabe et al. (47)	The partnership involved 21 local health departments (LHDs), 76 faith-based organizations (FBOs), and 1 academic health center, with the goal of developing and validating 2 sets of interventions. FBOs served as a link between the LHDs and community, enabling the LHDs and academic health centers to transfer information through training on psychological first aid (PFA) and guided preparedness planning (GPP). After PFA training, led by faculty and LHD leaders, the FBOs identified teams of 2–4 qualified persons to participate in GPP and serve as designated planners for the organization and communities. The FBO also served as a partner with the LHD representative to foster an enduring posttraining preparedness alliance. Trainees included leaders and members of congregations and communities, recruited by FBO partners.
McCabe et al. (72)	Collaboration involved 4 LHDs, 100 FBOs, and 1 academic health center. Training was led by faculty from the academic institutions. Technical assistance workshops were used to create drafts of joint parish disaster response plans, with criteria such as mental and behavioral health surges. Trainees included faith leaders and community members, recruited by FBO and LHD partners. The steering committee included academic and LHD representatives. The community advisory committee established in 1 county comprised faith leaders and an LHD emergency coordinator; this group helped plan and execute ideas for recruiting trainees.
McCabe et al. (73)	Representatives of several academic centers collaborated with faith leaders to design, deliver, and preliminarily evaluate the training. Academic partners trained faith leaders, of whom 1–2 per faith group conducted training in their communities. Trainees were recruited from congregations and the community. The steering committee engaged in project planning, implementation, and evaluation.
McCabe et al. (74)	Collaboration among FBOs, an academic institution, and leadership from LHDs took place in 4 rural counties. Participants for the training were recruited from 120 congregations. FBOs and LHDs led the recruitment. Training sessions were led by 2 licensed psychologists experienced as disaster responders and disaster mental health trainers. The curriculum was originally developed by the academic partner. The steering committee of academic and health department representatives guided project planning, implementation, and evaluation.
Stuck et al. (75)	An academic psychiatry training program developed a comprehensive curriculum integrating spirituality and cultural issues into didactics and clinical care. Multidisciplinary faculty of seminary professors, psychologists, and psychiatrists, modeled professional interactions and shared teaching throughout the training.
Intervention sustainability
Moore et al. (76); Pearson et al. (77)	Graduate and undergraduate social work students partnered with nurses in the Congregational Nurse Program. Students worked closely with staff at local congregations, faith-based agencies, and other religiously affiliated organizations. Nurses were the primary referral source for clients referred to the Congregational Social Work Education Initiative and served as a faith-based cultural guide. Students received intensive preservice training and complete field placement and learned how to navigate internal structures of congregations (i.e., working with clergy, volunteers, and lay persons). One church provided students and the program director space for training sessions and workshops.
Aten et al. (78)	The clergy, academic, and mental health partnership (CAMP) model originated from a previous collaboration between religious leaders from the Mississippi Coast Interfaith Disaster Task Force and academic researchers. CAMP uses a learning collaborative among faith, mental health, and community partners to promote networking and training and involves a disaster response network of clergy from all faith backgrounds.

About half of partnerships used a framework to inform or guide their partnership (Table 5). Specifically, eight partnerships (25%) reported using community-based participatory research (CBPR), and two (6%) used community-partnered participatory research (CPPR). CBPR is a well-established approach that focuses on strengthening trust in research and engages communities in addressing a topic of interest across all stages of research (79). CPPR is a variant of CBPR that emphasizes collaboration across three key stages, including the vision (developing shared goals and strategy), valley (carrying out tasks to achieve the vision and evaluating the work), and victory phases (recognizing successes, community dissemination, and sustainability) (80). For example, one partnership described the vision stage of engaging community members and creating a community coalition for mental health focused on training African American faith leaders (51).

TABLE 5.

