African Americans are much less likely than the general population to seek mental health services but are 20% more likely than Whites to report serious psychological distress. In the Black community, the Black church is extremely important in providing information as well as validation for the experiences and decisions of its members; what Black pastors say, matters. Guided by the Reasoned Action model, a series (n = 41) of in-depth interviews of Black Baptist pastors on their mental health communications yielded six broad findings: 1) The Black Baptist church operates in the Biblical, Institutional and Social/Cultural dimensions; it can be pastor-led, deacon-led or congregation-led. 2) Stigma in the congregation and community against mental illness constricts pastors' willingness to recommend specialty health services. Sources of stigma include: a. A belief that "God will solve all the problems"; b. A belief that good Christians don't have these problems, with the corollary that those who do are flawed Christians, violating the concomitant imperative to appear well; and or c. A belief that to be well is to be in control; the mind as a site of resistance. 3) The response to "troubles" and mental health issues is framed in terms of faith but frequently pastors recommend worldly action. 4) Pastors interviewed understood mental health issues as biomedical in their cause, with the possibility of associated trauma. Referral practices and terms varied. 5) Many pastors are aware of a gap in their knowledge of mental health and mental illness, which constrains their engagement with these issues. 6) "Sick pastors make sick people in the pews": pastors stressed by the need to take on congregants' troubles in addition to their own, are particularly hampered by the cultural imperative to appear flawless because of their leadership positions; hence they maintain a stigma-driven silence on their own mental health, contributing to the stigma-driven silence in the church.

Empowered pastors emphasized pastoral transparency with respect to mental health as theologically and managerially critical to the survival and growth of the African American Baptist church and the wellness of its congregants.