HEALTHCARE CHAPLAINCY COUNCIL OF VICTORIA INC. (HCCVI)

1. HEALTHCARE CHAPLAINCY COUNCIL OF VICTORIA INC. (HCCVI) ‘To explore the importance of spiritual wellbeing as a protective factor for people who have a mental illness for their mental health, wellbeing and recovery.’ Rosalind Cairns Manager, Mental Health HCCVI mentalhealth@hccvi.org.au

2. Interviews: 5 participants in a community based programme. All participants were women – aged 30-55 years All participants had a diagnosis of depression Some participants also experienced anxiety One had an acquired brain injury One lived with Asperger Syndrome

3. Method: • Unstructured, in-depth interviews participants were asked to describe and reflect on: • their lived experience of spirituality • the positive benefits, if any, of attending to spirituality in their treatment and care and in the recovery process Participants were encouraged to use own language to describe experiences & that there was no right or wrong answer. Open questions were used & all interviews commenced with the question “What is your understanding of spirituality?”

4. Spirituality: Some would say that spirituality is based on a belief in a personal God and in that we find meaning for our existence. Spirituality involves a personal quest to find meaning and purpose in life and a relationship to the Mystery/God and the rest of the universe (RuffingRahal 1984). Spirituality is a quality that goes beyond religious affiliation that strives for inspiration, reverence and awe, even in those who do not believe in any God (Murray and Zentner 1989). Spirituality is the search for meaning through the inner journey which is mediated through relationships; sometimes with each other, sometimes with nature and sometimes with God (Mowat 2006)

5. Drawing from these examples and for the purpose of this study spirituality is defined as an experience and process, not a religion; it is a quest for meaning and purpose, to be connected through relationship and to encounter hope. The universality of spirituality extends beyond doctrine, beyond cultural difference, and at the same time is uniquely individual. Spiritual care includes and may seek to meet religious need.

6. Spirituality as connectedness through • personal relationship with God/Higher power • spiritual and religious practices • relatedness with others • Recovery and Spirituality • Spirituality as a source of renewed meaning, purpose and hope in the recovery process • Mediated through meaningful activity

7. Spirituality from participants perspective “Spirituality is about having a connection to something greater than yourself and trusting in my life that things will work out.” Annie “My understanding of spirituality is that it is who we are. It is our essence that is what it is. It has nothing to do with what we look like. It is our essence. It is who we are.” Betty “Something that you believe in, faith gives you strength and it is all positive. And for me also angel, I believe in angels.” Carly “My spirituality is important to me; it is a way of life. I receive strength from my spirituality and it enables me to live each day.” Effie

8. Whereas Debbie, was not really sure what spirituality was nor did she believe that she had a spirituality, stating that she took part in the study because “…. nothing else had helped and maybe this could help me deal with my obsessions.” Debbie Perhaps Debbie’s search for what might help her cope with the difficulties and “obsessions” was her spiritual journey at this stage in her life.

9. Spirituality as connectedness through religious and spiritual practices: Perhaps our most basic human need is to enter into trusting, loving and caring relationships to connect to someone or something beyond the self. The experience of relationship with God and others is for most people the most significant way that they express and fulfil the spiritual needs (MacKinley 2006). All participants acknowledged a belief in a god or higher power although each person experienced and expressed this relationship differently. For some this connectedness was mediated through prayer and meditation which provided a source of strength and hope.

10. “… I have two mentally ill sons too so if I did not pray, if I did not believe then I would give up. I would think that there is no future, nothing is going to change. It enables me to live each day, I know I do not have to face the day alone and that I have God there....I do have a prayer partner who keeps in contact with me. A lot of people have said that I have changed heaps in the last year and the only thing that has changed is praying…my walk with God is important to me.” Effie “ I have gone to a Buddhist centre and done meditation and in my own way pray. I also like music, art and writing and I feel a real connection to those sort of things. Annie

11. “I do reiki healing. I go to this lady who moves my energy around, and moves the bad energy out and tries to calm me. I literally feel the energy move; it’s getting rid of the crap that we all accumulate by just living.” Betty “I occasionally go to church. When I do get there just being with other Christians to worship is important and I feel I belong. I know this woman who does reiki healing and tarot card and I go and see her. I take time out for me. People like her are helping me to try and move on each day positively.” Carly

12. Spirituality as connectedness through relatedness: Relationships with self, God and others lies at the heart of spirituality, and this may be expressed towards a God or higher power or towards other human beings. It is in and through relationships that an individual develops a sense of identity, of who they are and their place in the world. All participant indicated that their relationships with others was something that they highly valued… All indicated that relationship with family members was significant in in their recovery and continued well being.

