Abstract
The mental health profession had acknowledged the role played by religion and spirituality in identifying and addressing mental health needs in their patients. This article showed that spirituality and religion while distinct from each other plays a significant role in the treatment of mental health patients. It concluded that spiritual assessment and therapy should be integrated in mental health care strategies. Recommendations on the mental health profession included the integration of spirituality training among mental health workers and the use of this type of therapy in the profession in different societies.
Introduction
Because of the importance of attitudes toward recovery and spirituality among future mental health professionals in the medical field, and the strong orientation toward spirituality in the recovery movement, both in the lay movement, the focus of this article is to evaluate the role of religious and spiritual orientations and the patients’ perceptions of the importance of spirituality in their health and medical treatment.
The meanings of religion and spirituality appear to be evolving. Religion is moving from a broadband construct–one that includes both the institutional and the individual, and the good and the bad–to a narrowband institutional construct that restricts and inhibits human potential(Pargament, 1999). Spirituality, on the other hand, is becoming differentiated from religion as an individual expression that speaks to the greatest of human capacities (Pargament, 1999).
The differences between religion and spirituality need to be distinguished. Although some individuals express their spirituality through their religious faith, others do not (Burke, Flowers, Furr, and Graham, 2001). Religion generally refers to an integrated set of beliefs and activities (Corbett, 1990) whereas spirituality is seen as the meaning gained from life experiences (May, 1982), which may or may not be theistic in nature (Richards & Bergin, 1997). A belief in God can be integrated with meaningful life experiences, but individuals without a belief in God or a higher power can also have spiritual and meaningful experiences in life (Stoll, 1989).
A sense of spirituality embodies a broader construct definition than a sense of religion. Conceptualizations of “spirituality” in colloquial usage embody a “sensitivity or attachment to religious values and things of the spirit rather than material or worldly interests” whereas religion refers to “the service and worship of God or the supernatural” and an “institutionalized system” of attitudes, beliefs, and practices (Webster Dictionary, 1981). In current substance abuse literature, spirituality has been described in terms of one’s relationship with the universe, with other people, and with one’s self (Corrington, 1989). Spirituality has also been described as referring to people who are concerned with metaphysical issues as well as their day-to-day lives. Significantly, such definitions of spirituality note that a belief in God is not required in order to be spiritual (Gorsuch, 1993).
Religion is a search for significance in ways related to the sacred (Pargament, 1997). This definition bridges both functional and substantive traditions in the psychology of religion. Functionally, religion is a search for significance. By search, Pargament (1999) clarified that it is an efforts not only to find significance but to conserve significance once found or transform significance when necessary.
Spirituality is the heart and soul of religion. The search for the sacred is the most central religious function. Pargament (1997, 1999) defined spirituality as a search for the sacred. It is, the most central function of religion. It has to do with however people think, feel, act, or interrelate in their efforts to find, conserve, and if necessary, transform the sacred in their lives. The sacred encompasses concepts of God, the divine, and the transcendent, but it is not limited to notions of higher powers. It also includes objects, attributes, or qualities that become sanctified by virtue of their association with or representation of the holy (Pargament, Mahoney, & Swank, in press).
The mental health-care delivery system is composed of resources and organization components that affect utilization. The resource components include labor and capital for health care. The organization components are the entry for gaining access to the system and the structure for the delivery of services that are delivered. The service population components that impact utilization are delineated into predisposing, enabling, and need factors. Predisposing factors include demographic, social structural, and attitudinal-belief characteristics. Enabling factors are conditions that make health-care services available to an individual. The need factors are the perceptions that the individual has about the necessity to use the health-care delivery system to remedy actual or potential health problems.
Spirituality and Spiritual Care
In the past, mental health professionals and ministers have seen science and religion as separate, and attempts to connect them have been dismissed as disruptive and unhealthy (Fallot, 2001).
Over the years, however, there have been attempts by noted therapists such as Jung and others to integrate these two aspects of spirituality and mental health. In the last 20 years, a growing number of voices have joined in the discussion (Fallot, 2001). Many therapists now are beginning to consider the healing opportunities available when incorporating a more holistic view of mind, body, and spirit. Even the American Psychiatric Association (APA) has begun to consider the role of religion and spirituality in psychiatry (APA, 1994).
Such a dramatic shift in thinking is easy to understand when looking at the growing sense of isolation and alienation present in the patient population, which the mental health community can no longer ignore. With families eroding and communities no longer available to provide support, there is a growing sense of confusion and conflict about values, standards, and priorities (Aponte, 1996). People who come into therapy today are looking for something more. As Nicholas (1994) states, “Patients not only are coming into therapy with confusion about their own individual morality but are seeking to compensate for the lack of reliable and humane guideposts that are available in society as a whole” (p. 5). In this atmosphere, therapists are looked to for support as clients struggle with a loss of meaning and a sense of emptiness. A therapist who focuses on traditional therapies can provide only transitory relief for the emptiness and is limited because the process speaks primarily to individual pathology rather than the wider aspect of humankind (Karasu, 1999).
With such a lack of training and support, therapists do not have an easy task to incorporate spiritual or religious issues. Whether they acknowledge them or not, their attitudes and beliefs, experience with religion, and view of the world come with us when we enter a therapeutic session. For therapists to ignore that or not recognize it as important is to “leave unknown, unattended and unspoken, the values, morals and worldview that frame the therapy of the clinician” (Aponte, 1996, p. 97). Much better to recognize the importance of these beliefs, decide how the therapy will or will not reflect them, and establish a system that can integrate spirituality into the therapy.
