Starting Points for Spiritually Sensitive Mental Health Practice and Assessment
Edward R.Candy, Ph.D.
The word psychotherapy literally means "healing for the soul." The Greek root of "psycho" refers to breath, spirit, soul, and mind. Many languages note this connection between mind, breath, and spirit. Mental health is not just the absence of symptoms that relate back to mental disorders and maladies as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It is a dynamic condition of well being and well doing characterized by a sense of centeredness, clarity of perception and thinking, personal integrity, and relational responsibility. From a social work perspective, mental health practice should address the whole person in the context of his or her relationships and environmental setting. From the perspective of spiritually sensitive social work, mental health practice makes explicit this mind/spirit connection by honoring the whole person in environment with special attention to the way people work out a sense of meaning, purpose, and morally fulfilling relationships with oneself, other people, the world, and the ultimate ground of being, however one may understand it (for example, in theistic, atheistic, agnostic, animistic or other ways). In general, spiritually sensitive social work practice is not about imposing or restricting any particular religious beliefs or practices. However, it is about honoring the diverse religious and nonreligious ways that people find meaning, resilience, strength, resources, and creative transformation, even in times of joy and despair, crisis and stability, illness and ease.
In social work and related health and mental health professions, the past sixteen years has witnessed an incredible shift from major neglect of spirituality to a tremendous amount of research, educational and practice innovations, and publication on this subject (e.g. Canda, et al., 1999). In these fields, it is becoming common to define spirituality as having to do with people’s search for a sense of meaning, purpose, morality, and responsible relationship in the context of their understanding of ultimate reality or the divine (Canda and Smith, 2001). Religion refers to institutional patterns of beliefs, values, and behaviors concerned with spirituality and shared by a group with traditions developed over time (Canda and Furman, 1999). Thus, spirituality may be expressed through religion, but it need not be.
Spirituality as a resource for people with mental distress and illness
In the United States, most people profess some type of religious belief and affiliation and consider them to be important for their daily life and well being. Everyone is working out a spiritual path, whether or not one uses words such as spirituality, religion, and faith. Especially for people who face crisis, distress, serious illness, and disability, issues of spirituality often come to the forefront. Although people may experience harmful effects from unsupportive or damaging behaviors in religious and nonreligious spiritual groups and beliefs, there are a tremendous amount of spiritual resources to support mental health and resilience. Given the prevalence of religious and nonreligious spiritual perspectives, the universal human quest for meaning, and the opportunities for strength and resilience in spirituality, it is crucial for mental health practitioners to attend to spirituality.
There are now hundreds of quantitative and qualitative empirical studies about links between religion, spirituality, and health. For example, quantitative (statistical) studies have shown that religious commitment and participation are commonly associated with positive results such as: lessening the likelihood of suicide and suicidal impulses; enhancing self-esteem; lessening the likelihood of illicit drug use; lessening the likelihood of alcohol abuse; lessening the likelihood of juvenile delinquency; increasing the likelihood of marital satisfaction and stability; lessening the likelihood and severity of depression; and decreasing the severity of psychological distress (Larson & Larson, 1994). In interviews with 40 adults who had severe mental illness, Sullivan (1992), learned that some people associated positive effects with social support experienced in religious communities; a sense of meaning and self-understanding, including dealing with a mental illness, gained from religious beliefs and spiritual perspective; positive feelings in response to prayer and worship; a sense of support and love from God or a Higher Spiritual Power; and spiritual perspective on ways to cope with and transcend a mental disability. These studies reinforce the importance of building on the strengths of people’s inner spiritual practices (such as meditation, prayer, inspirational reading, and dream reflection) and resources (such as sense of loving relationship with the divine, personal wisdom, and spiritual experiences) as well as their outer spiritual support systems, such as religious communities, culturally based wisdom traditions, religious leaders and traditional healers, spiritual mentors, and wise relatives and friends.
