1. Research conducted as part of a Masters’ qualification ‘Assessing the frequency of care plan attention to the expressed spiritual or religious needs of service users in a Health and Social Care Trust: a descriptive study’ Julia Walsh November 2011

2. Introduction Part One - Questionnaire A - Demographics B - Spirituality and Spiritual Care Rating Scale C - Care plans and Mental Health D - Responsibility for Spiritual Care Part Two - Electronic Records Demographics Initial Assessments Recent Care Plan Advance Statement Results

3. Participants All participants were service users in receipt of an adult mental health service from a health and social care trust, recruited via Care Coordinators and flyers.

4. Gender Male31 Female40 Total71

5. Educational Attainment Primary School 18 Sec. School GCSE 17 Sec. School 'A' level 6 Coll./Uni. Degree 21 Post Graduate 5 Missing data 4 Total 71

6. Ethnicity White British 42 BME 29 Total 71

7. Religious or Spiritual Group Christian 19 Muslim 25 Any Other Religion 3 Spiritual Group 1 Other 1 Not religious 22 Total 71

8. Comparing demographic information from Questionnaire and from Electronic record Electronic record Not Known 25 Christian 21 Muslim 19 Other 4 No Religion 2 Spiritual Group 0 Any other religion 0 Total 71 Questionnaire 0 19 25 1 22 1 3 71

9. Religious/spiritual practice? From questionnaire Yes43 No28 Total71 From electronic records Yes 7 No 64 Total 71

10. Care Plans with or without reference to spiritual/religious matters SCPA - no care plan10 SCPA - no mention of spiritual/religious issues17 SCPA - text re spiritual/religious issues 8 CPA - no care plan 2 CPA - cultural/religious needs prompt – Yes 14 CPA - cultural/religious needs prompt – No 9 CPA - prompt plus text 9 CPA - no mention 2 Total 71

11. Initial Assessments – references to spiritual/religious matters None Found 52 Initial Assessment - no mention of spiritual/religious issues 11 Initial Assessment - text re spiritual/religious issue 8 Total 71

12. Advance Statement or Directive None found 62 No mention of spiritual/religious issues 7 Text re spiritual /religious Issues 2 Total 71

13. Spirituality and Spiritual Care Rating Scale – 17 statements I believe Care Coordinators can provide spiritual care by arranging a visit by the hospital Chaplain or my own religious leader if requested I believe Care Coordinators can provide spiritual care by showing kindness, concern and cheerfulness when giving care I believe spirituality is concerned with a need to forgive and a need to be forgiven I believe spirituality involves only going to Place of Worship (e.g. Church/Mosque) I believe spirituality is not concerned with a belief and faith in a God or Supreme being Agree 53 Uncertain 16 Disagree 2 Agree 65 Uncertain 4 Disagree 2 Agree 62 Uncertain 7 Disagree 2 Agree 14 Uncertain 5 Disagree 52 Agree 20 Uncertain 22 Disagree 29

14. I believe spirituality is about finding meaning in the good and bad events of life I believe Care Coordinators can provide spiritual care by spending time with a service user giving support and reassurance especially in time of need I believe Care Coordinators can provide spiritual care by enabling a service user to find meaning and purpose in their illness I believe spirituality is about having a sense of hope in life I believe spirituality is to do with the way one conducts one’s life here and now Agree 52 Uncertain 14 Disagree 5 Agree 56 Uncertain 10 Disagree 3 Agree 46 Uncertain 17 Disagree 6 Agree 60 Uncertain 9 Disagree 0 Agree 60 Uncertain 7 Disagree 2

15. I believe Care Coordinators can provide spiritual care by listening to and allowing service users time to discuss and explore their fears, anxieties and troubles I believe spirituality is a unifying force which enables one to be at peace with oneself and the world I believe spirituality includes areas such as art, creativity and self expression I believe Care Coordinators can provide spiritual care by having respect for privacy, dignity and religious and cultural beliefs of a service user I believe spirituality involves personal friendships, relationships Agree 58 Uncertain 9 Disagree 2 Agree 53 Uncertain 12 Disagree 4 Agree 40 Uncertain 27 Disagree 2 Agree 62 Uncertain 6 Disagree 0 Agree 56 Uncertain 12 Disagree 2

16. I believe spirituality does not apply to Atheists or Agnostics I believe spirituality includes people’s morals Agree 18 Uncertain 23 Disagree 29 Agree 53 Uncertain 14 Disagree 3

17. Care Plans and Spiritual Care – 8 statements I believe my spirituality should be taken into account in any explanation of my mental well-being I feel able to talk to my Care Coordinator about my spiritual beliefs and values My Care Coordinator has talked to me about my spiritual beliefs My Care Plan contains information about my spiritual needs and strengths Agree 53 Uncertain 12 Disagree 5 Agree 59 Uncertain 6 Disagree 5 Agree 52 Uncertain 8 Disagree 9 Agree 23 Uncertain 28 Disagree 19

18. I have an Advance Directive with information about my spiritual care wishes should I become too unwell to give directions myself I would like to understand my present ill-health in terms of spiritual beliefs My spiritual beliefs are based on religious faith I have consulted with a spiritual/religious leader about my present ill-health Agree 14 Uncertain 25 Disagree 30 Agree 35 Uncertain 28 Disagree 8 Agree 49 Uncertain 10 Disagree 12 Agree 24 Uncertain 7 Disagree 40

19. Religious/Not Religious Religious 49 Not religious 22 Total 71

20. Religious(49): Non-Religious(22) - 8 significantly different responses 1. Statement 1 (Ba) ‘I believe Care Coordinators can provide spiritual care by arranging a visit by the hospital Chaplain or my own religious leader if requested’ Religious respondents are more likely to agree or strongly agree with this statement, non-religious are more likely to be uncertain. 2. Statement 3 (Bc) ‘I believe spirituality is concerned with a need to forgive and a need to be forgiven’ Religious respondents are more likely to agree or strongly agree with this statement, non-religious less likely to strongly agree and more likely to be uncertain or disagree. 3. Statement 5 (Be) ‘I believe spirituality is not concerned with a belief and faith in a God or Supreme being’ Religious respondents are much more likely to disagree or strongly disagree with this statement, non-religious most likely to be uncertain. 4. Statement 10 (Bj) ‘I believe spirituality is to do with the way one conducts one’s life here and now’ Religious respondents are more likely to agree or strongly agree with this statement, non-religious less likely to strongly agree and more likely to be uncertain or disagree.