Frameworks and insights from faith community and mental health sector partnerships, by partnership stage^a

Study	Partners and partnership framework	Partnership insight
Partnership and intervention development
Ali et al. (48); Awaad et al. (49)	Faith partner: community-based organization (CBO); denomination: Muslim; mental health partner: academic institution; partnership framework: community-based participatory research (CBPR)	High satisfaction with community advisory board (CAB) operation: 86% of CAB members found group meetings useful, 79% enjoyed attending the meetings, and 71% thought the meetings were well organized. CAB expressed satisfaction with trust built with university team and the diversity of CAB (48). Facilitators: satisfaction with leadership and group dynamics (48). Challenges: recruitment of CAB members that represent the full diversity of the Muslim population, limited time and funding to sustain partnerships, ongoing engagement needed, burnout, and new mental health concerns during COVID-19 pandemic (49). Recommendations for improving CAB operation: thinking about sustainability, iterative development of CAB training and curriculum, financial compensation for participation (48). CAB goals for continued collaboration: more research activities and interventions, collaborations, and mental health advocacy (48).
Oppenheim et al. (50)	Faith partner: faith leaders, congregants; denomination: nondenominational Christian; mental health partner: academic institution; partnership framework: CBPR	Facilitators: involving community members in the CAB helped identify strategies to ensure study measures and processes were culturally appropriate (e.g., avoiding clinical tone) and feasible (e.g., involving congregants as interviewers). Programming ideas for the future: health fair and mental health education for the community.
Hankerson et al. (51)	Faith partner: faith leaders, faith-based organizations (FBOs); denomination: Catholic, Baptist; mental health partner: academic institution, state health department; partnership framework: community-partnered participatory research (CPPR)	Facilitators: support from lead pastor; icebreaker activities fostered relationships and reinforced CPPR principles; multiple communication channels (e.g., print, sermons, and social media) enhanced community participation; and organizing data in a way that’s easy to interpret (e.g., 1-pager). Challenges: balancing community and academic interests.
Milstein et al. (52)	Faith partner: faith leaders; denomination: Catholic, Protestant, Jewish; mental health partner: individual providers, clinical organization; partnership framework: CBPR	Conference provided opportunities to network and interact with people from diverse backgrounds; sparked ideas for plans for future actions, but participants recognized need for continued discussions toward collaboration. Challenges: clinicians find it harder to reach out to clergy than vice versa.
Sullivan et al. (53); Sullivan et al. (20)	Faith partner: faith leaders; denomination: not reported; mental health partner: health department; partnership framework: CBPR	Across all 3 sites, community members viewed partnerships as having more equal participation in the collaboration (score of 2.91 out of 4; where 1 = full control by institutional partners and 4 = full control by community partners), whereas institutional partners reported lower scores (1.99 out of 4) and felt that community partners could have taken more ownership (53). Challenges: mission drift noted at one site; issues recruiting diverse advisory board members; tensions between community members and “outsider” institutions; tensions between clergy and mental health providers; differences in attitudes toward root of mental health problems and solutions (20, 53). Clergy expressed wanting more training, and both clergy and mental health clinicians welcomed opportunity to collaborate (20).
Wong et al. (54)	Faith partner: FBOs; denomination: Protestant; mental health partner: individual provider; partnership framework: CPPR	Partners differed in the degree to which they felt the partnership met their expectations, but, overall, they valued engaging diverse perspectives and felt trust was built. Barriers: changes in leadership; disorganization; misunderstandings of planning process; scale of project felt too large; participation diverted time from their other work. Facilitators: commitment to the process; staying focused on larger goal; favorable leadership elements; feeling that they gained benefits (e.g., knowledge and networking). Engaging diverse perspectives was seen as both a facilitator and barrier. Partners achieved their goal of developing a set of recommendations for creating restoration centers.
Intervention implementation
Lampe et al. (55)	Faith partner: lay pastoral care facilitators; denomination: not reported; mental health partner: individual providers; partnership framework: na	Facilitators: appreciated program partners (supervisors) in offering feedback, peer support, and answers to trainee questions.
