Religion and Spirituality in Psychiatry

252 René Heftiof persons with serious mental illness mobilizereligious and spiritual resources to cope withtheir situation as caregivers. Second, higher religiositywas associated with greater self-esteemand self-care and less depression among familycaregivers. This pattern suggests that religiositymay bolster the internal coping resources offamily members who are caring for people withserious mental illness. The strongest relationshipobserved was the link between religiosity andself-care, suggesting a pathway whereby religiositymay contribute to enhanced well-beingamong caregivers by expanding the capacity ormotivation for self-care.3.3. The Key Role of ReligiousCommunities (Faith-Based Organizations)A recent survey of faith-based organizationsin the Los Angeles area highlighted a highdemand for mental health services in religiousand spiritual communities but also identifiedsignificant barriers to the implementationof such services; for example, limited expertiseand resources. In reporting these results,Dosset and colleagues (59) emphasized thatpartnerships between mental health providersand faith-based communities may be a particularlyeffective strategy for meeting the mentalhealth service needs of populations that areunderserved by the mental health system, suchas persons with low incomes, ethnically diversecommunities, and recent immigrants. In oneattempt to include caregiver services within areligious congregation, Pickett-Schenk ( 60)conducted a church-based support programfor African-American families coping with themental illness of a family member. In a study oftwenty-three caregivers, participants reportedthat they were highly satisfied with the groupand perceived gains in knowledge and morale.In another vein, NAMI provides support tofaith-based communities that are attempting toaddress the needs of persons with serious mentalillness through projects such as the FaithCommunities Education Project and Faith Net(www.nami.org/faithnet).It is critical for mental health professionalsto appreciate the role of religion and spiritualityamong persons with mental illness and theircaregivers. Clinical interventions should includeroutine assessment of this area, and interventionsshould be appropriately tailored to buildon relevant religious and spiritual resources,while respecting the diversity of backgroundand beliefs. It is important for mental healthprofessionals to effectively collaborate withclergy and other religious professionals in providingservices to persons with serious mentalillness and their caregivers. Collaborative partnershipsbetween mental health professionalsand religious and spiritual communities ( 61)represent a powerful and culturally sensitiveresource for meeting the needs of family caregiversof persons with mental illness.4. MENTAL HEALTH CARE PROGRAMSINTEGRATING RELIGION/SPIRITUALITY4.1. An Overview of Past and RecentProgramsTh e first therapy group on spiritual issueswas started by Nancy Kehoe in 1981 in theDepartment of Psychiatry at Cambridge HealthAlliance and Harvard Medical School, Belmont,Massachusetts. (62) She felt the need to provideseriously mentally ill persons with an opportunityto explore religious and spiritual issues inrelation to their mental illness. At first, the ideaof having such a group generated anxiety, fear,and doubt among staff members. It brought outthe ambivalence that many mental health professionalshave about religious issues, an ambivalencereflected in Gallup poll findings. (63)In addition, Bergin and Jensen’s work (64) hashighlighted the marked difference between thereligious beliefs and practices of the generalpopulation and those of the mental health professionals.Staff training and instruction alleviatedsome staff concerns about Kehoe’s group.However, the long-term success of the grouphas been the strongest factor in staff acceptance.Group rules contributing to its success are