Meaning in distress: Exploring religion, spirituality and mental health social work practice in Northern Ireland.

Abstract

This empirical study explores if, and how, religion and spirituality are relevant subjects for those experiencing mental distress in Northern Ireland (NI) and how, if at all, the subject is engaged with in mental health social work practice. Although there is some controversy in United Kingdom based research regarding the apparent benefit of religion and spirituality within mental health, service user research and literature suggests its importance within recovery. Literature on religion, spirituality and social work practice suggests the need to examine the social and political processes which persist around this subject in social work practice (Henery, 2003; Wong and Vinsky, 2009). This examination is appropriate given the role of religion within the political conflict in NI, the impact of the conflict upon social work practice (Campbell et al, 2013), the high incidence of mental ill health in NI and the apparent role of religion and spirituality within mental distress. This study considers how mental health social workers may engage with this subject within their practice not only as an aspect of service users’ identity but also within post conflict Northern Ireland. The study methodology and design drew upon narrative theory and grounded theory. I interviewed twelve mental health service users and twelve mental health social workers, and half of the participants from each group also took part in a follow-up telephone interview. All of the participants were invited to bring an object which expressed what religion and spirituality meant to them. Analysis explored the views and experiences of mental health service users and social workers about religion and spirituality, within specific aspects of the wider social field. Service user and social worker participants’ accounts suggested that whilst the role of religion and spirituality within mental distress was recognised, its inclusion in mental health social work practice was marked with questions of legitimacy. Some of these questions were explicitly framed within the conflict, whilst others were less so. The study found that although religion was associated with politics, sectarianism and violence, its role, and that of spirituality, as an aspect of identity and meaning-making, appeared to be underdeveloped. Two key findings are of particular note. 10 Firstly that service user participants had their own ‘hierarchy’ of religious and spiritual expression, which on occasion appeared to result in their being critical of other service users’ expressions. Secondly, some service users preferred to keep their spirituality to themselves as a strategy of empowerment. In addition the study also found that service users viewed the mental health professional relationship as focusing upon medical aspects of their care, for example physical health and medication management, with no scope to explore religion, spirituality and mental distress. Thus questions of legitimacy focused around the notion of privacy and whether talking about religion and spirituality within the mental health service user and social worker relationship was too sensitive, given its association with sectarianism. Furthermore, mental health service users were concerned about how a disclosure of religion and / or spirituality within mental distress would be viewed by the mental health professional: would it be viewed as indicative of deteriorating mental health? Overall the study identified a significant gap between how service users draw upon spirituality and / or religion within mental distress, and the space given to this within mental health social work practice. This gap is due to a myriad of factors ranging from the social worker’s biography, to wider issues around how religion and spirituality are conceptualised in contemporary society. This study also highlights the continuing impact of the Northern Ireland conflict on frontline social work provision. There is a need for policymaking to acknowledge the ambivalence that exists around spirituality and religion in mental health social work practice due to the conflict and other relevant factors. Finally, support is needed for practitioners and service users to acknowledge this aspect of mental well-being in a manner that gives service users choice about its inclusion in their mental health care.