Spiritual Care and

Behavioral Health

Sr. Dorothy Thum, RSM, RDLD, FACHESenior V.P., Mission and Values Integration

Mercy, Toledo, Ohio

Amy D. Marcum, MA, BCCSpiritual Care, Director

St. Rita’s Health Partners, Lima, Ohio

November 13, 2013

Mission Statement

Mission

Catholic Health Partners extends the healing ministry of Jesus by improving the health of our communities with emphasis on people

who are poor and under-served.

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Catholic Health Partners

• Located in Ohio and Kentucky

• 33,000 employees

• 24 hospitals – 8 of the hospitals have a behavioral unit

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Goals

• Describe a health system approach to spiritual care for behavioral health patients

• Identify spiritual care standards

• Describe the role of the chaplain in behavioral health

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Definition of mental illness

“Maladaptive responses to stressors from the internal and external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational, or physical functioning.”

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Behavioral Health Mental Illness: History

•Until mid to late 20th century, treatments for mental illness were primarily for behavioral control, rather than to cure an illness.

•Today focus is on behaviors that promote wellness and stabilization

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Behavioral Health:– Most vulnerable persons:• Socially isolated• Financially limited• Broken relationships• Faith community misunderstandings

– Two types• Temporarily struggling• Chronically ill

– Work with both groups of patients• In behavioral unit and other medical units

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Catholic Health Partners Goal

Catholic Health Partners Goal for Behavioral Health

– Help people live at their optimal level

– Potential for everyone to be a wounded healer

– Look at healing wholistically: body, mind, spirit

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Definition of Spirituality: life principle that pervades a person’s entire being and generates a capacity for transcendent values, integrates the biological & psychosocial

– Innate to everyone• Get in touch with our own spirituality• Wired for it • Different from religion

– Focus on purpose and meaning in our lives– Sense of unconditional love • You are the star in someone’s eye • Experience forgiveness of ourselves and others

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Catholic Health Partners System-Wide Behavioral Health Objectives

• Spirituality is an integral part of each person’s well-being• Multidisciplinary subgroup formed to address spiritual care.

Subgroup included chaplains, nurses, mission, unit managers, social workers, psychiatrist and CPE supervisor

1. Identify what is currently being done in each unit2. Identify best practices for inpatient care and aftercare3. Recommend future actions to address spiritual care 4. Establish standards for spiritual care for behavioral services

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What isn’t necessary or particularly helpful for chaplains …

• Knowing the details of the diagnosis or the reason the person was admitted

• Knowing what medications the person is taking

• Advising, directing, evaluating, judging – not counselor

• Role to pay attention to spiritual dimension • Speak to healthcare team about spiritual dimension

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In understanding the suffering of patients, we start to share the humanity of our clients. It is through this sharing of their humanity that healing is initiated.

Nolan, 1997

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Standards for Spiritual Care Services

1. The Spiritual Care department shall commit to provide chaplain services to behavioral services patients. • Faith sharing groups at least once a week

• Schedule is flexible to meet patient needs

• Worship service once per week• Individual consults • Provide communion service • Make appropriate prayer materials available

Example: Hospital behavioral manager funded a chaplain in her budget 13

Standards for Spiritual Care Services

2. Staffing considerations need to consider special skill set needed to serve behavioral services.• Chaplain is an integral member of healthcare team• Spiritual care specialist not therapist • Knowledge of behavioral health

Example: formation of chaplain in CPE program included didactics, and group experience

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Standards for Spiritual Care Services

3. Each Spiritual Care department shall require, and assist in providing for the continuing education of chaplains specifically targeted for behavioral services patients. – Behavioral Health Education: Care of the Wounded Soul – Crisis Prevention Training and de-escalating skills– Ongoing education modules developed for Intranet

portal– Training in leading faith sharing groups

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Standards for Spiritual Care Services

4. Each Spiritual Care department shall use assessment and screening tools to determine the spiritual needs of the patients and educate staff in the use of the tools. – Initial spiritual care screening: Social Workers– Educate health care team to listen for spiritual struggles– Individual consults: spiritual assessment completed by

chaplain

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Standards for Spiritual Care Services

5. Each Spiritual Care department shall demonstrate ongoing accountability – Patient Satisfaction Scores – On-going Collaboration with health care team– Electronic Health Record

• Document reason for consult • Chaplain documentation is helpful to the team

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Standards for Spiritual Care Services

6. Spiritual Care Services shall be provided across the continuum of care. • Discharge Planning

• Collaboration with faith community/and other community resources

• Outpatient model • Address needs of Cancer Center patients

• Patient Centered Medical Home • Include spiritual screening as component of care coordination

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Role of the Chaplain in Behavioral Health

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Ethical and Religious Directives for Catholic Health Services

“In accord with its mission, Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination…In particular, the person with mental or physical disabilities, regardless of the cause or severity, must be treated as a unique person of incomparable worth.” (1:3)

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“Incomparable Worth”

• Over identify with their illness and often struggle to see themselves with dignity and self worth

• Misconceptions with faith/belief: moral weakness, lack of faith, personal failure, etc.

