Spiritual care in mental health

In the face of the irrationality and uncertainty of the world around us, it is very helpful to articulate a system of beliefs and affections capable of arousing a subjective experience of peace and confidence.

From the simplest to the most complex explanations, from the most rational to the most experiential, more or less intimate or shared, narratives have the function of providing coherence and, therefore, meaning to human existence.

This need to seek to understand what is happening, to frame it within experience and give it meaning intensifies in moments of high suffering, situations in which it is not difficult to observe an intensification of the spiritual or religious area in previously versed people or even its initial appearance in less inclined people.

While there is no single, universally agreed-upon definition of spirituality and religiosity , spirituality is related to one's personal beliefs, meanings, purpose, and values in life, and is intrinsically linked to subjective quality of life. Religion is often conceived as a common institutional aspect of spirituality, with specific individual and social rituals.

The relationship between spirituality and mental health

Spirituality and religiosity play a prominent role in all aspects of life, especially those related to health and well-being . Spirituality is a broad term that encompasses everything from the essentially human dimension of personality to its cultural and religious manifestations.

More than half of the people served by mental health services have spiritual or religious beliefs that they consider important to help them cope with mental illness, but they often feel unable to talk about such concerns with their caregivers.

When a mental health crisis occurs, the healthcare system's mission is to treat its nature using a biopsychosocial approach: pharmacological, psychological, rehabilitative, and social interventions. To offer a holistic approach , spiritual and religious care should be included, provided by healthcare professionals specifically trained to understand and interpret people's narratives, especially in situations of mental crisis, and help them improve their quality of life.

It is worth noting that a relationship exists between spirituality and religiosity and mental health, a connection well-established in the literature, particularly regarding depressive disorders (Smith et al., 2003; Balbuena et al., 2013), suicide attempts, and completed suicides (Lawrence et al., 2016). Individuals with more developed spiritual or religious dimensions tend to experience less depression, have a higher perceived quality of life, and make fewer suicide attempts and commit suicides. This protective factor has also been observed in substance use disorders (Walton-Moss et al., 2013), where it has been shown to facilitate detoxification and withdrawal from substances. Studies related to other disorders such as bipolar disorder (Stroppa & Moreira-Almeida, 2013; Stroppa et al., 2018), obsessive-compulsive disorder (Buchholz, 2019), and post-traumatic stress disorder (Prieto-Ursúa & Jódar, 2020) provide less consistent evidence but yield promising results. Thus, spirituality directly impacts clinical status , has implications for the prevalence of certain disorders (especially depression and substance abuse), affects treatment (adherence, search for alternative therapies), and impacts health outcomes (better recovery and fewer suicide attempts), as well as the quality of life of the affected individual and their close circle (Koenig, 2009).

Considering that the totality of a human being includes their physical, emotional, social and spiritual dimensions; the fact of not including spirituality in the care process negatively impacts the health of the person being cared for and delays their recovery (Seyringer et al., 2007).

Spirituality and religiosity have the capacity to promote or harm mental health, depending on whether they represent a positive or negative religious coping mechanism, respectively. A person's attitude toward their process and treatment is crucial; therefore, spiritual and religious considerations have clinical repercussions. This implies the need to understand people's spiritual needs and capacities and to incorporate them into the recovery process (Weber & Pargament, 2014).

Healthcare teams working in the field of mental health must take all these factors into account.

In light of this evidence, many national and international professional societies have recognized that spiritual care should be integrated into comprehensive healthcare. The World Health Organization (WHO) and the World Psychiatric Association (WPA) have recognized spirituality as a dimension of quality of life and recommend including the spiritual dimension in mental health assessment and treatment. In several countries, such as Brazil, India, South Africa, the United Kingdom, and the United States, specific sections on spirituality and religiosity have been created within professional associations. The primary task is to identify beliefs and values in order to address them.

The Religion, Spirituality, and Psychiatry Section of the World Psychiatric Association (WPA) has undertaken a process aimed at achieving international agreement on the role of psychiatry in spirituality and religion. While no concrete consensus has been reached, the need for an appropriate exploration of how spirituality and religion manifest in individuals receiving mental health care has been accepted.

In summary, spiritual life is an integral part of every human being and refers to the meaning of life, values, and philosophical and religious beliefs. Spirituality and religiosity should be considered as another sphere within the holistic approach to mental health disorders. New advances in research and the evaluation of clinical outcomes will help to standardize and systematize spiritual and religious intervention in routine clinical practice.