Spirituality and Religion Spirituality and Religion in Psychiatry Residency in Psychiatry Residency

ProgramsPrograms

M . Jafferany, MDM . Jafferany, MDG-2 Resident G-2 Resident

Hennepin-Regions Psychiatry Hennepin-Regions Psychiatry ProgramProgram

INTRODUCTIONINTRODUCTION

►The relationship between spirituality The relationship between spirituality and medicine has been the focus of and medicine has been the focus of considerable interest in recent years.considerable interest in recent years.

►Studies suggest that many patients Studies suggest that many patients believe that spirituality plays an believe that spirituality plays an important role in their lives and important role in their lives and positive correlation between patient positive correlation between patient and spirituality or religious and spirituality or religious commitment and health outcome.commitment and health outcome.

Spirituality and PsychiatrySpirituality and Psychiatry

►Over the last two decades, mental Over the last two decades, mental health professionals have recognized health professionals have recognized the importance of religion in the lives the importance of religion in the lives of many people in US.of many people in US.

► Incorporation of patient’s spirituality Incorporation of patient’s spirituality into mental health assessment and into mental health assessment and treatment plans is gaining momentum.treatment plans is gaining momentum.

Patients vs. ProvidersPatients vs. Providers

►A clear disparity exists between A clear disparity exists between religiosity of general population and religiosity of general population and mental health professionals.mental health professionals.

►There is a growing public interest in There is a growing public interest in incorporating spirituality and incorporating spirituality and religiosity in health care delivery.religiosity in health care delivery.

Gallup PollsGallup Polls

► A Gallup poll survey in 1996 found that A Gallup poll survey in 1996 found that 96%96% of American believe in God and of American believe in God and 21%21% of of psychiatrists and psychiatrists and 28%28% of clinical of clinical psychologists are atheist or agnostic.psychologists are atheist or agnostic.

► Another survey in 1990 found that Another survey in 1990 found that 72%72% of of Americans agree that Americans agree that “My whole approach “My whole approach to life is based on my religion”,to life is based on my religion”, while only while only 39%39% of psychiatrists and of psychiatrists and 33%33% of clinical of clinical psychologists accepted this statement.psychologists accepted this statement.

Gallup GH. Religion in America 1996 Princeton NJ. The gallop organization 1996.Bergin Ae, Jensen JP. Religiosity of psychotherapists: a national survey. Psychotherapy. 1990. 27:3-7

Beliefs and Attitude of Beliefs and Attitude of Inpatients about SpiritualityInpatients about Spirituality

► 203203 family practice adult inpatients at two family practice adult inpatients at two hospitals were interviewed regarding their hospitals were interviewed regarding their views on the relationship between religion views on the relationship between religion and health. and health.

► 94%94% of inpatients believe spiritual health to of inpatients believe spiritual health to be as important as physical well being.be as important as physical well being.

► 77%77% wanted spiritual issues to be wanted spiritual issues to be considered in their careconsidered in their care

► 68% 68% reported no discussion of their religious reported no discussion of their religious beliefs by physicians.beliefs by physicians.

King DE , Bushwic B. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract 1994: 39:349-52

Spiritual NeedsSpiritual Needs

►A survey comparing the spiritual needs A survey comparing the spiritual needs of of 51 psychiatric inpatients51 psychiatric inpatients with those with those of 50 medical inpatients reported that of 50 medical inpatients reported that 80%80% of psychiatric patients and of psychiatric patients and 88%88% of of medical inpatients expressed the need medical inpatients expressed the need of for prayer.of for prayer.

► In addition, In addition, 65%65% of psychiatric patients of psychiatric patients and and 66%66% of medical patients of medical patients expressed a need for a visit from a expressed a need for a visit from a chaplain to pray with them.chaplain to pray with them.

Fitchett G, Burton LA, Savin AB The religious needs and resources of psychiatric patients. J Ner Ment Dis 1997; 185:320-6

Debate continuesDebate continues

►Debate continues regarding the optimal Debate continues regarding the optimal ways of addressing issues related to ways of addressing issues related to spirituality and religion.spirituality and religion.

► It is well known now that patient’s It is well known now that patient’s belief systembelief system plays a key role in patient plays a key role in patient development and remain a powerful development and remain a powerful influence on responses to current influence on responses to current illness, treatment and life demands.illness, treatment and life demands.