13. I have faith in the goodness of people. People are very important to me, my family, my friends and my cat...support from my family really helps me and support from my friends.” Annie • Depression or depressive episodes drain the person of energy and present a barrier for many to be or feel connected to others. Annie and Carly elaborated on the impact of depression on relationships and connectedness to others. • “I sometimes do feel disconnected to people because I do have periods of depression. I feel more connected to people actually when I am not depressed” Annie • “It has been a tough time. I take little steps; I don’t put a lot on my plate anymore, because I know if I take too much it will drain me out. When I think what I went through with that spiral effect of depression. People use to say ‘snap out of it’ but it is not that easy” Carly

14. The experience of being connected to others or at least one other provides the person with a sense of meaning in life. All participants expressed that it was relationships that provided them with meaning in life.

15. Debbie was the most emphatic regarding the significant role her relationship with her family had in her life and continued wellbeing, indicating that it is the care and support of her family that keeps her from further suicide attempts. “The most important thing in my life is my mum and my entire family. I would never want to lose my family. I only live for my family.” Debbie The researcher followed this statement up with the question ‘Does your life have meaning for your family?’ Her response: “Yes, they love me very much” indicating mutuality in the relationship and that Debbie was unconditionally loved and valued by them. Perhaps it is this source of love that keeps her connected to life.

16. Effie and her ‘boys’, two young men in their early twenties. “My kids, my boys are really important to me. I would say I live for my kids, I know I shouldn’t but I do. My faith is important although my kids come first. I do not want to lose my relationship with my boys. This is in jeopardy at times with the way we are with each other.” Effie Connectedness in the community. “Sometimes it is rewarding like in the afternoons when some of the mothers say hello and I will go over and chat with them.” Effie

17. The power of relationship, of loving and being loved has the ability to sustain the person through tough times and this is certain true for Betty. “My spirit my essence sustains me especially in tough times, but also all my babies. My four babies ranging in age from 19 to 26, but they are still my babies. I love them and they know it and they love me.” Betty All participants valued the connectedness with others that they felt at Karingal. Betty’s sentiment “I have good company here” was echoed by each participant.

18. The quest for meaning provides the criteria for what spirituality is and what the focus of spiritual care should be (Burnard). Meaning is the foundation for the development of mental health and well being. The primary motivating force that impels the person towards mental health is the quest for meaning and purpose (Frankl). Meaning provides a sense of purpose and direction in life and hope for a better future. Those who have experienced depression or any form of mental illness need renewed meaning and purpose in order to live with and combat the effects of the illness as they engage in their journey of recovery.

19. Recovery through renewed meaning & purpose Annie expressed this clearly when speaking about her understanding of spirituality, she stated; “I have often thought about what is the meaning of life or if there is any meaning at all and what we are here for. What is my purpose is and that sort of thing.” Annie “For me life is about searching for that meaning. I have got glimpses of it, many glimpses and I just have to get hold of it. I am still looking for that meaning and doing spiritual work helps.” Betty

20. Spirituality as mediated through meaningful activity: • Meaningful activity - activities that enable the person to grow in connection, confidence, and contribution to society, education, vocation and relationships. • Meaningful activity promotes wellbeing for all. Meaningful activity is beneficial for the person recovering from mental illness in several ways. • It provides a focus beyond self and affords the opportunity to give to others, developing a sense of self worth in the person. • Holds the possibility of breaking down the loneliness or isolation bring the person into contact with others. • Serves to give the person a sense of self worth and as being a valued and contributing person in the community; enhancing the person’s sense of self and identity as well as holding their integrity as a person.

