Int J Psychiatry Clin Pract 2014; 18: 304–307. © 2014 Informa Healthcare ISSN 1365-1501 print/ISSN 1471-1788 online. DOI: 10.3109/13651501.2014.902071
SHORT REPORT
The wishes of outpatients with severe mental disorders to discuss spiritual and religious issues in their psychiatric care
informahealthcare.com/ijpcp
Sylvia Mohr & Philippe Huguelet
Int J Psych Clin Pract Downloaded from informahealthcare.com by Yale Dermatologic Surgery on 12/27/14 For personal use only.
Department of Mental Health and Psychiatry, Service of General Psychiatry, University Hospital of Geneva, Geneva, Switzerland Abstract Objective. In a previous multisite comparative study of spiritual and religious coping (S/R) among outpatients with schizophrenia; S/R were adaptive for 80% of patients; harmful for 13%; and marginal for 7%. This importance was underestimated by clinicians. We created an interfaith therapeutic group to address such topics. The aim of the study is to assess patients’ wish to address S/R issues in their psychiatric care. Method. Psychiatrists asked consecutive outpatients about their wish; with who they shared S/R concerns; and their interest to enroll in the “Spiritual and Recovery Group”. Results. Among the 147 patients included less than half shared their spiritual concerns with other people. A quarter wished to address S/R issues in their care; 24/147 already shared those issues with a religious professional; half of them wished also to share them with their psychiatrist. Among the 21 patients who participated in an in-depth spiritual assessment 16 patients were directed to the S/R group and 5 patients were directed to groups addressing other therapeutic objectives. Conclusion. For one patient out of ten, S/R issues were of a clinical significance warranting integration into psychiatric treatment. This study shows that patients’ views are in accordance with former research, putting forward psychiatrists’ stance on this issue. Key words: Spirituality, religion, severe mental disorders, psychiatric care, recovery (Received 3 June 2013; accepted 4 March 2014)
Introduction In recent years, the role of spirituality and religion (S/R) in the coping and recovery processes of patients with severe mental disorders received a growing interest (Koenig et al. 2012). S/R coping may be adaptive (a resource for recovery), or not (a source of despair and suffering) (Fallot 2007; Koenig et al. 2012). A study of S/R coping among 276 outpatients with schizophrenia conducted in Switzerland, Canada, and the United States showed that S/R coping were adaptive for 80% (i.e., providing hope, comfort, meaning of life, enjoyment, love, compassion, self-respect, and self-confidence; as a resource to cope with their symptoms, substance misuse, and protecting against suicide; being supported by their religious community); harmful for 13% (i.e., contributed to a negative sense of self, in terms of despair and suffering as well as feelings of fear, anger, or guilt; despair after the failure of the spiritual healing; suffering from rejection by religious communities; increasing delusions, depression, suicide risk, and substance use); and marginal for 7% (Mohr et al. 2012). This importance of S/R is underestimated by clinicians (Huguelet et al. 2006). Hence a spiritual assessment should be conducted systematically in psychiatric care, in order to consider, if Correspondence: Sylvia Mohr, PhD, Department of Mental Health and Psychiatry, Service of General Psychiatry, University Hospital of Geneva, Rue du 31-Décembre 8, 1207 Geneva, Switzerland. Tel: ⫹ 41223823122. Fax: ⫹ 41223823105. E-mail: [email protected]
necessary, spiritual or religious issues into treatment. In a former research (Huguelet et al. 2011), we trained psychiatrists to conduct a spiritual assessment to their outpatients with schizophrenia. This elicited S/R issues which could be addressed in treatment for 67% of cases (i.e., supporting of positive coping; working on identity and values; differentiating delusions from faith; linking the patient with a religious professional; addressing negative religious coping; and addressing conflict between psychiatric care and S/R issues). However, this training did not allow psychiatrists to be fully at ease to address such topics. Hence, we created the “Spirituality and Recovery Group”. This interfaith group aimed to (1) foster leaning on spirituality to cope with the illness and to recover; (2) address potential deleterious aspects of spirituality; and (3) support social integration of patients in their religious communities (Mohr 2011). Patients were referred by their psychiatrist for an assessment to determine whether their needs and expectations were in accordance with the group’s goals and setting. Despite positive evaluations from patients who participated in the group, only few patients were referred by their psychiatrist. The assessment of spiritual needs and by whom the patient wants those needs to be addressed is essential (Sims 2007). The aim of the present study is therefore to assess patients’ wishes, in the context of an outpatients’ clinic in which those issues may be potentially integrated. More specifically we wanted to assess patients’ wishes concerning (1) the role of their psychiatrist on the issue of S/R and (2) their interest to enroll in the “Spiritual and Recovery Group”.