►Different schools of thoughtsDifferent schools of thoughts

ProponentsProponents

►They point to research findings that They point to research findings that support a positive relationship support a positive relationship between spirituality and health.between spirituality and health.

►Clinicians take a spiritual history Clinicians take a spiritual history during the assessment process and during the assessment process and remain open to discussing spiritual remain open to discussing spiritual issues during the course of treatment.issues during the course of treatment.

Barnes LL, Plotnikoff J, Fox K, Pendleton S. Spirituality, religion and pediatrics: interesting worlds of healing. Pediatrics. 2000; 106(4):899-908

OpponentsOpponents

►They argue that scientific evidence for They argue that scientific evidence for an association between spirituality and an association between spirituality and health status is lacking.health status is lacking.

►They concern about several ethical They concern about several ethical issues regarding physician issues regarding physician involvement in a patient’s religious or involvement in a patient’s religious or spiritual affairsspiritual affairs

Sloan RP, Bagiella E, Powell T. Religion Spirituality and Medicine. Lancet 1999; 353:664-67

H O P E modelH O P E model

►HOPE questionnaire was developed as HOPE questionnaire was developed as a teaching tool to help medical a teaching tool to help medical students, residents and practicing students, residents and practicing physicians, begin the process of physicians, begin the process of incorporating spiritual assessment into incorporating spiritual assessment into medical interview.medical interview.

► It covers the basic areas of inquiry for It covers the basic areas of inquiry for physicians to use in formal spiritual physicians to use in formal spiritual assessments.assessments.Anandarajah G, Hight E. Spirituality and medica practice: using the HOPE question as a practical tool for spiritual assessment. Am Fam Physician. 2001. 63(1):81-9

H O P E QuestionnaireH O P E Questionnaire

►HH- Sources of Hope, comfort, meaning, - Sources of Hope, comfort, meaning, strengths, peace, love, connectionstrengths, peace, love, connection

►OO- Organized religion- Organized religion►PP- Personal spirituality and Practices- Personal spirituality and Practices►EE- Effects on medical care and end of - Effects on medical care and end of

life issueslife issues

A P AA P A

►APA has recognized that psychiatrists APA has recognized that psychiatrists require basic understanding of require basic understanding of religious and spiritual issues.religious and spiritual issues.

►Curricular changes in US residency Curricular changes in US residency programs, since then followed.programs, since then followed.

►More than one third of medical schools More than one third of medical schools in US, now offers courses in religion in US, now offers courses in religion and spirituality.and spirituality.

Puchalski CM, Larson DB. Developing curricula in spirituality and medicine. Acad Med 1998; 73:970-4

Religion and Spirituality in US Religion and Spirituality in US curriculacurricula

► 80% of the members of the A A D P R T 80% of the members of the A A D P R T programs responded to a survey on the role of programs responded to a survey on the role of religion in psychiatric education. religion in psychiatric education.

► Results suggest that Results suggest that Religious ideation by resident candidates is a Religious ideation by resident candidates is a

relatively unimportant variable in the programs' relatively unimportant variable in the programs' selectionselection

Didactic instruction on any aspect of religion is Didactic instruction on any aspect of religion is infrequentinfrequent

Clinical supervision on religious dynamics is variableClinical supervision on religious dynamics is variable Academic progression is rarely impeded by behaviors Academic progression is rarely impeded by behaviors

emanating from residents' religious values. emanating from residents' religious values.

Sansome RA et al. The role of religion in psychiatric education: A national survey. Acad Psychiatry. 1990; 14:34-8

APA Practice Guidelines for the APA Practice Guidelines for the Psychiatric Evaluation of AdultsPsychiatric Evaluation of Adults

These guidelines were updated in These guidelines were updated in 1995 to include gathering information 1995 to include gathering information on “important religious influences on on “important religious influences on the patient’s life” in the personal the patient’s life” in the personal history and performing an evaluation history and performing an evaluation that is sensitive to the patients’ that is sensitive to the patients’ religious and spiritual beliefs. religious and spiritual beliefs.

American Psychiatric Association: Practice guidelines for the psychiatric evaluation of adults. Am J Psychiatry 1995; 152(11 suppl.):64-80

ACGME RequirementsACGME Requirements

►ACGME program requirements for ACGME program requirements for residency training in psychiatry were residency training in psychiatry were amended to reflect these new amended to reflect these new changes.changes.

