Early this spring, a parent called our office looking for help. Their teenager was struggling—seriously, the kind of struggle that includes thoughts of not wanting to be alive—and the family had done everything we so often tell families to do. They had already found an adolescent psychiatrist and made the appointment. The trouble was the date. They had called in the spring; the first available opening was in November.
Sit in that for a moment, wherever you happen to stand on the mental health care system. Your child is in danger now. The help exists, somewhere, behind a door that will not open for more than six months. You are a parent, and you are being asked to keep your child alive until November.
If you have pastored for any length of time, you know that locked door from the other side. You have walked someone you love toward help, done the responsible thing, and then watched the wait swallow the very moment they needed it most.
We were able to see that family quickly—our staff is large enough that we usually can. But I keep thinking about the families who don’t know a place like ours exists, who hang up the phone holding a November appointment and no idea what to do with the months in between. That wait is not a fluke. It is the ordinary experience of more and more people seeking care in America’s overstretched counseling systems—and the numbers say it will only get worse before it gets better.
I want to argue something that may sound strange coming from someone who has spent his life pointing people toward care: the strain on the professional system is not only a crisis to lament. For the church, it is a summons we should have been answering all along.
The Shortage, By The Numbers
Start with the demand. In 2024, roughly 23 percent of American adults—about 61.5 million people—experienced a mental illness in the past year.[^1] That same year, more than one in five adults reported symptoms of generalized anxiety.[^2] And the gap between need and care is wide: roughly half of the adults living with a mental illness received no treatment at all.[^3]
Now the supply. As of 2025, nearly half of the U.S. population—about 158 million people—lived in a federally designated mental health workforce shortage area, a place without enough providers to meet the population’s need.[^4] And the gap is projected to widen, not close. By the federal government’s own workforce modeling, the country would need more than 136,000 additional psychologists by 2038 simply to meet the unmet need that already exists today—before accounting for a generation more willing than any before it to ask for help.[^5]
The providers we do have are stretched thin. In the American Psychological Association’s most recent practitioner survey, more than half of psychologists reported no openings for new patients, about one in three said they could not meet the demand for treatment, and a third reported burnout—a strain falling hardest on early-career clinicians who represent the future of the workforce.[^6] We are asking a shrinking, exhausted field to absorb a surging, complex load. That arithmetic does not resolve. It compounds.
If you lead a church, here is what that math means in practice: the people in your pews who are hurting are increasingly going to find that the front door of professional care is locked, or that the wait behind it is longer than their crisis can survive.
What The Numbers Look Like From The Ground
I felt the weight of those numbers turn into faces recently. I had just come home from the largest gathering of pastors in the country, and the same story kept finding me—told by men shepherding churches in the forgotten corners of big cities and in rural counties most Americans will never drive through. My people cannot find help. Not help that is competent. Not help that is compassionate. Not help that is anywhere close by. Not help they can afford.
The data confirms what those pastors are living. More than half of all U.S. counties do not have a single practicing psychiatrist, and the gap is widest exactly where those pastors serve—in rural communities and in economically stressed cities where providers are few and far between.[^11][^13] “Just use telehealth,” someone always says. But nearly six hundred counties—home to more than ten million Americans—have neither a local psychiatrist nor the broadband to reach one remotely.[^12] You cannot log on to care that depends on a connection you don’t have.
Then comes the well-meaning question: what about the pastor? It is a fair question, until you meet the pastor. The man telling me his church had nowhere to send a member sinking into depression was himself working two jobs—part-time in the pulpit and full-time somewhere else to feed his family—as so many faithful pastors in hard places do. He is not a counseling center with office hours. He is one tired shepherd, and he already knows it.
And The Gap Is About To Widen
Here is what almost no one in those rooms had clocked yet: the pipeline that produces community counselors is about to narrow.
