Research has suggested that religious beliefs can be important in the recovery from mental health difficulties. In addition, many individuals find it helpful to seek support from church leaders and congregations. However, few studies in the United Kingdom have explored how and why church leaders provide this support. The study involved interviewing ten church leaders in south Wales regarding their experience of supporting congregants with mental health difficulties. Their accounts were analysed using a grounded theory approach. The results suggested that the leader’s concept of mental health difficulties was a major influence in the way in which support was provided. All the church leaders believed that mental health difficulties had a spiritual aetiology, but differed according to whether this was the main cause, or one of many. Leaders describe providing practical, spiritual, long-term and crisis support to individuals. Spiritual support was prominent and included counselling, bible teaching and prayer. The type of support available was influenced by the values the leaders held and the members of their congregation. Church leaders varied regarding how much they perceived a need to access mental health services for congregants. The leader’s perception of their competency to support the individual and whether they had positive prior experience of mental health services influenced this. The majority of leaders felt under-trained to support people with mental health difficulties and unsure what the mental health services could provide. A number of barriers may prevent church leaders from accessing services such as feeling mutual suspicion between mental health professionals and the church. Consequently, many leaders recommended a Christian counsellor instead of mental health services. This research suggests that church leaders provide a unique relationship for congregants, offering social support and hope. The implications of these findings for psychologists, mental health services and church leaders are discussed and recommendations for future research are made.