Help is

at hand

Spirituality and
Mental Health

The
1 Royal College of Psychiatrists

Introduction
Spirituality and psychiatry - on the face of it,
they do not seem to have much in common. But
we are becoming increasingly aware of ways in
which some aspects of spirituality can offer real
benefits for mental health.
This leaflet is for:
n anyone who has an interest in spirituality and
mental health
n anyone with a mental health problem
n carers and relatives
n professionals who may not be sure about
how to explore spiritual issues with their
clients/patients.
It looks at:
n how spirituality, mental health and mental
healthcare can connect
n how to make a place for spiritual needs
within a mental health service
n how spirituality can help mental health.
You don't need to hold a formal religious belief,
to take part in religious practices or belong to
an established faith tradition, to read this
leaflet or to experience spirituality.

What is spirituality?
Spirituality involves experiences of:
n a deep-seated sense of meaning and purpose
in life
n a sense of belonging
n a sense of connection of 'the deeply personal
with the universal'
2

acceptance, integration and a sense of

wholeness.

These experiences are part of being human - they

are as clearly present in people with a learning
disability as they are in anybody else.
Spirituality often becomes more important in times
of distress, emotional stress, physical and mental
illness, loss, bereavement and the approach of
death.
All health care tries to relieve pain and to cure but good health care tries to do more. Spirituality
emphasises the healing of the person, not just the
disease. It views life as a journey, where good
and bad experiences can help you to learn,
develop and mature.

How is spirituality different

from religion?
Religious traditions certainly include individual
spirituality, which is universal. But each religion
has its own distinct community-based worship,
beliefs, sacred texts and traditions.
Spirituality is not tied to any particular religious
belief or tradition. Although culture and beliefs
can play a part in spirituality, every person has
their own unique experience of spirituality - it can
be a personal experience for anyone, with or
without a religious belief. It's there for anyone.
Spirituality also highlights how connected we are
to the world and other people.

What is spiritual health care?

People with mental health problems have said
that they want:
n meaningful activity such as creative art,
work or enjoying nature
n to feel safe and secure
n to be treated with dignity and respect
n to feel that they belong, are valued and
trusted
n time to express feelings to members of staff
n the chance to make sense of their life
including illness and loss
n permission/support to develop their
relationship with God or the Absolute.
Someone with a religious belief may need:
n a time, a place and privacy in which to
pray and worship
n the chance to explore spiritual (and
sometimes religious) matters
n to be reassured that the psychiatrist will not
try to undermine their faith
n encouragement to deepen their faith
n to feel universally connected sometimes
the need for forgiveness.

What difference can spirituality make?

Service users tell us that they have gained:
n better self-control, self-esteem and
confidence
n faster and easier recovery (often through
healthy grieving of losses and through
recognising their strengths)

better relationships with self, others and

with God/creation/nature
n a new sense of meaning, hope and peace of
mind. This has allowed them to accept and
live with their continuing problems.
n

A religious/spiritual assessment
A helpful way to begin can be to ask "Would
you say you are spiritual or religious in any
way? Please tell me how." Another useful
question is, "What sustains you?" or "What
keeps you going in difficult times?" The answer
to this will usually reveal a person's main
spiritual concerns and practices.
Sometimes, a professional may want to use a
questionnaire. They will want to find out:
n what helpful knowledge or strengths do you
have that can be encouraged?
what
support can your faith community offer?
n
A gentle, unhurried approach works best at
its best, exploring spiritual issues can be
therapeutic in itself.

Setting the scene

What is your life all about? Is there anything
that gives you a sense of meaning or purpose?

The past
Emotional stress is often caused by a loss, or
the threat of loss. Have you had any major
losses or bereavements? How has this affected
you and how have you coped?

The present
Do you feel that you belong and that you are
valued? Do you feel safe and respected? Are you
and other people able to communicate clearly
and freely?
Do you feel that there is a spiritual aspect to your
current problem? Would it help to involve a
chaplain, or someone from your faith community?
What do I need to understand about your
religious background?

The future
What do the next few weeks hold for you? What
about the next few months or years? Are you
worried about death and dying, or about the
possibility of an afterlife? Would you want to
discuss this more? What are your main fears
about the future? Do you feel the need for
forgiveness about anything? What, if anything,
gives you hope?

