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Spirituality and Mental Health

Improving the lives of people with mental illness

Spirituality and mental health

Introduction
Spirituality and psychiatry - on the face of it, they do not seem to have much in common. But we are becoming increasingly aware of ways in which some aspects of spirituality can offer real benefits for mental health.

This leaflet is for: anyone who has an interest in spirituality and mental health anyone with a mental health problem carers and relatives professionals who may not be sure about how to explore spiritual issues with their clients/patients. It looks at: how spirituality, mental health and mental healthcare can connect how to make a place for spiritual needs within a mental health service how spirituality can help mental health.

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You don't need to hold a formal religious belief, to take part in religious practices, or belong to an established faith tradition, to read this leaflet - or to experience spirituality.

What is spirituality?
There is no one definition, but in general, spirituality: is something everyone can experience helps us to find meaning and purpose in the things we value can bring hope in times of suffering and loss encourages us to seek the best relationship with ourselves, others and what lies beyond. These experiences are part of being human - they are as clearly present in people with a learning disability and other conditions, such as dementia or head injury, as they are in anybody else. Spirituality often becomes more important in times of distress, emotional stress, physical and mental illness, loss, bereavement and the approach of death.

All health care tries to relieve pain and to cure - but good health care tries to do more. Spirituality emphasises the healing of the person, not just the disease. It views life as a journey, where good and bad experiences can help you to learn, develop and mature.

How is spirituality different from religion?

Religious traditions certainly include individual spirituality, which is universal. But each religion has its own distinct community-based worship, beliefs, sacred texts and traditions.

Spirituality is not tied to any particular religious belief or tradition. Although culture and beliefs can play a part in spirituality, every person has their own unique experience of spirituality - it can be a personal experience for anyone, with or without a religious belief. It's there for anyone. Spirituality also highlights how connected we are to the world and other people.

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What is spiritual health care?

People with mental health problems have said that they want: meaningful activity such as creative art, work or enjoying nature to feel safe and secure to be treated with dignity and respect to feel that they belong, are valued and trusted time to express feelings to members of staff the chance to make sense of their life including illness and loss permission/support to develop their relationship with God or the Absolute. Someone with a religious belief may need: a time, a place and privacy in which to pray and worship the chance to explore spiritual concerns to be reassured that the psychiatrist will not try to undermine their faith encouragement to deepen their faith to feel universally connected sometimes the need for forgiveness.

What difference can spirituality make?

Service users tell us that they have gained: better self-control, self-esteem and confidence faster and easier recovery (often through healthy grieving of losses and through recognising their strengths) better relationships with self, others and with God/creation/nature a new sense of meaning, hope and peace of mind. This has allowed them to accept and live with continuing problems.

A religious/spiritual assessment
A helpful way to begin can be to ask "Would you say you are spiritual or religious in any way? Please tell me how." Another useful question is, "What sustains you?" or "What keeps you going in difficult times?" The answer to this will usually reveal a person's main
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spiritual concerns and practices.

Sometimes, a professional may want to use a questionnaire. They will want to find out: what helpful knowledge or strengths do you have that can be encouraged? what support can your faith community offer? A gentle, unhurried approach works best at its best, exploring spiritual issues can be therapeutic in itself.

Setting the scene What is your life all about? Is there anything that gives you a sense of meaning or purpose?

The past Emotional stress is often caused by a loss, or the threat of loss. Have you had any major losses or bereavements? How has this affected you and how have you coped?

The present Do you feel that you belong and that you are valued? Do you feel safe and respected? Are you and other people able to communicate clearly and freely?

Do you feel that there is a spiritual aspect to your current problem? Would it help to involve a chaplain, or someone from your faith community? What do I need to understand about your religious background?

The future

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What do the next few weeks hold for you? What about the next few months or years? Are you worried about death and dying, or about the possibility of an afterlife? Would you want to discuss this more? What are your main fears about the future? Do you feel the need for forgiveness about anything? What, if anything, gives you hope?

Remedies What kind of support would help you? How could you get it? Have you thought about self-help?

A spiritual assessment should be considered as part of every mental health assessment. Depression and substance misuse, for example, can sometimes reflect a spiritual void in a persons life. Mental health professionals also need to be able to distinguish between a spiritual crisis and a mental illness, particularly when these overlap.

