Mental Health

Free for all?

Want to work with your staff to get better value for money and improve your patients’ experience? Unleash their spirituality, says Richard Harlow

In spite of these times of financial austerity, Sussex Partnership NHS Foundation Trust recently honoured its commitment to sponsor its third conference exploring how spirituality, art, massage, story telling, meditation and mindfulness can help your mental health. The conference included presentations by practitioners of mindfulness, Tai Chi, meditation, aromatherapy, art therapy, Qi-Gong, and traditional religious practices, alongside psychiatrists, social workers and nurses.

Some years ago this collection of disparate disciplines would have been scarcely imaginable in the UK. However, recent research has led to spiritual and religious therapies and coping strategies emerging to take their place alongside conventional ways of helping people to recover from mental distress.

Mindfulness based approaches now have NICE recommendation for treatment of various disorders. The techniques of mindfulness have been developed within Theravada Buddhism over 2500 years. They aim to increase the ability of the individual to achieve enlightenment, specifically by practicing detachment from thoughts and feelings. ‘Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgementally.’ 1 Specific exercises that are practiced across the Buddhist world have been shown to help with chronic pain, addictions, anxiety and depression.

The process of achieving NICE recommendation requires huge resources of money and time to build up the clinical evidence base. In the meantime, huge numbers of people will continue to use complementary and alternative therapies and practice religious rituals as part of their personal strategy to manage life’s stresses and illnesses. It is possible that they are all simply enjoying the placebo effect. But it is equally possible that these activities do enhance well-being and improve mental and physical health.

Sussex Partnership continues to commission new therapies in line with best practice commissioning. However, we have also attempted to encourage innovation and research around this area through an open approach to spirituality.

In 2008, the trust produced a spirituality strategy which delineated spirituality in broad terms. “This strategy uses the word spirit to describe the inner life of human beings – their emotions, intuitions, values, desires and creativity. It recognises that some would not choose this word to describe their inner life, which may also be called the self, the unconscious etc. It suggests that how people go about nurturing, feeding and channelling that ‘spirit’, is their spirituality.”

The strategy went on to call for research and innovation around spirituality: “We will support research in the area of spirituality with the same rigour as in other disciplines. Whilst maintaining the safety of our service users and staff, we will encourage experimentation.”

It is still early days to assess the validity of this approach but feedback so far suggests that whilst some units have paid for external facilitators to run tai chi or mindfulness groups, the units which have gained most have been those who have encouraged existing staff to develop an interest in one of these spiritual or complementary therapies and make it available to service users.

In Chichester, a whole ward team introduced morning and evening meditation sessions onto their acute admission ward. Feedback from patients was positive, and the ward saw incidents of violence drop considerably. 2

In another hospital for adults from 18 to 80 years of age, the activities co-ordinator, a trained nurse, offers tai chi and mindfulness groups alongside exercise, emotion management and pottery.

A staff nurse from a rehabilitation unit now offers aromatherapy to clients. A Buddhist chaplain offers meditation sessions. Occupational therapists run singing groups. And more and more psychologists are training in mindfulness techniques.

The concept that unifies these different activities is spirituality. Every one of the activities that is offered originated in a religious tradition. Today, they may have become largely separated from their original religious roots but they retain to a greater or lesser degree the belief that the real work occurs at a level beneath the physical/rational. To some people this will seem like religious cant but to others it makes obvious sense.

This ‘working at another level’ is what makes it hard for NHS organisations that are fixed on evidence to find the will or courage to fund them at least until a more substantial body of evidence is accumulated. The Sussex Partnership approach suggests that they may be provided by volunteers or members of staff who are paid to do something else. The nurses who run meditation sessions on their acute ward are still supervising and caring for their patients. Arguably they are doing it better than the nurse who is doing no such thing.

Professor John Swinton, author of the seminal book Spirituality and mental health 3, suggests that spirituality is not so much what we do but how we do it. It is a different way of looking and seeing. Spiritual care is care that connects people at a more profound level than ‘unspiritual’ care.

A recent book on psychiatry and spirituality, published by the Royal College of Psychiatrists 4, defined spirituality as ‘a distinctive, potentially creative and universal dimension of human experience arising both within the inner subjective awareness of individuals and communities, social groups and traditions.’

What both writers seem to be suggesting is that, although spirituality may be hard to define, we are missing a trick if we exclude or marginalise it. Spirituality is not the same as religion. Religious care is the job of chaplains. It revolves around the cultural and religious needs of those who adhere to a specific religion or belief. Spiritual care can (and should) be practised by people who do not claim to be religious (although religious people have less excuse for not practising it). Spiritual care happens when people connect at a deeper level. It is something that we have all experienced but strangely our mental health services often seem designed to guard against it rather than facilitate it.

The concept of ‘spiritual care’ may help to allay fears that allowing alternative therapies into mental health care invites a ‘free for all’ of mysticism and superstition. The potency and efficacy of these practices may be unproven as yet but what counts is that they facilitate a meaningful encounter between staff member and service user.

The staff nurse who offers aromatherapy to service users described the benefits as follows:

Aromatherapy treatments take place in a quiet location, allowing time for reflection on spiritual/personal matters.
Spirituality has been described as ‘linking the personal with the universal’. Clients sometimes see aromatherapy as a way of connecting with the natural world because only natural oils are used.
Because of the one to one time enjoyed with the therapist, service users feel safe, secure, and valued.
If the client wants to speak to the therapist during a massage/treatment, feelings and emotions can be expressed in a safe and supportive environment.
This open approach to spirituality has produced other positive results:

The small paid chaplaincy team is supplemented and supported by over 90 staff spirituality advocates from different disciplines and belief groups. They have volunteered to help teams to recognise and support patients’ spiritual and religious needs. The aim is that every ward and community team has at least one advocate.
Every in-patient unit now has a multi-faith room for prayer, reflection or reading. These were mostly equipped by charitable donations.
Volunteers from diverse local faith communities assist with chaplaincy and offer support to service users who are discharged from hospital.
And what about the negative results? Well, there are none. It really does seem as though the best things in life are free.

References:

Jon Kabat-Zinn, (2004): Wherever you go, there you are.

See Mental Health Practice (RCN publishing)(forthcoming) for a full description.

John Swinton (2001). Spirituality and mental health.

Ed. C Cook (2009). Psychiatry and Spirituality.

Rev Richard Harlow is a chaplain and multi faith and spiritual care team leader with Sussex Partnership NHS Foundation Trust.

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