Thompkins et al. (56)	Faith partner: faith leaders; denomination: not reported; mental health partner: individual providers; partnership framework: na	Facilitators: 2 public health officials who contributed to the videos were church members, allowing them to blend spiritual with public health messaging.
Caplan and Cordero (57)	Faith partner: faith leaders; denomination: Presbyterian, Catholic; mental health partner: CBO; partnership framework: CBPR	Challenges: some faith leaders did not participate because their approach to mental illness differed from that of the researchers, and they did not recognize stigma reduction as a priority in the community; lack of continued participation of clergy was in part due to other commitments.
Williams et al. (58)	Faith partner: faith group; denomination: Baptist; mental health partner: individual providers; partnership framework: CBPR	Facilitators: forming relationships with church leaders and staff helped engage lead pastor and empowered church leaders to have ownership of the program and serve as champions during implementation; conference helped build relationships; flexible scheduling. Challenges: inconsistent funding, which inhibited evaluation of the Promoting Emotional Wellness and Spirituality Program and any follow-up training.
Kirchner et al. (59)	Faith partner: faith leaders; denomination: not reported; mental health partner: clinical organization; partnership framework: na	Facilitators: bilateral communication and equal power between collaborators; situating the program in a medical center of the U.S. Department of Veterans Affairs (VA). Partners in Clergy arm maintained regular meetings with stakeholders (e.g., clergy) and began expanding to additional counties (i.e., success of pilot encouraged dissemination into other rural areas).
Intervention evaluation
Mitchell et al. (60)	Faith partner: faith leaders; denomination: Methodist, Anglican, nondenominational; mental health partner: academic institution, individual providers; partnership framework: na	Facilitators: recruitment of churches that recognized the importance of strengthening couples’ relationships in their community and were willing to allocate resources for the workshops.
Ali et al. (61)	Faith partner: faith leaders; denomination: Methodist, Mennonite, Episcopal, nondenominational; mental health partner: CBOs; partnership framework: CBPR	Facilitators: engaging FBOs, peer lay educators, and emphasizing holistic approach through health and well-being contributed to the remote program’s feasibility and acceptability.
Nogueira and Schmidt (62)	Faith partner: FBO; denomination: Catholic; mental health partner: individual providers; partnership framework: na	na
Weaver et al. (63)	Faith partner: faith leaders; denomination: not reported; mental health partner: individual providers; partnership framework: na	na
Ormond et al. (64)	Faith partner: faith leaders, congregants; denomination: not reported; mental health partner: individual providers, Academic institution, CBOs; partnership framework: na	na
Pandya (65)	Faith partner: transnational spiritual organizations; denomination: Christian, Muslim, Hindu, Sikh; mental health partner: individual providers; partnership framework: na	na
Pyne et al. (66)	Faith partner: faith leaders; denomination: Protestant Christian; mental health partner: health department (in the VA); partnership framework: na	Clinicians recognized potential value of collaborating with clergy, but some challenges were noted (e.g., limited direct communication with clergy).
Garner and Kunkel, 2020 (67)	Faith partner: faith leaders; denomination: nondenominational; mental health partner: individual providers; partnership framework: na	Future work should engage all leaders from a church, not only ministerial members, and engage mental health community to assist in implementation.
Lynch et al. (68)	Faith partner: faith leaders, congregants; denomination: Baptist; mental health partner: academic institution (medical university); partnership framework: na	Facilitator: engaging church members and pastors in the design and implementation of the study to collect data that reflected their own community motivated them to partner with the research team.
Scribner et al. (69)	Faith partner: faith leaders; church volunteers; denomination: not reported; mental health partner: individual providers, community connector; partnership framework: na	Bridges to Care and Recovery followed 3 recommendations: develop collaboration with African American congregations for education and skill building, measure effectiveness, and develop relationships with faith community. Program does not depend entirely on future funding; can persist with training among wellness champions and behavioral health ministries. Sustainability could be strengthened with future training and maintenance of skills and a full-time project director and referral supervisor.
