Spirituality in Psychiatry Flashcards
What questions are useful to help people explore their own spirituality?
- What do I believe in?
- What gives my life meaning?
- What do I hope for?
- Who do I love and who loves me?
- What do I understand by the term spirituality?
- How am I with others?
- What would I change about my relationships?
- Am I willing to heal the relationships that trouble me?
- Do I have any sense of what may be considered sacred or divine?
- Are there things that I do regularly to increase my sense of connection with nature, my fellow men and women, and/or God?
What is the definition of spirituality?
There are many, often the best one is a personal definition
RCPsych: (2006)
The essentially human, personal and interpersonal dimension, which integrates and transcends the cultural, religious, psychological, social and emotional aspects of the person, or, more specifically, concerned with soul or spirit.
In healthcare, spirituality is identified with experiencing a deep-seated sense of meaning and purpose in life, together with a sense of belonging. It is about acceptance, integration and wholeness
Others:
“The spiritual dimension tries to be in harmony with the universe, strives for answers about the infinite, and comes essentially into focus in times of emotional stress, physical and mental illness, loss, bereavement and death.” (Murray & Zentner, 1989)
“Spirituality is about wholeness. It is important to recognise the principle of an entirely seamless and interconnected reality that this entails.” (Culliford, 2011)
What is the difference between spirituality and religion?
Spirituality: Broader, more inclusive, relates to a ‘meaning-making’ ‘cultivation of connectedness’, does not imply any belief in a supreme being
Religion:
Belief + ritual within the context of a specific structure/institution, more than one individual/group explores and explains movements towards shared meaning and connectedness, a ‘container’ of spirituality
What is the impact of spiritual/religious beliefs/practices on physical and mental health?
Epidemiological studies (2001) state: 80% beneficial 10% report negative effects
Scientifically identified benefits include:
- Improved general wellbeing
- Illness prevention
- Improved recovery from illness
- Increased ability to cope with continuing distress and disability
What are spiritual needs?
‘Spiritual needs are linked with human expectations to find meaning, purpose and value in life. These needs can be specifically religious, but even people who have no religious faith have belief systems or ideologies that give their lives meaning and purpose.’ (Murray et al, 2004)
Individuals may be searching for answers for:
- Questions on the meaning of life
- Personal identity or loss of identity
- Changes of role and degree of independence
- Searching for something greater than ourselves or ‘God’
- Searching for some purpose in human pain and suffering.
Why is performing a spiritual needs assessment important?
“There is no better way to ‘get alongside’ the patient than to enquire about what gives his or her life the most meaning and what they find to be most helpful during times of adversity. These questions point towards what holds meaning in a patient’s life and concentrate on the patient’s strengths rather than weaknesses” (Culliford & Eagger, 2009)
Assessment provides a guide and a systematic approach to identifying the spiritual needs of patients. It gives a basis for joint decision making and goal setting while providing a focus to validate the existence of problems
Can improve clinician-patient relationship; may clarify how illness may challenge a patients belief system and how it might impact their management of and recovery from a problem
When might you perform a spiritual needs assessment?
To be decided on the assessment of each individual case:
Initial screening: a minimal tick-box procedure, or brief screening questions to be followed up in more detail later
As a part of the admission process or first assessment
Ongoing process: depends on trust, rapport and continuity.
Where should a spiritual history be documented?
Can be included as a key part of the psychiatric history in an attempt to understand how the patient is relating to their current experiences
In specific care plans
What are some initial screening/existential questions?
What has sustained you (both inwardly and outwardly)?
From what sources do you draw strength, hope and courage in order to cope?
Where do you find peace?
Who truly understands your situation?
When you are afraid or in pain, how do you find comfort?
For what, if anything, are you most deeply grateful?
What is your clearest sense of the meaning of your life at this time?
Why is it important that you are alive?
To what or whom are you most devoted?
To whom (or what) do you express love most freely?
What is the FICA model?
Puchalski and Romer (2000)
Faith and belief
- Do you consider yourself spiritual or religious?
Is spirituality something important to you?
Do you have spiritual beliefs that help you cope with stress/ difficult times?
If the patient responds “No,” the health care provider might ask:
What gives your life meaning?
Importance of the faith/belief:
- What importance does your spirituality have in your life?
Has your spirituality influenced how you take care of yourself, your health?
Does your spirituality influence you in your healthcare decision making? (e.g. advance directives, treatment etc.)
Community:
Are you part of a spiritual community?
Is this of support to you and how?
Is there a group of people you really love or who are important to you?
Address in care:
How would you like me, your healthcare provider, to address these issues in your healthcare?
What are the HOPE questions?
Anandarajah & Hight (2001)
Hope (sources of):
- What brings you meaning/comfort/strength/love/peace/connection
- What is there in your life that gives you internal support?
- What do you hold on to in difficult times?
- What keeps you going?
Organised religion:
- Do you consider yourself as part of an organised religion? How important is this to you?