Int J Psych Clin Pract Downloaded from informahealthcare.com by Yale Dermatologic Surgery on 12/27/14 For personal use only.
DOI: 10.3109/13651501.2014.902071
Patients’ wishes to discuss spiritual and religious issues in their psychiatric care
Methods Patients were recruited by their psychiatrist at an outpatient clinic affiliated with the Department of Mental Health and Psychiatry in Geneva. This clinic is composed of first-line psychiatrists assisted by nurses, psychologists, and social workers who provide psychotherapy, somatic treatments, and rehabilitation to people with severe mental disorders. In order to get a representative sample, all psychiatrists participated in this study and included all their patients prospectively on their agenda over a three-month period. The study was approved by the ethical committee of the University Hospitals of Geneva. The psychiatrists asked their patients (1) whether they wished to address S/R issues in their care at the clinic; (2) whether they shared those issues with someone, if yes with whom; (3) whether they wanted to meet the psychologist who conducts the “Spirituality and Recovery Group” at the clinic for a therapeutic indication based on clinical and spiritual assessment (Mohr et al. 2007). As S/R may be linked with age, gender, ethnicity, and diagnosis (Loewenthal 2010), comparisons between patients’ desire to discuss S/R issues in their care and patients’ characteristics were analyzed using means, ranks, or frequencies (independent t-test, Chi-square, Wilcoxon-rank test) with a probability level less than 0.05 for rejecting the null hypothesis. Results Sociodemographical and clinical variables of all included patients (n ⫽ 147) are presented in Table I. For a third of patients, religious preference was not recorded in medical chart; of the remaining patients 51% were Christians, 13% Muslims, and 3% of other religions. Patients’ wishes
to address S/R issues in their psychiatric care are presented in Table II. The main finding is that 25% wished to address S/R issues in their psychiatric care. Those wishes were statistically independent of all sociodemographical and clinical characteristics. Among all patients (n ⫽ 147), 16% already shared spiritual and religious issues with a religious professional; half of them wished also to share them with their psychiatrist. Among the 75% of patients who DO NOT wished to share S/R issues in their psychiatric care, 64% do not share those issues with anybody, 23% shared them only with relatives, 10% shared them with a chaplain or a religious professional, and 3% shared those issues against their will due to hallucinations or delusions with religious contents. Among the 25% of patients who wished to share spiritual or religious issues in their psychiatric care, a third do not share those issues with anybody, a third share them only with relatives, a third already shared them with a chaplain or a religious professional, and two-third wished to meet the psychologist for an in-depth spiritual assessment. Among the 24 patients who wished to meet the psychologist for an in-depth spiritual assessment, 3 patients dropped out. The interview led to set other therapeutic objectives than the “Spirituality and Recovery Group” for 5 patients (i.e., self-esteem group, individual cognitive-behavioral therapy for managing delusions, and hallucinations). For 16 patients, the group was found as potentially helpful (i.e., in the perspective of a decrease of feelings of loneliness through sharing spirituality with others; by clarifying the confusing overlap between psychotic symptoms and spirituality; by supporting helpful forms of S/R coping strategies; by addressing spiritual struggles about the
Table I. Clinical and sociodemographic characteristics of 147 psychiatric outpatients in a study on patients’ wishes to address spiritual and religious issues in their care. Wishes to address S/R issues n ⫽ 37 (25%) Gender Male Female Ethnicity Caucasian African Asian Other Marital status Single Married separated, divorced, or widowed Has child or children With disability insurance Living in a halfway house Diagnosis Psychosis Depressive and/or anxiety disorders Personality disorders Mental disorders due to an organic condition Age (years) Duration of illness (years)
305
Total n ⫽ 147 (100%)
21 16
57% 43%
81 66
55% 45%
24 8 2 3
65% 22% 5% 8%
103 28 8 8
70% 19% 5% 5%
18 6 13 17 24 7
49% 16% 35% 46% 65% 19%
76 25 46 60 103 29
52% 17% 31% 41% 70% 20%
25 7 3 2
68% 19% 8% 5%
89 37 12 9
61% 25% 8% 6%
mean
sd
mean
sd
47 17
11 14
46 16
10 12
306
S. Mohr & P. Huguelet
Int J Psychiatry Clin Pract 2014;18:304–307
Table II. Wishes to address spiritual or religious issues in their psychiatric care among 147 outpatients with severe mental disorders. Questions 1. Do you wish addressing spiritual or religious issues in your psychiatric care? 2a. Do you share spiritual or religious issues with someone? 2b. If yes, with whom?