Syed et al., 2020 (70)	Faith partner: faith leaders; denomination: Muslim; mental health partner: CBO, individual providers, academic institution; partnership framework: na	Training facilitated interactions between mental health professionals and religious leaders, thereby improving likelihood of referral.
Kelley et al. (71)	Faith partner: faith leaders; denomination: Christian; mental health partner: clinical organization; partnership framework: na	Facilitators: involving nonfaculty community providers and clergy in the training helped with psychiatric residents’ willingness to partner with clergy in future treatment.
Baird et al. (40)	Faith partner: faith leaders; denomination: Christian; mental health partner: individual provider, academic institution; partnership framework: conceptual logic model of CBPR	na
Jameson et al. (44); Stanley et al. (45)	Faith partner: FBOs; denomination: Baptist, United Methodist, nondenominational; mental health partner: academic institution; partnership framework: na	Facilitators: use and expand existing relationships in the community; build reciprocal relationships; work with FBOs with established reputations for providing similar services; treat community partners as individuals and understand their unique needs, resources, and viewpoints; maintain ongoing communication; strive for sustainability; involve community stakeholders; and foster communication and dissemination (44).
McCabe et al. (46); McCabe et al. (47)	Faith partner: FBOs; denomination: Christian; mental health partner: health department, academic institution; partnership framework: systems-based partnership model	Facilitators: having at least 1 advocate in the organization who modeled enthusiasm for the partnership; multiple forms of communication (e.g., e-mails, flyers, and meetings) (46). Challenges: requiring multiple recruitment efforts before final decision to collaborate (46). Local health department (LHD) representatives successfully generated ideas to sustain and advance their preparedness relationships with FBOs beyond the study (47).
McCabe et al. (72)	Faith partner: faith leaders; denomination: Christian; mental health partner: health department, academic institution; partnership framework: systems-based partnership model	Feasibility demonstrated by high willingness (80% of invited LHDs agreed to participate), readiness (representatives of academic and LHDs attended all meetings of steering committee), and ability (partners recruited 10 FBOs and 15 individuals per county to attend workshops). All LHD partners produced at least 3 ideas for strengthening relationships communities.
McCabe et al. (73)	Faith partner: faith leaders; denomination: Christian, Jewish, Muslim; mental health partner: academic institution; partnership framework: na	Feasibility of partnership model demonstrated through all FBOs approached to participate agreeing to collaborate in the project; all faith leaders attended all the meetings of the steering committee, and all FBO groups had at least 6 individuals attend the workshops.
McCabe et al. (74)	Faith partner: faith leaders; denomination: Christian; mental health partner: health department, academic institution; partnership framework: systems-based partnership model; ready, willing, and able	31.5% of trainees applied to be members of the Medical Professional Volunteer Corps, and Maryland state policy changed to accept lay members into the Corps.
Stuck et al. (75)	Faith partner: seminary; denomination: Protestant Christian; mental health partner: academic institution; partnership framework: na	Facilitators: seminary group noted that they had previous negative experiences with psychiatrists and psychologists but opportunity to interact in the training improved this element. Mental health group noted training helped build relationships with clergy but wanted information on how to interact with other faiths and to provide more referrals.
Intervention sustainability
Moore et al. (76); Pearson et al. (77)	Faith partner: congregational nurses, faith leaders; denomination: not reported; mental health partner: academic institution; partnership framework: na	Challenges: recruiting students; community language and cultural barriers, issues of trust, privatization of state’s public mental health system; and sustainability given only 1 funder and 1 permanent staff member (76, 77). Initiative moving toward an integrated model of care, where student will work closely with nurse practitioner (77).
Aten et al. (78)	Faith partner: faith leaders; denomination: not reported; mental health partner: individual providers, CBOs; partnership framework: 7-component framework	Facilitators: guiding principles helped success of partnership, which focused on collaboration among diverse agencies and partners, strength-based focus, empowering and strengthening preexisting community infrastructures and resources, promoting information sharing, and inclusion of diverse perspectives. Achieved sustainable partnerships with ongoing grant funding and project sponsorship.

