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We read the article by Baetz and others (1) with interest, as we emphatically agree with the principle of acknowledging the spiritual aspect of patients' lives to address the person as a whole. However, we were disappointed to find that the published results do not seem to support the clinical implications stated at the beginning of the article. Unfortunately, the cross-sectional nature of this study does not allow us to assess the potential benefits of "support[ing] this potentially significant coping resource" or of "involv[ing] spiritual advisors, such as clergy or chaplains, when needed." Although the authors may have shown a correlation between religious involvement and mental health, they have not demonstrated that external support for religious involvement has any effect upon patient outcome.

This paper starts with an attempt to chart the contemporary history of the term "Compliance" and its cognates. It also discusses the recently published guidelines concerning the assessment of adherence in patients with serious mental illnesses, dedicating its middle part to comment on the research and clinical methods to assess adherence in patients. The current consensus amongst experts can be summarized, from a clinical point of view, in a simple rule of thumb: enhancing adherence should depend on simple interventions originating from a multidisciplinary perspective and should include patients' input. Despite its apparent simplicity, improving the assessment of adherence and favouring its enhancement can generate interesting ethical quandaries that will be approached in the light of the relatively new emergent notion of "moral distress.".

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