Assessment of spiritual resources in a mental health context
In order to tap spiritual resources, helpers first need to know what they are for the mental health service consumer. One simple way to begin is to ask the person during initial assessment whether spirituality, religion, or faith are important to her or him in any way; and if so, would the person like to include them in the helping process. Then the consumer can describe what they mean to him or her and give examples. This can easily be done in the context of a strengths assessment by including spirituality as one domain of life to consider. Any such question should be open-ended and should allow the person to indicate whether spirituality is relevant, what words are appropriate to describe this aspect of life, and what ways, if any, spirituality should be addressed. In keeping with the NASW Code of Ethics and the principle of client self-determination, no particular ideological or religious agenda should be imposed or insinuated. On the other hand, social workers and other mental health professionals should not restrict or denigrate any particular religious or non-religious spiritual perspectives of clients.
Sometimes mental health professionals are reluctant to address religious and spiritual issues because they are worried about exacerbating delusions or hallucinations with religious content. This raises another more complex assessment issue: How to distinguish between psychopathology and spiritual experiences that may appear strange or problematic? Transpersonal theory in psychology and social work provides some helpful distinctions (Canda and Smith, 2001; Nelson, 1994). Assessment can explore distinctions between common qualities of some mental disorders and spiritual experiences and crises that are sometimes mistaken for psychopathology, such as: symptoms generated by organic disease (e.g. a brain lesion) versus absence of organic pathology; chronic long term debilitation versus short term incapacitation; subjective sense of meaningless chaos versus meaningful life disruption and transformation; disability versus intensified ability; incoherent speech versus poetry, metaphor and paradox; religious delusions versus spiritual inspirations; ego inflation versus ego transcendence and genuine humility; involuntary dissociation versus spiritual trance; hallucinations versus mystical visions and insights. This is complicated because spiritual crises and experiences can intersect with mental illness symptoms, and, in a more human way of putting it, people with serious mental distress and mental illness (and all of us are some point) may find some of the strongest insights, strategies, and environmental supports for dealing with the challenges through spiritual experiences and support groups. Further, some people endure periods of intense spiritual suffering and mental distress as part of the spiritual journey.
The DSM-IV-TR offers some cautions and help in this regard. DSM-IV introduced a V-Code, V62.89 Religious or Spiritual Problem, to be used when religious or spiritual issues are the focus of clinical attention but are not part of a mental disorder and may or may not be related to one (p. 741). Several sections of the DSM-IV-TR include cautions to complete diagnosis in the context of the person’s larger life context, culture, and religion, so that inappropriate ethnocentric or religiously biased judgments are not made. Further, Appendix B (Criteria Sets and Axes Provided for Further Study) includes Dissociative Trance Disorder and Appendix I (Outline for Cultural Formulation and Glossary of Culture-Bound Syndromes) includes guidelines for cross-cultural assessment, with many examples of religiously related types of distress or mental disorder. In general, the authors of successive editions of the DSM have been moving toward approaches to assessment that are more contextual, culturally aware, religiously informed, and based on international research.
There is a danger of drifting into a technocratic, expert-driven approach to studying, evaluating, and ‘doing to’ the client, while consider implications of diagnosis and assessment. That is far from what spiritually sensitive practice is about. Canda and Furman (1999) provided a comprehensive framework for spiritually sensitive social work practice. It can be summarized by going back to the link between spirit, mind, and breath mentioned in the beginning of this essay. Mental health practice should literally be a conspiracy between client and worker. The roots of the word conspiracy mean "to breathe together" or "to be together in spirit." The helping process is most powerful and satisfying when worker and client join in rapport and empathy, breathe together, get centered together, and work creatively together to enlist the highest, deepest, and widest resources for resilience and recovery. When we engage these resources, we can enjoy well being and health in a profound way even while we respond to the challenges of mental distress, illness, and disability.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Washington, DC: American Psychiatric Association.
Canda, E. R. & Furman, L. D. (1999). Spiritual diversity in social work practice: The heart of helping. New York: Free Press.
Canda, E. R., Nakashima, M, Burgess, V. & Russel, R. (1999). Spiritual diversity and social work: A comprehensive bibliography with annotations. Alexandria, VA: Council on Social Work Education.
Canda, E. R. & Smith, E. (Eds.) (2001). Transpersonal perspectives on spirituality in social work. Hazelton, PA: Haworth Press.
Larson, D. B. & Larson, S. S. (1994). The forgotten factor in physical and mental health: What does the research show? An independent study seminar. MD: National Institute for Healthcare Research.
