Hello and welcome. I am Jose Villarreal, Clinical Director of Behavioral Health at Erie Family Health Centers and Community Care Expert for SMI Advisor. I am pleased that you are joining us for today's SMI Advisor webinar. The topic is The Protective and Healing Role of Spirituality in Mental Health Recovery, Utilizing a Spiritual Health Framework to Improve Patient Engagement. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Seeking for experts from across the SMI clinical community, our interdisciplinary team efforts have been designated to help you get the answers you need for the care of your patients. Today's webinar has been designated for one AMA PRA Category 1 Credit for Physicians, one Continuing Education Credit for Psychologists, and one Social Work Continuing Education Credit. Time for participating in today's webinar will be available until August 6 of 2022. Slides from the presentation are available in the handout area, found in the lower portion of your control panel. Select the link to download the PDF. Please feel free to submit questions throughout the presentation by typing them in the question area, also found in the lower portion of your control panel. We'll reserve 10 to 15 minutes at the end of the presentation for some question and answers. Now, I would like to introduce today's faculty, Nanette Larson. Nanette Larson is a nationally recognized leader in mental health recovery who has spent the last 20 years providing leadership in Illinois' public health system and developing recovery-oriented trauma-informed systems of care. She is an emotional CPR practitioner and an advanced-level facilitator for Wellness Action Plan, better known as WRAP, and a certified recovery support specialist. Thank you, Nanette, for facilitating today's webinar. The floor is yours now. Good afternoon. Thank you so much, and it's so good to be with you all today. I am going to just start by reviewing our learning objectives, and then we will jump in. So, we will be discussing and describing the benefits of spirituality in mental health recovery, developing strategies and increasing skills to discuss spirituality with mental health patients and consumers, and utilizing a spiritual health framework tool with patients and consumers to promote improved spiritual well-being and overall well-being. Research has shown that a gap exists between the actual inclusion of spirituality by mental health professionals regarding the benefits of spirituality in mental health treatment and the value placed on spirituality by the people we serve, the patients and consumers of mental health services. In other words, people who receive mental health services place a high value on spirituality. Research shows there are tremendous benefits to spirituality in mental health treatment, but mental health professionals rarely include spirituality in treatment and support services. The graphic on this slide depicts it as a divergence. The broad white arrow on the left depicting value and benefits with the narrow red arrow on the right depicting inclusion. This gap or divergence may be due to a combination of any number of factors, such as a lack of understanding about the ways people connect with spirituality within our contemporary society and within their mental health, a discomfort in discussing the topic, and a lack of training and resources in this area. Using the search feature on SMI Advisor, for example, resulted in a total of zero results under the keywords spirit, spirituality, or religion. Further, one of the evaluators for this webinar marked the topic as a two out of five in the category of relevance. These two simple data points highlight the very gap of which I'm speaking and support the need for today's webinar. Myself, a person formerly categorized as having serious mental illness, for me, spirituality was and is most important in my recovery. And as you will learn today, such is often the case for the individuals receiving our mental health services. Spirituality and religion are fundamental to many people's lives, health, and well-being, and are crucial for the effective delivery of holistic and person-centered care. Since 2011, spirituality has been considered an ethical obligation in general health care in regard to practice, research, and policy. And in 2015, the Executive Committee of the World Psychiatric Association accepted a multifaceted position statement on spirituality and religion in psychiatry. Among other things, it delineates ethical considerations for clinical practice and person-centered care. Specifically, it states, quote, the consideration of individual spirituality, religious beliefs, and practices, and their relationship to the diagnosis and treatment of psychiatric disorders should be considered essential components of psychiatric history taking, training, and professional development. Additionally, the World Psychiatric Association has included religion and spirituality as part of the core training curriculum for psychiatry. Consider for a moment your personal integration of spirituality in clinical practice. What tools do you use to support patients and consumers in discovering and developing their spiritual well-being? How frequently do you revisit the topic with the people you serve? Today's webinar is designed to equip you with additional strategies and skills to do just that. Perhaps some of the difficulty in integrating spirituality into clinical practice comes from the challenge of defining it. Interestingly, both terms, spirituality and religion, lack universally agreed upon definitions. This was even acknowledged in the statement from the World Psychiatric Association on spirituality and religion. However, there are common threads of understanding that can guide our discussion today and aid our conversation with the people we serve. Spirituality is commonly understood to be more personal and more personally defined. It tends to involve an individual's core values and beliefs and what they identify as giving their lives meaning and purpose. Some people identify as both spiritual and religious, while others identify as spiritual but not religious at all. Religion is more commonly understood to involve beliefs, practices, and rituals or