Spiritual practices
These span a wide range, from the religious to secular which may not be obviously spiritual. You may: belong to a faith tradition and take part in services or other activities with other people take part in rituals, symbolic practices and other forms of worship go on pilgrimage and retreats spend time enjoying nature give of yourself in acts of compassion (including work, especially teamwork) spend time in meditation, deep reflection or prayer follow traditions of yoga,Tai Chi and similar disciplined practices read scripture listen to singing and/or playing sacred music, including songs, hymns, psalms and devotional chants spend time in contemplative reading (of literature, poetry, philosophy etc.) appreciate the arts be creative - painting, sculpture, cookery, gardening etc. make and keep good family relationships make and keep friendships, especially those with trust and intimacy join in team sports or other activities that involve cooperation and trust.
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Spiritually-informed therapies
Over recent years there has been increasing interest in treatments that include the spiritual dimension. In addition to established 12step programmes for alcohol and substance misuse, new approaches such as mindfulness-based cognitive therapy for the treatment of stress, anxiety and depression (MBCT) and compassion-focussed therapy are now being actively researched and supported.

Spiritual values and skills

Spiritual practices can help us to develop the better parts of ourselves. They can help us to become more creative, patient, persistent, honest, kind, compassionate, wise, calm, hopeful and joyful. These are all part of the best health care.

Spiritual skills include: being honest and able to see yourself as others see you being able to stay focused in the present, to be alert, unhurried and attentive being able to rest, relax and create a still, peaceful state of mind developing a deeper sense of empathy for others being able to be with someone who is suffering, while still being hopeful learning better judgement, for example about when to speak or act, and when to remain silent or do nothing learning how to give without feeling drained being able to grieve and let go. Spirituality emphasises our connections to other people and the world, which creates the idea of reciprocity. This means that the giver and receiver both get something from what happens, that if you help another person, you help yourself. Many carers naturally develop spiritual skills and values over time as a result of their commitment to those for whom they care. Those being cared for, in turn, can often give help to others in distress.

The place of chaplaincy/pastoral care

Times have changed. Hospital chaplaincy now involves clergy and others from many faiths, denominations and humanist organisations. Chaplains (also called spiritual advisors) are increasingly part of the teams that provide care both in and outside hospital.

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A modern mental health chaplaincy or department of spiritual care should: have access to a sacred space get on well with local clergy and faith communities provide information about local religious groups, their traditions and practices be aware that, sometimes, an individuals engagement with religious beliefs and activities can be unhelpful and even damaging be able to give advice on difficult issues, such as paranormal influences, spirit possession and the ministry of deliverance work closely with the mental health team so that spiritual needs can be recognised and helped make sure that service users and patients know about them.

Education and research

There is evidence that people who belong to a faith community, or who hold religious or spiritual beliefs, have better mental health. So, the relevance of spirituality is now being recognised in courses for mental health care students and practitioners.

About the Spirituality and Psychiatry Special Interest Group (SPSIG)

The Spirituality and Psychiatry Special Interest Group of the Royal College of Psychiatrists was founded in 1999 to: help psychiatrists to share experiences and to explore spirituality in mental healthcare increase knowledge of the research linking spirituality with better health raise the profile of spirituality in patient care. The SPSIG has now over 3000 psychiatrists. It runs an active programme of one-day events for members and holds occasional conferences open to the general public. Information about these meetings (and the texts of all the talks) can be found in the SPSIG Newsletters at the SPSIG website.

How to start ..?

Spirituality is deeply personal. Try to discover what works best for you. A three-part daily routine can be helpful:

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a regular quiet time (for prayer, reflection or meditation) study of religious and/or spiritual material making supportive friendships with others with similar spiritual and/or religious aims and aspirations. You can find out about spiritual practices and traditions from a wide range of religious organisations. Secular spiritual activities are increasingly available and popular. For example, many complementary therapies have a spiritual or holistic element that is not part of any particular religion. The internet, especially internet bookshops, the local yellow pages, health food shops and bookstores are all good places to look. There is also a wide range of papers about spirituality and mental health that can be downloaded from the publications archive of the SPSIG website.