Remedies
What kind of support would help you? How
could you get it? Have you thought about selfhelp?
A spiritual assessment should be part of every
mental health assessment. Depression and
substance misuse, for example, can sometimes
reflect a spiritual void in a persons life. Mental
health professionals also need to be able to
distinguish between a spiritual crisis and a mental
illness, particularly when these overlap.

Spiritual practices
These span a wide range, from the religious to
secular which may not be obviously spiritual.
You may:
n belong to a faith tradition and take part in
services or other activities with other people
n take part in rituals, symbolic practices and
other forms of worship
n go on pilgrimage and retreats
n spend time in meditation and prayer
n read scripture
n listen to singing and/or playing sacred
music, including songs, hymns, psalms and
devotional chants
n give of yourself in acts of compassion
(including work, especially teamwork)
n engage in deep reflection (contemplation)
n follow traditions of yoga, Tai Chi and similar
disciplined practices
n spend time enjoying nature
n spend time in contemplative reading (of
literature, poetry, philosophy etc.)
n appreciate the arts
n be creative in painting, sculpture, cookery,
gardening etc.
n make and keep good family relationships
n make and keep friendships, especially those
with trust and intimacy
n join in team sports or other activities that
involve cooperation and trust.

Spiritual values and skills

Spiritual practices can help us to develop the
better parts of ourselves. They can help us to
become more creative, patient, persistent,
honest, kind, compassionate, wise, calm,
hopeful and joyful. These are all part of the best
health care.
Spiritual skills include:
being honest and able to see yourself as
others see you
n being able to stay focused in the present, to
be alert, unhurried and attentive
n being able to rest, relax and create a still,
peaceful state of mind
n developing a deeper sense of empathy for
others
n being able to be with someone who is
suffering, while still being hopeful
n learning better judgement, for example about
when to speak or act, and when to remain
silent or do nothing
n learning how to give without feeling drained
n being able to grieve and let go.
n

Spirituality emphasises our connections to other

people and the world, which creates the idea of
reciprocity. This means that the giver and
receiver both get something from what happens,
that if you help another person, you help
yourself. Many carers naturally develop spiritual
skills and values over time as a result of their
commitment to those for whom they care. Those
being cared for, in turn, can often give help to
others in distress.

The place of chaplaincy/pastoral care

Times have changed. Hospital chaplaincy now
involves clergy and others from many faiths,
denominations and humanist organisations.
Chaplains (also called spiritual advisors) are
increasingly part of the teams that provide care
both in and outside hospital.
A modern mental health chaplaincy or pastoral
care department should:
n have access to a sacred space
n get on well with local clergy and faith
communities
n provide information about local religious
groups, their traditions and practices
n be aware that, sometimes, an individuals
engagement with religious beliefs and activities
can be unhelpful and even damaging
n be able to give advice on difficult issues, such
as paranormal influences, spirit possession
and the ministry of deliverance
n work closely with the mental health team so
that spiritual needs can be recognised and
helped
n make sure that service users and patients
know about them.

Education and research

There is some evidence that people who belong
to a faith community, or who hold religious or
spiritual beliefs, have better mental health. So,
spirituality is now covered in courses for mental
health care students and practitioners.

About the Spirituality and Psychiatry

Special Interest Group
The Spirituality and Psychiatry Special Interest
Group (SPSIG) of the Royal College of
Psychiatrists was founded in 1999 to:
n help psychiatrists to share experiences and to
explore spirituality in mental healthcare
n to increase knowledge of the research linking
spirituality with better health
n to raise the profile of spirituality in patient
care.
The SPSIG has now over 2500 psychiatrist
members. It runs an active programme of one-day
events for members and holds occasional
conferences open to the general public.
Information about these meetings (and the texts of
all the talks) can be found in the SPSIG
Newsletter at the SPSIG website.

How to start ..?