^ana, not available.

Other partnership frameworks identified in this review included the systems-based partnership model and the ready, willing, and able model, which were used in the context of disaster planning and mental health preparedness (46, 47, 72, 74) (Table 5). The clergy, academic, and mental health partnership model (CAMP) developed a seven-component framework involving a learning collaborative, information dissemination, outreach, training sessions, clinical services, care for caregivers, and research (78) (Table 5).

Most studies reported partnership insights such as challenges and facilitators (Table 5). Challenges to effective faith community and mental health partnerships included limitations to recruiting partners that represented the entire priority population (49, 53), limited time and funding to sustain partnerships or evaluate impacts (49, 58), competition for partners’ time or skills (57, 77), partner burnout (49), and tensions between the partners, such as having different interests, different attitudes toward mental illness, and limited communication (51–53, 57, 66). Furthermore, a few studies emphasized the role of contextual factors, beyond the partners, that affected the partnership, such as emerging mental health concerns (49) and local policies that affected the population or access to services (77).

Facilitators of an effective faith community and mental health partnership identified in this review included having diverse perspectives represented (54, 78); support from faith leaders (51, 58) or other advocates from an organization (46, 47); bilateral and diverse communication channels such as in-person, print, and online (46, 47, 51); engagement with faith partners who recognized the importance of the mental health topic or were already providing similar services (44, 60); reciprocal relationships and equal power (44, 59); and satisfaction with leadership and group dynamics (48). Several studies also emphasized the importance of building on community assets such as preexisting relationships, resources, and infrastructure (44, 59, 78).

Discussion

This is the first review to investigate the scope and evidence base for mental health and faith community partnerships that aim to address mental health needs in the United States. Most articles reported effectiveness outcomes, providing a picture of the potential impacts of interventions that were implemented through mental health and faith community partnerships. The types of interventions evaluated were wide ranging. Six evaluations examined the effects of building capacity among faith communities to deliver various types of interventions, including evidence-based programs (e.g., Prevention and Relationship Enhancement Program (60), technically assisted cognitive-behavioral therapy for depression (63)), spiritually based mental health programs (61, 66), and mental health screening and referral (67, 70). Four evaluations, led by the same author, trained faith and community members in psychological first aid or disaster planning response (46, 47, 72–74). Four evaluations involved the faith community and mental health professionals jointly delivering mental health education, screening, referral, and counseling (68, 69) and spiritually based mental health programming (45, 65). Three evaluations involved the delivery of mental health education programs in faith-based settings conducted solely by mental health professionals (62) or jointly with faith leaders (64) or community experts (40). The final three evaluations centered on faith leaders and mental health professionals jointly conducting education and training for mental health trainees and seminary students on how to collaborate and address spiritual and mental health issues (71, 75–77).

The findings of this review illustrate the capacity of communities of faith in addressing mental health across the continuum of care, including prevention, education, stigma reduction, screening and referral, and the delivery of evidence-based treatment and spiritually based approaches. For example, the MHCPP, which involved U.S. Department of Veterans Affairs chaplains and mental health providers partnering with local clergy, included meetings to identify barriers to collaboration and promote bidirectional referrals or spiritual counseling, education on mental health, education on faith-related and spiritual concepts, counseling for veterans, and services such as community events to help build trust between the faith and mental health sector and reduce stigma about mental health (20, 53).

Absent in the reviewed studies was evidence of the mental health sector’s involvement of faith communities in supporting the recovery process (e.g., ensuring adherence to treatment, reintegration into the community, or psychosocial support). Two partnerships focused on training among psychiatric residents and psychology interns to increase their knowledge and willingness to collaborate with clergy, but it was not clear whether any partnerships actually resulted in mental health professionals working with the faith community to aid in the recovery process (71, 75). Furthermore, in none of the partnerships was the faith community described as playing a role in providing psychosocial support (e.g., support groups), in contrast with findings that about one-quarter of religious congregations in the United States report providing services to support people with mental illness (81). Altogether, our findings suggest that many faith communities are willing to and do provide various types of support for people with mental illness, but their efforts may be siloed from the mental health sector, and, even when partnerships are formed, the collaborations may be disproportionately one-sided. As found in this review, referrals were primarily unidirectional from faith communities to the mental health sector (67–70).

