Spirituality and mental health

Descriptions of spirituality, in general, include the ideas that it: 

• Is a sense of seeking the best relationship with ourselves, with others and with what may lie ‘beyond’.
• Can help us to find meaning and purpose in life.
• Can give us a sense of hope.

• Can support us in the times of suffering and loss that we all experience.

But, sometimes, spirituality can itself be a source of stress.

Spirituality is a central part of many cultures. It can be just as important for a person with intellectual disability, mental illness, dementia or head injury, as it is for anybody else. It can become 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. Beliefs and a sense of spirituality can also be important - especially when thinking about treatments or interventions.

Spirituality can be seen as a journey. Experiences, good and bad, can help us to learn, develop and mature. And, for many of us, mental and physical illnesses are part of that journey.

• To feel safe and secure.
• To be treated with dignity and respect.
• To feel that they belong, are valued and trusted.
• Time to express their 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 however they perceive a wider reality.

• A time, a place and privacy in which to pray, worship or meditate.
• The chance to explore spiritual concerns.
• To know that the psychiatrist will respect your faith.
• To feel that you can talk about your faith.

• Sometimes – to be helped with forgiveness.

Spirituality is very personal, even for those who belong to an organised religious group. So, a plan that involves someone’s spirituality can only be made together with the person concerned.

A doctor or nurse may ask about your spirituality because it can be an important part of your life and can affect how you feel (4). Depression or substance misuse, for example, can sometimes reflect a sense of emptiness in a person's life. A mental health professional will be able to tell the difference between a spiritual crisis and a mental illness – which may, of course, overlap (5). A gentle, unhurried approach is important. At its best, exploring spiritual issues can, in itself, be therapeutic.

• What is life all about? What gives you a sense of meaning or purpose?
• If you do believe in God - how do you understand your relationship with God?
• What is God like? What does he think about you?
• If you could ask God anything, what would you ask?
• Do you find yourself asking ‘Why is this happening to me?’, ‘Can I be forgiven?’, ‘Am I lovable?’, ‘Who can I trust?’.
• What do you think happens after death?
• Do your spiritual beliefs make you uneasy about any parts of your treatment plan?

• Spend time in meditation, mindfulness, prayer, deep reflection.
• Spend time in reflective reading (of literature, poetry or scripture).
• Play or sing sacred music.
• Belong to a faith tradition.
• Take part in services, rituals, symbolic practices or worship.
• Go on pilgrimages or retreats.
• Engage in fasting or other lifestyle disciplines.
• Spend time enjoying nature.
• Like to be creative - painting, sculpture, cookery, gardening etc.

• Help other people.

• How can your spiritual life support your recovery? 
• Do you have spiritual questions that you want to explore?
• Is there is anything stressful or difficult about your spirituality?

• Has your illness affected your spiritual life?

• What sort of spiritual support might help to strengthen you and build your recovery?
• What help would you need to get it?

• Is there someone caring for you with whom you can talk about your spiritual life? 

• Work closely with the mental health team to recognise and support any spiritual needs.
• Work closely with local clergy and faith communities.
• Provide information about local religious groups, their traditions and practices.
• Recognise that, in some circumstances, an individual can focus on religious beliefs and activities to an extent that is unhelpful - and may even be harmful.
• Advise on difficult issues such as experiences of paranormal influences, spirit possession and the ministry of deliverance.

• Make sure that patients know about this type of help.

The Spirituality and Psychiatry Special Interest Group of the Royal College of Psychiatrists (12) 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 health.

• Raise the profile of spirituality in patient care.