Recent federal law phases out Grad PLUS loans beginning in 2026 and caps graduate borrowing—roughly $20,500 a year and $100,000 over a lifetime for most master’s programs.[^14] Supporters frame this as a needed check on federal lending and runaway tuition; that is a real debate, and thoughtful people land in different places on it. But set the politics to the side and follow the plumbing. Under the Department of Education’s narrow definition of a “professional” degree, the very fields that staff community mental health—social work and counseling—along with much of ministry and seminary training, are left out of the higher borrowing limits granted to medicine and law and capped at roughly half.[^15] Analysts who are otherwise on opposite sides of this fight agree on the direction of the effect, even as they argue about its wisdom: fewer people will be able to afford the degrees that produce social workers, counselors, and trained ministers.[^15]
Whatever you conclude about the policy, the consequence for the church is not in dispute. The forward-thinking church should plan now for a near future with fewer, not more, professional counseling resources in its community.
Three Things That Cannot Fill The Gap
So line up the institutions we keep hoping will solve this, and look at them honestly.
The government cannot fill the gap. By its own workforce projections it is staring at a shortfall that grows for the next decade—and its most recent moves will, whatever the intent, thin the pipeline further.
The pastor cannot fill the gap. Not the bivocational pastor with two jobs and a county full of need. Not even the best-resourced senior pastor. No single person was ever meant to be the sole soul-care provider for an entire congregation, let alone an entire community.
The mental health system cannot fill the gap. It is overwhelmed, unevenly distributed, financially out of reach for many, and shrinking in exactly the places the need is greatest.
That is a sobering list. But read it again, because it quietly reveals something. Every one of those three is a single point of care—one program, one professional, one pastor—asked to bear a weight no single point of care can hold. And the one resource we keep overlooking is the only one that was never built as a single point of care at all.
A Clarifying Strain, Not Just A Crisis
That overlooked resource, of course, is the church—not the solo pastor, but the whole body of Christ, with its many members and many hands. Which is exactly why it would be too easy to read all of this as bad news and stop there. The strain is something else as well. It is clarifying.
For two generations, the church has quietly outsourced a ministry that once belonged to it. Soul care—the patient, prayerful work of walking with a struggling person toward Christ—got rebranded as a clinical specialty, credentialed and professionalized, and the unspoken message to pastors and ordinary believers became: this is above your pay grade; refer it out. And so we did. We built our referral lists and we relaxed. The trouble we now face is not only that the professional system is overwhelmed. It is that the church forgot it ever had a role.
But the historic position of the church was never that the soul is a problem for specialists. The cure of souls is among the oldest pastoral callings we have. Long before there was a counseling profession to refer to, the body of Christ understood that suffering, sin, fear, and sorrow are addressed in their deepest place not by technique alone but by a living God who speaks. “Sanctify them by the truth; your word is truth” (John 17:17). That is not a slogan. It is a claim about where real change comes from—and it is a claim the church is uniquely positioned, and divinely commissioned, to make.
What Is The Church’s To Carry
Let me be careful here, because this is exactly the point where good intentions go wrong in both directions.
The church is not called to become the mental health system, and it should not pretend it can. There are biological and medical realities—genuine illness, the effects of the body on the soul—that require a physician’s care, and the wise church partners gladly with medical professionals rather than playing the hero. Discernment about when to refer is itself an act of love. Recovering soul care does not mean abandoning that discernment. It sharpens it.
But hear what is actually flooding the system. An enormous share of the burden landing on overwhelmed clinicians is not exotic pathology. It is the ordinary weight of being human in a fallen world: a marriage that has grown cold, a man crushed by shame, a mother drowning in worry, a believer who cannot feel the nearness of God. This is not foreign territory for the church. This is home. This is the very ground the Scriptures speak to most directly and most powerfully, and it is precisely the load the professional system was never designed to carry alone—and now demonstrably cannot.
When the church recovers its competence in that work, two things happen at once. The people who belong inside the body of Christ get the care that is theirs to receive there. And the strained clinical system is freed to do what only it can do for those who truly need it. The church filling its own gap is not competition with professional care. It is relief for it.
The Gap Inside The Church
Here is the set of numbers that should keep church leaders awake, and it is the one I find most hopeful—because the willingness is already there, on both sides.