With respect to the effectiveness of such partnerships, the preliminary evidence from the reviewed studies shows promising outcomes, such as improvements in mental health symptoms, literacy, and stigma as well as increased referrals. Only one partnership yielded negative outcomes. In this partnership, a culturally tailored mental health education program addressing stressors related to refugee resettlement resulted in increased levels of anxiety and depression, which were attributed to an initial lack of awareness of symptoms or trouble understanding the Likert scale response options for the mental health measure (40). Nonetheless, most of the reviewed studies were pilot studies, and all had weak designs, except for two RCTs (45, 65).

Additionally, only two partnerships reported on the sustainability of implemented interventions (76–78). The CSWEI was an interdisciplinary initiative linking social work students with congregational nurses, and together, they worked closely with local clergy and other religiously affiliated organizations to provide a range of behavioral health services (e.g., screening, education, and counseling) to diverse low-income communities (76, 77). The other intervention was CAMP, which involved clergy and mental health providers partnering to provide services (e.g., counseling) addressing emotional and spiritual needs during natural disaster emergencies (78). Both partnerships built on well-established programs (Congregational Nurse Program and social work academic program) and networks (large interfaith disaster task force) and focused on capacity building among partners to promote mutual benefits and on a team-based approach that promoted mutual collaboration. Building on existing infrastructure; creating equal opportunities for growth and engagement; and linking complementary skills, expertise, and resources may have contributed to the sustainability of these partnerships. Furthermore, consistent funding was identified as an important factor to sustaining these partnerships. The CSWEI was fully funded by a foundation loosely affiliated with a local health care system, whereas CAMP was funded by multiple grants (outreach and research) and sponsorships (e.g., donations from local organizations). Although these partnerships are valuable examples for sustaining future mental health and faith community collaborations, evidence of their impacts was missing. The CSWEI reported on referral rates and process outcomes (satisfaction, attendance, and others), but neither partnership reported on the mental health outcomes of the populations served, pointing to a gap in understanding the extent to which these efforts improved community mental health.

Nearly half of the partnerships reported on the feasibility, fidelity, acceptability, or appropriateness of, or satisfaction with, interventions. Only two partnerships identified potential concerns related to the acceptability of interventions with respect to the number of sessions (40) and suggested tailoring to individuals from different faith traditions (55). Most partnerships involved multicomponent approaches, which may be better positioned to address multiple needs in a population than single-component approaches (e.g., education only). In particular, having the faith community facilitate the entire continuum of care may help improve acceptability, feasibility, and ultimately uptake among congregants. For example, the West Side Alive (WSA) partnership involved mental health screenings conducted by pastors, paid staff, and health professionals, and follow-up services, including counseling and referrals, were provided only by the mental health partner (68). In contrast, the Bridges to Care and Recovery (BCR) program trained church volunteers (called wellness champions) to facilitate all activities from leading education workshops to providing referrals and linkages to additional services, including counseling (69). These two distinct approaches yielded different outcomes with respect to community acceptance of the referrals. Among those screened by WSA and flagged for a social worker referral, only 37% chose to speak to the onsite social worker (68). In contrast, in BCR, about 95% of clients referred to the program accepted and used its services (69). BCR included education, which may be a key first step in the continuum of care to ensuring people accept and follow through with referrals. BCR was also funded by the state’s department of mental health, but the authors noted that the program’s sustainability was not entirely dependent on future funding and could continue with the capacity built with the wellness champions and church health ministries that were created, which may contribute to sustained acceptability and uptake in the community.

