Sunday, 25 November 2012

Spiritual Strengths Assessment in Mental Health Practice

Spiritual Strengths Assessment in Mental Health Practice

  1. Edward R. Canda

+ Author Affiliations

  1. Vincent R. Starnino, LICSW, Ph.D., is an Assistant Professor at Indiana University School of Social Work (IUPUI), where he teaches in the area of mental health. His main area of research focuses on the recovery process from severe mental illness. Vincent has several publications focusing on the role of spirituality in recovery and has presented internationally on the topic.
  2. Sachiko Gomi, MA, MSW is a Ph.D. student in the Social Welfare department of the University of Kansas. She has publications in the areas of cultural diversity, spirituality and the holistic approach to social work both in Japan and the USA.
  3. Edward R. Canda, MA, MSW, Ph.D., is Professor in the School of Social Welfare of the University of Kansas, USA, and coordinates the online Spiritual Diversity and Social Work Resource Center there ( He founded the Society for Spirituality in Social Work, currently co-edits the Council on Social Work Education's (USA) Religion and Spirituality Clearinghouse, and has more than 150 publications mostly related to connections between spirituality, cultural diversity, and health and mental health resilience.

*Correspondence to Vincent R. Starnino, Indiana University, School of Social Work (IUPUI), 902 W. New York Street, Indianapolis, IN 46202, USA. E-mail: vstarnin@iupui.eduAccepted October 2012.               


Proponents of recovery and strengths-based approaches recognise spirituality as an important factor in mental health recovery.                    

Minimal guidance is available, however, for how to assess spirituality with people diagnosed with severe mental illnesses. To address this gap, six focus group interviews were conducted with a total of forty-eight community mental health service providers and users who have been involved in spiritual strengths assessment.
An additional panel of ten international leaders in the strengths case management approach gave feedback on focus group insights in order to expand recommendations congruent with the strengths model.
Findings revealed that, while spirituality can be a recovery-related resource for people with severe mental illnesses, some service providers and users experience challenges related to spiritual strengths assessment such as a sense of discomfort about the topic, and uncertainty related to defining spirituality and setting relevant case management goals.
This article addresses these and other challenges by offering guidelines for spiritual assessment within the context of the strengths model.


MD, PhD, FRCP, FRCGP, FRCPsych, Unit of Mental Health Sciences, Faculty of Brain Sciences, University College London Medical School, London; Louise Marston, PhD, Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London; Sally McManus, MSc, National Centre for Social Research, London; Terry Brugha, MD, FRCPsych, Howard Meltzer, PhD, Academic Unit of Social and Epidemiological Psychiatry, Department of Health Sciences, University of Leicester, Leicester; Paul Bebbington, PhD, FRCP, FRCPsych, Unit of Mental Health Sciences, Faculty of Brain Sciences, University College London Medical School, London, UK.



Religious participation or belief may predict better mental health but most research is American and measures of spirituality are often conflated with well-being.


To examine associations between a spiritual or religious understanding of life and psychiatric symptoms and diagnoses.


We analysed data collected from interviews with 7403 people who participated in the third National Psychiatric Morbidity Study in England.


Of the participants 35% had a religious understanding of life, 19% were spiritual but not religious and 46% were neither religious nor spiritual.

Religious people were similar to those who were neither religious nor spiritual with regard to the prevalence of mental disorders, except that the former were less likely to have ever used drugs (odds ratio (OR) = 0.73, 95% CI 0.60-0.88) or be a hazardous drinker (OR = 0.81, 95% CI 0.69-0.96).

Spiritual people were more likely than those who were neither religious nor spiritual to have ever used (OR = 1.24, 95% CI 1.02-1.49) or be dependent on drugs (OR = 1.77, 95% CI 1.20-2.61), and to have abnormal eating attitudes (OR = 1.46, 95% CI 1.10-1.94), generalised anxiety disorder (OR = 1.50, 95% CI 1.09-2.06), any phobia (OR = 1.72, 95% CI 1.07-2.77) or any neurotic disorder (OR = 1.37, 95% CI 1.12-1.68). They were also more likely to be taking psychotropic medication (OR = 1.40, 95% CI 1.05-1.86).


People who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder.

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