traditions that are agreed upon by groups of people and practiced within a community of believers. Most people who are religious also consider themselves to be spiritual and may consider their religion to be their pathway to spirituality. Statistics reported by the Pew Research Center published in 2021, just last year, show that approximately 70% of Americans identify with a specific religion, while 30% are religiously unaffiliated. Looking more closely at that unaffiliated group, we find that that includes 3% who identify as atheist, 4% who identify as agnostic, and the largest group within that 30%, which is 16%, indicate, quote, nothing in particular, or that was the category that they chose of the three categories in the unaffiliated group. For the purpose of this webinar, I'll be using the term spirituality to be inclusive of both the religiously affiliated and those that are in the unaffiliated category, as it is the most inclusive term and covers a universal experience that we all have regarding spirituality. I think that will become more clear as we move forward. Because of how the terms are defined, systematic reviews of the academic literature have identified more than 3,000 empirical studies investigating the relationship between religion, spirituality, and health. These studies provide substantial evidence demonstrating that spiritual and religious beliefs and practices result in numerous positive mental, physical, and social health outcomes. Among the top three are meaning, identity, and coping. Many people use their spiritual beliefs to give meaning to and make sense of their life experiences, including experiences with mental illnesses. This was one of the most frequently occurring themes in the systematic reviews of the literature. Secondly, participants drew on their spiritual frameworks to develop and negotiate a spiritual identity. Spirituality enabled many participants to develop a more empowered view of themselves. Spirituality represents for many the core essence of who they are, shaping their identities through their experiences of illness, struggle, and recovery. A third prominent theme was coping, referring to the many ways people reported using their spirituality to deal with the challenges of their mental health problems. This includes a variety of spiritual practices participants reported that helped, such as prayer, meditation, mindfulness, attending a place of worship or quiet space, or reading religious or spiritual materials. They also noted the importance of spiritual relationships, whether with God, a spiritual figure, or a genuine reciprocal relationship with another spiritual person. Sometimes people's faith, spirituality, or relationship with God kept them alive or kept them from harming themselves during times of their most difficult struggles with mental health problems. Even more specifically, studies have shown that spirituality promotes other-directedness, helps people to release the need for control, provides and encourages forgiveness, encourages thankfulness, and provides hope. When I consider the five benefits listed on this slide, a few things stand out to me. First, these are things we all benefit from. Second, these are things I desperately needed in my own mental health recovery journey living with serious mental illness. And third, these are things individuals receiving mental health services generally tend to need support with. The more tools we have in our toolkit as mental health professionals, the more able we are to support the individuals we serve in attaining these research-based benefits. And the better off we and they will be. Of course, that's part of the problem. So while numerous studies have shown the importance, the value, the benefits, the importance of mental health professionals being aware of and prepared to support this spiritual dimension, you have offered specific strategies or tools for increasing mental health professionals' comfort in this area and their skill and their ability to actually engage patients in the discussion. So this pie chart, very simple. What I have termed the spiritual health framework is just that. It's an easy-to-use tool for mental health professionals to use to discuss spirituality with individuals receiving services. The simplicity of a pie chart means that it can be utilized anywhere. Anywhere you are, you can pull up a napkin and draw a pie chart. Any paper, anywhere, anytime, it's a conversation that you can have with somebody. So the spiritual health framework has four equal quadrants, first, meaning and purpose, second, values and principles, third, sense of community, and fourth, spiritual practices. And on the following slides, we're going to consider each of these quadrants individually. If I had better PowerPoint skills, this would be like nifty and you would see meaning and purpose pulled out from the pie. But I spent way too much time trying to figure it out and we just have a pie. So the first quadrant we're talking about is the meaning and purpose quadrant here, unlabeled because I couldn't figure it out. That's part of my spirituality, genuineness and authenticity, highly valued in my life. All right, so we start here because meaning ranks highest on the list of importance in terms of the benefits of spirituality in mental health and well-being. Research has shown that having meaning and purpose in life supports wellness and recovery and that it is through spirituality that people find meaning and purpose. So I'm going to repeat that because it's kind of circular, right? So research has shown that having meaning and purpose supports wellness and recovery and that it's through spirituality that people find meaning and purpose. So recall the gap discussed at the beginning of this webinar, mental health patients and consumers place a high value on spirituality. And the research shows there's tremendous benefit to including spirituality in mental health services, but there's a lack of actual inclusion of spirituality by mental health professionals in treatment and support services. Those are research-based known things, high value by consumers, high benefit outcomes based and low inclusion. It's as if, this is how I see it. It's as if there were a good