Int J Psych Clin Pract Downloaded from informahealthcare.com by Yale Dermatologic Surgery on 12/27/14 For personal use only.
3. Do you want to meet the psychologist leading the “Spirituality and Recovery Group”?
spiritual meaning of mental illness, suffering, theodicy, sin, and guilt). However, 3 patients could not attend the group due to vocational obligation at the scheduled time; and 3 patients were reluctant to enter into a group setting. Therefore, for those patients, S/R issues were addressed in their individual psychiatric care. Discussion A quarter of the 147 outpatients wished to address S/R issues in their psychiatric care. An in-depth spiritual assessment of 21 patients elicited that for 16 of them, addressing S/R issues was of considerable clinical importance. Those results are in line with those obtained in Québec in a quite similar population: 22% of subjects had S/R goals unmet by the offered services (Lecomte et al. 2005). Such discrepancies were also elicited in a Swedish study of immigrants with psychosis showing that the greatest differences between health-care staff, patients, and families involved religious issues (Hultsjö et al. 2011). In psychiatric hospitals, patients’ spiritual needs may be even greater, 88% in US (Fitchett et al. 1997) and 85% in Brazil (Lucchetti et al. 2012). Our results point out a gap between spontaneous referrals for addressing S/R issues and patients’ wishes. In order to progress toward the standards of a recovery-oriented service, the first step should be a routine assessment of spiritual needs. Due to the existing heavy load of day-to-day psychiatrists’ tasks, such an assessment should not be time consuming. This screening assessment could be limited to the importance of spirituality and religiousness in life and in coping with the illness, the patient’s involvement in a religious community, and the patients’ wishes to address those S/R issues in psychiatric care and by whom (Sims 2007). To go further, training in S/R issues is a key target (Galanter et al. 2011). A recovery-oriented facility should address S/R issues in the same way they should for cultural and identity issues (Whitley 2012). S/R issues could be considered in an idiographic narrative approach looking at their dynamics in the person’s life in relationship with a person-centered psychiatry (Verhagen 2010; Camp 2011). Then, depending on institutional contexts of public services, S/R issues could be integrated in psychiatric care, ranging from referral to a religious professional, exploration of spirituality in individual and group settings, bringing in spiritual concepts and practices into psychotherapies, to holistic care programs (Mohr 2011). Some patients wished to address
Answers
n
%
YES NO NO, but with a religious professional only YES NO only relatives a chaplain or a religious professional only the psychiatrist YES NO
37 98 12 64 83 36 24 4 24 123
25 67 8 44 56 56 38 6 16 84
S/R issues only with religious professionals, others only with mental health professionals, or with both. Hence collaboration with religious professionals should be fostered. In the case of delusions or hallucinations with a religious content, psychiatrists sometimes address spiritual or religious issues against patients’ wishes. This particular point underlines the importance of training for mental health professionals and collaboration with chaplains working in psychiatric care. Indeed, delusions or hallucinations with a religious content may coexist with S/R coping strategies (Mohr et al. 2010). In order to address patients’ S/R issues in psychiatric care, a short screening assessment of those issues should be done systematically. After this step, the integration of S/R issues in psychiatric care could be proposed in order to progress toward a comprehensive recovery-oriented psychiatric care. This objective also includes training for mental professionals on S/R issues, as well as clinical research to evaluate specific interventions including such issues. This study entailed some limitations that hinder generalization. Indeed, religious preference and the importance of S/R were assessed only through the in-depth spiritual assessment for 14% of patients; hindering therefore comparison of wishes, or not, to address S/R issues on S/R dimensions. Psychiatrists’ skills to address S/R issues with their patients were not investigated. Key points • • •
Outpatients’ wishes to address S/R issues into their psychiatric care are largely underestimated by psychiatrists. The routine of a short screening assessment of those issues should be done systematically in the care management process. After this step, the integration of spiritual or religious issues in psychiatric care could be proposed in order to progress toward recovery-oriented psychiatric care.
