Coming out for Spirituality in Healthcare
OCSW had its first conference on 4th April 2019, held at Unipart House in Oxford.
Spiritual Care Matters: the importance of spirituality in health and social care was sold out with a waiting list. Participation exceeded the expectations of OCSW director Rev Dr Guy Harrison, Development Officer Rhonda Riachi, and the OCSW Reference group (drawn from local health, social and spiritual care staff, academics and experts by experience). At the pre-conference coffee the atmosphere was buzzy and congenial. It was immediately clear that, though there were representatives from various faiths in the room, the day was not about religion. Here we were seeking a fresh language to talk about something beyond and yet inseparable from psychological and physical health. That which Viktor Frankl describes as “Wholeness…. that makes man complete.”
The day was introduced by Stuart Bell CBE (Chief Exec of Oxford Health NHS Foundation Trust) who succinctly described the health and social care challenges we are facing 70 years after the birth of the NHS. He included a burgeoning ageing population, the widening health and inequality gap in our society, cuts to social care budgets, issues of staff wellbeing, and highlighted the need to incorporate spiritual care into the way we think about mental and physical health within our communities and healthcare systems. I found it incredibly heartening that this important man – responsible for Oxford Health – was so clearly pro-spirituality not just as a fluffy concept (nice, but non-essential to the core business of delivering cost-effective healthcare) but as a necessary and central component of health and wellbeing for all stakeholders. After all, at one time or another we will all enter the kingdom of the unwell as patients or carers – not just as professionals - and know what it means to experience the pain of grief or the absence of health. In this frightening and lonely place we need so much more than technological medicine. Here, kindness, connection, compassion and humanity are all. This set the tone for what seemed to be a recurring theme throughout the day: a collective desire to examine the slippery taxonomy of spirituality which is a subject that can be so widely (mis) interpreted. If the bottom line is that spirituality is a core part of what it means to be human whatever your religious beliefs, then how is it to be conceptualised or defined and what language can we use to talk about, research, educate and support its flourishing within our healthcare communities?
This theme was picked up by keynote speaker Rabbi Baroness Julia Neuberger whose crisp opening gambit was that spirituality is still not on the healthcare agenda and lies well down on the list of important and urgent issues from policymakers downwards. Yet if we look from the other end of the lens (and I have seen this many times in practice) it's often those working at the bottom end of the system who deliver the best spiritual care, although the Lithuanian cleaner leaning on a mop to have a chat with the bedbound patient, or the healthcare assistant washing the old man in the care home would not call it that. We work within a deficit model that sees patients as problems to be fixed by experts (rather than as individual persons to be heard and understood) and the fallout is dehumanising for everyone, caregiver and recipient alike. Baroness Neuberger pointed out that on the medical education agenda, although things are improving (with courses at University of Bristol – for example – including mindfulness, narrative medicine, creative writing and existential philosophy for medical students) much more importance needs to be placed on the subtle, interpersonal skills needed to deliver excellent psycho-spiritual care across health and social care contexts. There is still a squeamishness and anxiety around discussions about “spiritual care” in medical settings. People get confused between spiritual care and religious proselytization, and/or they want to know that spiritual care works.
I have found in my short career as guest lecturer on a palliative care MSc course that there is always one smart young doctor who – with the best evidence-based medicine intentions in the world – wants to know what outcome measures are validated to test the efficacy of spiritual care (luckily there are some, and yes there is evidence!). I try to explain that we have to be flexible enough as educators, researchers and practitioners to bridge the epistemological divide and value the stories, songs, poems, art and anecdotes generated by people entering and leaving the kingdom of the unwell just as we value the cold hard certainty of a .05 significance level.
We were treated to extremely poignant, inspiring examples of this by hearing the lived experiences of poet and artist Joanna Tulloch and disability activist Ellen Bassani who spoke movingly about their extraordinary suffering and equally extraordinary survival and spiritual flourishing. Joanna used a beautiful metaphor of cultivating a garden, where “a love and grace is available to everyone, whatever they call it” and shared her darkest times of severe mental illness and her way back to connection and acceptance via creativity and self-compassion. Ellen told us about her journey from rejected, blind little girl to fulfilled and successful adult. Her exhortation to trust was – for me – particularly moving: “Approach each person as if they were the most noble person on the planet” she said, and see what kindnesses comes back. Her lack of sight had given her the ability to really embody what it means to “tune in” and her talk was a masterclass in how to celebrate (rather than bemoan) our particular challenges and turn them into gifts.
Creativity moves us on and into a deeper felt understanding of what it means to stand in another’s shoes. After some liberating community singing with Sally Horner, there was a Forum Theatre session lead by Susie Stead. I had heard about Forum Theatre as a public engagement tool from a research context but had not experienced it as a participant. In a short time, Susie had us warmed up and disinhibited; pairing up, laughing, mirroring, and sculpting our bodies to describe words and feelings (see picture of “Care”). This was followed by a short play based on a busy psychiatric ward, where after the first “performance” the audience could chip in to change the script and actions of the characters and thus avert the suicide of one of the patients. It was really chastening to hear, see and feel the exhaustion, tension, lack of resource and chaos of the ward and to witness the way events could be pulled, stretched and diverted by audience members so that the ‘workers’ and ‘patients’ experience improved in front of our eyes in real time. Every member of the cast clearly needed our compassion from the grieving psychologist to the anxious patient calling for her pills.
The last part of the day included breakout sessions in different rooms. In a sense, these were “How to” sessions where attendees had the chance to explore creative ways to connect with themselves and their patients. David Elliott lead a group on art therapy with children, Jo Barber shared the lived experience of using Music to explore spirituality within a mental health context, and Dr Jane Fossey took a group exploring the importance of connecting with Nature to enhance wellbeing. My session was called Breath-Body-Mind integration and aimed to give participants an experience and understanding of the importance and utility of the body and breath as vital clinical tools in working with complexity.
A number of posters were on display throughout the day for which participants could vote for their favourite. The prize was deservedly won by Julian Ellis (music therapist) whose beautiful and eye-catching poster Rhythm is Life- Life is Rhythm illustrated the subtle, vital life-force of our internal and external rhythmic states and interconnections throughout the lifespan.
I also particularly enjoyed Lucy Speakman’s poster Five Ways to Wellbeing. This piece described her work with a local COPD support group, but in a sense the Five Ways offer a nice precis of the outcomes and experience of the whole conference:
- Connect (so many interesting people in one space!)
- Be active (get into the body – Forum theatre, singing, breathing)
- Take notice of the world around you (nature, music, people, art…)
- Keep learning (this day was a feast for learning)
- Give (look out as well as in – our conference was all about looking forwards and looking for opportunities to share, link, grow).
Blog author: Kate Binnie
Music, Yoga and Mindfulness Therapist / Palliative Care MSc
Senior Research Associate, University of Bristol
Viktor E. Frankl Man’s Search for Meaning (1948). Random House ed (2000), p34.