Psychiatric Intensive Care: What does the Bible have to say about it?

A perspective from Dr Andrew Collins, consultant psychiatrist

He’s been sent to the locked ward.” I wonder what image those words conjure up?

I work part-time as a psychiatrist in a Psychiatric Intensive Care Unit (PICU), and the other half of my week in the field of biblical counselling. PICU is a ward that cares for the acutely mentally unwell. The patients on this ward typically suffer from conditions such as schizophrenia, mania, drug-induced psychosis and personality disorder; they require the secure environment of a PICU because of an acute risk of physical aggression or of absconding from hospital.

Does biblical counselling have a role in a setting like a Psychiatric Intensive Care Unit?

1. Biblical counselling affects how we see our work

We see those made in God’s image. Patients come in with many different kinds of disturbance: often their minds have lost touch with reality; their behaviour can be bizarre, unpredictable, disinhibited, threatening; aggression is not uncommon. Yet each one is a person made to reflect and represent God; they still possess the worth and dignity of God’s image-bearers.

We see the effects of the Fall. Our patients often have lost rational thinking; they have confused, broken minds; there is hostility and paranoia with roots in a fear of men; there can be grandiose thinking with roots in our common human pride. Illness and sin – results of the Fall – present in a disturbed mix.

We see psychiatric diagnoses from a biblical perspective. Mental illness can be distilled into the beautiful simplicity of 1 Thessalonians 5:14: the unruly – angry, aggressive; the fainthearted – depressed, anxious, fearful, needy; the weak – confused, irrational, psychotic, disabled. And often it’s a moving feast of all three!

But we also see the mercies of God. The PICU ward provides necessary containment for the good and safety of the patient and others; there is help and care given as staff try to restore calm, routine, structured activity, sleep, and appetite; medication is prescribed that within weeks often calms and helps restore rational thinking. These things are gifts from God, who graciously sends his rain on the just and unjust.

2. Biblical counselling can also affect how we do our work

As with any work setting, opportunities for conversational ministry – speaking truth in love – abound. On the PICU, we have a morning ward round where active listening and constructive responses are vital if we are to make it to lunchtime!  Speaking truth in love with our patients is a challenge – a wonderful challenge. We face all kinds of needs, and all kinds of conversation are required. For example, discussing prescription of an antipsychotic with an acutely psychotic patient requires a blend of encouragement (this will help), warning (you really need this and need to keep taking it), and helping the weak (I know you don’t think you are unwell but you do need treatment). Paul’s all-encompassing summary from 1 Thessalonians 5 is so helpful – “be patient with all”. Regrettably this is not so much an account of how I work, as how I would like to!

Does biblical counselling have a role in an acute psychiatric setting? Absolutely.

Dr. Andrew Collins works part-time as a consultant psychiatrist in Psychiatric Intensive Care and part-time in biblical counselling from his home in Northern Ireland. As well as offering a counselling service, Andrew provides teaching and training on pastoral and mental health issues for churches and conferences. His counselling is based upon the conviction that the Word of God is a sufficient guide for living in the world today.