With big interest I read the question and contributions and thank you all very much. Hugo Simkin, has your study been published (how could I get it?)? It converges with studies we have been conducting in Germany in clinics or departments of psychiatry and psychotherapy.

Cf. Eunmi Lee, Klaus Baumann, German Psychiatrists' Observation and Interpretation of Religiosity/ Spirituality, in: Evidence-Based Complementary and Alternative Medicine (2013), http://dx.doi.org/10.1155/2013/280168 (15.11.2013).

and Lee, Eunmi / Zahn, Anne / Baumann, Klaus: “Religion in Psychiatry and Psychotherapy?” A Pilot Study: The Meaning of Religiosity/Spirituality from Staff’s Perspective in Psychiatry and Psychotherapy. Religions 2 (2011), 525-535; doi:10.3390/rel2040525

(both open access)

A patient study is about to being published.

In my opinion, spiritual care should not be reduced either to palliative care (as field) or to chaplains ("pastoral care") but as part of a professional competence and attitude of nursing staff and physicians likewise. Due to the troubled relationships between religion(s) and science(s), the exciting task is to find adequate standards and training elements which aim at the benefit of the patients in a wholistic way. It is a joy to read similar viewpoints in this discussion.

Dear Ian - a very interesting question for us; please send on the results of your literature search. What particular outcomes are you interested in, and how do you define / categorise " all aspects of spiritual and existential care " ? For example there is some literature on the beneficial effects of music/ art/ aroma/ light/ even pets in different groups. Attached is a review, published three years ago, of 50 articles on the subject of pastoral care in hospitals ( Proserpio T1, Piccinelli C, Clerici CA. (2011) Pastoral care in hospitals: a literature review. Tumori. 97(5):666-71. doi: 10.1700/989.10729.)

Hope this helps.

Dear Ian - a very interesting question for us; please send on the results of your literature search. What particular outcomes are you interested in, and how do you define / categorise " all aspects of spiritual and existential care " ? For example there is some literature on the beneficial effects of music/ art/ aroma/ light/ even pets in different groups. Attached is a review, published three years ago, of 50 articles on the subject of pastoral care in hospitals ( Proserpio T1, Piccinelli C, Clerici CA. (2011) Pastoral care in hospitals: a literature review. Tumori. 97(5):666-71. doi: 10.1700/989.10729.)

Hope this helps.

Thanks Avijit. That's really helpful. We're probably going to centre our investigation around exploring the work of the Trust's Spiritual Care Team (formerly the Chaplaincy Team). In view of their scope to help support people in many ways, not just religious / those of a faith, that's why I said "all aspects". However, in reality, we may only be able to look at certain aspects of their role I suspect.

I'll make sure I let you know how we get on!

Regards.

Iain

For a long time religion and spirituality have been considered as a secondary issue on mental health and clinical practice in Argentina. Nevertheless, in recent years this viewpoint has begun to be reviewed, and religion and spiritualty are now remarkable variables in both clinical work and research. In 2011, with a group of colleagues, we we conducted a study to investigate religious and spiritualty beliefs and practices of psychologists and psychiatrists in the metropolitan area of Buenos Aires, the importance that they give to them in clinical practice and how much they knew about the religious diversity in their area of practice. The preliminary results indicated that the population polled differed significantly from the general population in terms of adhesions and religious practices. Also, beyond this disparity, there was a marked tendency in relation to the inclusion of religion and spiritualty in clinical practice. The relatively low knowledge of religious diversity should be taken into consideration, since it could lead to conflicts with the users of mental health system.

