Exploring the acceptance of religious assistance among patients of a psychiatric hospital.

BACKGROUND: Spiritual issues are rarely addressed by psychiatric institutions in daily routine practice. AIMS: To report the prevalence of, and factors associated with, inpatients' acceptance of religious assistance in a psychiatric hospital. METHODS: All patients evaluated by the religious assistance service in a psychiatric hospital were included. Patients admitted were asked about their need for religious assistance and were assessed on several religious aspects. Additional information was collected from patients' hospital charts. A comparison between those who accepted the religious assistance and those who did not was performed. RESULTS: Most of the 213 patients evaluated requested religious assistance (85.0%), including those that reported having no religion (79.1%). Patients with a diagnosis of schizophrenia (p = .010) and lower intrinsic religiousness (p = .002) tended to request less religious assistance. More than 80% of patients requested assistance based on religious traditions other than their own. CONCLUSION: Most psychiatric inpatients were willing to participate in religious assistance sessions, even those without formal religious affiliations. Patients with lower intrinsic religiosity and schizophrenia tended to request less assistance. We believe the findings of this study can serve to foster discussion on whether psychiatric hospitals should provide a structured religious care service.

Spiritist psychiatric hospitals in Brazil: integration of conventional psychiatric treatment and spiritual complementary therapy.

In Brazil, during the XX century, dozens of Spiritist psychiatric hospitals emerged seeking to integrate conventional medical treatment with complementary spiritual therapy. This combined inpatient treatment is largely found in Brazil, where many psychiatric hospitals stem from the Spiritist movement. The present report describes the use of these spiritual practices, their operating structure, health professionals involved, modalities of care, and institutional difficulties in integrating spiritual practices with conventional treatment in six leading Brazilian Spiritist psychiatric hospitals. These hospitals combine conventional psychiatric treatment with voluntary-based spiritual approaches such as laying on of hands ("fluidotherapy"), lectures regarding spiritual and ethical issues, intercessory prayer, spirit release therapy ("disobsession") and "fraternal dialogue". The non-indoctrination and optional nature of these spiritual complementary therapies seem to increase acceptance among patients and their family members. In conclusion, the Spiritist psychiatric hospitals in Brazil have, for more than half a century, provided an integrative approach in the treatment of psychiatric disorders, associating conventional and spiritual treatments, more specifically Spiritist therapy. The lack of standardized treatment protocols and scientific studies remain a barrier to assessing the impact of this integrative approach on patients' mental health, quality of life, adherence, and perceived quality of treatment.

Aspectos éticos e legais da assistência religiosa em hospitais psiquiátricos / Ethical and legal aspects of religious assistance in psychiatric hospitals

A assistência religiosa a pacientes com transtornos psiquiátricos graves internados é um problema pouco discutido entre psiquiatras. Aspectos legais asseguram o direito à assistência religiosa aos pacientes, no entanto alguns aspectos específicos conduzem a reflexão e cautela em determinadas situações. Assim, objetiva-se com o presente trabalho discutir os aspectos éticos, legais e científicos da assistência religiosa em hospitais psiquiátricos. Serão abordados também alguns comentários sobre os conceitos de autonomia, beneficência e não maleficência, contidos nos princípios bioéticos. Ao final, é apresentada a experiência do Hospital João Evangelista na abordagem de tais casos. Como conclusão, situações de conflito ético e legal podem surgir, pois os pacientes têm direito a receber assistência religiosa, porém podem apresentar manifestações psicopatológicas que poderiam levar a prejuízo de seu quadro clínico diante da abordagem religiosa. A orientação dos familiares e as relações entre hospital, médico, paciente e família são essenciais para a resolução de tais conflitos.

The religious assistance to inpatients with severe psychiatric disorders is a problem rarely discussed among psychiatrists. Legal aspects ensure the right to religious assistance to such patients, although some specific aspects lead to reflection and caution in certain situations. Thus, the main of the work is to discuss ethical, legal, scientific and religious aspects of religious assistance in psychiatric hospitals. It will also address some comments on the concepts of autonomy, beneficence and nonmaleficence, contained in bioethical principles. Finally, it will be presented the experience of the João Evangelista Hospital approach on such cases. In conclusion, ethical and legal conflicts can appear because patients have the right to receive a religious attendance. However, in some conditions, this assistance could lead to a worse in patient's clinical status. Family orientation and doctor-patient-hospital relationship are essential to resolve these conflicts.