When people of faith struggle, most say they would turn to their church. In a 2024 national survey, 57 percent of people who belong to a religious community said they would likely reach out to a faith leader if they were struggling with their mental health—and 68 percent said they would seek professional care if a faith leader recommended it.[^7] Clergy are already carrying this load: nearly three-quarters of them report being approached for help with mental illness at least once in the past year.[^8] And the conviction is there—nearly nine in ten Protestant pastors say the local church has a real responsibility to support people facing these struggles.[^9]
The equipping is what’s missing. Only about three in ten pastors say they feel “very well-equipped” to help congregants with their mental and emotional health,[^10] and just four in ten have any kind of plan in place for supporting affected families.[^9] So picture the situation honestly: a congregation full of hurting people who would rather come to the church than anywhere else, a pastor who believes it is his calling to help and is already being asked to, and a gap of preparation standing between them. That is not a crisis of willingness. It is a crisis of readiness. And readiness can be built.
Building Churches That Are Ready
This is the work the Biblical Counseling Center exists to do, and it is the reason I am more convinced than ever that what we do matters. For thirty-five years we have given ourselves to a single sentence: helping churches care for people. The shortage now bearing down on the country is, for us, simply a larger version of the need we have spent three and a half decades answering.
The answer is not to send pastors to seminary again or to ask every believer to become a clinician. It is to equip the ordinary church for the ordinary—and not-so-ordinary—work of caring for souls, with competence and with confidence. That happens along a few clear lines.
Through our Training Institute, we equip pastors, lay leaders, and everyday believers to bring Christ-centered, compassionate, and competent care to the people already sitting in front of them. Over the years more than fifteen thousand people have been trained this way—not to replace professional care, but to recover the church’s own ministry of soul care and to know, with clarity, when and how to partner with medical care.
Through our Care Network, we help churches stop improvising and start building. Most congregations don’t lack compassion; they lack structure. We help a church stand up a care team that knows what it is doing—people prepared to walk patiently with the struggling rather than reflexively reach for a referral list that has nothing left to give.
And we put a usable framework in their hands. Our PLAN approach—Prepare, Listen, Ask, Navigate—gives an ordinary believer a faithful, repeatable way to come alongside a hurting person without freezing, without overstepping, and without leaving them alone in the wait.
The Moment In Front of Us
I do not think the counselor shortage is good news. People are going to suffer in the gap it creates, and some of that suffering will be needless. But I have learned to watch for what God does in the moments when the systems we leaned on start to give way.
The strain on the professional system is exposing a truth the church should never have let itself forget: hurting people want to be cared for by a community that knows and loves them, in the name of the One who actually changes hearts. The demand is here. The willingness is here. The only thing missing is a church that is ready—and readiness is something we can build, congregation by congregation, before the next person knocks on a door we have finally prepared to open.
That is not a burden the church should fear. It is a calling the church was made for. Let’s get ready to answer it.
Tim Allchin serves as Executive Director of the Biblical Counseling Center, where for thirty-five years the mission has remained the same: helping churches care for people. To learn how your church can build a ready, equipped culture of care, visit biblicalcounselingcenter.org.
Notes
[^1]: Substance Abuse and Mental Health Services Administration (SAMHSA), 2024 National Survey on Drug Use and Health (NSDUH), released July 28, 2025: 23.4% of adults (61.5 million) had any mental illness (AMI) in the past year. https://www.samhsa.gov/newsroom/press-announcements/20250728/samhsa-releases-annual-national-survey-on-drug-use-and-health
[^2]: SAMHSA, 2024 NSDUH. For the first time, the survey measured generalized anxiety disorder (GAD); 21.7% of U.S. adults reported GAD symptoms in the past year. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2024
[^3]: SAMHSA, 2024 NSDUH: Mental Health Treatment Among People Who Had a Mental Health Condition in the Past Year. Among adults with AMI, roughly half received no mental health treatment in the past year. https://www.samhsa.gov/data/report/nsduh-2024-pst-yr-mhtx-adult-adol