Spirituality is deeply personal. Try to discover
what works best for you. A three-part daily
routine can be helpful:
n a regular quiet time (for prayer, reflection or
meditation)
n study of religious and/or spiritual material
n making supportive friendships with others with
similar spiritual and/or religious aims and
aspirations.
You can find out about spiritual practices and
traditions from a wide range of religious
organisations. Secular spiritual activities are
10

increasingly available and popular. For

example, many complementary therapies have
a spiritual or holistic element that is not part of
any particular religion. The internet, especially
internet bookshops, the local yellow pages,
health food shops and bookstores are all good
places to look.

Further reading
Barker P. & Buchanan-Barker P. (Eds). 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.
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.

11

Kabat-Zinn J. (2004) Wherever You Go, There

You Are. Piatkus Books.
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.
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.

Websites
The Royal College of Psychiatrists Spirituality and
Psychiatry Special Interest Group
www.rcpsych.ac.uk
The Multi-Faith Group for Healthcare Chaplaincy
website has valuable information about
traditions, symbols, teachings and practices of
nine world religions. www.mfghc.com
The National Spirituality and Mental Health
Forum an independent registered multi-faith
charity. http://mhspirituality.org.uk

12

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, 8192.
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 3rd Year Medical Students
Clinical Teacher. 6: 22-27.
Eagger S. (2005) A guide to the assessment of
spiritual concerns in mental healthcare.
www.rcpsych.ac.uk
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.

13

Koenig H., McCullough M., & Larson D. (2001)

Handbook of Religion and Health. Oxford:
Oxford University Press.
Murray R. & Zentner J. (1989) Nursing Concepts
for Health Promotion. London: Prentice Hall
(Adapted)
Nathan M. (1997) A study of spiritual care in
mental health practice: patients and nurses
perceptions. MSc thesis. Enfield: Middlesex
University.
Neely D. & Minford E. (2009) FAITH: spiritual
history-taking made easy. Clinical Teacher.
6: 181-185.
Post S., Puchalski C. & Larson D. (2000)
Physicians and Patient Spirituality: Professional
Boundaries, Competency, and Ethics. Annals of
Internal Medicine. 132: 578-583.
Puchalski C. & Larson D. (1998) Developing
curricula in spirituality and medicine. Acad.
Med. 73(9), 970-974.
Swinton J. (1999) Building a Church for
Strangers: Theology, Church and Learning
Disabilities. Edinburgh: Contact Pastoral Trust.
Swinton J. (2002) Spirituality and the Lives of
People with Learning Disabilities. The Tizard
Learning Disability Review. 7, 4: 29-35.

14

World Health Organization. (1998) WHOQOL

and Spirituality, Religiousness and Personal
Beliefs: Report on WHO Consultation. Geneva:
WHO.

15

The Royal College of Psychiatrists produces:

n a wide range of mental health information for patients,
carers and professionals
n factsheets on treatments in psychiatry, such as
antidepressants and cognitive behavioural therapy
These can be downloaded from our website:
www.rcpsych.ac.uk/info
A range of materials for carers of people with mental health
problems has also been produced by the Partners in Care
campaign. These can be downloaded from
www.partnersincare.co.uk
For a catalogue of all our available materials, contact the
Leaflets Department, The Royal College of Psychiatrists, 17
Belgrave Square, London SW1X 8PG. Tel: + 44 (0)207 235
2351 ext. 6259; Fax: +44 (0)207 235 1935;
email: leaflets@rcpsych.ac.uk.
This leaflet was produced by the Royal College of Psychiatrists
Spirituality and Psychiatry Special Interest Group Executive
Committee.
Series Editor:
Dr Philip Timms
Expert Review:
Dr Larry Culliford and Dr Andrew Powell
Illustration by Lo Cole/eastwing.co.ukk
March 2010. Due for review: March 2012. Royal College of
Psychiatrists, all rights reserved. This leaflet may not be
reproduced in whole or in part without the permission of the
Royal College of Psychiatrists.s.
Copyright: Royal College of Psychiatrists, all rights reserved.
The
Royal College of Psychiatrists is grateful to Birthday House
This leaflet may not be reproduced in whole, or in part, without the
Trust
for supporting
theCollege
production
of this leaflet.
permission
of the Royal
of Psychiatrists.

NO HEALTH WITHOUT MENTAL HEALTH

www.rcpsych.ac.uk/info

The Royal College of Psychiatrists is a registered charity in England and Wales

(228636) and in Scotland (SC038369).