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Sacred Ground

“Jesus’ healing mission went further than caring only for physical affliction. He touched people at the deepest level of their existence; he sought their physical, mental and spiritual healing (John 6:35, 11:25-27). He “came so that they might have life and have it more abundantly” (John 10:10).

ERD’s General Introduction

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Role of the Chaplain in Behavioral Health

• Helping to find meaning and purpose• Uncovering & encouraging spiritual practices• Listening....– Struggles/Hopes– “Where is God in all of this for you?”– “Where do you experience peace?”

• Helping to find hope• Promoting dignity and self worth

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Specialized Ministry

• Recognition of special knowledge/skills/needs• Own biases and abilities• Potential for harm, vulnerabilities – clinical

training • Education and training• Chaplains have special skills to offer • Potential for healing/contributions to the

overall treatment

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Spirituality Groups

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The Curative Factors (13)(Irwin Yalom & Molyn Lesczcz)

Curative Factors Definition

Universality Members recognize that other members share similar feelings, thoughts and problems

Altruism Members gain a boost to self esteem through extending help to other group members

Instillation of hope

Members encouraged by other members’ success – develop optimism/motivation for their own improvement

Cohesiveness Feelings of trust, belonging and togetherness experienced by the group members

Existential factors Accepting responsibility for authorship of life

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Listening for….

Spiritual Struggles

Spiritual Hopes

Spiritual Practices

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Spiritual Struggles

• Feeling life lacks meaning/purpose• God’s silence in the midst of crisis/suffering• Guilt—distance from God• Image of God as punitive/angry• Shame—feeling unworthy• Values• Isolated/alienated• “I used to go to church but stopped going”

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Spiritual Struggles

• Importance to express thoughts and feelings

• Validate and normalize

• Reframe struggle as a time of potential personal growth and change.

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Spiritual Hopes and Awe Moments

• I will get through this…

• Experiences of…– Peace– Gratitude– Forgiveness– Grace– Direction/purpose in life– Compassion – Connection to self and others– Hope– Joy

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Spiritual Hopes & Awe Moments

• Sharing in light of Crisis/illness

• Remembering

• Validate and Affirm

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Behavioral Health and Spirituality

“I started having anxiety and panic attacks, so I stopped doing meaningful volunteering… I would like to try to do this again.”

“When I was in the hospital, going through a very difficult time, I felt a warm, loving presence, and I knew that God was with me.”

“I had not been to church in years, and I received communion when the volunteer came around, at that moment I felt a deep peace that has stayed with me. I started praying again.”

“The overhead prayer made me feel safe. I felt I would be treated with care and respect.”

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What Spiritual Practices Might Help?

• Faith sharing, exploring• Spiritual direction• Reading• Journaling• Identifying spiritual hope• Music• Time with nature• Prayer/Meditation• Reading sacred scripture• Caring gestures

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Specific Issues

• Confidentiality: Checking with health care team to understand specific policies for unit

• Boundaries: Attachment, use of touch • Documentation/Communication: Chaplain

may learn valuable information from the patient to share with the team - effective documentation and collaboration with the team

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Quest for the Living GodMapping Frontiers in the Theology of God

“On different continents, under pressure from historical events and social conditions, people of faith have glimpsed the living God in fresh ways… Christian faith does not believe in a new God but, finding itself in new situations, seeks the presence of God there.”

~Elizabeth Johnson

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References

• Kehoe, Nancy; Wrestling with Our Inner Angels: Faith, Mental Illness, and the Journey to Wholeness. Jossey-Bass; San Francisco, CA. 2009.

• Lowery, Michele; Chapter 21“Behavioral Health”; Professional, Spiritual & Pastoral Care: A Practical Clergy & Chaplain Handbook. Edited by Rabbi Stephen B. Roberts. Skylight Paths Publishing, Woodstock, Vermont. 2012.

• NAMI National Alliance on Mental Illness: Faithnet. www.nami.org/faithnet . 2013.

• Pargament, Kenneth; Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred. The Guilord Press; New York. 2007.

• Pathways to Promise: Ministry and Mental Illness www.pathways2promise.org . 1999 – 2013.

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