North American and Canadian clergy are often referred to as gatekeepers of the mental health system. In this capacity, two factors are important: (1) the clergy's attitudes assume considerable importance since they are likely to affect the working relationships between ministers and professional mental health workers and (2) the socio-political processes throughout respective communities affect referral routes to the most appropriate mental health service. The writer was interested in clergy-counseling practices and associated referral patterns in a city on New Zealand's southern most island. A questionnaire was therefore developed to assess clergy's attitudes about the etiology and treatment of mental illness, quantitative aspects of clergy-counseling, and referral patterns. The questionnaire was mailed to 80 clergy in the city of Christchurch. The results suggest that: (a) more clergy (83%) most commonly selected psychological reasons (e.g., "stress in living") than spiritual reasons (17%), (e.g., "stunted spiritual growth") for mental illness; (b) overall, clergy view the effectiveness of their counseling as due to cognitive change, catharsis and ventilation, not to transference or behavior change; (c) that 31% of clergy spend between four and one half hours and 10 hours per counseling, and 19% spend between ten hours and 20 hours per week in formalised counseling; (d) the clergy's major community contacts were found to be the local physician and the Marriage Guidance organization; (g) the evidence suggests that family physicians, not clergy, are the gate-keepers for purposes of referrals to mental health services; (h) referrals seem to be uni-directional from clergy to mental health professionals with community mental health professionals making few contacts with clergy for purposes of consultation, referral, or acknowledgement. This study has a number of limitations and results cannot be generalized owing to lack of randomization, low response rate, little incentive to reply to the questionnaire, definitional problems, a biased sample (no attempt was made to identify why non-respondents chose not to reply), difficulty for readers in calculating answers to some questions, the subjectivity of respondents' replies (i.e., it is likely they had not kept records with respect to the counseling and referral patterns over the past two years) and inadequate follow-up.
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