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Psychiatric Social Work, a specialised branch of Social work, which concerns with theoretical as well as clinical work and the knowledge of Psychiatry-which primarily deals with problems of the mind and associated disorders. The essential purpose of Psychiatric Social Work is to help the people with problems of the mind and/or with behavior problems or we can say precisely the problems of mind and brain and their solutions.
It has grown as the result of the need felt and its realization for people with mental or emotionally disturb could be helped more effectively by understanding their social and/or environmental factors responsible for the problems of mind and brain in their management. Professionally trained Psychiatric Social Worker is the qualified member of psychiatric team treating comprehensively the patients with psychiatric disorders or behavioral problems. These professionals utilize social work principle, techniques for the purpose of diagnosis, patient care and treatment and finally plan the rehabilitation of the patients in the family and in the community. Besides they also provide other services to mentally challenged people like therapeutic treatment, social rehabilitation, crisis intervention or outreach services in the community. A psychiatric Social Worker (PSW) works in close association with psychiatrist, child guidance clinics, social services department as the team in the psychiatric hospital; and they also extend their work in families and communities for mentally challenged people. The role and responsibilities of the psychiatric social worker is fast increasing never before and he is no longer confine to the hospital or psychiatric clinic, but they are accepting the new challenges as the mental health hygienist in various public activities and helping the preventive mental schemes of the government for the people.
Mental health professional includes various professional includes all practitioner who offers their services for improving an individual's mental health or to treat mental illness include psychiatrists, Clinical/Psychiatric social workers, clinical psychologists, , psychiatric nurses, mental health counsellors, professional counsellors, pharmacists, as well as many other professionals like medical anthropologists. These professionals often treat comprehensively the psychiatric illnesses, disorders, conditions and other issues, however, their scope of practice varies cases to case.
Role of Psychiatric Social Worker: What do they do?
A psychiatric social worker helps the mental health professional-psychiatrist and families of patients in a similar way as counsellors and psychologists do. Their main job is to assess patients and develop patients’ specific plans of care. They also provide therapy or counselling services to patients, as well as help family members to deal with patients with mental illness in the family. Psychiatric social workers generally interviews with admitted patients, members of their families, agency staff and others, and through collateral investigations, the range of services needed by residents and their families; plans and develops a social plan of care for each resident and his/her family which may include direct counselling, treatment provided by other agency support services and/or referral to other agencies; conducts individual and group therapy sessions; instructs and directs other agency support staff in therapeutic techniques; arranges for services from referral agencies; reviews resident and family social situations as necessary and modifies social plan of care as indicated; explains the scope of services to the resident and family as is appropriate; provides direct crisis intervention services when required; maintains case records and prepares reports; participates in development of multidisciplinary plans of care and their reviews; facilitates development of interdisciplinary active treatment plans, writes monthly summaries of progress toward active treatment goals, arranges interdisciplinary reviews of active treatment plan periodically.
Their role includes to explain the treatment plans to patients and their families, maintaining patient records, preparing reports, monitoring progress, and reviews of psychosocial treatment plans. Psychiatric social workers may also offer individual and group therapy sessions to patients, instruct other mental health staff in therapeutic techniques, and provide crisis interventions, arranging the services from referral agencies and to help patients send back to the community.
There is wider demand of Psychiatric Social Worker (PSW) can work as Case Manager, Researcher, Rehabilitator, in mental health institutions, in community mental health programme, as a member of multidisciplinary team. A psychiatric social worker helps people who struggling with mental health problem and cope with them. A PSW provides counselling services to patients and family members and to helps them to obtain both financial and medical services. He or she might also investigate homelessness and job placement options for recovering patients.
The PSW is appointed for most of the cases, a mentally ill patient in prison or in psychiatric hospital to help him or her deal with psychiatric issues. Some people voluntarily seek help from social workers to learn how they can obtain financial, medical, or personal assistance. Many licensed social workers provide interpersonal counselling services, helping patients, family members, and helping the caregivers to learn more about mental disorders and the best ways to cope with them.
Another main goal of most psychiatric social workers is to help patients to live and work in society with the highest degree of self dependent. These professional also arranges the special living facilities for inpatient in hospitals, halfway houses/ home, or assist in home living facilities. He or she may also contact potential employers to find out about job possibilities and explain a client's situation. In addition, a psychiatric social worker helps patients and their families obtain services and financial assistance from non-profit community organizations or other government organisations.