In the last two centuries, no one questioned the organic medicine, but often the psychological and spiritual medicine and care was questioned. To what extent human suffering, a patient as a complete human person is the object of today's medicine? The answer to that question depends on meeting and emotional relationship of doctor with the patient. The doctor is acting unconsciously under the influence of emotional forces, which strongly affects the patient. Doctors, in general, do not want patients who are dying, or patients with severe suffering to whom, by the nature of their illness, can little or nothing to help. Doctors often avoid such patients. It is difficult for doctor to meet with his failure, with his defeat, and in certain ways it's a dying patient, or a patient to whom doctor can't help. On the other hand, especially such a patient has unrealistic expectations from the physician. Patient sees the doctor as almighty person who knows everything and will solve his health problems. It often means that the gap between the patient's needs and expectations and the capabilities of the doctor is very big. It is not easy for doctor to tolerate such difference and to have reasonable sense for it, but it is much harder for the doctor to experience the reaction of the patient when he finds out himself betrayed in his faith to the doctor and in the power of medicine. The need of a patient for human contact, understanding and support is very strong. Thus, a doctor who has a great ability for empathy or understanding and acceptance of the patients, and also the ability to overcome his own negative emotions, can stand in his psychic conflicts that arise in relation to the patient and his disease.

Dear Ian,

Aspects of spiritual and existential care is such a rich area for further exploration and an area of growing interest; so glad to hear that you and your student are focusing on it. In case you haven't accessed it yet, one resource to turn to is Consensus Conference report:

Puchalski, C., et al (2009). Improving the quality of spiritual care as a dimension of palliative care: The report of the Consensus Conference. Journal of Palliative Medicine 12 (10), pp. 885-904.

Thanks Hugo, Lindsay, Doncho, Francesca and Susan. All really interesting, with some useful topics to consider an reference sources. Much appreciated! Iain

Thanks Iain for initiating discussion on this very important and somehow neglected issue in the broader medical professional and scientific community. I will add some comments on the benefit of the doctor and patient from application of the findings of psychological medicine and spiritual care? For physicians, the application of knowledge of psychological medicine and spiritual care means better diagnostics and greater therapeutic effect. The patient will better cooperate with the doctor who has moderate psychological approach, and better cooperation will often provide more accurate, easier and faster diagnosis. Accepting the physician with confidence, his treatment and advice will surely reflect positively on the patient behavior and effects of treatment. The doctor with adequate psychological approach to the patients will surely enjoy a growing reputation in his environment than a doctor who doesn't do it. The doctor who takes care for the emotional and spiritual needs of patients will certainly be satisfied with himself and with the patients.

The benefit for the patient from application of the knowledge of psychological medicine and spiritual care is that the patient becomes active and interested to help him/herself in treating his/her illness. Better communication of the patient with the doctor would ensure better outcomes and quality of life of the patient. Good emotional relationship with the doctor facilitates preventive, therapeutic and rehabilitative actions and effects for the current and new diseases.

From Public Health point of view, the topic of psychological medicine and spiritual care deserves much bigger attention in medical education, research and practice.

With big interest I read the question and contributions and thank you all very much. Hugo Simkin, has your study been published (how could I get it?)? It converges with studies we have been conducting in Germany in clinics or departments of psychiatry and psychotherapy.

Cf. Eunmi Lee, Klaus Baumann, German Psychiatrists' Observation and Interpretation of Religiosity/ Spirituality, in: Evidence-Based Complementary and Alternative Medicine (2013), http://dx.doi.org/10.1155/2013/280168 (15.11.2013).

and Lee, Eunmi / Zahn, Anne / Baumann, Klaus: “Religion in Psychiatry and Psychotherapy?” A Pilot Study: The Meaning of Religiosity/Spirituality from Staff’s Perspective in Psychiatry and Psychotherapy. Religions 2 (2011), 525-535; doi:10.3390/rel2040525

(both open access)

A patient study is about to being published.

In my opinion, spiritual care should not be reduced either to palliative care (as field) or to chaplains ("pastoral care") but as part of a professional competence and attitude of nursing staff and physicians likewise. Due to the troubled relationships between religion(s) and science(s), the exciting task is to find adequate standards and training elements which aim at the benefit of the patients in a wholistic way. It is a joy to read similar viewpoints in this discussion.

Having just concluded teaching a class on the Psychology of Religion, I'm familiar with some of the latest research in this area.

Foremost, it is important to note the distinction between "religion" (primarily more formal and institutional) and "spirituality" (primarily more personal and may not involve an organized institution). Generally, people who adopt or have a deeper spirituality - a personal sense of faith - have numerous physical health benefits when confronting illness or staying in a hospital. In psychology this may be thought of as "intrinsic religiosity," or religion pursued for one's own personal sake rather than because of some social reason or reason for gain (e.g. "I must have faith to avoid eternal damnation").

