This is the tenth installment of my posts based on the book: Spirituality and Psychiatry, which was kindly sent to me by the Royal College of Psychiatrists.
The first part can be found here, the second here, the third here, the fourth here, the fifth here, the sixth here, the seventh here, the eighth here, and the ninth here.
This chapter begins thusly:
Spirituality has been part of the professional code of practice for physicians and other healthcare professionals in the UK since the inception of the National Health Service (NHS).
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There is a lack of published material on the provision of formal spiritual care services within the health sector. It certainly appears to be a hotchpotch of policies and influences. It would seem that in the reforms that saw mental health trusts splitting off from acute and community trusts, many pastoral care departments were left behind. With no specific service level agreements or funding streams, this area of care was, and still is, often ignored.
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In my opinion, and experience, this will not come as an enormous shock to users of mental health care provision in the UK.
I have oft noted on this blog, my anecdotal observations of a disproportionate number of Christian in-patients in psychiatric wards. In view of this, it was validating to read the following corroboration:
Interestingly, the national census of in-patients in mental health hospitals carried out by the Commission for Health Inspection, National Institute of Mental Health England (NIMHE) and the Mental Health Act Commission (Commission for Audit and inspection, 2005) found a surprisingly high percentage of religious affiliation, even if it does not equate with religious belief.
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Why should this be the case? This is a question I have asked of many and never received a satisfactory response. My adversaries have used this to assert that a person must be prone to mental illness in order to accept the Christian narrative. My response is:
It is either that Christianity is the religion of the mad, which I’m happy with, or Christians are for some reason more prone to mental problems. Or perhaps Christ came for the sick…..
This chapter cites much of the legislation and policies surrounding spirtitual care provision in mental health services and notes some of the successes and some of the failures. It would seem that spiritual care within the NHS is as much a ‘postcode lottery’ as everything else.
Within this chapters section looking at who is responsible for providing a spiritually-orientated approach within mental health – should be multidisciplinary of course – a specific document is cited as providing a particularly valuable supportive spiritual framework. This document is called the Wellness and Recovery Action Plan – WRAP. This is what’s noted of the WRAP:
It approaches spirituality as a dimension for empowerment and growth. It incorporates concepts such as meaning and purpose as goals for well-being and embraces the work of faith communities.
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To be frank this took me by surprise, and as I have WRAP to hand, I thought I’d see if I could spot this. The following is the questions they may be referring to:
b. This is what carries a sense of meaning and significance for me, this is what inspires me and reminds me of my values.
This is the only example I can find which may refer to spirituality, which is not much considering the WRAP I have in front of me has some 20 pages of questions. I will note however that this is the second question on the list, which demonstrates its importance.
However, this is not to denigrate the WRAP which is a fabulous tool for those recovering from a psychiatric ‘crisis’. If you are in recovery and have not completed a WRAP, you should bring this up with your mental health care team.
Spiritual care is dependent on staff training, and it’s disappointing to note that only about a third of UK medical schools teach on spirituality within their undergraduate curriculum.
The rest of the chapter looks at the role, training, and pressures on NHS Chaplains and it’s worth noting that clinical staff, as well as partnering with chaplaincy staff, should also be recipients of spiritual care.
There are 100 chaplains employed by 40 of the 75 mental health trusts in England and Wales. Less than half work full time in mental health.
As much ink is spilt on the topic of NHS Chaplains, especially by the likes of the National Secular Society, I won’t cover this section. It goes without saying that I’m in favour of NHS chaplains and would like to see them further embedded in NHS culture.
If you wish to read further on the work of hospital chaplains, then I would guide you to their professional bodies, namely, The College of Healthcare Chaplains, the Scottish Association of Chaplains in Healthcare, and the Association of Hospice and Palliative Care Chaplains.
At the end of the day, spiritual care should be the shared responsibility of all who work in the NHS.
I shall finish by citing a portion of the conclusion:
With massive and perpetual organisational pressures on the NHS, the humane imperatives of spirituality can be easily forgotton. It is a tribute to the dedication and preceptiveness of so many people that the spiritual dimension is now firmly on the agenda. There exists such a great deal of legislation, policy and guidance that NHS trusts can no longer ignore this aspect of patient care. Spiritual care can be seen as a unifying and encouraging presence in the NHS, but only if the whole approach is anchored to a clear system of governance and a set of values that celebrate cultural diversity.
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