How EAPs can support the spiritual care needs of employees
For many Americans, spiritual care continues to be the preferred type of support for mental health care.
Employee assistance plan (EAP) providers are increasingly expanding benefits to include “whole person” care—support for the physical, mental and social needs of covered employees. This mirrors the widespread acceptance of the bio-psycho-social model in medicine, an approach that began to be adopted during the 1980s, and is now standard practice in acute care settings throughout the US.
Related: 3 steps to choosing the right EAP for your organization
However, as a clinician in practice in a major medical center in Los Angeles, I am aware that this model leaves out an aspect of care that is hugely important to a very large number of Americans: spirituality, and the discipline of spiritual care.
Clear trends in the data
Researchers in the 1950s found that more than 30% of those seeking mental health care were actually contacting clergy for support, rather than mental health providers. In 1988, seeking help from the clergy was as common as seeking care from mental health providers. In 2002, researchers found that clergy continue to be contacted by higher proportions than psychiatrists (16.7%) or general medical doctors (16.7%).
A more recent Social Work research journal found that 25% of those with mental health care needs sought support from clergy rather than bio-psycho-social providers. Independently, the US Department of Health and Human Services reported the same finding, making it clear that many people are avoiding the bio-psycho-social model. For this large group of Americans, spiritual care has been the preferred type of support for many years.
The spiritual needs of patients have become more apparent during the pandemic, and EAPs have struggled to respond client’s spiritual care needs because their mental health care providers are not specialists in this modality.
Specialist spiritual care skillset
Of course, many psychotherapists and social workers, as well as behavioral health providers and coaches are well aware of the value of spirituality. Many are skilled and sensitive to clients’ spiritual needs. They may provide generalist spiritual care and recommend mindfulness meditation or popular apps such as Mindspace and Calm. Some providers may be comfortable praying with their patients.
However spiritual care is not mental health care, it’s a complementary but separate profession. When we talk about spiritual care, we are talking about specialist professionals who are highly educated theologically, experienced clinically and trained to support the spiritual and religious needs of a culturally and religiously diverse population.
Specialists in the field do not proselytize—do not seek to advance their beliefs or convert their clients to their faith. That is important, as often spiritual or religiously motivated folks in the broader population may feel a calling to do just that, and so impose spirituality on their clients, even with the best of intentions.
While specialist spiritual care providers all have strong faiths and may even be ordained clergy themselves, their training and professionalism as spiritual care counselors means they have committed not to proselytize, but to support the client in finding strength and meaning in the client’s own beliefs and practices.
The specialist spiritual care skillset has been developed over more than four decades in the acute care health system of US, Canadian, and European hospitals. Initially this care was called Pastoral Care, or Chaplaincy—reflecting the language of the first practitioners, who were mostly white, male, Protestant ministers.
The field quickly evolved to be more representative in terms of gender and race and faith. And practitioners are now often called spiritual care providers. Many of these specialists are Board certified, meaning they have a Masters in Divinity degree, completed a spiritual care residency in a hospital, worked for two years or more and signed up to a rigorous code of professional ethics.
Well-documented health benefits
According to Harold Koenig, MD, a professor of Psychiatry and Behavioral Sciences at Duke University Medical School, (full disclosure: I am a researcher on a study led by Dr. Koenig, testing a spiritual approach to the treatment of Moral Injury,) five factors indicate why spirituality needs to be added to the bio-psycho-social paradigm:
- Spiritual beliefs are common among patients and serve a distinct purpose
- Spiritual beliefs affect clients decisions about lifestyle and health
- There is a relationship between faith and health
- Many patients want their providers to address matters of faith and health
- Addressing spiritual beliefs with patients often improves the doctor-patient relationship
Spiritual beliefs are very common: according to the Pew Research Center “Self-identified Christians of all varieties” made up 63% of the US adult population in 2021. This number was down somewhat from 75% in 2011—there was a rise of folks who identify as atheist, agnostic and “nothing in particular.” However, the numbers of religiously affiliated are still huge. Their belief systems are powerful and affect the decisions they make about their health care.
The relationship between health and spirituality is well documented. Many people draw on their faith to cope with health challenges. According to pain specialist, Steven Richeimer, MD, “Prayer is the most common non-pharmaceutical method of pain management and the most popular form of alternative medicine practiced in the United States. Data released by the American Psychological Association show that the number of adults in the United States who pray for their health increased 36% between 1999 and 2007.”
Expert-level spiritual care
For an EAP that wants to address the spiritual needs of covered employees, The Joint Commission—the body that licenses hospitals in the USA—suggests a place to start: “a spiritual assessment should, at a minimum, identify and accommodate a patient’s religious, spiritual or practices that influence care in every aspect from food to medicine, to end of life.”
A spiritual assessment—as opposed to a screening or taking a history—requires a specialist spiritual care provider. These clinically trained professionals identify supportive beliefs and practices, as well as spiritual distress and ways in which their faith or spirituality may actually be causing them suffering. They can then support the client in their growth and healing process.
While other health care providers should be aware of spiritual needs of clients at a generalist level, spiritual assessment is an expert-level initiation of care by a professional spiritual care provider. Once the client’s beliefs and practices and needs have been identified, the provider can then begin to develop a plan of care, which addresses the spiritual suffering of the individual client, and reflects their beliefs and values.
A separate profession
This is where a professional spiritual care provider may differ most from a clergy person, working in a church or synagogue. The job of clergy is to lead members in their faith. They guide people in the tenets of the faith and how to apply it in their lives.
However, the provider of spiritual care is very different. As mentioned earlier, the first rule for professional spiritual care providers is; “no proselytizing.” The primary intervention for a chaplain is to listen to the client. We seek to understand who the client is in terms of faith, family and current experience. And then develop a plan of care with the client.
The beliefs and practices of each client are the starting point for a professional spiritual care provider. We respect them and seek to help folks in difficult times reconnect with their strengths and heal where there is suffering, within the scope of that client’s belief system.
Spiritual care is highly complementary to other types of care. In the hospital setting, we support the same patients as our mental health and medical care provider colleagues—every day. But we provide a different type of care—and we’re very clear that we do not treat mental health issues.
So spiritual care is different from both the bio-psycho-social model, and from the approach of typical clergy. It is a separate profession, for a separate set of needs. Spiritual care should be an included benefit in “Whole Person” care to make sure that there is expert spiritual care support available for the very large segment of the population that prefers it and for those who need it. Spiritual care providers are part of the interdisciplinary care team in medical centers around the country. With the arrival of specialist spiritual care in the EAP space, we can be partners in the care of covered populations in EAPs too.
Geoffrey Tyrrell, D.Min. (Geoff@thecompanychaplain.com) is the founder of The Company Chaplain, a provider of telehealth Spiritual Care services for EAPs. Geoff is a Board Certified spiritual care provider with many years experience providing and leading programs to support health care workers.
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