Religious traditions, especially in the West, have historically condemned suicide. This attitude has changed over time, such that compassion for the deceased and for survivors, together with appreciation of underlying troubled mental states, has led to an increasing emphasis on prevention and support. Membership of faith communities and spiritual practices are generally, but not always, protective against suicide. Some therapeutic treatments have evolved from a spiritual background. Spiritual beliefs and attitudes, such as a search for meaning, can be considerations for those contemplating suicide, as seen in case histories. Taking spiritual factors into account in both assessment and management is beneficial. Severely ill people may wish for assisted dying as a way of ending their suffering. Laws and attitudes to this differ internationally and change over time. People bereaved by suicide are a vulnerable group, and require appropriate support by both spiritual and health professionals.

Humans are a highly social species with multiple physiological systems that have evolved specifically for social relating. There is now considerable evidence that the quality of our social relationships has an impact on both physical and mental health. Especially important is the dimension of feeling supported, valued and cared for, as opposed to feeling unsupported, devalued, excluded and uncared for. This chapter explores how compassion-focused therapy is rooted in working with these evolved, care-focused, motivational and physiological regulating systems. It is a therapy that highlights and helps patients to recognise the value of developing a compassionate orientation to themselves and others. The chapter also explores the degree to which some, but not all, spiritualities pursue the same goals, and how spiritual orientations to compassion can – for those with such views – support their progress through therapy.

Concerns that American psychiatry was neglecting an important dimension of human experience led to the introduction into DSM-IV of a V Code for a Religious or Spiritual Problem. The 1994 DSM-IV also included the new Outline for a Cultural Formulation, later accompanied by a Cultural Formulation Interview and 12 Supplemental Modules added to help clinicians to gather information for the Outline for Cultural Formulation. Recommendations from the APIRE Workgroup led to revisions in DSM-5, and outlined several areas for future research into the implications of spirituality, religion and culture for diagnosis and treatment. In particular, future research will need to better clarify the relationship between spiritual/religious and psychopathological phenomena, the different manifestations of psychiatric disorders in religious populations, the influences of spirituality/religion on the course and outcome of mental disorders, and the role of spirituality/religion in developmental and personality disorders.

Spirituality is a deeply personal universal human experience, and people with intellectual disability may miss out on the expression of this vital part of their identity, which is a fundamental human right. An understanding of people with intellectual disability as creative communicators has been gained through action research, but spirituality is still a poorly understood aspect of their lives, giving rise to unmet needs. Outdated practices and beliefs about the origins of disability have led to a culture of exclusion or, at best, tokenism. Around the world, reports are still emerging of marginalization, discrimination and even abuse because of negative spiritual attribution or views about cognitive abilities and consequent economic worth. Faith communities and secular care providers need to incorporate new learning about the importance of spirituality for mental health into mainstream planning of care with the involvement of people with intellectual disabilities who communicate creatively as co-producers.

This chapter discusses why a spiritual assessment is necessary when planning a patient’s mental health care and treatment. It considers the following reasons why psychiatric patients’ spiritual needs should be addressed: (1) the role of spirituality in helping people to stay well, which aligns with the current strengths-based approach to care; (2) patient/carer demand; and (3) increasing research evidence of a positive link between spirituality and mental health. The various approaches to spiritual assessment are described, including the initial brief screening, the spiritual history and the more in-depth assessment that may need to be undertaken by a chaplain or therapist. Tools relevant to each approach are presented before considering what happens after the assessment. Finally, some of the challenges associated with spiritual assessment are discussed, such as documenting/sharing information about spiritual issues, conflict between clinician and patient worldviews, and clinician discomfort/lack of preparedness. Links to educational resources are provided.

Psychosis and spirituality are often accompanied by profound and disorienting difficulties with understanding, meaning and purpose. In this chapter the authors draw on their experience as rehabilitation psychiatrists, and their view of spirituality as an essential and integral aspect of being fully human, to explore key interrelationships between spirituality and psychosis in the service of promoting health and healing. Using examples of lived experience they illustrate ways in which the practical application of spiritual perspectives can be important in enabling recovery – from understanding a person’s experience in the context of their personal, religious and cultural background, to re-visioning practice as person-centred care, and from recognising the needs of individual practitioners to service development and cultivating a culture that values peer support. They argue that there is no special or specific ’spiritual’ therapy, but rather that the conscious embodiment of kind, careful and ethical practice upholds spiritual qualities.