Some specific findings include that people who have an intrinsic religiosity tend to cope better and have better overall well-being when faced with illness, especially chronic conditions. And, people who have an intrinsic religiosity also tend to recover quicker following surgery or after entering hospital care.

Findings tend to be more mixed when it comes to psychological health. But, people who pursue religion for intrinsic reasons do generally seem to have better coping. However, it seems that in some individuals intrinsically pursued religion is associated with higher rates of anxiety (perhaps linked to a fear of not living up to expectations advocated by one's faith?). The links between mental health and religion/spirituality are only recently being investigated in greater depth.

There are many sources for this information, but two I'd recommend...

1) Paulotzian & Park's (2013) text "The Handbook of the Psychology of Religion and Spirituality" -- it includes two excellent chapters on the link between health and religion/spirituality along with abundant information throughtout. For example, many chapters discuss the link between religion/spirituality and coping with stressful life events (e.g. illness).

2) The February 2010 special issue of Personality and Social Psychology Review - special issue fully devoted to religion/spirituality. There are some good articles here that explore how religion/spirituality may play a role in stress management and especially death ("Terror Management Theory").

Hope these ideas help! I know they're from a psychology perspective, but I'd suggest that the effects that emerge from religion/spirituality when it comes to health must be approached from a psychological perspective. As for gaps - Paloutzian and Park's book is a great place to start. They have whole chapters that identify these as of 2013, including with respect to health and healthcare.

Ene of this month (May) European conference on Spirituality and Health in Malta (with Dr Koenig). See also free newsletters re this subject (Duke University) and free letter of European Institute Spirituality and Health (Switzerland)

Yes. It is necessary due to the fulfillment that individuals glean from such care. They struggle with questions that go unanswered which in turn affects their psychological outlook that overall affects their health and the desire to go on living. I had that same experience many years ago and nearly died from pneumonia. My sister sent me the book 'Seven Spiritual Laws of Success' by Deepak Chopra and I was miraculously healed, not from reading the book or Chopra's healing gifts per se', but having the epiphany that there was more out there than what I had been originally taught while growing up that did not suffice for me. This new knowledge literally gave me the 'will' to live.

As a life coach for the past 17 years that has involved coaching as much on spiritual growth goals for my clients as is fulfilling a life purpose and the ability to 'discover' that purpose - that gives an affirmation of life (Joseph Campbell, all books) and following one's bliss. Without this needed ingredient in modern day health care we are really just running to catch up as the medical industry is being left behind very quickly by those who want more, who need more and who will find more or they may just give up. The affirmation of life is greater in the heart and the human spirit than it is in the physical body - it is so strong, when present in an individual, that it can literally cure cancer itself

Sharon Stone DD

Attachment is a psychology of religion paper from my undergrad that may be of help. Also ref. publication 'Going Clear, Doorway to the Divine', 2009 Sharon R. Stone.

Psychology of Religion

Swami Stone/Sharon R. Stone

BS, DD, VHT, RMT, 2010

Abstract

Psychology is about finding relief from the pressures and stressors of life whereby increasing ones overall mental health. Psychology of Religion is the exploration of blending spiritual practices as well, leading to a more holistic psychological practice. Findings have shown that having a more personal type of religious practice over an institutional one brings a greater sense of self-esteem and empowerment for many individuals. Regardless of the type of psychology blended with this personal religious practice, the end result is a higher self-efficacy and strong sense of mind that leads to a healthy life. The topic of institutional vs. personal religion is very important when relating to the psychology of religion because of the majority of individuals who actually participate in either an institutional or a personal form of religion and the effect that this has on their state of mind and overall mental wellness.