Further reading
Barker P. & Buchanan-Barker P. (Eds). Spirituality and Mental Health: Breakthrough. Whurr. Butler-Bowen T. (2006) 50 Spiritual Classics. Nicholas Brealey Publishing. Cook, C., Powell, A. & Sims, A. (Eds) (2009) Spirituality and Psychiatry. RCPsych Publications. Coyte M. Gilbert, P. & Nicholls V. (Eds.) (2007) Spirituality, Values and Mental Health: Jewels for the Journey. Jessica Kingsley. Culliford L. (2007) Love, Healing and Happiness. O Books. Fontana D. (2003) Psychology, Religion and Spirituality. BPS Blackwell. Forest J. (2007) The Road to Emmaus: Pilgrimage as a Way of Life. Orbis Books. Galanter M. (2005) Spirituality and the Healthy Mind: science, therapy, and the need for personal meaning. Oxford University Press. Kabat-Zinn J. (2004) Wherever You Go, There You Are. Piatkus Books. Kornfield J. (1994) A Path With Heart . Rider. Nataraja S. (2008) The Blissful Brain. Gaia Books. Post S. & Neimark J. (2007) Why Good Things Happen to Good People. Broadway Books. Royal College of Psychiatrists (2011) Recommendations for psychiatrists on spirituality and religion. Scott Peck M. (1997) The Road Less Travelled. Rider. Swinton J. (2001) Spirituality and Mental Health Care: Rediscovering a Forgotten Dimension. Jessica Kingsley. Whiteside P. (2001) Happiness: The 30-Day Guide. Rider.

Websites
The Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group
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The Multi-Faith Group for Healthcare Chaplaincy website has valuable information about traditions, symbols, teachings and practices of nine world religions. The National Spirituality and Mental Health Forum - an independent registered multi-faith charity. For additional resources, try typing spirituality and health, or spirituality and psychiatry into an internet search engine.

References
Anandarajah G. & Hight E. (2001) Spirituality and Medical Practice: using the HOPE questions as a practical tool for spiritual assessment. American Family Physician, 63, 81 92. Cook C.C.H (2009) Substance Misuse. In Cook, C., Powell, A. & Sims, A. (Eds) Spirituality and Psychiatry 139-168> RCPsych Publications. Culliford L. (2002) Spirituality and Clinical Care. British Medical Journal. 325:1434-5. Culliford L. (2007) Taking a Spiritual History. Advances in Psychiatric Treatment, 13, 212-219. Culliford L. (2009) Teaching Spirituality and Healthcare to 3rd Year Medical Students Clinical Teacher. 6: 22-27. Eagger S. (2005) A guide to the assessment of spiritual concerns in mental healthcare. Faulkner A. (1997) Knowing our own minds. London: Mental Health Foundation. Gilbert P. & Nicholls V. (2003) Inspiring Hope: Recognising the Importance of Spirituality in a Whole Person Approach to Mental Health. London: National Institute for Mental Health in England. Gilbert, P. (2009) Introducing compassion-focused therapy Advances in Psychiatric Treatment , 15, 199-208. Koenig H., McCullough M., & Larson D. (2001) Handbook of Religion and Health. Oxford: Oxford University Press. Murray R. & Zentner J. (1989) Nursing Concepts for Health Promotion. London: Prentice Hall. (Adapted) Nathan M. (1997) A study of spiritual care in mental health practice: patients and nurses perceptions. MSc thesis. Enfield: Middlesex University. Neely D. & Minford E. (2009) FAITH: spiritual history-taking made easy. Clinical Teacher. 6: 181-185. Post S., Puchalski C.& Larson D. (2000) Physicians and Patient Spirituality: Professional Boundaries, Competency, and Ethics. Annals of Internal Medicine. 132: 578-583. Puchalski C. & Larson D. (1998) Developing curricula in spirituality and medicine. Acad Med. 73(9), 970-974. Swinton J. (1999) Building a Church for Strangers: Theology, Church and Learning Disabilities. Edinburgh: Contact Pastoral Trust. Swinton J. (2002) Spirituality and the Lives of People With Learning Disabilities. The Tizard Learning Disability Review. 7, 4: 29-35. World Health Organization. (1998) WHOQOL and Spirituality, Religiousness and Personal Beliefs: Report on WHO Consultation. Geneva: WHO. This leaflet was produced by the Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group Executive Committee.
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Series Editor: Dr Philip Timms Expert Review: Dr Larry Culliford, Dr Andrew Powell, Professor Chris Cook

Illustration by Lo Cole: www.locole.co.uk

This leaflet reflects the best available evidence at the time of writing.

January 2013. Due for review: January 2015. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from the Head of Publications. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 7235 2351 x 2552.

Charity registration number (England and Wales) 228636 and SC038369.

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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