Acknowledgments None. Statement of interest None of the authors reports conflicts of interest. The research was supported by the Department of Mental Health and Psychiatry, University Hospital of Geneva, Switzerland.
DOI: 10.3109/13651501.2014.902071
Patients’ wishes to discuss spiritual and religious issues in their psychiatric care
Int J Psych Clin Pract Downloaded from informahealthcare.com by Yale Dermatologic Surgery on 12/27/14 For personal use only.
References Camp ME. 2011. Religion and spirituality in psychiatric practice. Curr Opin Psychiatry 24:507–513. Fallot RD. 2007. Spirituality and religion in recovery: some current issues. Psychiatr Rehabil J 30:261–270. Fitchett G, Burton LA, Sivan AB. 1997. The religious needs and resources of psychiatric inpatients. J Nerv Ment Dis 185:320–326. Galanter M, Dermatis H, Talbot N, McMahon C, Alexander MJ. 2011. Introducing Spirituality into Psychiatric Care. J Relig Health 50:81–91. Huguelet P, Mohr S, Betrisey C, Borras L, Gillièron C, Marie AM, et al. 2011. A randomized trial of spiritual assessment of outpatients with schizophrenia: patients’ and clinicians’ experience. Psychiatr Serv 62:79–86. Huguelet P, Mohr S, Borras L, Gillièron C, Brandt PY. 2006. Spirituality and religious practices among outpatients with schizophrenia and their clinicians. Psychiatr Serv 57:366–372. Hultsjö S, Berterö C, Arvidsson H, Hjelm K. 2011. Core components in the care of immigrants with psychoses: a Delphi survey of patients, families, and health-care staff. Int J Ment Health Nurs 20:174–184. Koenig HG, King D, Carson VB. 2012. Psychotic disorders. In: Handbook of religion and health. Oxford: Oxford University Press, pp 207–223. Lecomte T, Wallace CJ, Perreault M, Caron J. 2005. Consumers’ goals in psychiatric rehabilitation and their concordance with existing services. Psychiatr Serv 56:209–211.
307
Loewenthal KM. 2010. Spirituality and cultural psychiatry. In: Bhugra D, Bhui K, editors. Textbook of cultural psychiatry. Cambridge: Cambridge University Press, pp 59–71. Lucchetti G, Braguetta CC, Vallada C, Vallada H. 2012. Exploring the acceptance of religious assistance among patients of a psychiatric hospital. Int J Soc Psychiatry 5:1–7. Mohr S. 2011. Integration of spirituality and religion in the care of patients with severe mental disorders. Religions 2:549–565. Mohr S, Borras L, Betrisey C, Pierre-Yves B, Gillièron C, Huguelet P. 2010. Delusions with religious content in patients with psychosis: how they interact with spiritual coping. Psychiatr 73:158–172. Mohr S, Borras L, Nolan J, Gillièron C, Brandt PY, Eytan A, et al. 2012. Spirituality and religion in outpatients with schizophrenia: a multi-site comparative study of Switzerland, Canada and the United States. Int J Psychiatry Med 44:29–52. Mohr S, Gillieron C, Borras L, Brandt PY, Huguelet P. 2007. The assessment of spirituality and religiousness in schizophrenia. J Nerv Ment Dis 195:247–53. Sims A. 2007. Spiritual aspects of management. In: Bhugra D, Bhui K, editors. Textbook of cultural psychiatry. Cambridge: Cambridge University Press, pp 434–444. Verhagen PJ. 2010. The case for more effective relationships between psychiatry, religion and spirituality. Curr Opin Psychiatry 23:550–555. Whitley R. 2012. Religious competence as cultural competence. Transcult Psychiatry 49:245–260.