medication available, studied research shown to be effective and desired by patients, but for whatever reason it wasn't being prescribed. So the spiritual health framework is a tool that's just kind of being designed to help bridge that gap. Likely you're familiar with Man's Search for Meaning first published in 1946 by Dr. Viktor Frankl, one of the world's leading psychiatrists at that time. It describes how the author's experiences as a prisoner in Auschwitz during World War II helped him to discover that the desire to find meaning in life is essential to the human experience, even more so than the desire for pleasure or for power. People with a strong sense of purpose in life tend to do better on a number of different measures of mental health, wellbeing, and even cognitive functioning. A survey of 3,489 adults between the ages of 32 and 84 established that a purpose in life was associated with higher scores for memory, executive functioning, and overall cognition. I don't know about you, but I find those things astounding that having purpose in life can affect our executive function and our cognitive abilities. Over the years, I have had the privilege of knowing many individuals with serious mental illnesses whose lives have been radically changed through their discovery of meaning and purpose. One such individual, a gentleman living with schizophrenia, attended a week-long training that I was conducting in Chicago. The stress of that training and the venue itself, which was situated right literally outside the window with the L, so it was constant noise and stress for all of us, but particularly for him, triggered his symptoms. By the end of the five days, he was not well, but the training also led to his discovery of meaning and purpose because it led to him becoming a certified RAP facilitator. RAP, if you are not familiar with it, is Wellness Recovery Action Planning, and he became certified to facilitate RAP and ended up facilitating RAP at the nursing home where he had formerly been a resident. The meaning and purpose he experienced through that meaningful life role resulted in a significant decrease in his symptoms over time. This is just one story of hundreds that I could share. Watching people's lives transform before my very eyes is something that has given my life meaning and purpose. As Viktor Frankl said, life is never made unbearable by circumstances, but only by lack of meaning and purpose. Meaning and purpose can seem elusive and esoteric. Thus, when looking at this quadrant of the spiritual health framework, it's important to assist individuals in their exploration and discovery by using questions that are more down-to-earth. On this slide, you can see a few questions that you can ask that may assist individuals in identifying the things that give their lives meaning and purpose. I've used these same questions in hundreds of workshops over the past two decades. These questions open up the conversation quickly. They're not difficult for people to answer. When we start talking about meaning and purpose, people's eyes are kind of glazed. It seems very far away, but the minute you ask the question, what matters to you the most, answers start coming quickly. People know what matters to them. The first question, what matters to you the most, in particular, has had tremendous opportunities for people to have what I call aha moments, what professionals refer to as insight. It has particularly helped to broaden the conversation, to broaden the conversation and expand individuals' thinking about spirituality, particularly those for whom the word is very closely associated with religion. Often, the moment we mention spirituality, people's minds automatically go to religion, so it can help to discuss the differences between religion and spirituality first, before introducing the spiritual health framework. It can also help to continuously reinforce that spirituality is about what matters to you the most, that they are the ones that will be leading the conversation and defining the terms. This tends to help individuals understand that it's not what anyone else says. It's what they say for themselves. When we introduce this question, what matters to you the most, some of the most common responses tend to fall into what I call the four F's, faith, family, friends, and finances. Honestly, with family probably being the number one response, family matters most to a lot of people, and when you help them think more expansively about the concept of spirituality and kind of open the door to it's about what matters to you the most, don't get locked in on what someone else says is your spirituality. They're able to quickly say, well, I know what matters to me the most. It's my family. For me, for Nanette, it is my faith. I know that answer, but it's not the same for everyone. It's so important that we give them the lead in the conversation. I remember one time when I shared this notion of the four F's, workshop participants tried to make all the rest of their responses start with the letter F. It's kind of fun, but also a little bit off, but you know, we got things like fun, freedom, fantasy. I don't know. I can't remember, but the board was filling up with words that started with the letter F. So, the second question, what keeps you going? The answer to this one may be the same as the answer to the first one, or it may be different. So, really pausing, allowing the individual to ponder and consider, because sometimes asking it differently helps the person to identify what, what I call, helps them to hold on, right, when all else seems hopeless and lost, which then points them back to what is it that matters most? The third question, what would you be willing to sacrifice for? Sometimes this is a little too deep for folks, so sometimes it's better to stick with the first two questions, but then other individuals or groups are really willing to go a step further and look at question three. So, what would you be willing to sacrifice for? Sacrifice can come in many different forms, and if something matters enough to us, right, question one, we may give up sleep or food or money or time or countless other things in order to have that one thing remain and be secure in our