Psychiatry, religion and spirituality: a way forward

Abstract

Innovative and effective approaches to crisis services As a patient, I was recently under the care of a London crisis intervention team. The compassion of the individual staff members was negated by systemic flaws in the way the service was delivered. The experience was very unsettling. Different staff would arrive twice daily at my home because shift patterns would not allow the same workers to see me regularly. Consequently, a constructive, consistent relationship with members of the crisis team was not possible. A stream of strangers entered my small, cramped flat, and the crisis team actually became part of my mental trauma. The problem with the crisis team as an institution is that it is about cost-cutting rather than caring. It felt like a mere sticking plaster on a huge mental wound. While cost-cutting remains the ethos, patients are bound to suffer. The loss of in-patient beds is putting pressure on community services that they cannot sustain. Cost-cutting may masquerade as streamlined efficiency and effectiveness, but it is really a way to hobble and cripple psychiatric provision. Good treatment cannot be delivered without flexibility and variety, both community-based and hospital-based. The crisis team concept is an ineffective halfway (and half-baked!) house between community and hospital.

A Spiritual Problem? Primary Care Physicians’ and Psychiatrists’ Interpretations of Medically Unexplained Symptoms

“…Despite a recent tendency to include spirituality as part of mental health care, some psychiatrists feel that intervention in spiritual matters crosses professional boundaries. 19,26 We also found that psychiatrists were more likely to interpret these symptoms as medical conditions that would improve with treatment by physicians. As noted, psychiatrists tend to have more training in and comfort with addressing the mental, emotional, social and spiritual dimensions of patients' experiences.…”

Author's reply

“…3 This was addressed to the immediate past-President of the College, who did not respond. Instead, a position paper, written by Professor Cook on behalf of the SPSIG, has quietly passed through the College committee machinery, and is now Royal College of Psychiatrists policy.…”

“…[2][3][4] Various putative mechanisms to explain this observation include retention overflow consequent to inhibition of detrusor contraction due to anticholinergic action, reduced sphincter tone due to anti-adrenergic activity, 5 sedation and lowering of the seizure threshold, 6 drug-induced diabetes mellitus resulting in polyuria 6 and drug-induced diabetes insipidus.…”

Home treatment teams and compulsory admissions – more information needed

“…I would be extremely concerned that patients with the major mental illnesses under Bohmer's standard care model would be classed as needing 'standard care' and would be handled by non-medical professionals. 1 To me, this is callous care and not standard care. It is a theoretically smart sounding concept, but, at a clinical level, most good clinicians would appreciate that just knowing the protocol and guidelines without knowledge of various other possibilities in the vast array of medical complexities is a dangerous practice.…”

“…We read with interest the article by Hansen et al, 1 which brings the important issue of patient satisfaction back on the agenda. We would, however, encourage our colleagues to go further and collect patient satisfaction data for psychiatric services routinely.…”