Multidisciplinary perceptions and considerations for spiritual care and biblical framework counseling in mental health

Background: Religious/Spiritual (R/S) care is often desired by mental health clients for culturally sensitive, patient-focused treatment that can promote positive health behaviors and outcomes. Yet providers may be hesitant or overlook this need and treatment guidelines are limited. This mixed-method study aimed to gain insights on existing R/S care, as well as perspectives on what support would be considered for patients choosing Biblical Framework Counseling (BFC) for schizophrenia. This is part of a project aimed to collaboratively extend population-based, mental health care access in resource–constrained communities of both the US, a High-Income Country (HIC), and Low-to-Middle Income Countries (LMICs) in Africa. The project was led by an Africa- Diaspora Citizen Engagement Collaborative (CEC) and is entitled Multi-level Engagement eCoCM (expanded Collaborative Care Model) for Mental Health Integration in Primary and Specialty Care of Resource-Constrained Communities. Methods: A mixed methods approach, comprising of 1) qualitative literature synthesis of 40 journal articles and medical education guidelines for spiritual care, 2) semi-structured survey of 54 multidisciplinary respondents, 3) case report of a patient with schizophrenia treated with Biblical Framework Counseling (BFC), and thematic analysis. Results: The literature review identified multidisciplinary health professional provision of R/S, medical, and/or psychological interventions as monotherapy, concurrent, or integrated strategies. There was a paucity of medical education guidelines. Qualitative themes encompassing literature review, multidisciplinary survey, and BFC case were developed from the extraction of coding categories of disciplines, treatment, and values. Overall themes included 1) there is some multidisciplinary willingness to provide or coordinate R/S care for mental health clients, with varying attitudes about BFC efficacy or implementing biblically based interventions; 2) the ways or extent of care to be provided involves a balance of patient preferences, provider practice considerations and scope; and 3) R/S care implementation can be facilitated via interprofessional education and research that inform on professional and patient-centered values and skills. Survey respondents supported interventions for confirmatory mental health diagnosis and history, scheduled patient follow-ups, ethical hand-offs or referrals, spiritual growth and maintenance, medication management and adherence, and individual psychotherapy depending on professional-patient spirituality congruence, comfort-level with biblical based interventions, and perceived relapse potential. Recognizing both healthcare and spiritual care treatment perspectives and ethical considerations could assist the selection of R/S care approach. Graduate Medical Education (GME) and other health professional programs and guidelines may incorporate these considerations, new and existing R/S interventions, and multidisciplinary provider scope of practice as options for clinician training, mobilization, and design of R/S care practice models. Future research steps should comprise anecdotal case reports, evidence-based case series, and implementation science studies across a broader range of mental disorders.