Further reading

• Barker P. & Buchanan-Barker P. (Eds). (2003) Spirituality and Mental Health: Breakthrough. Whurr.
• Butler-Bowen T. (2006) 50 Spiritual Classics. Nicholas Brealey Publishing.
• Cook, C., Powell, A. & Sims, A. (Eds) (2009) Spirituality and Psychiatry. RCPsych Publications. (PDF)
• Coyte M. Gilbert, P. & Nicholls V. (Eds.) (2007) Spirituality, Values and Mental Health: Jewels for the Journey. Jessica Kingsley.
• Culliford L. (2007) Love, Healing and Happiness. O Books.
• Fontana D. (2003) Psychology, Religion and Spirituality. BPS Blackwell.
• Forest J. (2007) The Road to Emmaus: Pilgrimage as a Way of Life. Orbis Books.
• Galanter M. (2005) Spirituality and the Healthy Mind: science, therapy, and the need for personal meaning. Oxford University Press.
• Kabat-Zinn J. (2004) Wherever You Go, There You Are. Piatkus Books.
• Koenig H.G. (2013) Spirituality in Patient Care: Why, How, When, and What, West Conshohocken, PA, Templeton.
• Kornfield J. (1994) A Path With Heart. Rider.
• Nataraja S. (2008) The Blissful Brain. Gaia Books.
• Post S. & Neimark J. (2007) Why Good Things Happen to Good People. Broadway Books.
• Royal College of Psychiatrists (2013) Recommendations for psychiatrists on spirituality and religion. (PDF)
• Scott Peck M. (1997) The Road Less Travelled. Rider.
• Swinton J. (2001) Spirituality and Mental Health Care: Rediscovering a Forgotten Dimension. Jessica Kingsley.
• Whiteside P. (2001) Happiness: The 30-Day Guide. Rider.
• American Psychiatric Association Foundation (2016) Mental Health: A Guide for Faith Leaders. Arlington, VA, American Psychiatric Association Foundation
• Barber J., Parkes M., Wilson C. (2015) Handbook of Spiritual Care in Mental Illness, Birmingham and Solihull Mental Health NHS Foundation Trust (available for free download from BSMHFT website)
• Barker P. & Buchanan-Barker P. (Eds). (2003) Spirituality and Mental Health: Breakthrough. Whurr.
• Cook, C., Powell, A. & Sims, A. (Eds) (2009) Spirituality and Psychiatry. 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.
• Cook C.C.H. (2015) Religion and spirituality in clinical practice, BJPsych Advances, 21, 42-50
• Cook, C. C. H., Powell, A. & Sims, A. (Eds.) (2016) Spirituality and Narrative in Psychiatric Practice: Stories of Mind and Soul, London, RCPsych Press.
• Coyte M. Gilbert, P. & Nicholls V. (Eds.) (2007) Spirituality, Values and Mental Health: Jewels for the Journey. Jessica Kingsley.
• Craigie F.C. (2008) Positive Spirituality in Health Care. Minneapolis, Mill City.
• Enright, R. D. & Fitzgibbons, R. P. (2015) Forgiveness Therapy: An Empirical Guide for Resolving Anger and Restoring Hope, Washington DC, American Psychological Association.
• Fletcher J. (Ed) (2019) Chaplaincy and Spiritual Care in Mental Health Settings, JKP, London
• Galanter M. (2005) Spirituality and the Healthy Mind: science, therapy, and the need for personal meaning. Oxford University Press.
• 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.G. (2013) Spirituality in Patient Care: Why, How, When, and What. West Conshohocken, PA, Templeton.
• Koenig H.G. (2017) See individual resources on research and clinical applications in different religious traditions, all published on the Createspace Publishing Platform:
• Buddhism and Mental Health
• Catholic Christianity and Mental Health
• Hinduism and Mental Health
• Islam and Mental Health
• Judaism and Mental Health
• Protestant Christianity and Mental Health
• Koenig H. (2018) Religion and Mental Health. Academic Press, London.
• Royal College of Psychiatrists (2013) Recommendations for psychiatrists on spirituality and religion. PS03_2013 (available for free download from RCPsych website)
• Swinton J. (2001) Spirituality and Mental Health Care: Rediscovering a Forgotten Dimension. Jessica Kingsley.
• Swinton J. (2002) Spirituality and the Lives of People With Learning Disabilities. The Tizard Learning Disability Review. 7, 4: 29-35.
• Williams M., Penman D. (2011) Mindfulness: A Practical Guide to Finding Peace in a Frantic World (Includes Free CD with Guided Meditations), Piatkus

Websites

• Exploring spirituality with people who use mental health services
• The Royal College of Psychiatrists’ Spirituality and Psychiatry Special Interest Group -  A wide range of papers about spirituality and mental health can be downloaded from the publications archive on the website
• The National Spirituality and Mental Health Forum - an independent registered multi-faith charity.
  For additional resources, try typing ‘spirituality and health’, or ‘spirituality and psychiatry’ into an internet search engine.

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. (2002) Spirituality and Clinical Care. British Medical Journal. 325:1434-5.
• Culliford L. (2007) Taking a Spiritual History. Advances in Psychiatric Treatment, 13, 212-219.
• Culliford L. (2009) Teaching Spirituality and Healthcare to 3^rd Year Medical Students. The Clinical Teacher, Volume 6, Issue 1, pages 22-27, March 2009.
• Eagger S. (2005) ‘A guide to the assessment of spiritual concerns in mental healthcare’ (PDF).
• 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.
• Neely D. & Minford E. (2009) FAITH: spiritual history-taking made easy. Clinical Teacher. 6: 181-185.
• 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.
• Mental Health Foundation. Making space for spirituality: How to support service users. London: Mental Health Foundation; 2007. 11 p.
• Mental Health Foundation. Taken seriously: The Somerset spirituality project. London: Mental Health Foundation; 2002. 68 p.
• Jones S, Sutton K, Isaacs A. Concepts, Practices and Advantages of Spirituality Among People with a Chronic Mental Illness in Melbourne. J Relig Health. 2019;58(1):343-55.
• Cook CCH. Recommendations for Psychiatrists on Spirituality and Religion. London: Royal College of Psychiatrists; 2013. Report No.: PS03/2013 
• Barker PJ, Buchanan-Barker P, editors. Spirituality and Mental Health: Breakthrough. London: Whurr; 2004.
• Dossett W. Addiction, spirituality and 12-step programmes. International Social Work. 2013;56(3):369-83.
• Rosmarin DH. Spirituality, Religion, and Cognitive-Behavioral Therapy. New York: Guilford; 2018. 230 p.
• Gilbert P. Introducing compassion-focussed therapy. Advances in Psychiatric Treatment. 2009;15:199-208.
• Enright RD, Fitzgibbons RP. Forgiveness Therapy: An Empirical Guide for Resolving Anger and Restoring Hope. Washington DC: American Psychological Association; 2015. 358 p.
• Pargament KI. Spiritually Integrated Psychotherapy. New York: Guilford; 2011. 384 p.
• Fletcher J, editor. Chaplaincy and Spiritual Care in Mental Health Settings. London: Jessica Kingsley; 2019.
• Powell A. The Spirituality and Psychiatry Special Interest Group of the Royal College of Psychiatrists. In: Cook C, Powell A, Sims A, editors. Spirituality and Psychiatry. London: RCPsych Press; 2009. p. xv - xviii.

Credits

This leaflet was originally written by Dr Andrew Powell and Dr Larry Culliford, in 2006 and was revised in 2010, 2013, 2015 and 2018. The present major revision, was undertaken in 2020 by Professor Chris Cook and Dr Lucy Grimwade, with support from the Royal College of Psychiatrists’ Spirituality and Psychiatry Special Interest Group Executive Committee. It reflects the best available evidence at the time of writing.