Vertical Habits and Mental Illness in Worship

The vertical habits framework is easy to understand and talk about. It gives people the words to bring every part of themselves--even mental illness--to God in worship.

Chaplain Kristin Moore had planned worship to focus on giving thanks. Instead youth living in the Cincinnati Children’s Hospital psychiatric unit turned the service into a huge lament. As they realized staff wouldn’t try to talk them out of their feelings, kids opened up even more. Moore recalls, “We were in it together, no matter how long it took.” Something beautiful happened between kids who didn’t get along. While listening to one unload, the other reached out a hand and said, “I’m sorry.”

Cheryl Shea always included a responsive prayer of confession for an adult mental health support group that worshiped together in Edmonton, Alberta. A leader would begin, “For the times we have lied to one another and the times we have been lied to,” and the rest would respond, “Heal us, Jesus, Savior of the world.” Shea says that confessing their pain about being mistreated and mistreating others led them to see that everyone needs God’s mercy.

Moore and Shea used the vertical habits—words that build relationships with God and others—to create safe, simple, and inclusive worship for youth and adults affected by mental illness.

Create a space of safety, welcome, and trust

Most youth Moore works with have a history of trauma. Shea has counseled many adults who deal with post-traumatic stress disorder (PTSD) because they’ve been abused. People with mental illnesses often feel stigmatized, judged, disrespected, or feared by those who describe themselves as “normal.”

That’s why it’s essential, Moore explains, to create a “physically, emotionally, and spiritually safe worship environment and take time to build trust. Both tasks require authenticity, constancy, availability, tolerance for being tested, and establishment of appropriate boundaries.”

Youth start to share questions and concerns once they understand she wants to learn how they think rather than tell them how to think. “The sheer power of relationships becomes incarnational. After going through the vertical habits, kids tell me, ‘I’m still not sure about God, but if it’s like this, then maybe it’s worth thinking about,’” Moore says.

An anonymous woman on a disabilities concerns forum describes the blessings of people who consistently embody God’s love. “I asked Jesus into my heart in second grade because of my Sunday school teacher. My current pastor sometimes repeats the same scripture and reminds of God’s promises over and over. He is a constant prayer warrior for all of us. He and his wife accept me the way I am,” she writes.

Keep worship simple, experiential, and interactive

Since mental health issues usurp mind share, simple worship works best. Someone may need to briefly leave worship because of medicine, stress, or feeling overwhelmed by crowds. He or she can more easily return and reconnect if each worship element builds on a central thought.

Shea’s service plans followed the same pattern and included the habits of praise, confession, thanksgiving, petition, lament, illumination, service, and blessing. “For people used to a more charismatic, less structured service, it was new, even awkward, to repeat patterns in worship. But the vertical habits’ simple language really helped our folks connect and communicate with God,” she says.

Shea’s sermons were experiential, interactive, and had just one point. During a “treasures in jars of clay” service, people painted their names on clay pots. Her St. Patrick’s Day “great cloud of witnesses” service featured a quiz show that affirmed each worshiper’s strengths so people could find encouragement in the present as well as in the Bible.

At Cincinnati Children’s Hospital, Kris Moore experimented with how “visual art, writing, movement, drumming, and music can operate like a Trojan horse. The activity is the vehicle by which we gain access to their interior space and world.”

Teaching liturgical movement through song helps youth learn a concept “down to their bones, so they can recall the message through movement memory, melody memory, and word memory,” Moore says. This happened with Richie McDonald’s “I Turn to You,” a song about turning to the Lord when nothing else in the world makes sense. When a girl with severe emotional and attention deficits began to dissociate (space out), a staff member noticed, put on “I Turn to You,” and pumped the volume. Within seconds the girl returned to the present moment.

Everyone matters in God’s family

When Shea asked the Edmonton worshipers for feedback, she was sure they’d say the music was horrible. “Instead, people said, ‘It’s so great we can sing and it doesn’t matter what we sound like.’ It was more important for them to feel like they could participate and have a voice,” she says. Support group members loved taking responsibility for the coffee time after worship.

In Cincinnati, Moore invites youth to be liturgists, create art specific to the day’s scripture, bring in projects they’ve completed as a form of self offering, lead prayer, and participate as able.

Ideally, churches that truly welcome people will make room for their gifts. Shea knows a man with schizophrenia who enjoys working in the church nursery with others. Medication helps him manage very well and he adjusts when he’s not well. Yet he’s been rejected by Christians who equate schizophrenia with child molestation.

The anonymous online poster writes, “Give us a chance to succeed in church responsibilities. Accept us if we sometimes need to back out for an episode of mental illness, just as someone with a physical illness would be accepted.”

Learn More

See how churches, schools, and other groups have used Vertical Habits. Buy The Worship Sourcebook, the resource Cheryl Shea used to develop worship services for an adult mental health support group. Buy the book Soul Surgeon by Cheryl Shea.

Kristin Moore adapted the evidence-based HealthRHYTHMS Adolescent Protocol to use drumming in worship. Sometimes she’d ask individual drummers to create a drum prayer, drum lament, drum confession, or drum story. Sometimes the whole group would drum, instinctively finding rhythms that sounded good together.

Join online conversations and find resources about churches and mental illness in the Disabilities Concerns discussion network.

Use or adapt this Christian worship service plan from National Association on Mental Illness (NAMI).

Browse worship resources for people affected by post-traumatic stress disorder (PTSD) caused by war. Others develop PTSD because of child sexual abuse, 90% of which is commited by a family member or someone the child knows. Find help from RAINN (Rape, Abuse, and Incest National Network) or Darkness to Light.

Start a Discussion

  • Who keeps track of individuals and families who deal daily with mental illness? What structures does your church have in place to offer support and respite?
  • When did you last ask someone to tell their story about living with a mental illness…or ask how they’d like to serve…or find out what prevents them from participating more fully in church life?
  • How might using the common language of the vertical habits help your church more fully integrate people affected by mental illness?

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