As mentioned before, a psychiatric social worker can help with future employment and housing needs of the patient. The way how this is done is by liaisoning with potential employers and landlords and explains to them the needs of the such person. Social workers can also help the patients get financial assistance from various government organizations, non- profit organizations and NGO’s. In order to become a Psychiatric social worker there are some minimum qualifications needed to get certified.
Clinical and Non Clinical Role of Psychiatric Social Worker:
They work in close association with Clinical professionals and Non Clinical and they do both kind of the work- clinical and non clinical.
The Clinical Psychiatric Social Work may include one or more of the following:
- Reception- Accepting the patient
- Diagnosis / Analysis of Patient
- Rehabilitation of Patient
- Pre- convalescent
- Pre-Parole Services
- Follow- Up : after care
- Case History
- Case Work with Patient
- Case Work with Relative
- Orientation of the Staff
- Advocating for care
- Protecting the vulnerable
- Providing forensic practice functions
- Increasing social well-being
- Providing case management for complex and high-risk cases
- Providing clinical supervision or direction of clinical programs
- Providing psychosocial treatment
Whereas the non clinical work may include the following:
- Promotion of Mental Health
- Conducting Workshop
- Case Identification
- Providing Referral Services
- Providing Recreational Therapies
- Program Administration
- Training for Health Volunteer
- Mental Health Awareness Camp
- Program planning and development
- Providing education and resources
- Administration of community services or programs
- Assessment of client needs for macro community programs or services
- Coordination and/or evaluation of service delivery
- Advocacy on behalf of persons or groups with unmet service needs
- Analysis and development of social welfare policy
- Organizational analysis
- Provision of training about community needs and problems
- Human Right of Psychiatric Patients
Who can become Psychiatric Social Worker?
In India, any person who has the regular post graduate degree in Social work with Medical and Psychiatric specialization; are eligible for the M.Phil or Ph.D in Psychiatric Social Work. The minimum requirement for psychiatric social workers either M.Phil or Ph.D in Psychiatric Social Work as a full time residential clinical programme from recognised Institute. However the psychiatric social work aspirants often choose to major in medical and psychiatric social work during their post graduation.
In other countries, fresh psychiatric social work professional, besides the M.Phil./PhD in PSW, must pass a written examination to practice the psychiatric social work and they are awarded the license to practice it independently. Licensing tests are designed to ensure that a professional practice the psychiatric social worker fully understands the fundamentals requirements of his job, legal matters-which varies country to country, and the importance of confidential practices and professional ethics.
There are some of the Premier Institutes in India offering the highly specialized Research Degree (M.Phil or PhD) programme in Psychiatric Social Work:
- National Institute of Mental Health and Neurological Sciences (NIMHANS), Hosur Road Bangalore, Karnataka.
- Ranchi Institute of Neuro- Psychiatry and Allied Sciences (RINPAS), Government of Jharkhand Kanke, Ranchi, Jharkhand.
- Central Institute of Psychiatry (CIP), Government of India, Kanke, Ranchi, Jharkhand.
- Pt. B.D. Sharma University of Health Sciences, Rohtak. Harayana.
- Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Sonitpur, Tezpur, Assam.
Besides these, there are many other Institutes in Delhi, Amritsar, Agra, Gwalior and Kolkata are planning to initiate the training programme leading to M.Phil in Psychiatric Social Work.
Psychiatric Social Work: Skills and knowledge imparted A professional PSW is well equipped with the skills imparted during their training the knowledge of generic social work methods and principles; various interviewing techniques, psychiatric assessment- principles and evaluation methods; knowledge of natural human growth and development of behaviour; knowledge of mental health treatment modalities used in individual or in group and for family therapy; knowledge of health and welfare measures and the ways these resources may be utilized; knowledge of programs, planning and techniques; ability to write the medical case history and mental status examination; knowledge about classification of mental and behaviour disorder (i.e. Personality Disorder, Psychoactive Substance use Disorders, Schizophrenia, Mood Affective Disorders, Neurotic Stress Related and Somatoform Disorders, Post Traumatic Stress Disorder etc.) according to ICD -10 & DSM-IV and their diagnostic criteria, Knowledge of psychopathology (illusions, hallucination, delusion, Neologisms, Perseveration and circumstantiality, etc. ) knowledge