►Two changes in the ACGME Two changes in the ACGME requirements related specifically to requirements related specifically to include include didacticdidactic and and clinical clinical instruction instruction on religious and spiritual factors.on religious and spiritual factors.

American Medical association. Graduate Medical Education Directory 1995-1996: Program requirements for residency education in psychiatryChicago IL: American Medical Association; 1995

A Model CurriculumA Model Curriculum

► The curriculum is organized into 11 modules The curriculum is organized into 11 modules that address the following topics:that address the following topics: The relation between religion and mental health.The relation between religion and mental health. Interviewing and assessment skillsInterviewing and assessment skills Religion and spirituality in human developmentReligion and spirituality in human development Working with clergyWorking with clergy Working in the C-L settingsWorking in the C-L settings Introduction to God imagesIntroduction to God images Introduction to charismatic religious experienceIntroduction to charismatic religious experience Introduction to cultsIntroduction to cults Religious and spiritual issues in the treatment of Religious and spiritual issues in the treatment of

women, substance abuse and abused persons.women, substance abuse and abused persons.

Larson DB, Lu Fg, Swyers JP. A model curriculum for psychiatry residency training programs: religion and spirituality in clinical practice. Revised ed. Rockville, MD. National institute of healthcare research; 1997

John Templeton Foundation John Templeton Foundation Spirituality and Medicine AwardSpirituality and Medicine Award►National institute of healthcare National institute of healthcare

research in 1999, established JTF research in 1999, established JTF award to support the incorporation of award to support the incorporation of training in religion and spirituality, into training in religion and spirituality, into residency curricula for psychiatric residency curricula for psychiatric residency training programs.residency training programs.

►By 2001, 16 psychiatric residency By 2001, 16 psychiatric residency programs in US had received this programs in US had received this award.award.

JTF Award programsJTF Award programs

► In these programs, the mandatory curriculum spans In these programs, the mandatory curriculum spans the length of residency and include both didactic the length of residency and include both didactic and clinical components.and clinical components.

► Time devoted to the didactic component ranges Time devoted to the didactic component ranges from 12 to 81 hours.from 12 to 81 hours.

► The clinical component includesThe clinical component includes Group case-based discussionsGroup case-based discussions Teaching clinical interviewing skills needed to take a Teaching clinical interviewing skills needed to take a

religious and spiritual history.religious and spiritual history. Formal collaboration with chaplainsFormal collaboration with chaplains Mandatory case based supervision during clinical rotations.Mandatory case based supervision during clinical rotations. Offering of clinical and research elective opportunities.Offering of clinical and research elective opportunities.

Religion and Spirituality in Religion and Spirituality in Canadian curricula in 14/16 Canadian curricula in 14/16

programsprograms

TRAINING AVAILABLETRAINING AVAILABLE Residency Residency programsprograms

LecturesLectures 44

Research electivesResearch electives 33

Case-based supervisionCase-based supervision 99

Clinical electivesClinical electives 22

No training availableNo training available 44

A New Proposal for Canadian A New Proposal for Canadian CurriculaCurricula

► Introduction to religion and spirituality and Introduction to religion and spirituality and Psychiatry.Psychiatry.

► Religion and spirituality in human developmentReligion and spirituality in human development► Overview of selected major religions (Buddhism, Overview of selected major religions (Buddhism,

Taoism, Hinduism)Taoism, Hinduism)► ChristianityChristianity► IslamIslam► JudaismJudaism► Transpersonal psychologyTranspersonal psychology► First Nations spirituality and ShamanismFirst Nations spirituality and Shamanism► Religious and spiritual issues in psychotherapyReligious and spiritual issues in psychotherapy► Resident-facilitated case conferenceResident-facilitated case conference

A New Proposal for Canadian A New Proposal for Canadian Curricula …….Curricula …….

►The proposed curriculum is limited to The proposed curriculum is limited to 10 10 academic sessionsacademic sessions (90 -120 minutes each). (90 -120 minutes each).

►This differs from Larson’s model in This differs from Larson’s model in emphasizing basic knowledge about emphasizing basic knowledge about specific religious and spiritual practices.specific religious and spiritual practices.

►Suggested course faculty include members Suggested course faculty include members of psychiatry, religion and anthropology of psychiatry, religion and anthropology departments as well as clergy and other departments as well as clergy and other religious leaders from the community.religious leaders from the community.