Institutional vs. Personal Religion

and how they relate to the field of Psychology of Religion

Psychology at its essence is about empowerment with the end purpose of building a higher self-efficacy and stronger sense of mind and personal power. This increased personal power facilitates an individual in participating in a healthier life. The topic of institutional vs. personal religion is very important when relating to psychology because of the majority of individuals who participate in either an institutional or a personal form of religion. Among these individuals, it is noted how those with a more personal religious view, such as Buddhism, which is apart from an institutional form are more likely to be mentally healthy, empowered and in possession of a high self efficacy (Virtbauer, para 8-9, 2008). Personal religion is in direct contradiction to those who participate in an institutional religious form because of the more individualized religious practice, which is apart from an institutional dogmatized belief system of control. Those who practice institutional religion without the personal connection are more likely to lack the sense of a personal responsibility when it comes to choices that they are taking an active role in choosing. Rather than letting a group of men choose what they are to do, act on and believe in, those with a more personal religious form of belief tend to truly weigh the consequences of their actions and words and measure who will be affected, before they act (Fox, para 8-9, 2009). William James makes it clear that those who participate in a personal religious style are more psychologically aware and conscientious of the importance of personal integrity, regardless of what a church ‘organization’ tells them. Psychology of Religion and how personal vs. institutional religious practices are integrated within that field will be addressed, the end result being that personal religious practices are more psychologically efficacious in building the overall mental health of an individual over that of an individual that participates an institutional religious practice only (Virtbauer).

Psychology of Religion:

Historically, psychology of religion is seen as a field that has had a rising and falling interest over the years (Beit-Hallahmi, 1974), (Neilson, para, 2, 2000). Psychology's early influences from the likes of William James, in ‘Principles of Psychology’ was representative of a state-of-the-art text in psychology at the time it was published (Neilson). James was the president of the American Psychological Association at the time and was deeply interested in religious phenomenological experiences and sought to understand the individual religious experience of the mystics (Neilson). Other influential psychologists such as G. Stanley Hall felt compelled to improve psychological theory regarding religious practice (Neilson). After the earlier push in psychology toward behaviorism there was a time of neglect of the religious or spiritual matters in regards to the psychological (Neilson, para 2, 2000). Reductionist methods from the behaviorism camp did not allow for much room regarding matters of faith or theoretical constructs that could not be empirically tested (Neilson). As a result, psychology left behind the field of religion for other more scientific topics and it was neglected for decades to follow (Neilson).

Psychologist’s interest in religion did not resume until the 1950’s. Gordon Allport attempted to describe the ‘role’ of religion in an individual’s personal experience and as a result made an important mark in the field. He came up with the distinction between intrinsic vs. extrinsic religious motivations (Neilson, para 3, 2000). This remains the most influential approach of psychological studies in the US since and there have been several developments that have combined to suggest that there is resurgence in this field (Neilson). As a result the APA has dedicated a division to focus on the psychology of religion (Neilson).

Institutional vs. Personal Religion:

William James a U.S. psychologist and philosopher served as the president of the APA wrote one of the first psychology textbooks on the psychology of religion (Neilson, para 1, 2001). James makes a distinction between institutional and personal religion (Sohel, para 1-6, 2009). According to James, institutional religion describes the religious group or organization, and this organization plays an important part in a society's culture (Sohel). Personal religion however refers to the individual who is having a mystical experience. This mystical experience can happen to someone regardless of the culture they are from. “James was most interested in understanding personal religious experience. If personal religious experiences were what James preferred, dogmatism was something that he disliked. Dogmatic thought, whether religious or scientific, was anathema to James. The importance of James to the psychology of religion--and to psychology more generally--is difficult to overstate. He discussed many essential issues that remain of vital concern today (Neilson, para 3, 2001). Taken from ‘Varieties of Religious Experience’, James is quoted as saying “The theorizing mind tends always to the over-simplification of its materials. This is the root of all that absolutism and one-sided dogmatism by which both philosophy and religion have been infested (CSP, para 1, no date). James is referring here to the institutional form of religion in which dogmatism reigns supreme over logic of any kind. He is drawing a drastic contrast between what he feels is a more authentic personal religious path over the institutional one where rules and set standards are dogmatically followed and which can be an inauthentic path to one who practices it.