This review also extracted insights into how mental health and faith community partnerships are created, function, and engage, all of which can help inform future collaborations. Past work has identified several barriers that faith communities have experienced in working with the mental health sector, including previous negative experiences with mental health professionals (82), reluctance to work with government agencies or mental health professionals (21, 25), and hesitancy among congregants to discuss their beliefs and spiritual practices with mental health professionals (83). Indeed, this review also identified tensions between the two partners, including a mismatch in interests and attitudes toward mental illness (51–53, 57) and limited communication between partners (66). We also found evidence of additional barriers that have not been thoroughly examined in previous research, including challenges related to partner characteristics (e.g., inadequate representation of the community), limited resources (e.g., time or skills), contextual factors (e.g., emerging health concerns and local policies), and program-related factors (e.g., limited funding).

Several studies also reported on key facilitators to partnership success, which included partner characteristics (e.g., adequate representation of the community) (54, 78), leadership and personnel support (46, 47, 51, 58), previous experiences working on mental health or providing similar services (44, 60), partner assets (previous relationships, resources, and infrastructure) (44, 59, 78), and factors reflecting partner dynamics, such as positive partner interactions, mutual engagement, and equal power (44, 48, 59). Additional facilitators and challenges were likely not reported in the reviewed studies because most focused on the impacts of a program on health outcomes. However, information about factors that inhibit or enhance successful partnerships is invaluable to improve and replicate their efforts in the future.

About half of the reviewed partnerships focused on minoritized racial-ethnic groups, pointing to their potential to advance mental health equity (84). Previous research suggests that faith communities serving Black or African American populations may be particularly willing to address mental health needs and collaborate with the mental health sector (37, 85). A previous review of faith community and mental health collaborations (86) identified only two studies that focused on African American populations and one study on Latino populations from 1980 through 1999; none focused on Asian or Muslim populations. The present review identified 14 studies focused on African American or Black populations, but only two studies focused on Latino populations. To our knowledge, our review identified the sole study of a mental health and faith community partnership involving an Asian American community and two studies with Muslim populations. This paucity of studies points to a critical gap, given that Asian and Muslim populations experience high mental health disparities and unique challenges to receiving mental health treatment, such as stigma, cultural beliefs about treatment, and experiences of discrimination (7, 87, 88). More work is needed to engage Latino, Asian, Muslim, and other underresearched populations that also experience significant mental health disparities, particularly in light of the potential pathways to mental health care that could be accessed through provisions in the Affordable Care Act (89). For example, as noted in a qualitative study with Muslim community members and imams (90), religious leaders may play a key role in addressing stigma in the community. Faith community and mental health partnerships may enable training such leaders in evaluating psychological symptoms, which may enhance congregant’s comfort in disclosing their symptoms and the leaders’ likelihood to refer congregants to mental health services.

Although the promise and importance of partnering with faith communities to address mental health needs are now widely recognized (91, 92), this review identified multiple opportunities for future work. First, more research is needed to better understand the factors that influence partnership development, program implementation processes and determinants (barriers and facilitators), and partnership or program sustainment. Future studies may consider using a framework to guide evaluation of facilitators and barriers to partnership and program implementation. For example, the exploration, preparation, implementation, and sustainment (EPIS) framework identifies key determinants of successful program implementation across each EPIS phase, including outer context (e.g., policies), inner context (e.g., organizational characteristics), bridging factors (e.g., partner dynamics), and program factors (e.g., funding) (93). Theories and conceptual frameworks offer critical guidance to improving collaboration as well as program design, implementation, and evaluation. However, our review found low use of theories or frameworks to guide partnership or program development and evaluation.

Second, a gap in capacity building exists in the mental health sector around concepts related to faith and spirituality as well as understanding the capabilities of faith communities in mental health care. Faith communities can assist with enhancing mental health professionals’ spiritual competence (e.g., gaining a better understanding of religious beliefs and coping and improving knowledge of when to refer to faith communities). Such training may help reduce the mental health sector’s perceived biases about the role of faith communities. Third, given that most of the reviewed studies engaged academic or clinical partners, more work is needed examining partnerships that engage government partners such as local mental health departments, which may be key for program sustainability.

