Missing pieces? : Considering religion and spirituality in mental health care : a dissertation presented to Massey University in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand

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There is a substantial body of evidence to show that religion and spirituality are important to mental health. Religious/spiritual individuals who utilise mental health services often express a preference for religion/spirituality (R/S) to be considered in their care and a growing number of studies have suggested that the consideration of R/S is important for client outcomes. However, a consistent rhetoric in the literature has been that R/S is largely neglected and minimised by mental health practitioners. It is unclear to what extent New Zealand mental health clients perceive that R/S is considered in their care. Furthermore, no research has uncovered factors that predict clients’ perceptions that R/S has been considered and their satisfaction with this. This dissertation helps to address these gaps through an international survey of religious/spiritual mental health clients, with a focus on the New Zealand portion of the sample. Hierarchical logistic regression was used to investigate the factors that predict discussion and consideration of R/S in mental health care and clients’ satisfaction with this. Results indicated that just under half of New Zealand participants had discussed R/S with their most recent mental health practitioner and perceived that R/S was satisfactorily considered in their care. It was also found that the likelihood of clients discussing R/S was strengthened by the similarity of practitioners’ religious/spiritual beliefs to their clients’ (client-practitioner matching), more positive client expectations, greater importance placed on R/S considerations by clients, seeing a psychotherapist as opposed to a psychiatrist, and seeing a practitioner in the United States as opposed to New Zealand or England. The extent that R/S was subsequently perceived by clients to have been considered in their care was influenced by all but the last two of these factors. Clients’ satisfaction with the way R/S was considered did not differ between unmatched and matched clients, but was lower for clients who were uncertain regarding similarity of their practitioners’ religious/spiritual beliefs. Clients’ perceptions that their practitioner understood the relevance of R/S to their recovery predicted a greater degree of satisfaction. Satisfaction was affected when clients’ expectations were not met. Findings suggested the need for practitioners to strive to become more aware of clients’ religious/spiritual beliefs and related concerns, to understand their relevance, and to take collaborative action on the basis of this knowledge. Recommendations for practice are discussed, as are recommendations for clients and future research.
Mental health and religion, Mental health and spirituality