According to Alan Fox, a Professor of Asian and Comparative Philosophy and Religion in the Philosophy Department and Director of the Honors Program at the University of Delaware interprets James views as, “Religious institutions are traditions, which are always bound to historically defined perspectives. But some of these perspectives are no longer viable, such as those that contradict modern discoveries (Fox, para 6, 2009). According to Fox, if religious institutions aren't meeting the more personal needs of their members then why do the memberships remain so attractive to so many people? (Fox). He feels that those who follow institutional religions lack personal confidence and do not allow themselves to trust in their own instincts. In other words they like to be told what to do. He goes on to explain the illogical thought behind institutional religion here, “If someone else didn't say it, it isn't true; if someone else did say it, it is likely true; and if it is written down especially in the Book, it must be true. This might help explain the appeal of concepts like vicarious sin and redemption. Such doctrines suggest that we are hopeless sinners, but it is Adam's fault, not ours. We can be saved, but not by our own sacrifice, rather by the sacrifice of a redeemer, whether Christ or Amida Buddha (Fox, para 8, 2009). In essence, those who follow an institutional form of religious practice do not take responsibility for their lives and let others make decisions for them, which would in logic appear that they have a much lower self-efficacy than those who practice a personal religion. Fox goes on to say that this type of thinking can lead to dangerous attitudes and that we forfeit responsibility for our own morality, “This thinking can lead to dangerous attitudes. Once we forfeit responsibility for our own morality, we always have an excuse, which justifies behavior that is clearly immoral,…(Fox, para 9, 2009). In the ‘Chronicle of Higher Education’, Dr. Phil Zuckerman who teaches sociology at Pitzer College points out in an article on the ‘Virtues of Godlessness..’, that “…religion may not have such positive societal effects. It can often be one of the main sources of tension, violence, poverty, oppression, inequality, and disorder in a given society (para, 10, 2009). There are many other sources in mainstream psychology that cite similar observations, which are not mentioned here, but the overall majority consensus does not favour an institutional religious form over a more personal religious form in regards to maintaining a successful state of mental health.

What Might Spirituality in the form of Personal Religion Offer the Contemporary Practicing Psychologist?

A philosophy that could be categorized as a personal religious form of Buddhism when mixed with psychology is becoming synonymous in western society. Western psychologists have been realizing for quite some time that Buddhist philosophies of mindfulness and other personal religious practice are helping people mentally, physically and spiritually. Almost all streams of psychology and psychotherapy in the current times are reflecting a Buddhist psychological theory (Virtbauer, para 8-9, 2008). The more successful theoretical and practical psychological ‘treatment’ happening today has experienced the integration of the Buddhist teachings within their working theories (Virtbauer). The main push now is the integration the Buddhist teachings in already existing psychological or psychotherapeutic lines of thought as the end goal (Virtbauer, para 8-9, 2008). Buddhist mindfulness and acceptance techniques have been one of the most flourishing and successful innovations in psychotherapy. This

is very important to the different schools of psychotherapy. “A development worthy of note within the different schools of psychotherapy is the fact that not only psychotherapies with a traditionally close relation to eastern thought --

as Gestalt therapy or transpersonal psychology --engage in dialog with Buddhist traditions, but also the most scientifically orientated behavior therapies have recently been influenced by Buddhist thought. Some even speak of a 'spiritual turn' in behavior therapy. "Technologies of acceptance", as in Marsha Linehan's Dialectical Behavior Therapy (DBT; Linehan 1998, 23), mirror traditional Buddhist values and are partly drawn directly from Buddhist meditation techniques (Virtbauer). The successful integration of personal religion and psychological therapies has given much validation to the importance of a practice of personal religion in regards to successful mental health treatment and this will continue to show the lack of validity of a more institutional form of religion as supporting good mental health or wellbeing in this society.

How does Personal Religion aid the Psychologist Today?

