Religion and Spirituality in Psychiatry

222 Marcus M. McKinneyleaders who have partnered with clinicians oncare for their members refine their identity andeffectiveness as an important “provider of care”in the community. It is no surprise that such collaborationsallow clinicians to expand their referralbase and expand their knowledge of spiritualresources. They may also increase their comfortin addressing spiritual issues in therapy to theextent such a partnership is established.If we admit that stigma related to acknowledgingone has an emotional struggle is a very commonexperience, then we might look in a more sophisticatedway at what role people play in recovery andcare. For example, part of our modern experienceis to hold high the level of hard-earned training inany given field. So medicine and counseling (andgovernmental authorizing bodies) may have verystrict guidelines giving license to levels of practice.Professional credentials, organizations, andextensive designations seek, appropriately, to raisethe quality of care for people. However, we mayhave to consider ways to strengthen quality whilebroadening access at the same time.Let’s consider some of the barriers that mightinhibit a person seeking help from seeing a fullycredentialed psychiatric professional. First, economics.In addition to the stigma sometimesexperienced by a person “admitting” they areill or struggling with emotional issues, manypeople go to faith leaders in the communitybecause they cannot afford the inevitable cost ofseeing a “credentialed” mental health provider.The credentialing movement brings assumedquality and cost.Second, people may ask for help, but resisttreatment. With this in mind, a movement to trainand support people who are in the spiritual communityseeking clinical skills to offer pastoral counselingis worth considering. The Substance Abuseand Mental Health Services Administration in theUnited States has increasingly found good outcomesfrom “psychological first aid.” (4) Some professionalorganizations have begun to incorporatea category of membership that embraces this levelof intervention that comes closer to the networkof trust and access that people seem to appreciate.For example, the American Association forPastoral Counseling (5) now offers an entry membershiplevel designated ‘Pastoral Care Specialist’.Some faith leaders find this movement validatingtheir front line role as providers of care embeddedin the community.We also need to keep in mind that many peopleseek mental health services through their primarycare provider, that is, people go to a physician oftenfor emotional and psychiatric reasons, be it to seekmedicine or ask for guidance. Most psychotropicmedication in the United States is dispensedthrough a primary care physician. If we are seriousabout early detection, prevention, or even effectivereferral, the larger community of care must be reimagined.Informal links between physicians, mentalhealth providers, and spiritual leaders representa strong fabric of recovery for assessment, support,and care in our communities.In the United States there is significant interestin how primary care physicians addressmental health needs. For our purposes here,let me illustrate great potential in an integrativeapproach that can strengthen quality andexpand access.For decades, I have worked alongsidephysicians at a large acute care hospital in anurban setting (Hartford, Connecticut). First asa chaplain, then as a pastoral counselor takingreferrals, I worked primarily in the hospital setting.I would hear from my physician friends how thecounseling needs of patients had grown and theresources to get them help had decreased. Theactual problem seemed to be that they could nolonger refer a patient to their own preferred localmental health provider in their community. Theyhad to keep a list of common insurance companies… a “panel” of providers. Provider lists wouldchange, sometimes every six months. The referralprocess would frustrate patients. Eventually manyphysicians simply gave up and suggested theirpatients call their own insurance company. Ofcourse, that nonpersonal referral does not usuallyget followed up. And many patients came back totheir physician with their symptoms worse.We piloted a process to embed a pastoralcounselor in some of the medical practices sothe counseling referral process could be more