SHORT REPORT
The wishes of outpatients with severe mental disorders to discuss spiritual and religious issues in their psychiatric care
informahealthcare.com/ijpcp
Sylvia Mohr & Philippe Huguelet
Int J Psych Clin Pract Downloaded from informahealthcare.com by Yale Dermatologic Surgery on 12/27/14 For personal use only.
Department of Mental Health and Psychiatry, Service of General Psychiatry, University Hospital of Geneva, Geneva, Switzerland Abstract Objective. In a previous multisite comparative study of spiritual and religious coping (S/R) among outpatients with schizophrenia; S/R were adaptive for 80% of patients; harmful for 13%; and marginal for 7%. This importance was underestimated by clinicians. We created an interfaith therapeutic group to address such topics. The aim of the study is to assess patients’ wish to address S/R issues in their psychiatric care. Method. Psychiatrists asked consecutive outpatients about their wish; with who they shared S/R concerns; and their interest to enroll in the “Spiritual and Recovery Group”. Results. Among the 147 patients included less than half shared their spiritual concerns with other people. A quarter wished to address S/R issues in their care; 24/147 already shared those issues with a religious professional; half of them wished also to share them with their psychiatrist. Among the 21 patients who participated in an in-depth spiritual assessment 16 patients were directed to the S/R group and 5 patients were directed to groups addressing other therapeutic objectives. Conclusion. For one patient out of ten, S/R issues were of a clinical significance warranting integration into psychiatric treatment. This study shows that patients’ views are in accordance with former research, putting forward psychiatrists’ stance on this issue. Key words: Spirituality, religion, severe mental disorders, psychiatric care, recovery (Received 3 June 2013; accepted 4 March 2014)
Introduction In recent years, the role of spirituality and religion (S/R) in the coping and recovery processes of patients with severe mental disorders received a growing interest (Koenig et al. 2012). S/R coping may be adaptive (a resource for recovery), or not (a source of despair and suffering) (Fallot 2007; Koenig et al. 2012). A study of S/R coping among 276 outpatients with schizophrenia conducted in Switzerland, Canada, and the United States showed that S/R coping were adaptive for 80% (i.e., providing hope, comfort, meaning of life, enjoyment, love, compassion, self-respect, and self-confidence; as a resource to cope with their symptoms, substance misuse, and protecting against suicide; being supported by their religious community); harmful for 13% (i.e., contributed to a negative sense of self, in terms of despair and suffering as well as feelings of fear, anger, or guilt; despair after the failure of the spiritual healing; suffering from rejection by religious communities; increasing delusions, depression, suicide risk, and substance use); and marginal for 7% (Mohr et al. 2012). This importance of S/R is underestimated by clinicians (Huguelet et al. 2006). Hence a spiritual assessment should be conducted systematically in psychiatric care, in order to consider, if Correspondence: Sylvia Mohr, PhD, Department of Mental Health and Psychiatry, Service of General Psychiatry, University Hospital of Geneva, Rue du 31-Décembre 8, 1207 Geneva, Switzerland. Tel: ⫹ 41223823122. Fax: ⫹ 41223823105. E-mail: [email protected]
necessary, spiritual or religious issues into treatment. In a former research (Huguelet et al. 2011), we trained psychiatrists to conduct a spiritual assessment to their outpatients with schizophrenia. This elicited S/R issues which could be addressed in treatment for 67% of cases (i.e., supporting of positive coping; working on identity and values; differentiating delusions from faith; linking the patient with a religious professional; addressing negative religious coping; and addressing conflict between psychiatric care and S/R issues). However, this training did not allow psychiatrists to be fully at ease to address such topics. Hence, we created the “Spirituality and Recovery Group”. This interfaith group aimed to (1) foster leaning on spirituality to cope with the illness and to recover; (2) address potential deleterious aspects of spirituality; and (3) support social integration of patients in their religious communities (Mohr 2011). Patients were referred by their psychiatrist for an assessment to determine whether their needs and expectations were in accordance with the group’s goals and setting. Despite positive evaluations from patients who participated in the group, only few patients were referred by their psychiatrist. The assessment of spiritual needs and by whom the patient wants those needs to be addressed is essential (Sims 2007). The aim of the present study is therefore to assess patients’ wishes, in the context of an outpatients’ clinic in which those issues may be potentially integrated. More specifically we wanted to assess patients’ wishes concerning (1) the role of their psychiatrist on the issue of S/R and (2) their interest to enroll in the “Spiritual and Recovery Group”.