[^4]: KFF (Kaiser Family Foundation), “A Look at Strategies to Address Behavioral Health Workforce Shortages,” 2025: nearly half of the U.S. population—47%, or about 158 million people—lives in a mental health workforce shortage area. https://www.kff.org/mental-health/a-look-at-strategies-to-address-behavioral-health-workforce-shortages-findings-from-a-survey-of-state-medicaid-programs/
[^5]: Health Resources and Services Administration (HRSA), Bureau of Health Workforce, National Center for Health Workforce Analysis, behavioral health workforce projections (December 2025): an additional 136,350 psychologists would be required by 2038 to meet all unmet need. https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand
[^6]: American Psychological Association, 2024 Practitioner Pulse Survey: 53% of psychologists had no openings for new patients; about one-third (32%) reported being unable to meet patient demand; about one-third (34%) reported burnout, with rates higher among early-career psychologists. https://www.apa.org/pubs/reports/practitioner/2024
[^7]: American Psychiatric Association, “New Polling Data Shows Most People of Faith Would Seek Mental Health Care if Recommended by Their Faith Leader,” September 16, 2024 (survey of 2,201 adults conducted by Morning Consult): 57% of those in a religious community would likely reach out to a faith leader if struggling; 68% would seek care if a faith leader recommended it. https://www.psychiatry.org/news-room/news-releases/new-polling-data-shows-most-people-of-faith-would
[^8]: U.S. Department of Health and Human Services, Strengthening the Mental Health and Wellbeing of Tomorrow’s Faith Leaders: nearly three-fourths of clergy report being approached at least once in the past year for help with mental illness. https://www.hhs.gov/sites/default/files/partnership-center-strengthening-the-mental-hand-wellbeing-of-tomorrows-faith-leaders.pdf
[^9]: Lifeway Research, “Pastors Have Congregational and, for Some, Personal Experience With Mental Illness,” August 2, 2022: 89% of U.S. Protestant pastors say local churches have a responsibility to provide resources and support for individuals with mental illness and their families; 40% have a plan for supporting affected families. https://research.lifeway.com/2022/08/02/pastors-have-congregational-and-for-some-personal-experience-with-mental-illness/
[^10]: Barna Group, “The Mental & Emotional Health of Pastors and Their Congregants,” 2020: only 30% of pastors say they feel “very well-equipped” to help congregants with matters of mental or emotional health. https://www.barna.com/research/mental-emotional-health-among-pastors/
[^11]: Association of American Medical Colleges (AAMC), “A growing psychiatrist shortage and an enormous demand for mental health services,” February 2026: more than half of U.S. counties lack a single practicing psychiatrist, with the gap widest in rural areas. https://www.aamc.org/news/growing-psychiatrist-shortage-enormous-demand-mental-health-services
[^12]: “Mental Health Outcomes Among Patients Living in US Counties Lacking Broadband Access and Psychiatrists,” JAMA Network Open, 2023: 596 counties (19% of all U.S. counties), home to 10.5 million residents, lacked both a psychiatrist and broadband coverage; as of 2019, 21.3 million U.S. residents—nearly a quarter of rural residents—lacked broadband. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502528/
[^13]: Commonwealth Fund, “Understanding the U.S. Behavioral Health Workforce Shortage,” 2023: many rural areas and economically stressed cities have few, if any, behavioral health providers—reinforced by low insurance reimbursement and historical underinvestment. https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-health-workforce-shortage
[^14]: One Big Beautiful Bill Act (2025); see university financial-aid summaries of the law: Grad PLUS loans end for new borrowers as of July 1, 2026, and graduate borrowing is capped at roughly $20,500/year and $100,000 lifetime ($50,000/year and $200,000 lifetime for programs the Department of Education classifies as “professional”). Proponents describe the changes as reducing federal lending and refocusing subsidies on undergraduate and workforce training. https://sfs.harvard.edu/changes-federal-student-loans
[^15]: The Education Trust, “How the Elimination of Grad PLUS Loans and Classification of Professional Degrees Harm Women and Students of Color,” December 2025; and Council on Social Work Education (CSWE), “Education Department Definition Limits Access to Social Work Education,” November 2025: under the Department of Education’s narrow definition of a “professional” program, fields such as social work and counseling are restricted to roughly half the borrowing available to medicine and law—changes these analysts warn will deepen existing workforce shortages in social work and mental-health care. https://edtrust.org/rti/eliminating-grad-plus-loans-professional-degrees-harms-women-students-of-color/ • https://www.cswe.org/news/newsroom/cswe-education-department-definition-limits-access-to-social-work-education/
A note on the two “APA”s: footnote 6 is the American Psychological Association (the practitioner survey); footnote 7 is the American Psychiatric Association (the faith poll). Worth keeping straight if an editor asks.