Fourth, this review highlights the limited evidence base on the effectiveness, feasibility, and sustainability of mental health sector partnerships with faith communities across the continuum of mental health care and their ability to provide spiritually integrated holistic care. Partnerships between the health sector (beyond just mental health) and faith communities are not new and have been implemented globally to address a range of health issues (92, 94, 95); however, they are rarely evaluated rigorously, and multiple challenges to starting and maintaining such partnerships remain (96). The reviewed literature offered several recommendations to navigating challenges and improving the implementation and efficacy of partnerships with faith communities, including obtaining buy-in from faith leaders, building trusting and respectful relationships, welcoming diverse perspectives while reconciling differences, coproduction, and giving faith communities tangible power over the work (85, 96, 97). Furthermore, a critical factor to the success of these partnerships that must not be overlooked is the role of funding. Developing and sustaining health-faith community partnerships warrants dedicated and consistent investments. For example, for the past four decades, the Substance Abuse and Mental Health Services Administration has been providing states with grant funding to support faith communities helping individuals with mental health and substance use disorders and to promote integrated, collaborative care models (99). In particular, investing in peer facilitators (e.g., individuals from the faith community) who can coordinate services across the continuum of mental health care, as demonstrated in a few example partnerships in this review (55, 60, 69), may be a vital element to ensuring that partnerships are acceptable, feasible, and sustainable.

This review fills several gaps in understanding the role of faith community–mental health partnerships in addressing mental health needs in the United States. However, a few limitations are worth noting. Recent data on service attendance suggest declining religiosity among young adults (5), pointing to a potential limitation related to the populations that faith community and mental health partnerships reach. None of the articles in this review focused on young adults; thus, additional work is needed on targeted strategies (e.g., partnering with young adult ministries) that may enhance reach in this population, particularly given its high mental health needs (1). Another limitation was the dearth of rigorous study designs, limiting understanding of the impacts of faith community–mental health partnerships. The included studies also largely focused on African American or Black populations, and few studies focused on other populations that experience high mental health disparities (e.g., Latino, Asian, and Muslim).

Our review had a few methodological limitations. First, we focused on peer-reviewed articles; thus, we may have missed other important faith community and mental health partnerships that were not explored in the peer-reviewed literature. Second, this review was limited to articles published between 2010 and 2023 and may have missed other relevant studies published before or shortly after this time frame. Third, we included articles only if they provided a clear description of how the faith community and mental health partners were involved in the partnership; however, it is possible that some studies engaged such partners but did not detail their involvement sufficiently. Thus, this review does not reflect the full extent of relevant partnerships that have been implemented or are ongoing in the United States.

Conclusions

This review highlights how faith communities can be critical partners in addressing mental health needs and disparities in the United States. Faith communities have historically been underutilized in mental health care despite their shared vision with the mental health sector in promoting the well-being of individuals with mental health needs and despite their ability to offer vital hope, familiarity, and spiritual support (32, 33). The findings of this review point to the improving recognition of faith communities as partners in promoting better mental health. Faith communities are trusted sources of health information, have flexible infrastructure for health programming, and have reliable social networks for disseminating resources (98). For these reasons, faith communities play an especially important role in addressing mental health disparities (4). As such, strategies that promote trust building, coleadership in the delivery of an intervention, and active participation of congregants are warranted (98). This review provides support for initiatives to engage and build the capacity of faith communities to facilitate mental health education and early detection of mental disorders, shape social norms and stigma regarding mental health treatment, and establish linkages to mental health care. Overall, our findings reveal a limited but promising number of partnerships that leverage and connect the cultural, spiritual, and clinical assets of faith and mental health partners to develop approaches that center communities’ values, access, and preferences. Future work can help build a stronger evidence base to support more faith community and mental health partnerships as part of broader initiatives and policies to address mental health and disparities in the United States.