Another large part of Buddhism at the core of the belief system is the emphasis on non-judgment, compassion and mindfulness. Living in the present moment, or in a state of mindfulness technique is used in stress reduction, “…examples include Jon Kabat-Zinn's Mindfulness Based Stress Reduction (MBSR), and Mindfulness-Based Cognitive Therapy for Depression (MBCT) by Segal, Williams, and Teasdale. A further approach within newer behavioral and cognitive interventions is Acceptance and Commitment Therapy (ACT), which does not have a direct connection to eastern philosophies (ACT is built on Relational Frame Theory (RFT)), but arrives at comparable assumptions (Virtbauer). The emphasis is an attitude of acceptance through non-judgment in this present moment, no matter what is going on that might be causing one stress. Changing thoughts that control the inner language is the point of mindfulness. When one can stop the thoughts that are stressful through the personal religious experience of meditation while in the moment, their brain waves drop from beta to theta and then it is possible to change the thoughts associated with the stress. When this self-empowering form of practice becomes a habit, the mind begins to clear and in so doing over time one can build a higher self-efficacy. We learn that we can validate ourselves through a commitment to changing inner thought patterns to become a more whole person (Stone, pg 76, 2009; Sollod, para 33,no date).

There has been a great deal of interest in the relationship between psychology and spirituality in recent years. There have been many books, conferences and articles to support health care professionals interested in this field (Plante, para , 2008). “Professional psychology has appeared to have rediscovered spirituality and religion with renewed interest in integrating this aspect of life into professional psychological services. Since 96% of Americans believe in God and 40% attend religious services on a weekly basis or more (e.g., Gallup & Lindsay, 1999), spirituality and religion is an important aspect of life for many. Yet most psychologists have little if any training on these matters (Plante). There are many spiritual and religious tools that can and are being used by psychologists in their work with clients that do not take away from the client’s favored religious form

or lack of religion of either the clients or the psychologists (Plante). Through combining a personal religion with psychology a person can achieve greater overall health mentally, physically and spiritually, without dogma or having to pay homage to creeds or gurus that do not support the personal belief systems of the person which only leads to a low self esteem and unhappiness in life. Other forms of personal religious practice that can be combined easily and effectively with psychology are meditation, partnership forms of prayer, seeking a calling in life, acceptance of self and others, ethical values and behaviors, being part of something greater than oneself, forgiveness, gratitude, volunteering, rituals, social justice, spiritual role models, bibliotherapy and community support. (Plante).

Conclusion:

Psychologists have been conducting research and practice with various areas for over one hundred years and religion has been benefiting societies for thousands of years (Plante). It is not only possible, but also logical to combine the two areas together to achieve a greater sense of tangible health and wellness on all levels psychologically, physically and spiritually. Many personal forms of religion like Buddhism have been teaching psychological forms of therapy that have been helping individuals for millennia and to ignore the significance of this truth would reduce the highly successful quality of current psychological care to the imagery of a bunch of children stumbling in the dark when there was a light switch already on the wall (Plante).

References:

CSP, para 1 (no date). The Varieties of Religious Experience, James. Retrieved on January 4th, 2010 from

http://csp.org/experience/james-varieties/james-varieties2.html

Fox, A., para 6-10, (2009). Institutional Trappings, Religion and Dis-religion in a "One-Size-Fits-All" World. Retrieved on January 5th, 2009 from:

http://www.policyinnovations.org/ideas/commentary/data/000135

Nielsen, M., para 1-5 (2000). Psychology of Religion in the USA, Georgia Southern University. Retrieved on January 3rd, 2010 from: http://www.psychwww.com/psyrelig/USA.html

Nielsen, M., para 1-3 (2001). Notable People. Retrieved on January 5th, 2010 from

http://www.psychwww.com/psyrelig/psyrelpr.htm

Plante, T., para 1-16 , (2008). What Might Spirituality and Religion Offer the Contemporary Practicing Psychologist?, Santa Clara University. Retrieved on January 5th, 2010 from:

http://www.psychwww.com/psyrelig/plante3.html

Sohel, para 1-6,(2009). Phpbb, Mental Disorders, Religion and Psychology Blog. Retrieved on January 6th 2010 from:

http://www.minddisorders.com/forum/post-2041.html

Sollod, R., para 33, (1993) Integrating Spiritual Healing Approaches and Techniques into

Psychotherapy, Department of Psychology, Cleveland State University. Retrieved on January 6, 2010 from:

http://www.psychwww.com/psyrelig/sollod2.html

Stone, S., pg 76, (2009). ‘Going Clear, Doorway to the Divine’, Light in the Dark Publishing, Kansas City, MO.

