The enormous charge to the mental health care system to keep hospital length-of-stays brief while delivering Person-Centered care grows increasingly complicated. One key to meeting regulatory mandates while focusing on long-term healing is to use simple spiritual recovery tools that people can learn and practice daily.
Spiritual care givers, especially chaplains working in tandem with other clinical disciplines in mental health care settings, can teach a variety of accessible spiritual recovery tools, including during a brief hospitalization. Goals of such tools are that people’s long-term spiritual, emotional and cultural needs could continue being met upon discharge, that they maintain consistency in positive coping mechanisms, and that they foster lasting supportive connections to care teams’ efforts.1
One example of how such a tool can be used from the time of admission to discharge and beyond might include such a scenario: A person might be troubled by a persistent thought, such as “God has abandoned me.” This thought is usually complexly a symptom of a mental illness and related to painful past experiences. Especially damaging for many people are the feelings of abandonment and rejection that can stem from disconnects with spiritual and religious leaders who are not equipped to address mental illness and crises. A trained spiritual care giver in mental health issues can provide presence and a listening ear, while a person discusses a baseline spiritual problem. Such spiritual care and counseling is vital in the moment. That is the “being with” aspect of spiritual care. However, an action step is also required. If the person is discharged from a facility after 10 days, and they have had clear insight into and pastoral counseling about their spiritual pain, it is likely that such a spiritual problem will not disappear upon discharge. Even with significant relief of psychiatric symptoms through medication and a multi-disciplinary treatment plan to addressing psycho-social stressors, a persistent spiritual problem needs a consistent, long-term plan. A spiritual recovery tool that can be taught and integrated during a hospital stay and practiced daily afterward can have enduring effects.
Many Spiritual and Pastoral Care Departments in healthcare settings develop their own tools, or use any number of helpful tools that can be found through literature reviews. The Department of Pastoral Care and Education at NewYork-Presbyterian has developed a spiritual screening tool, C.A.R.E.S.©,2 that is two-fold: firstly we use it to assess people’s spiritual, emotional and cultural needs, and secondly it becomes part of the treatment plan, and like many aspects of a mental health treatment plan, it is a tool or resource that a person can take home with them to continue to practice and develop positive coping habits.
C.A.R.E.S.: The New York Presbyterian Spiritual Screening Tool. Assessment and Treatment – When to call a chaplain,
and when a person or their loved one(s) has spiritual CARES:
This model breaks down into what the chaplain or a member of the multi-disciplinary team screens for: Compromised coping: The person or family has experienced major loss within the last one to three years; Asking “Why”: The person is asking questions of meaning or purpose, or has a pervasive sense of loss of meaning and purpose; Religious needs: The person requests specific religious, sacramental or cultural needs; Emotional suffering: The person is struggling with pervasive emotional suffering, such as hurt, fear, current or previous losses; and Support: The person has limited or no external support.
By exploring these areas in depth, spiritual care givers can aid a person in assessing what coping is working well, what is lacking, and what approaches can bolster spiritual, emotional and cultural needs. By identifying and naming strengths and concerns in each of the C.A.R.E.S. categories, a person and a spiritual care giver can outline an action/treatment plan that the person can take ownership of and be responsible for after discharge. The person and the spiritual care giver can make a covenant (contract) that the person will continue to practice this tool by self-assessing how and where they are in each of the C.A.R.E.S. categories and then act accordingly if something is not being addressed. The person can practice self-assessment and action in their own prayer or meditation time, or ask family, loved-ones, and trusted members within a community-based support network to participate and provide support.
In looking at Compromised coping, a person might get more deeply in touch with forms of denial, unresolved losses, or behaviors that continue to enable compromised coping. Such behaviors might bring momentary relief, but the person may later experience more negative feelings about their overall health. For instance, choosing integrative medicine practices, such as gentle relaxation techniques, tracing a finger-labyrinth, or using aromatherapy to soothe, can lead to small but significant steps in forming new habits that can eventually replace ineffective coping mechanisms.
