LAWRENCE — Spirituality has been recognized as a key component in helping many individuals recover from severe mental illness. However, there is often little to no training for mental health care providers in how to use spirituality as a potential resource in helping the individuals they serve.
Researchers at the University of Kansas have developed a set of guidelines for making spirituality part of recovery based on research they performed both with providers and consumers of mental health services.
Edward Canda, professor of social welfare and courtesy professor of religious studies; Sachiko Gomi, doctoral student of social welfare, and Vincent Starnino, former KU doctoral student and current assistant professor at Indiana University, conducted focus groups with 48 providers and consumers of mental health services to find out their experiences with spirituality and how it can be improved.
“Spirituality and culture” is a domain of the Strengths Assessment. Developed at KU in the 1980s, the Strengths Assessment is a system that focuses on an individual’s strengths, positive attributes, resources and more to help craft goals and plans for recovery instead of focusing on the problem.
“A person should never be reduced to a diagnostic label, or only one, negative aspect of their personality,” Canda said. “That’s not all they are.”
The Shumaker Family Foundation and the Office of Mental Health Research and Training provided funding for the study. The findings have been published online in the British Journal of Social Work.
“Mental health practitioners were often unsure what to do with it,” Canda said of spirituality and culture. “We thought it would be good to do a project that explored this from the perspective of both the providers and the consumers.”
Participants were providers and consumers who had experience using the spirituality and culture domain in mental health services. Both said they would like to see it used more frequently and thoroughly in providing services for individuals with severe mental health issues such as depression, schizophrenia or bipolar disorder.
While spirituality and culture can be a useful domain to help individuals, it can also be an uncomfortable topic to breach.
“Providers often thought, ‘Is it OK to even be discussing this?,’” Canda said. “How can I do it in a way that’s respectful to the client without imposing my own values on them?”
The researchers have developed a list of recommendations based on their findings. They plan to make them available to mental health providers internationally, both online and in accessible, leaflet form. The main recommendation is to be aware of spirituality and let the client direct how it can be used in an assessment to develop treatment plans.
If a consumer mentions spirituality, such as being part of a faith community or informal spiritual group, a provider should make note of it and ask followup questions. Being involved in the faith or community can often help in recovering from mental illness, including providing a sense of meaning and hope and opportunities for social connections and support.
If a consumer does not mention spirituality, the researchers recommend a provider ask non-leading questions about their sources of meaning, purpose and worldview to explore if it is an important part of their life.
“One of the main themes is to let the client lead,” Gomi said. “Providers can help consumers be aware of spirituality, but it should not be forced. Providers can help consumers explore what’s really important in their lives.”
Whether a person says they enjoy going to church, or find peace and tranquility among nature, for example, either can be used in developing a plan for recovery, personal goals and so on. Providers should also address spirituality respectfully, Canda said, recognizing differences among religions, being sensitive to nonreligious forms of spirituality and being alert for potential difficulties from spirituality itself.
People can have stress or exacerbation of symptoms from negative judgment stemming from their spirituality, Canda said, such as viewing mental illness as a punishment for one’s sins. That can open a conversation about the consumer’s possible goal to change this negative belief and, if he or she wishes, can explore connections with spiritual support systems that are understanding and open to the experiences of people with mental illness.
“It’s not about pushing an agenda of the mental health worker. It’s more about the quality of building a helping relationship,” Canda said.
The recommendations are adaptable to the unique aspects of each mental health practice and individual. Naturally, not everyone views spirituality — a sense of life, purpose or the transcendent — the same way. While some do not associate it with religion, many do. And among them, there are numerous different religions. Spirituality is combined with culture in the Strengths Assessment system because in many cultures, spirituality is so prevalent the two are inseparable, Canda said.
Given the documented success of spirituality in helping individuals with mental illnesses recover, the researchers argue it should be more commonly addressed, albeit in a respectful manner.
“The starting point should be that practitioners are aware of spirituality and explore it,” Canda said. “And it is imperative that they use it respectfully.”