Virtbauer, G., para 8-9, (2008) Buddhism as a Psychological System: Three Approaches

University of Vienna. Retrieved on January 6, 2010 from: http://www.psychwww.com/psyrelig/virtbauer.htm

Zuckerman, P., para 10 (2009). The Virtues of Godlessness: The least religious nations are also the most healthy and successful, Pitzer College. Retrieved on January 6, 2010 from: http://www.psychwww.com/psyrelig/zuckerman.htm

I think it would be a good idea.

I don't have any research result on this, but I find spiritual care very interesting especially for chronic patients

Jay Michaels made some very useful comments previously about the distinction between religion and spirituality in the literature and in practice.

I wanted to reiterate these - it is indeed the case that there is a growing body of literature that a personal spirituality, or sense of faith, has physical health benefits and improved coping and well-being.

In my own profession - social work - the last decade has witnessed a modest yet vocal renewed interest in assessment and support including spirituality. For an extended period the predominance of the medical model in health care, counselling and community services has resulted in a silence regarding these aspects to a person, their coping and their inner world.

Iain, thank you for this interesting question!

Jay also noted that 'The links between mental health and religion/spirituality are only recently being investigated in greater depth.'

A team I have been involved in for the last 3 years, looking at the experience of service users with severe and complex needs in accessing mental health care, has recently published outcomes. We used standardised measures for the recovery orientation of the service - the REE and the RSA.

Interestingly - and very relevant to this discussion - though participants felt very positive about the services they received overall, and especially the focus on goal-planning and person-centred care, it was raised that two neglected areas were sexuality and spirituality.

We as clinicians in health and mental health services seem reluctant or resistant to discuss spirituality with clients/service users/consumers; this is the case even if spirituality is important to us in our own lives, and even if the organisation in which we work has an explicit faith-based mission (as is the case in the hospital culture in which my research work is based).

This is very interesting indeed, and an aspect of assessment and intervention our health service is now actively seeking to re-think and engage in service development to redress.

Dear Melissa, thank you for the indication of your study and study results - they fit well to the results we got in our research projects and to the search for suitable ways (and trainings, consequently) how to address religious/ spiritual needs, aspects and questions in mental health care and health care in general.

For some badlly needed critical thinking on these issues, Google

Richard P. Sloan and see

Sloan, R.P. (2006). Blind Faith: The Unholy Alliance of Religion and Medicine. New York: St. Martin's Press.

Generally in hospital we all observe the glomy atmosphere .Irrespective of caste ,creed & religion,we should create the holy spiritual environment just in the entrance hall so that the patience & visited to visit the hospital may get an holy atmosphere .

Besides consulting room & especially the surgerical theatre before undertaking surgery surgeon should create an environment of comforts on patience which he can also see in the expressing & feeling on the face of surgeon .To me in such case faith healing always play a part & our hospital should also implement the same surrounding atmosphere .

You should search for publications from Harold Koenig, Alexander Moreira-Almeida. And i suggest you read something about de Theory of Human Care from Jean Watson: watsoncaringscience.org

Suggested readings:

Sloan, R.P. (2006).  Blind Faith: The Unholy Alliance of Religion and Medicine. New York: St. Martin's Press.

Sloan,  R.P. (2007). Attendance at Religious Services, Health, and the Lessons of Trinity. Psychosomatic  Medicine,  69,  493-494.

Sloan, R.P & Bagiella, E. (2002). Claims about religious involvement and health outcomes. Annals of Behavioral Medicine, 24, 14–21.

Sloan, R.P.,  Bagiella, E.  &  Powell, T. (1999). Religion, spirituality, and medicine. Lancet, 353, 664–667.

Sloan, R.P., Bagiella, E., VandeCreek, L., Hover, M., Casalone, C., Hirsch, T.J., Hasan, Y., Kreger, R., Poulos, P. (2000). Should physicians prescribe religious activities? New England Journal of Medicine, 342, 1913-1916.

Reading and discussing Sloan's position is a must, in my opinion. It helps to clarify misunderstandings and misconceptions of what spiritual care is or should be about. Thank you for the list of some of his publications.