By Austine Duru
Mental illness is often misunderstood, and in some circumstances ignored or treated as taboo. It is not uncommon for chaplains to be asked for assistance in addressing mental illness. In fact, early research and major surveys in this area (Regier, et al., 1984; Hohmann & Larson, 1993; Wang, Berglund, & Kessler, 2003) show that many people in the general population tend to seek help from clergy, pastoral counselors, and chaplains rather than from mental health professionals. As mental health institutions grapple with patients’ unmet religious and spiritual needs, professional chaplains can be an important ally in providing religious and spiritual interventions for mental health patients.
To evaluate the impact of religious and spiritual interventions on individuals with diagnosed mental health problems, J.P.B. Goncalves et al undertook a systematic review and meta-analysis of randomized controlled clinical trials in seven different scientific and academic databases. The study, which was published in Psychological Medicine (2015), yielded interesting results that might help chaplains. The findings show that RSI provided additional benefits to mental health patients, especially in levels of anxiety and other clinical symptoms. The study further identified opportunities for studying the impact of RSI on mental illness and other health conditions, such as neurodegenerative diseases.
In older adults, spirituality has been shown to play a significant role in the well-being of individuals who suffer from dementia and other mental health problems (Puchalski, 2001). Mental illness cuts across age brackets, but when it manifests in older individuals, it poses unique challenges for families, healthcare providers and geriatric patients. This was the subject of a study published by Anita M. Y. Goh et al, in Asia-Pacific Psychiatry (2012) titled “Pastoral Care in Old Age Psychiatry: Addressing the Spiritual Need of Patients in an Acute Aged Mental Health Unit.” The findings show that the clinical care of patients is optimized by developing a comprehensive understanding of their spiritual needs and providing more holistic services. This is the unique role of the spiritual care provider working as part of the multidisciplinary healthcare team. This study has implications for specialized training and skills development for chaplains who work in mental health facilities.
Psychiatric patients often have unmet spiritual needs, in spite of the increasing body of literature that associates religious beliefs and spirituality with positive health outcomes on mental health symptoms such as depression and suicide, and higher levels of well-being (Van Ness P., et al, 2002). This is especially true when one considers the unmet spiritual needs of underserved populations with mental health problems. In his recent work titled The Imam and the Mental Health of Muslims: Learning from the Research with Other Clergy, Dr. Osman M. Ali takes a closer look at the mental health needs of Muslims. While this is not a formal research work, it relied heavily on available research literature to explore some of the challenges and gaps in meeting the spiritual needs of Muslim individuals dealing with mental illness. The author acknowledges a 2011 survey by Abu-Ras and Laird, which found a chronic lack of trained and certified professional chaplains in the United States and more importantly, that the needs of Muslim patients may not readily be met by using the interfaith chaplaincy model.
An interesting study by Virginia Ross et al. (2016) explores how the ongoing role of suicide prevention among clients affects mental health professionals. It also tried to identify some of the thoughts and feelings associated with this role. This research may be meaningful for chaplains, especially those who work in mental health facilities. The authors of this work suggest that the renewed focus on preventing suicide adds additional burden on mental health workers. It is not clear whether chaplains were surveyed for this study, but it shows that mental health workers experience elevated stress and anxiety because of suicide prevention. The authors conclude that self-care strategies are needed for those workers.
Apart from mental health workers, friends and family members often constitute important support systems for both mental health patients and other patient populations. Family caregivers are often referred to as “hidden patients” (Kristjanson L. et al, 2011) because of the adverse effects of the burden of caregiving. Two recent research studies explore the mental health needs of caregivers. The first, “Spiritual Care Training for Mothers of Children with Cancer: Effects on Quality of Care and Mental Health of Caregivers,” by Somaieh Borjalilu et al, (2016) explores the effectiveness of spiritual care interventions for the mental health well-being of mothers who care for children with cancer. This quasi-experimental study comes out of Teheran. The study found that spiritual care intervention for mothers of children with cancer produced positive outcomes such as decreased anxiety and reduced spiritual challenges. This study supports training caregivers to recognize and address spiritual and emotional pain.
Another substantive research work on the mental health needs of caregivers by Peter Hudson et al., (2015) is titled, “Reducing the Psychological Distress of Family Caregivers of Home Based Palliative Care Patients: Longer-Term Effects from a Randomized Controlled Trial.” The study explores the effects of one-on-one psychoeducational intervention aimed at mitigating stress for caregivers of cancer patients receiving home-based palliative care. The finding shows that even small psychoeducational interventions can yield greater mental health benefits for family caregivers. This finding supports existing evidence and may help chaplains in palliative care or hospice settings get additional resources.
Access to mental health services is certainly one of the greatest challenges facing modern healthcare. One possible solution is using the growing field of telemedicine for mental health services. Leslie A. Morland et al, (2015) investigates in “Telemedicine Versus In-Person Delivery of Cognitive processing Therapy for Women with Post Traumatic Stress Disorder: A Randomized Noninferiority Trial.” The researchers studied a sample of veterans and civilian women who were given cognitive behavioral therapy for their PTSD through both videoteleconference and in-person treatment. The authors conclude that providing a trauma-focused cognitive therapy using VTC produced outcomes that were not different from in-person treatments. This finding has implications for the broader expansion of mental health services to remote and rural locations, or in areas with huge gaps in access to trained mental health providers. It also has significant implications for addressing the spiritual needs of mental health patients and staff. Of note is the potential implications this study might have for understanding and mitigating moral injury in mental health patient populations.
Austine Duru, BCC, is regional director of mission, ethics and pastoral care at SSM Health in Madison, WI.