- What aspects are helpful and not so helpful?
- Are you part of a religious/spiritual community? Does it help you? How?
Personal spirituality and practices:
- Do you have personal spiritual beliefs that are independent of organised religion? What are they?
- Do you believe in God? What kind of relationship do you have with God?
- What aspects of your spiritual practices do you find most helpful to you personally? (Prayer, meditation, scripture, services, music, being in nature etc)
Effects on medical/psychiatric care + End of life issues:
- Has your current situation (being unwell) affected your ability to do the things that usually help you spiritually? (or affected your relationship with God)
- As a doctor, is there anything I can do to help you access the resources that usually help you?
- Are you worried about any conflicts between your beliefs and your medical situation/care?
- Would it be helpful for you to speak to a chaplain/community spiritual leader?
- Are there any specific practices or restrictions I should know about in providing you medical care? (diet? blood products?)
What is are the components of a Spiritual Wellbeing Assessment? (more suitable to psychiatric care)
To be asked on admission to a ward or service:
- Are there aspects of your beliefs, spirituality, faith or religion that you would like us to know about and consider during your time in our service (or admission)?
- What would you like us to record for your religion or belief in your personal records? (please put onto electronic records)
- Are there any practical things that you would like us to try to do or avoid doing with regard to your beliefs?
- Regardless of answers above. The Trust chaplains/faith visitors may be available for people of all faiths and people who are not religious. Would you like to see a chaplain or similar person? Or is there anyone from your faith or belief community you would like us to contact?
- Is there anything else you would like to tell us about what is important to you and that could help us to provide you with spiritual care?
To ask later on once person is settled (if appropriate):
- What lifts your spirits and would help support your recovery?
- In the past, what has given you strength to cope during difficult times?
- Does your faith or belief help you make sense of your current situation – can you say how?
- Has becoming unwell affected your faith or beliefs in any way? Has it affected your interaction with your faith community?
- The Trust Chaplains/faith visitors may be available for people of all faiths and people who are not religious. Would you like to see a chaplain or similar person? Or is there anyone from your faith or belief community you would like us to contact?
- Would it help you if we were to build up contacts for you in the community, such as churches/mosques, support groups?
- Has it been helpful talking about your faith or beliefs, and if not, is there something more important to you that you wish to talk about?
What other domains can be assessed under spiritual needs? What kinds of questions can you ask? (Mnemonic)
Mnemonic: A BOAST(ful) CLERIC (asks all the right questions)
Affirmation: Does the individual feel affirmed by their past and present experiences and relationships? What gives them affirmation, and can a vacuum be filled?
Belief and meaning: What are the beliefs that give meaning and purpose to a person’s life and the symbols that reflect them?
Obligation and vocation: What sense of calling and obligation does the person have in their life and how are these expressed in relationships?
Authority and guidance: Where does the individual look for guidance about life meaning in moments of stress? Is this fixed or flexible?
Strength and hope (sources): Where does the individual derive their strength from and what gives them hope?
Transcendence: What provides an individual with their sense of transcendence? This may or may not involve relating to a divine entity.
Community: How does the individual relate to their significant community? Is the service facilitating positive connection with the community?
Love and relatedness: How does the individual relate to those intimate with them – family, relatives, friends and others?
Experience and emotion: How does the experience of illness and the associated feelings relate to the individual’s life meaning?
Rituals and practices: Exploring the rituals that support the person’s life meaning and how they are being used in the present situation.
Identity: What are the components which make up an individual’s identity, nurture and nature, ethnicity, values and belief systems?
Courage and growth: This involves questions about how the person has coped with crises in the past and how adaptable their views/beliefs are now.
What kinds of expressions may indicate the need for a spiritual exploration? (Mnemonic)
When the BIRD FLAPs
Bitterness: what have I done to deserve this?
Isolation: my family, neighbours, friends, God, etc. have abandoned me
Regret: I should have been a better person!
Doubt: is there really a god/a purpose for existence?
Fear: I am not sure there is anything after death/perhaps I might go to hell
Loss of hope: I see no future/a negative future stretching endlessly ahead
Anger: directed at God, other people or self
Punishment/guilt: I must have done something wrong!
What is important when considering spirituality and psychotic symptoms?
Important to differentiate psychotic symptoms from a ‘spiritual emergence’ (related to a destabilising period of rapid spiritual growth) and from mystical experiences (which are both common and often positive)
People undergoing a spiritual emergence may require support and relevant guidance to make sense of their experience, medication is/may be unlikely to benefit as the outcome of this process is eventually positive (whereas psychosis is typically destructive)
Religious grandiosity may be masking a feeling of being unworthy or unloved and the religious content may hint at a spiritual solution - when well enough, should explore the true origins of their distress through a religious lens
May be important to ask what the patients spiritual leader/community member makes of their experiences - if pastor is encouraging of medical help, may make your job easier
