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 issue
carers and relatives
professionals who may not be sure about how to explore spiritual concerns 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.
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 and healing 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 just as important to people with intellectual disability or other conditions, such as dementia and head injury, as they are in anybody else.
Spirituality often becomes more important in times of 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 necessarily 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 everyone. Spirituality also highlights how connected we are to other people and the world.
What is spiritual health care?
People with mental health problems have said that they want:
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 mental health carers
meaningful activity such as creative art, work or enjoying nature
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 respect their faith
encouragement to deepen their faith
sometimes – to be helped with forgiveness.
What difference can spirituality make?
Patients say that they 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 enabled them to accept and live with continuing problems or to make changes where possible.
A spiritual assessment
This should be considered as part of every mental health assessment. Depression or substance misuse, for example, can sometimes reflect a spiritual void in a person's life. Mental health professionals also need to be able to distinguish between a spiritual crisis and a mental illness, particularly when these overlap.
A helpful way to begin is to be asked "Would you say you are spiritual or religious in any way? Please tell me how." Another useful question is, "What gives you hope?" or "What keeps you going in difficult times?" The answer to this will usually reveal a person's main 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 is important – at its best, exploring spiritual issues can be therapeutic in itself.
Setting the scene
What is your life all about? Is there something 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 or suffered abuse? How has this affected you?
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 situation? Would it help to involve a chaplain, or someone from your faith community? What needs to be understood about your religious background?
The future
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?
The next step
What kind of support would work for you? How could you best be helped to get it? Is there someone caring for you with whom you can explore your concerns?
Spiritual practices
These span a wide range, from the religious to non-religious. 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
join team sports or other activities that involve co-operation and trust
spend time in contemplative reading (of literature, poetry 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.
Spiritually-informed therapies
Over recent years there has been increasing interest in treatments that include the spiritual dimension. In addition to established 12-step programmes for alcohol and substance misuse, new approaches such as mindfulness-based cognitive therapy for the treatment of stress, anxiety and depression (MBCT), compassion-focussed therapy and forgiveness 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
finding the capacity for forgiveness
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.
How to start …..?
Spirituality is deeply personal. Try to discover what works best for you. A three-part daily routine can be helpful:
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 Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group's website.
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.
A modern mental health chaplaincy or department of spiritual care should:
get on well with local clergy and faith communities
provide information about local religious groups, their traditions and practices
recognise that in some circumstance for an individual to be focussing on religious beliefs and activities can be unhelpful and even harmful
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 patients know about the help available from departments of spiritual care.
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 a membership of around 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 given) can be found in the SPSIG website.
Further reading
Barker P. & Buchanan-Barker P. (Eds). (2003) Spirituality and Mental Health: Breakthrough. Whurr.
Coyte M. Gilbert, P. & Nicholls V. (Eds.) (2007) Spirituality, Values and Mental Health: Jewels for the Journey. Jessica Kingsley.
Galanter M. (2005) Spirituality and the Healthy Mind: science, therapy, and the need for personal meaning. Oxford University Press.
Koenig H.G. (2013) Spirituality in Patient Care: Why, How, When, and What, West Conshohocken, PA, Templeton.
Swinton J. (2001) Spirituality and Mental Health Care: Rediscovering a Forgotten Dimension. Jessica Kingsley.
Websites
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.
Cook C.C.H. (2013) Controversies on the Place of Spirituality and Religion in Psychiatric Practice. In Cook C.C.H. (Ed.) Spirituality, Theology and Mental Health, London, SCM, 1-19.
Craigie F.C. (2008) Positive Spirituality in Health Care. Minneapolis, Mill City.
Culliford L. (2009) Teaching Spirituality and Healthcare to 3rd Year Medical Students. The Clinical Teacher, Volume 6, Issue 1, pages 22-27, March 2009.
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. (2011) Handbook of Religion and Health. Oxford: Oxford University Press.
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.
Series Editor: Dr Philip Timms
Expert Review: Dr Andrew Powell, Professor Chris Cook, Dr Larry Culliford.
This leaflet reflects the best available evidence at the time of writing.
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 3701 2552.
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