Improving Health Care Through Faith Partnerships
What does a mother do when she hears the words “I don’t want to live” from her adult son? How does she respond when he has just been laid off from his job and it will take six weeks to get an appointment at the local community mental health center?
In Memphis, Tennessee, we were able to get immediate help for this suicidal young man through a unique program that links religious communities and their resources with hospitals and health care professionals. The mother asked her pastor for help. And fortunately, her pastor knew about our Congregational Health Network (CHN). The network has a program called the Emotional Fitness Center that provides peer mentors and screeners who work in congregations and neighborhoods to provide services and immediate referrals to health care professionals when needed.
The next day the young man saw a peer mentor at a neighboring church (he was resistant to talking to the mentor at his own church) who arranged for him to get an appointment with a program-partner psychiatrist. Thanks to a quick response and sliding scale payments, the young man got on needed medication and was enrolled by his peer mentor in a support group run out of a local church. Within eight weeks, he was past the worst of his symptoms and able to find a new job.
This CHN model is based on the idea that the body, mind, spirit, and community are inextricably connected. As this young man’s story demonstrates, faith-based initiatives that address health care in this proactive, holistic way can greatly improve the wellbeing of all community members and neighbors. The CHN model is an attempt to advance health, not just patch the cracks in our broken health care system. As we already know, our health care system is in profound disarray. Approximately 46 million Americans lack health insurance, 8 million of whom are children. Millions more are under-insured and vulnerable to co-pays that are now the leading cause of bankruptcy among Americans. Health care costs are escalating four times faster than wages for many complex reasons including professional guilds, extraordinary technology, litigation, and onerous administrative costs.
I have spent my life working to link faith and health in a way that results in improved health—not only in the delivery of health care, but also in overall individual and community wellness. I have learned that communities and whole nations have far more resources relevant to the health of their members than those in the formal professional healthcare services system.
In my job as senior vice president at Methodist LeBonheur Healthcare, I share a common table with religious communities in Memphis so that we can become effective partners in advancing the health of all citizens, members, and neighbors. Basically, we use community organizing to improve community health.
Methodist Hospital is a very large health care provider. It has a $1.2 billion budget, roughly a 40 percent market share, and coverage in all quadrants of the city. But getting access to healthcare services is not remotely enough and will not by itself change health dynamics or status, especially in a place like Memphis where so many other fundamental lifespan determinants work against us. The role of the faith partners includes the social networks of trust that are crucial to both advocacy and helping people navigate to the services that do exist. The challenge is not just the reimbursement system or insurance card.
When I think of the young man who was threatening suicide, I see the many ways that the faith and communitybased health care that we have set up here in Memphis works to get health services to people in caring, efficient, and cost-effective ways.
The system works because it builds upon the trusted role that churches already play in their communities. When people are in crisis, they often ask their congregational leader for guidance, so it makes sense that those leaders develop meaningful relationships with community health resources. It also makes sense for congregations to invest their social capital in the neighborhood’s health services. The system is accountable to provider and recipient and we know our roles change back and forth over our lifespan. I am an executive today but at some point a patient.
The full system of community health assets is held together by a mix of money and trust, and the latter is usually a bigger gap. Church-based healthcare workers are effective because people are more likely to know and trust them and therefore consult them sooner rather than later. After-care and referral are also much easier and more efficient with the CHN. People are much more likely to come back for follow-up visits in their neighborhoods and problems with recovery can be identified before they become another health care crisis. The CHN program is designed to help people get connected with the kind of help they really need. We call the folks who work on making these connections “navigators”, because that’s what they do: work with a person to help him find his way to what he needs wherever it is anywhere in the community, not just at our particular hospital.
A lot of the time, people don’t really need a hospital. What they often need is a health care professional—a doctor, a counselor, or a social worker. And sometimes what they really need is a bus ticket to get mom home after surgery. The “navigators” help facilitate the needed connections by means of a thick, complex web of trust among many types and kinds of organizations. The hospital is the biggest, by far, and the referral network is not complete without it. But most of the time people need something else.
I am often asked how we get congregations to participate. The opposite question is better: how does a community get the hospital to participate? The first step is for everyone to realize that we share a fundamental concern and hope for the human beings who are both our patients and their members and neighbors. Then we work at making the religious resources within the community visible, so everyone knows what organizations and structures exist as potential partners; in our model we call that Religious Health Assets mapping. It is extremely important that the mapping and analysis be done with congregations and their leaders.
The second step is to work on getting a real, robust, and broad range of congregations to participate. We are two years into a five-year process of building a covenant relationship with twenty percent, roughly 400, of Memphis’ congregations. The strategy is to have a critical mass of congregations linked to each other and the faith-based treatment system to advance the journey toward better health for thousands of members and neighbors. Today, we have 136 in the network and one or two join every week. The relationship is spelled out in a covenant written with the congregational leaders to increase the reality of partnership and shared ownership of our common work.
We never forget that we are working in a swamp of nearly intractable disparities. Only one aspect of those disparities is receiving health care services, but given low health status, access to services is critical. Professional healthcare providers often do not notice, or are ill-equipped to provide, smooth and trusted referral pathways from the earliest detection and care to the highest level of intervention and back. But this care is essential if people are to stay with their treatment.
The Reverend Bobby Baker, the Director of CHN, challenges everyone in the network to make their work about effective results. He reminds us that this work reflects both our most mature faith and the most relevant science.
We have promised our congregational leaders that our shared labor is intended to bring our community more closely into alignment with what Dr. King called the dream of the Beloved Community. It is surely audacious to hope out loud in such a troubled and challenged time on the soil that holds his blood. But since 1918, when the United Methodist established this hospital, we have been hoping more and more boldly as our vision clears.
Rev. Dr. Gary Gunderson is Senior Vice President of Methodist LeBonheur Healthcare in Memphis, Tennessee and Faculty in the Rollins School of Public Health at Emory University in Atlanta, Georgia. He is also a Scholar Associate of the Faith and Progressive Policy Initiative at the Center for American Progress.