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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2013
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Massey University
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Abstract
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.
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Keywords
Mental health and religion, Mental health and spirituality