Int J Psych Clin Pract Downloaded from informahealthcare.com by Yale Dermatologic Surgery on 12/27/14 For personal use only.
DOI: 10.3109/13651501.2014.902071
Patients’ wishes to discuss spiritual and religious issues in their psychiatric care
Methods Patients were recruited by their psychiatrist at an outpatient clinic affiliated with the Department of Mental Health and Psychiatry in Geneva. This clinic is composed of first-line psychiatrists assisted by nurses, psychologists, and social workers who provide psychotherapy, somatic treatments, and rehabilitation to people with severe mental disorders. In order to get a representative sample, all psychiatrists participated in this study and included all their patients prospectively on their agenda over a three-month period. The study was approved by the ethical committee of the University Hospitals of Geneva. The psychiatrists asked their patients (1) whether they wished to address S/R issues in their care at the clinic; (2) whether they shared those issues with someone, if yes with whom; (3) whether they wanted to meet the psychologist who conducts the “Spirituality and Recovery Group” at the clinic for a therapeutic indication based on clinical and spiritual assessment (Mohr et al. 2007). As S/R may be linked with age, gender, ethnicity, and diagnosis (Loewenthal 2010), comparisons between patients’ desire to discuss S/R issues in their care and patients’ characteristics were analyzed using means, ranks, or frequencies (independent t-test, Chi-square, Wilcoxon-rank test) with a probability level less than 0.05 for rejecting the null hypothesis. Results Sociodemographical and clinical variables of all included patients (n ⫽ 147) are presented in Table I. For a third of patients, religious preference was not recorded in medical chart; of the remaining patients 51% were Christians, 13% Muslims, and 3% of other religions. Patients’ wishes
to address S/R issues in their psychiatric care are presented in Table II. The main finding is that 25% wished to address S/R issues in their psychiatric care. Those wishes were statistically independent of all sociodemographical and clinical characteristics. Among all patients (n ⫽ 147), 16% already shared spiritual and religious issues with a religious professional; half of them wished also to share them with their psychiatrist. Among the 75% of patients who DO NOT wished to share S/R issues in their psychiatric care, 64% do not share those issues with anybody, 23% shared them only with relatives, 10% shared them with a chaplain or a religious professional, and 3% shared those issues against their will due to hallucinations or delusions with religious contents. Among the 25% of patients who wished to share spiritual or religious issues in their psychiatric care, a third do not share those issues with anybody, a third share them only with relatives, a third already shared them with a chaplain or a religious professional, and two-third wished to meet the psychologist for an in-depth spiritual assessment. Among the 24 patients who wished to meet the psychologist for an in-depth spiritual assessment, 3 patients dropped out. The interview led to set other therapeutic objectives than the “Spirituality and Recovery Group” for 5 patients (i.e., self-esteem group, individual cognitive-behavioral therapy for managing delusions, and hallucinations). For 16 patients, the group was found as potentially helpful (i.e., in the perspective of a decrease of feelings of loneliness through sharing spirituality with others; by clarifying the confusing overlap between psychotic symptoms and spirituality; by supporting helpful forms of S/R coping strategies; by addressing spiritual struggles about the
Table I. Clinical and sociodemographic characteristics of 147 psychiatric outpatients in a study on patients’ wishes to address spiritual and religious issues in their care. Wishes to address S/R issues n ⫽ 37 (25%) Gender Male Female Ethnicity Caucasian African Asian Other Marital status Single Married separated, divorced, or widowed Has child or children With disability insurance Living in a halfway house Diagnosis Psychosis Depressive and/or anxiety disorders Personality disorders Mental disorders due to an organic condition Age (years) Duration of illness (years)
305
Total n ⫽ 147 (100%)
21 16
57% 43%
81 66
55% 45%
24 8 2 3
65% 22% 5% 8%
103 28 8 8
70% 19% 5% 5%
18 6 13 17 24 7
49% 16% 35% 46% 65% 19%
76 25 46 60 103 29
52% 17% 31% 41% 70% 20%
25 7 3 2
68% 19% 8% 5%
89 37 12 9
61% 25% 8% 6%
mean
sd
mean
sd
47 17
11 14
46 16
10 12
306
S. Mohr & P. Huguelet
Int J Psychiatry Clin Pract 2014;18:304–307
Table II. Wishes to address spiritual or religious issues in their psychiatric care among 147 outpatients with severe mental disorders. Questions 1. Do you wish addressing spiritual or religious issues in your psychiatric care? 2a. Do you share spiritual or religious issues with someone? 2b. If yes, with whom?
