Religion and Spirituality in Psychiatry

Community Psychiatry and Religion 221community who may also have local religiousresponsibilities. Many congregations designatethat chaplains or pastoral ministers goto local institutions to minister to their ownmembers.Pastoral counselor : As mentioned earlier, thiscategory has unique implications for meetingthe mental health and spiritual needs of people.From dealing with the everyday worriesof life to complicated psychiatric situationsrequiring support in the community, this personcan be a lifeline to recovery for someonesuffering from psychiatric illness.Heath-care institutions in a community mayhave designated spiritual care providers who havetraining in mental health. Typically they will becalled chaplains and can be found in pastoral caredepartments. In times of economic challenge orin poor areas, there may be no one on the hospitalstaff with the role of pastoral caregiver. If thereis a chaplain, he or she can be helpful in exploringcommunity resources addressing spiritualityand mental health. Generally speaking, however,a chaplain will not often have a community practicefor referral. The work to access communityresources will likely take a few more steps.3. STEP 3: STRENGTHEN QUALITYAND EXPAND ACCESS3.1. Reflection from the Republicof Trinidad: Reverend Elton Adams,Protestant Minister“In Trinidad and Tobago the only place ofresource for the mentally ill person is in the mainhospital. A person with psychiatric illness mightgo first to a general hospital and, if needed, go tothe long-term mental health facility. All costs forthis care is born by the government.“In our country it is often believed that a personwith mental illness is ‘filled with a demonor evil spirit.’ This brings the experience ofbeing shunned by family as well as the community.Medication is used a great deal. Seldomare patients seen by a pastoral counselor. We donot usually have chaplains in this role. Pastors,Pundits, and Imams visit their people.“The main barriers to getting help seem to bestigma issues and shame, even felt by the wholefamily at times. Private counseling would be verycostly. Often there is a sense of failure. A widelyheld belief is that illegal drugs are the main reasonfor much of the mental illness in my country.”People seeking psychiatric care usually valueboth clinical and empathic skills. Ideally they areall wrapped up in one provider. More realistically,we may find them in a mix of “providers” includingprofessionals, faith leaders, and others. Not allcaregivers, even if carefully chosen by a client, arenecessarily “trained” to provide the empathic andclinical services needed. We must acknowledgethe important value of sophisticated psychiatrictraining while appreciating that “real knowledgeof the human soul” may be sometimes found inthe caregiver who has less clinical training. And,of course, there are many who work to acquireskills both in psychology and spirituality.It is also worthwhile to consider developing acommunity training program designed to buildrelationships and increase knowledge (spiritualand behavioral health) in ways that are not tootime consuming or complex. It can be as simpleas a single event for spiritual leaders, a forumto talk briefly on how to assess common mentalhealth problems (depression, anxiety, dealingwith stress), that invites spiritual insight intostrategies for healing.Usually faith leaders with responsibility forcongregational leadership (like a youth pastoror priest) are trained in theological insight andministry application. “Pastoral care” might bestdescribe the intervention often required of theirwork with members. Typically the membersthemselves set the agenda. As leaders are trainedfor more “counseling” skills, the shift will moveto hold the leader in more accountable roles.“Pastoral counseling” signifies a more psychologicallyrigorous training, sometimes performed byprofessionals whose single ministry is counselingin a religious, private, or institutional setting.Whether trained in listening skills for supportor clinical assessment skills for treatment, faith