Asking “why?” is vital to anyone’s mental health. Repressing sadness, anger, or any strong emotions can lead to a greater sense of disconnect from the whole. Asking the difficult questions can create fresh insights and awareness, and provide an opening for releasing pent-up emotions. Starting such a conversation with a psychiatrist, social worker, chaplain, or any health care worker, clergy person, 12-Step sponsor, community liaison, etc., can keep the doors open to a “why” stance that can help someone safely explore questions that can lead to continued understanding and meaning-making.
People can identify a Religious need while hospitalized, and in the process might become reacquainted with a beneficial practice through attendance in a spirituality group or worship service.3 However, as is common for those who left a religious community behind, the person might be baffled about how to continue the newly-learned spiritual practice upon discharge. The aspect of the C.A.R.E.S. model that leads to creation of a spiritual treatment plan can connect the dots from the current care being received at the hospital to the post-discharge possibilities of numerous outside resources. The chaplain can research and contact outside resources, and provide a list for the person, much like what any other member of the clinical care team might do related to their discipline and a person’s healthcare needs. This can provide an uninterrupted sense of spiritual care after discharge.
Emotional suffering takes a toll on mind-body-spirit health in whatever degree it is felt. Trusting another person to listen to feelings and thoughts, whether with a mental health caregiver, community support, friend, or family member, can assist in putting problems in perspective and prioritizing what to address and how, if necessary. If a person talks with a chaplain while in the hospital, the benefits of the conversation will give the person a model for what they might desire after discharge, perhaps as a daily practice or as needed.
Support is the keystone to healthy mind-body-spirit living. A daily practice of a gratitude list for all of one’s supports, or perhaps a “wish” list of supports not yet in place, will keep a person attuned to the need for support and the dangers of isolating. In order for the health care system to deliver quality Person-Centered Care, the mental health consumer will experience a greater wholeness, whether through an immediate crisis or life-long symptoms, if they remain committed and curious as to who can assist, when and how. Remembering that there is always help nearby, even if the first step is the hospital emergency room, can assure the person through their fears and doubts that supportive help is on the way.
The Rev. Lynne M. Mikulak is the Coordinator of Pastoral Care and Education at the Westchester Division of NewYork-Presbyterian. She is a board-certified chaplain through the Association of Professional Chaplains and a certified supervisor through the Association for Clinical Pastoral Education, Inc. She is an ordained minister in the United Church of Christ. She has a Master of Divinity from Yale University Divinity School and a Master of Social Work from the University of Connecticut School of Social Work.
- Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals, Oakbrook Terrace, IL: The Joint Commission, 2010. Regarding assessment, Ch. 2, p. 15 states, “identify patient cultural, religious, or spiritual beliefs and practices that influence care”, and regarding a treatment plan, Ch. 3, p. 21, states, “Accommodate patient cultural, religious, or spiritual beliefs and practices.”
- © 2009 New-York Presbyterian Hospital, Rev. Dr. Beth Faulk Glover, Corporate Director of the Department of Pastoral Care and Education
- The Joint Commission’s Standards Supporting the Provision of Culturally and Linguistically Appropriate Services, 2009, states that inclusion of spirituality groups can address the following needs: Standard PC.1.10, Element of Performance EP 8 – After screening, clients are matched with the care, treatment, and services in the organization most appropriate to their needs; Standard PC.4.50, EP 1 – Clients are encouraged to participate in developing their plan for care, treatment, and services, and their involvement is documented, & the organization has a process for involving clients in their care, treatment, and service decisions; Standard PC.6.10, EP 2 – The client receives education and training specific to the client’s needs as appropriate to the care, treatment and services provided, & the assessment of learning needs addresses cultural and religious beliefs, emotional barriers, desire and motivation to learn, physical and cognitive limitations, and barriers to communication as appropriate; Standard RI.2.10, EP 2 – Each client has a right to have his or her cultural, psychosocial, spiritual and personal values, beliefs, and preferences respected.