21. 5. Statement 18 (Ca) ‘I believe my spirituality should be taken into account in any explanation of my mental well-being’ Religious respondents are much more likely to agree or strongly agree with this statement, non-religious more likely to be uncertain or disagree. 6. Statement 21 (Cd) ‘My Care Plan contains information about my spiritual needs and strengths’ Religious respondents were more likely to agree, strongly agree or be uncertain about this statement, non-religious more likely to disagree. 7. Statement 24 (Cg) ‘My spiritual beliefs are based on religious faith’ Religious respondents are much more likely to agree or strongly agree with this statement, non-religious to disagree or strongly disagree. 8. Statement 25 (Ch) ‘I have consulted with a spiritual/religious leader about my present ill-health’ Religious respondents were more likely to agree and strongly agree with this statement, non-religious to disagree or strongly disagree.

22. Muslim/Christian Christian 19 Muslim 25 Total 44 Data removed 27 Total 71

23. Muslim(25): Christian(19) - 5 significantly different responses 1. Statement 1 (Ba) ‘I believe Care Coordinators can provide spiritual care by arranging a visit by the hospital Chaplain or my own religious leader if requested’ The Muslim group were more uncertain about Care Coordinators ability to arrange a religious visit. 2. Statement 4 (Bd) ‘I believe spirituality involves only going to a Place of Worship (e.g. Church/Mosque)’ Christian respondents were more likely to strongly disagree; Muslim respondents more likely to disagree or be uncertain. 3.Statement 13 (Bm) ‘I believe spirituality includes areas such as art, creativity and self expression’ Muslim respondents were much more uncertain about this broader ‘existential’ definition of spirituality, Christians were more likely to agree and strongly agree. 4. Statement 15 (Bo) ‘I believe spirituality involves personal friendships, relationships’ Muslim respondents were more uncertain about whether spirituality involved relationships. All the Christian respondents agreed or agreed strongly with the statement. 5. Part D (D9) – Who do you believe should be responsible for providing Spiritual Care? ‘Should a combination of all be responsible for providing Spiritual Care?’ Christian respondents were more likely to say ‘Yes’ to this question (1=’Yes’, 2=’No’).

24. White British(42): BME(29) - 6 significantly different responses 1. Statement 3 (Bc) ‘I believe spirituality is concerned with a need to forgive and a need to be forgiven’ White British respondents are more likely to agree with the statement, BME respondents are more likely to strongly agree. 2. Statement 4 (Bd) ‘I believe spirituality involves only going to a Place of Worship (e.g. Church/Mosque’ White British respondents are more likely to disagree and strongly disagree with this statement, BME respondents are more likely to be uncertain or disagree. 3. Statement 13 (Bm) ‘I believe spirituality includes areas such as art, creativity and self expression’ White British respondents are more likely to agree or agree strongly with this statement, BME respondents more likely to be uncertain.

25. 4. Statement 16 (Bp) ‘I believe spirituality does not apply to Atheists or Agnostics’ White British respondents are more likely to disagree with this statement; BME respondents are more likely to be uncertain. 5. Statement 24 (Cg) ‘My spiritual beliefs are based on religious faith’ White British respondents are more likely to be uncertain or disagree with this statement; BME respondents are more likely to agree or strongly agree. 6. Statement 29 (D4) Who do you believe should be responsible for providing Spiritual Care? ‘Should Service Users be responsible for providing Spiritual Care?’ White British respondents are more likely to agree that Service Users should be responsible for providing spiritual care; BME respondents more likely to disagree.

26. Male (31): Female(40) - 2 significantly different responses 1. Statement 23 (Cf) ‘I would like to understand my present ill-health in terms of spiritual beliefs’ Women are more likely to agree and strongly agree with this statement; men are more likely to disagree. 2. Statement 31 (D6) Who do you believe should be responsible for providing Spiritual Care? ‘Should Service User’s Family and Friends be responsible for providing Spiritual Care?’ Women are more likely to agree with this statement; men more likely to disagree.

27. Summary of findings Participants think about and define ‘spirituality’ in different ways Participants were most likely to agree about the importance of ‘spiritual care’ The area of most disagreement was whether ‘spirituality’ was a religious concept Care Coordinators do not routinely include any exploration of ‘spirituality’ in assessments or care plans Care Coordinators have not checked information held in ‘demographics’ for accuracy

28. Some recommendations Organisational agreement of what ‘spirituality’ and ‘spiritual care’ means Guidance for staff to be available at induction and included in the training for Care Coordinators Audit of demographic information on religion More discussion about what spirituality means for the non-religious Clarity about how their spiritual needs/strengths are assessed and documented in care plans

29. ‘One size does not fit all’ This research provides further evidence of the lack of attention paid to service users’ spiritual and religious needs Training needs are highlighted in this research Training, as in ‘cultural capability’ model, must include examining the attitudes, beliefs and values of staff