Int J Psych Clin Pract Downloaded from informahealthcare.com by Yale Dermatologic Surgery on 12/27/14 For personal use only.
3. Do you want to meet the psychologist leading the “Spirituality and Recovery Group”?
spiritual meaning of mental illness, suffering, theodicy, sin, and guilt). However, 3 patients could not attend the group due to vocational obligation at the scheduled time; and 3 patients were reluctant to enter into a group setting. Therefore, for those patients, S/R issues were addressed in their individual psychiatric care. Discussion A quarter of the 147 outpatients wished to address S/R issues in their psychiatric care. An in-depth spiritual assessment of 21 patients elicited that for 16 of them, addressing S/R issues was of considerable clinical importance. Those results are in line with those obtained in Québec in a quite similar population: 22% of subjects had S/R goals unmet by the offered services (Lecomte et al. 2005). Such discrepancies were also elicited in a Swedish study of immigrants with psychosis showing that the greatest differences between health-care staff, patients, and families involved religious issues (Hultsjö et al. 2011). In psychiatric hospitals, patients’ spiritual needs may be even greater, 88% in US (Fitchett et al. 1997) and 85% in Brazil (Lucchetti et al. 2012). Our results point out a gap between spontaneous referrals for addressing S/R issues and patients’ wishes. In order to progress toward the standards of a recovery-oriented service, the first step should be a routine assessment of spiritual needs. Due to the existing heavy load of day-to-day psychiatrists’ tasks, such an assessment should not be time consuming. This screening assessment could be limited to the importance of spirituality and religiousness in life and in coping with the illness, the patient’s involvement in a religious community, and the patients’ wishes to address those S/R issues in psychiatric care and by whom (Sims 2007). To go further, training in S/R issues is a key target (Galanter et al. 2011). A recovery-oriented facility should address S/R issues in the same way they should for cultural and identity issues (Whitley 2012). S/R issues could be considered in an idiographic narrative approach looking at their dynamics in the person’s life in relationship with a person-centered psychiatry (Verhagen 2010; Camp 2011). Then, depending on institutional contexts of public services, S/R issues could be integrated in psychiatric care, ranging from referral to a religious professional, exploration of spirituality in individual and group settings, bringing in spiritual concepts and practices into psychotherapies, to holistic care programs (Mohr 2011). Some patients wished to address
Answers
n
%
YES NO NO, but with a religious professional only YES NO only relatives a chaplain or a religious professional only the psychiatrist YES NO
37 98 12 64 83 36 24 4 24 123
25 67 8 44 56 56 38 6 16 84
S/R issues only with religious professionals, others only with mental health professionals, or with both. Hence collaboration with religious professionals should be fostered. In the case of delusions or hallucinations with a religious content, psychiatrists sometimes address spiritual or religious issues against patients’ wishes. This particular point underlines the importance of training for mental health professionals and collaboration with chaplains working in psychiatric care. Indeed, delusions or hallucinations with a religious content may coexist with S/R coping strategies (Mohr et al. 2010). In order to address patients’ S/R issues in psychiatric care, a short screening assessment of those issues should be done systematically. After this step, the integration of S/R issues in psychiatric care could be proposed in order to progress toward a comprehensive recovery-oriented psychiatric care. This objective also includes training for mental professionals on S/R issues, as well as clinical research to evaluate specific interventions including such issues. This study entailed some limitations that hinder generalization. Indeed, religious preference and the importance of S/R were assessed only through the in-depth spiritual assessment for 14% of patients; hindering therefore comparison of wishes, or not, to address S/R issues on S/R dimensions. Psychiatrists’ skills to address S/R issues with their patients were not investigated. Key points • • •
Outpatients’ wishes to address S/R issues into their psychiatric care are largely underestimated by psychiatrists. The routine of a short screening assessment of those issues should be done systematically in the care management process. After this step, the integration of spiritual or religious issues in psychiatric care could be proposed in order to progress toward recovery-oriented psychiatric care.