To accomplish this task requires a willingness by mental health professionals need to self-reflect on the role their own belief systems play in their work, as well as a desire to have a dialogue with clients on spiritual and religious issues. This open attitude allows clients to explore their own spiritual views and develop ways to translate their beliefs into moral guides that can bring strength and inspiration. For many clients, religion and spirituality are deep sources of identity and compose a central theme in understanding motivation and meaning. Being open to this aspect adds a fuller dimension to the therapy and may consolidate and sustain recovery (Fallot, 2001).
Incorporating an awareness of spiritual and religious issues into the mental health setting requires a certain level of insight and preparation before a session. This preparation requires an assessment of feelings and attitudes about the world, how we live, and what we think of as important in life (Bolletino, 2001). In this view of wholeness, mental health professionals takes on the task of helping clients self-realize, to search for meaning and the best way of being that uses the most of themselves (LeShan, 1999). Rather than exploring past causes for current problems or how clients got that way, therapists should emphasize what clients are trying to accomplish or become, what their dreams are (Bolletino, 2001). With this focus, the client is encouraged to make inner changes that can create a better way of life, with the past becoming relevant “only insofar as it blocks the way to the future” (Bolletino, p. 97). Effects of Spiritual Assessment on Mental Health Care Management
Assessment is critical to the incorporation of strengths into the therapeutic milieu. Without a reliable means for finding consumers’ strengths, workers tend to revert to practice models that are based on the identification of problems and deficits (Ronnau & Poertner, 1993). In addition to identification, strengths must be organized into a conceptual framework that suggests particular interventions. Gathering data is not an assessment in itself; the information must be interpreted, organized, integrated with theory, and made meaningful (Rauch, 1993). Accordingly, assessment is defined as the process of gathering, analyzing, and synthesizing salient data into a multidimensional formulation that provides the basis for action decisions (Rauch, 1993).
As Mattaini and Kirk (1991) observed, assessment is an underdeveloped area in mental health work. Nowhere is the lack of maturation more evident than in the area of spiritual assessment (Sherwood, 1998). Although there have been numerous calls for the reintegration of spirituality into the therapeutic dialogue (Poole, 1998), multidimensional instruments that assess spirituality in a therapeutically constructive fashion are conspicuously absent. Surveys have shown repeatedly that mental health have received little training in issues related to spirituality or spiritual assessment (Hodge, 2001). Furman and Chandy (1994) found that more than three-quarters of practitioners received little or no training in spirituality during their graduate education, despite the central role it plays in the lives of many consumers.
An additional factor stimulating interest in assessing spirituality is the profession’s growing acceptance of the strengths perspective, which posits clients’ personal and environmental strengths as central to the helping process. With growing use of clients’ capabilities in the clinical dialogue to ameliorate problems, interest in how to identify clients’ strengths, such as spirituality, has increased (Hwang & Cowger, 1998).
Spiritual and Cross Cultural Care
Certainly the evolving meanings of religiousness and spirituality may reflect large-scale sociodemographic changes. As boundaries between countries and cultures have become more open, we have seen a proliferation of Eastern religions and alternative religious beliefs in the United States and Europe. They have brought with them alternative religious groups and practices. Alternative quasi-religious movements in the United States and Europe have also prompted changes in labels and meanings of these constructs.
Disparities in mental health status continue to exist across cultural care. These disparities of poor health, in part, are attributed to decreased access to health-care services (Jewell and Russell, 1992). However, culture plays a key role in health-care utilization patterns. The predominate barriers include inability to pay for services, lack of transportation and child care, decreased understanding of treatment plans, and inability to incorporate prescribed health plans into daily living patterns.
According to Murdock (1972), culture is a combination of habitually performed behaviors, intelligence for problem solving, communication through language, and the existence of social life or a society. Differences in health behaviors will vary among people of various cultures.
Health-care service utilization is directly related to factors within the healthcare delivery system and to the population targeted for services (Jewell and Rusell, 1992). Utilization of services is characterized by the type of care received, the site of delivered care, the purpose of the health encounter, the number of visits made, and the time period for rendered care. Utilization patterns will vary for preventive, illness-related and maintenance care.
Conclusion
Mental health professionals must acknowledge the growing benefits that spirituality and religion plays in mental health treatment. In this regard, their training must also incorporate spirituality as an alternative therapy. Furthermore, the church can be used as a mechanism for increasing health-care utilization. The social networks within the church have a positive impact on health promotion, early detection of disease, and health maintenance. With the assistance of the clergy and church lay leaders, these beliefs should be incorporated into training programs for mental health workers.
Consequently, although all areas of community needs in addition to those pertaining to health (e.g., needs related to education, employment, and political activism) should be assessed, the mental health can provide input into the development of community needs assessment tools and the analysis of data that address the health component. Health providers should recognize that immediate needs and community plans for interventions may not pertain to potential or existing health problems. Recommendations Mental health professionals and hospitals must assess individual’s and families’ beliefs about potential and existing health problems and subsequent treatments. Spiritual assessment data must be integrated into a comprehensive plan of care. Assessment information should be obtained about uses of informal lay health networks before and throughout the course of illness and during wellness. Health promotion practices should be identified, evaluated for their efficacy, and integrated into wellness plans.
Communication between spirituality scholars and other mental health-care providers should be promoted as a necessary component for care of clients. This should hold true in across cultural mental health care- accepting the differences within the culture, assessing individual health beliefs and practices, and integrating these beliefs and practices into plans of care, intercultural communication with mental health clients and families can be enhanced.
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