4.1. Religion and spirituality within the Health and Social Care Trust’s policy
Mental health social worker participants’ stories regarding the Trust’s approach towards religion and spirituality were mixed. Six participants stated explicitly that the Trust does not address religion and spirituality, and none of the participants
disclosed the Trust actively exploring religion and spirituality in any policies over and above those which promote respect and equality. Three participants talked about mindfulness training provided by the Trust and of these, two talked about having attended this training. The participants did not give any detail about the mindfulness training but did identify it as being the closest they have had to training on exploring religion and / or spirituality in practice. Whilst these participants stated that they did not incorporate religion and / or spirituality into their practice, they did disclose having incorporated principles of mindfulness. However, despite this training they did not ask service users about religion and / or spirituality within their experience of mental distress.
007, male:
The type of work that we do it’s trying to be intuitive about how people are [and] getting a sense of them. And sometimes that’s not always about verbal communication and mindfulness it speaks to me about awareness, about things, situations, people, places and being able to focus on things that are out there.
Another participant, who does not ask service users about religion and / or spirituality, also talked about mindfulness and spirituality as overlapping concepts but that mindfulness had greater resonance and application for him personally, than religion and / or spirituality. Although only three participants talked about mindfulness it is interesting that despite this training none of these participants asked mental health service users about the role of religion and / or spirituality within their experiences of mental distress.
Analysis prompted consideration about whether the terms religion and spirituality are baggage terms in Northern Ireland. Do the terms carry negative permutations and inferences which prevent mental health social workers from exploring the subject in their practice with mental health service users? Whilst the Trusts’ provision of mindfulness training is a step towards addressing religion and spirituality in practice, analysis suggested ongoing controversy regarding the recognition and exploration of religion and spirituality in mental health social work practice. Therefore, it may be necessary to consider an additional or alternative approach.
4.2. The need for training on religion and spirituality specifically
Six participants expressed a need for further training in social work practice on religion and spirituality. The expressed need for training centred on the controversial nature of, and the unacknowledged importance of, religion and spirituality in the lives not only of those experiencing mental distress but also as an issue for social work practice in the North of Ireland. Analysis of mental health social worker participants stories revealed the difficulties which some participants experienced around the subject including, self-disclosure, person centred practice, the medical model, social worker values, team discussions, supervision and the controversial yet relevant nature of the subject within social work practice. Participants expressed the need for training to address these issues. In the following excerpt the participant responded to a question about training on religion and spirituality in social work practice.
009, female:
I think because of where we live everyone has shied away from talking about spirituality but I feel it’s such a part of our lives that it can’t be ignored.
In a previous chapter I discussed the inclusion of religion and spirituality within the mental health service user assessment and that social worker participants varied in their practice of asking service users about this. This suggests that whilst the Trust may attempt to address religion and spirituality it is up to the individual social worker to carry out the assessment, and to ask the service user that question. It appears that the inclusion of religion and spirituality in mental health social work practice varies between social worker participants and remains quite controversial and sensitive.
5. Conclusion
This discussion located the mental health social workers’ stories within the wider social field regarding religion, spirituality, mental distress and social work practice. By taking cognisance of the wider social context this discussion has highlighted the absent presence of religion and spirituality in mental health social work practice in Northern Ireland. Analysis suggested that although social worker participants acknowledged religion on a cultural level in Northern Ireland, overall they appeared uncomfortable engaging with this as an aspect of meaning - making within their practice with mental health service users. Analysis suggested that religion and spirituality may be engaged with in three ways: 1) the practitioner may not actively
seek information on it at all, 2) as only as an equal opportunities exercise without further exploration, or 3) it may be explored in depth as an aspect of the service user’s identity and meaning - making.
Furthermore, it appeared that this discomfort and uncertainty extended to intra and inter-professional relationships, as social worker participants discussed sussing colleagues out and the importance of trust. This was particularly apparent when participants discussed religion and spirituality being humourised in the multidisciplinary context, and that this is perhaps suggestive of the discomfort this subject evokes amongst mental health care professionals. One social worker participant talked about religion and spirituality as being “the elephant in the room” which no one talked about. The participants’ stories suggested that whilst there is training about mindfulness social worker participants continued to express uncertainty about exploring religion and spirituality within their practice.
Chapter fourteen: Discussion of findings
1. Introduction
The literature review identified four key areas of discussion. Firstly, Wood’s (2010) discussion about secularisation reshaping religion and spirituality was highlighted as this recognises reduced church memberships alongside growing interest in theistic and secular spiritualities. Secondly, research within the UK suggests the value which some mental health service users place upon religion and spirituality within their experience of mental distress (Mental Health Foundation, 2002; Cornah, 2006). Research in Northern Ireland (Hughes et al, 2012) supports this existing UK research. However, there remains a lack of exploration about if and how this is translated into mental health services in Northern Ireland where religion is a site of division and conflict. Thirdly, it appears that the UK social work profession has been reluctant to engage with religion and spirituality within practice. This is particularly apparent within social work practice in Northern Ireland. Fourthly, underpinning all of these questions is the context of Northern Ireland, and that due to the political conflict religion has become associated with sectarianism, conflict, division, oppression and political division (Mitchell, 2005; Brewer et al, 2010; Brewer et al, 2011; Hayes and Dowds, 2010). Thus a key focus of the discussion is to explore whether, and in what ways, the conflict has shaped how religion and spirituality are engaged with in mental health social work practice.
This chapter draws together the service user and social worker findings, whilst also referring to the research and theories discussed in the literature review. This discussion readily acknowledges the difficult emotions which this complex and multifaceted subject evokes for mental health service users and mental health social workers alike. It is not offered as a criticism of service users and social workers, but drawing upon participants’ diverse views and experiences, this study seeks to offer insight about this area of service user experience and social worker professional practice. It is hoped that these issues will be critiqued and developed by further research in the field of social work practice, other helping professions and in mental health. The study is also relevant within peace and conflict studies regarding how religion and spirituality are engaged with in post conflict societies.