Acknowledgments None. Statement of interest None of the authors reports conflicts of interest. The research was supported by the Department of Mental Health and Psychiatry, University Hospital of Geneva, Switzerland.
DOI: 10.3109/13651501.2014.902071
Patients’ wishes to discuss spiritual and religious issues in their psychiatric care
Int J Psych Clin Pract Downloaded from informahealthcare.com by Yale Dermatologic Surgery on 12/27/14 For personal use only.
References Camp ME. 2011. Religion and spirituality in psychiatric practice. Curr Opin Psychiatry 24:507–513. Fallot RD. 2007. Spirituality and religion in recovery: some current issues. Psychiatr Rehabil J 30:261–270. Fitchett G, Burton LA, Sivan AB. 1997. The religious needs and resources of psychiatric inpatients. J Nerv Ment Dis 185:320–326. Galanter M, Dermatis H, Talbot N, McMahon C, Alexander MJ. 2011. Introducing Spirituality into Psychiatric Care. J Relig Health 50:81–91. Huguelet P, Mohr S, Betrisey C, Borras L, Gillièron C, Marie AM, et al. 2011. A randomized trial of spiritual assessment of outpatients with schizophrenia: patients’ and clinicians’ experience. Psychiatr Serv 62:79–86. Huguelet P, Mohr S, Borras L, Gillièron C, Brandt PY. 2006. Spirituality and religious practices among outpatients with schizophrenia and their clinicians. Psychiatr Serv 57:366–372. Hultsjö S, Berterö C, Arvidsson H, Hjelm K. 2011. Core components in the care of immigrants with psychoses: a Delphi survey of patients, families, and health-care staff. Int J Ment Health Nurs 20:174–184. Koenig HG, King D, Carson VB. 2012. Psychotic disorders. In: Handbook of religion and health. Oxford: Oxford University Press, pp 207–223. Lecomte T, Wallace CJ, Perreault M, Caron J. 2005. Consumers’ goals in psychiatric rehabilitation and their concordance with existing services. Psychiatr Serv 56:209–211.
307
Loewenthal KM. 2010. Spirituality and cultural psychiatry. In: Bhugra D, Bhui K, editors. Textbook of cultural psychiatry. Cambridge: Cambridge University Press, pp 59–71. Lucchetti G, Braguetta CC, Vallada C, Vallada H. 2012. Exploring the acceptance of religious assistance among patients of a psychiatric hospital. Int J Soc Psychiatry 5:1–7. Mohr S. 2011. Integration of spirituality and religion in the care of patients with severe mental disorders. Religions 2:549–565. Mohr S, Borras L, Betrisey C, Pierre-Yves B, Gillièron C, Huguelet P. 2010. Delusions with religious content in patients with psychosis: how they interact with spiritual coping. Psychiatr 73:158–172. Mohr S, Borras L, Nolan J, Gillièron C, Brandt PY, Eytan A, et al. 2012. Spirituality and religion in outpatients with schizophrenia: a multi-site comparative study of Switzerland, Canada and the United States. Int J Psychiatry Med 44:29–52. Mohr S, Gillieron C, Borras L, Brandt PY, Huguelet P. 2007. The assessment of spirituality and religiousness in schizophrenia. J Nerv Ment Dis 195:247–53. Sims A. 2007. Spiritual aspects of management. In: Bhugra D, Bhui K, editors. Textbook of cultural psychiatry. Cambridge: Cambridge University Press, pp 434–444. Verhagen PJ. 2010. The case for more effective relationships between psychiatry, religion and spirituality. Curr Opin Psychiatry 23:550–555. Whitley R. 2012. Religious competence as cultural competence. Transcult Psychiatry 49:245–260.