21. “Karingal has been really good in the programmes I come to, even the little pot I am doing is making me feel really good because I have created it, I have done it and I enjoyed doing it. I know I have help from the council but this is different. They do for me whereas at Karingal I do things. Things that I achieve.” Effie “I am now a school crossing supervisor. So that actually gets me out of bed in the morning. I have to get out. I have to go and do the school crossing. That gives me meaning too.” Effie

22. Carly and Annie are involved in organising and participating in client centred programmes through Karingal as a means of activity and yet also as a means of giving back to the community that has been part of their recovery journey. When asked what has sustained her through difficult times Carly responded; “My sisters. Yes and when I work in this field. It is challenging working with difficulty behaviours, but I enjoy it. Isee just little smiles, if they smile at me or acknowledge my name, that is an improvement and I think, Oh that’s wonderful. It can be baby steps and that’s all I need. I just love working in this field.” Carly

23. Betty was not involved in any actual employment although found meaning through her interest in and study of philosophy. “I do enjoy doing philosophy every week, and practical philosophy which I love. Practical philosophy is where you feel your feet on the floor, air on your face and the way you hear. It is very, very calming. Every Tuesday I do that.” Betty Debbie indicated that participating in the programmes at Karingal was helpful and enjoyable her hope for her future is “that one day I work again.” Debbie

24. Recovery and hope. Spiritual beliefs are a powerful source of hope for many people. Having a sense of hope is the foundation for ongoing recovery from mental illness. Hope provides that motivation that keeps a person moving towards recovery and well being. at times of unwellness it may be difficult for the person to hold and maintain hope, and it may mean that for a time another carries that hope. The aim is always that the person will develop and hold within them their own sense of hope. Within the recovery process it is vital that the person encounter hope. Hope is the belief in a positive outcome related to events and circumstances in a person’s life. All participants held a sense of hope although they acknowledged that it was more difficult to maintain this hope at times of unwellness.

25. “I suffer from depression so there were a lot of times when I haven’t felt much hope. However hope is believing, believing that good things can happen, that I can get some joy out of life; even when there are some difficult times there are still simple things that I can enjoy.” Annie “One day I hope I will work again, one day I hope that the obsessions will be gone. There is a lot to hope for.” Debbie “I was going to say getting up in the morning but no the real hope for me is seeing the world as a better place.” Betty

26. Concluding thoughts • Spirituality as experienced through connectedness with God/higher power was important (ABCE) • For some participants spiritual practices provided that connectedness. • Spirituality was a motivator and means through which they viewed the world and their place in life. • All participants held the belief that life could be different thus their spirituality provided a source of hope for the future and in the recovery journey. • Spirituality holds the potential to offer meaning beyond the experience of mental illness, meaning that offers the person a deeper and renewed sense of self and value as a contributing person in society. • It also afforded the person a source of strength and courage in coping with mental illness.

27. Spirituality as mediated through relationships was vital for all participants. • For each participant the connectedness with family seemed to have withstood the effects of mental illness on the person’s life. • For Effie, Carly and Betty there was an element of guilt around the impact that the mental illness had on their children. • Participants spirituality is the means through which they embark on the personal quest for meaning, hope, value and connection to a higher power – not necessarily related to any institutional religion. • It is apparent that participants’ experience of spirituality very much paralleled the view of Mowat who saw spirituality as a process and search for meaning through the inner journey mediated through relationship with self, other and God or a higher power. (Mowat 2006).

28. That attending to spirituality is an integral part of all recovery based programmes. •  That spiritual assessment is part of recovery programmes. •   (Pulchalski 2007, Culliford 2005). • One of the limitations of this study was the small number of participants. • That the study is replicated and analysis be compared to this study

29. “The thing that I would never want to lose is my sense of self. Although at times I feel I have lost in some ways. Like when I become unwell. I don’t think I would ever lose it completely but it has been a bit scary when that has happened. I am still finding myself and I believe that will continue throughout my life as I discover more about myself and learn and change perspective on things. I believe that there is a core self that you keep always.” Annie This last comment of Annie is rather profound that the core self remain. It may be battered, bruised and at times fragile yet even within the experience of mental illness the core self remains. This sense of Annie’s around her core self echoed the words of Patricia Deegan: “You carry within you a precious flame, a spark of the divine. You were born to love and be loved. That is your birthright. Mental illness cannot take that away from you. Nobody can take that from you.”(Deegan)