Spirituality/religion – and even the lack thereof – are integral elements of the human condition. Clinicians trained in child and adolescent mental health are in a unique position to understand religious and spiritual aspects of developmental, biological, psychological, sociological and family processes that inform psychopathology, multiple treatment modalities, coping and resiliency. Evidence-based studies of specific methods for integrating spirituality/religion into child and adolescent treatment are less robust than for adult patients, but spiritually sensitive therapy offers hope and healing for children, as it does for adults. Family therapy is also becoming a preferred treatment modality to address religious and spiritual concerns in multifaith, or conservative, families of diverse faith traditions, religious minorities, and with religious and spiritual issues arising with LGBT+ youth. All clinicians working with children and adolescents can benefit from understanding the role of spirituality in their lives and those of their families.

As other chapters in this book have made clear, spirituality has a part to play in treatment planning in all areas of psychiatry. Patient-centred psychiatry will always properly consider the ways in which the spiritual/religious concerns of patients might have an impact upon treatment. These concerns can often be utilised to good effect, but sometimes, if they go unrecognised, they may present barriers to effective treatment. It is important to know, for example, if a patient might not take their prescribed medication because they feel that they need to trust in God, rather than in tablets. More positively, prayer, meditation and other religious practices can provide significant coping resources during the course of treatment and recovery, and it is helpful for the clinician to affirm this rather than neglect or, worse still, undermine it.

This chapter explores the ways in which mental health patients experience spirituality, based on case studies of patients and emerging data from an ongoing study in Birmingham, UK. Psychiatric patients commonly experience spirituality/religion as an awareness of something beyond their physical senses that is of great importance to them. Many turn to spirituality when they become unwell, deriving great strength from it, and for most patients it is closely linked with recovery. However, spirituality does not always have a positive impact, and spiritual struggles can increase mental distress. Spirituality thus has a major influence on mental well-being and recovery. Spiritual care aims to overcome spiritual problems and maximise the benefits of spirituality. It involves finding the right person to help each individual and is very popular with patients. Many patients also want to talk about their spirituality with clinicians and have their spiritual needs addressed as part of clinical treatment.

Traditional Western science has had little interest in the concept of mind, and has only recently begun to recognise the relationship between spirituality and health. A better understanding of mind has allowed us to establish the scientific concepts behind the spiritual dimension of healing, and the close correlation between religious and spiritual practice and positive changes in a number of stress-related physiological systems. Meditation and prayer have both been shown to improve brain function, and together with practices such as forgiveness and positive thinking, and a supportive social structure, have been shown to benefit both mental and physical health. Meditation has particular clinical applications in those conditions where high arousal and anxiety are a part of the pathology. Controlled studies of prayer have produced mixed outcomes, but prayer is a widespread religious practice and may have positive effects on the person praying – for example, in terms of pain relief.

This chapter provides a brief overview of the ageing process in relation to psychopathologies encountered in the practice of old age psychiatry. In addition, it addresses the role of spirituality and religion in ageing, and discusses ways in which people approach the challenges of transition in later life. The authors discuss the importance of a multidimensional and holistic approach that includes paying sufficient attention to core aspects of being and personality, which can convey important information with regard to coping skills and how they influence responses to diagnosis, treatment and outcome. Deep among these core aspects lie the root constructs of a person’s vision of life and personal meanings, and what some would describe as the presence of a spiritual/transcendent dimension.

Historically, mental health care was provided within a religious context. As scientific approaches to the study of mind and brain developed from the seventeenth century onwards, the spiritual and religious elements of care became separated from the biological, psychological and social elements. The rift grew under the combined influences of biological reductionism, Darwinism, behaviourism and psychoanalysis. In the later twentieth century, a new wave of scientific research on spirituality and religion began to reverse this trend. Spirituality came to offer a more subjective and individualised approach to transcendence, which did not necessarily require religious affiliation. Psychiatrists have found a more positive place for spirituality in both clinical practice and research. This has been reflected internationally, in professional organisations, policy, debate and training. A growing evidence base demonstrates the positive benefits of spirituality/religion for mental health, and patient-centred care requires that spiritual/religious issues be addressed with sensitivity and respect.