Religion and Spirituality in Psychiatry

Community Psychiatry and Religion 223personal and the site of care more familiar topatients. We included a sliding scale fee for mostanyone, based on his or her ability to pay. Theactivity was significant. And the ability to referto mental health providers was easier because thepastoral counselor understood the psychiatric process.Such an integrative approach does not haveto be huge. But it probably needs to be personal.A final word on quality: It is important toremind ourselves an individual who is credentialed(licensed, certified, or otherwise designatedas authorized to provide mental health services)may not necessarily produce good outcomes for aperson. In the same way, spiritual intention doesnot guarantee a desired outcome for people seekingmental health support. The best assurance ofquality is accountability through having a caringsupervisor. Supervision would be a place to safelyaddress how to improve the counseling work. Webelieve this is a lifelong need for clinical and spiritualcaregivers. And this enhances the likelihoodthat mutual referral will take place.4. STEP 4: IDENTIFY REASONSTO REFERWhat motivation(s) should we identify amongclinicians and spiritual providers of care thatmight make referrals beneficial? “Referral” and“collaboration” take a common protocol in hospitalsand among medical professionals. It is lesscommon with religious leaders. That is not to saythey would not jump at the opportunity. Bothdisciplines would have reservations, however. Itprobably only makes sense if you feel the patientcould benefit and your work would be amendedin ways that could sustain healing outcomes.In a hospital setting, medical professionalsrefer frequently to other subspecialties. Peopleknow each other and their expertise pretty well.(Economic factors in Western Medicine maychange this notion: The growing categories ofPhysician Assistant and Hospitalist may createmore distance in the collaborative experienceamong even health practitioners.) Progress notes,often the residue of exhaustive assessment, areshared between peers. The language is commonand complex. There are lots of abbreviations. Amulti-disciplinary team in a hospital shifts a littlecloser to “collaboration,” although the team islikely also schooled in medical language.From a patient’s perspective, they may feelreferral honors their desire to talk about spiritualissues safely. It can “normalize” their care to takeinto account their whole person.When practitioners feel their care of clientsand families will be enhanced by having spiritualissues addressed, many reasons to refer or collaboratewith spiritual providers can be found thatboth facilitate care and honor the larger healingfabric that patients access frequently in everydaylife. These reasons may have clinical and diagnosticimplications and enhance client-centeredapproaches.By using patient-approved collaboration,a practitioner will better “translate” spiritualthemes. For example, if “guilt” is an issue frequentlyraised in therapy, a spiritual providermay shed light on how guilt is framed within thepatient’s belief system. Pathology can be differentiatedmore effectively. A faith leader may greatlyappreciate simple, clinical clarification. Religionhas a remarkable way of inviting pathologicalprojections unless there is careful insight.When clinicians are caring for more impairedclients who might benefit from socially meaningfulactivity, religious resources can build on anysocialization tasks prescribed.Spiritual themes permit the possibility of ashift away from the stigma associated with mentalillness. Where the faith leader or religiousenvironment is empathic, a “client” can find languagethat is dynamic for healing, helping themto feel that, as James Hillman notes, all humanshave problems. To be human is a problem. Weare all on that common ground.But let’s not be naïve. It must be acknowledgedthat some religious perspectives might add tostigma by (like some medical models) labelingthe illness in such a narrow and negative way thatthe person is defined by the illness. This can putblame on the person. It is less likely, of course,that such a community would warm up to collaboration.But in any community, there will be