lives, and again, thinking about family, right? Probably many of you listening to this webinar can say, I have sacrificed everything for my family, for my son or daughter or my spouse or my mother, father, right? It really kind of just hones in on the fact that this really is what's giving your life meaning and purpose. What would you be willing to sacrifice for? So, before we move forward, I'd like for you to consider your responses to these questions. What matters to you the most? Just going to give you a moment. You probably have already been thinking of them, but if you haven't, this is the moment to do so. What keeps you going? And who or what would you be willing to sacrifice for? Some of my responses over the years have included, I've already mentioned for the first question, faith. Faith is my number one. My faith is definitely what matters to me the most in my life. It guides all my decisions. It is my guiding light. It is my true north, and it is absolutely the number one. And having treatment providers that not only respect that, but also incorporate it into my treatment is really, really, really important to me. Second question, what keeps you going? Well, for 10 years, the answer to that question was mom. My mom passed away last year. On my most difficult days, days that I didn't want to get up, that I didn't want to keep going, and some of those days that I even thought it was like I just was going to give up and give up, it was like I just was going to give up entirely. I wouldn't give up because I knew my mom needed me. I also knew that she wouldn't be here forever, and she's not. So that's been a little scary for me. I've had to identify other things that keep me going, which takes me back to my first question, right? Faith is what matters to me the most. Question three for me, what would you be willing to sacrifice for? Health. Health is my answer to question three. I have sacrificed a lot. I have sacrificed a lot for my health. I don't ever want to be as sick as I once was, mentally or physically. I once was very, very, very sick with mental illnesses. I live with multiple sclerosis, and I have been very, very, very sick with MS, and I don't ever want to be that sick again. Sometimes I think I've sacrificed way too much for my health. Sometimes I wonder if it's worth it. But then I remember that I don't do this for me. I think if I was doing it for me, I probably wouldn't do it. I do it so I can keep helping other people, keep making a difference in the mental health system, keep doing webinars like this one today, keep being a beacon of hope for other people, and then I'm convinced that it's worth it. The second quadrant in the spiritual health framework is values and principles. On the pie chart, it's the lower right quadrant. Right here. Our personal sense of spirituality forms the basis for the values and principles that guide our lives. These values and principles develop our internal guidelines for personal conduct. We may not even be conscious of them, but each of us has them. Our values and principles contribute to our sense of meaning. Hello, quadrant one. Help us make decisions and help us to persevere through adversity. As Walt Disney's son Roy Disney once said, it's not hard to make decisions once you know what your values are. There is a difference between values and principles. Values are more idea or concept based, whereas principles put that idea or concept into action. The chart on the right, developed by Brian Penney, gives examples of how he has lined up his values with associated principles. I personally think of values like anchors. They help us keep from floating out to sea. And principles are like our compass. They give us direction in life. They help us know which way to go. They're more action based. You see the values are like nouns and the principles are like start with verbs. But, you know, it's not really the distinction that matters between values and principles. What matters is our supporting individuals in identifying their own personal values and principles. We've all heard phrases like, quote, unquote, my clients aren't motivated. Maybe you've even said it yourself. In reality, they're not motivated to do what we want them to do. So supporting the individual to consciously identify their values is part of their spiritual health. And it also assists mental health professionals to be able to tap into that which intrinsically motivates them. Person-centered care puts the individual's values at the center of treatment. Providers, of course, are not to superimpose their values onto the people they serve, but rather to identify and support the values of the person. Whether we think about it or not, values play a large role in the decisions and choices we make and the things we do every day. And this is true for everyone. And it's the core of why mental health recovery works best when it is self-directed, based on the individual's priorities and values, not ours. By aligning treatment goals with the individual's authentic values, engagement just occurs more naturally. For example, many individuals we serve place high value on their independence. The way providers interact with them may unintentionally disrespect this value, simply due to the historical role and manner of caretaking in mental health services. Consider for a moment how the following values might affect a person's goals in life. What about someone who values adventure or achievement? What about someone who values risk-taking? That's a value. People actually value risk-taking. What are we doing when we're constantly protecting every person that we support when they have a value? They value risk-taking. What about someone who values generosity and selflessness? How about people who value freedom? I mean, we all do, right? I mean, this is America. So freedom is something we all value. I have a long list. I'm just picking off the list. But you kind of get the point. So how do we go about supporting others and identifying their values and principles? Sometimes it can help to ask individuals to think of someone they admire. Then ask them what it is they admire about that person. That may be a more subtle way of getting at the question of values and principles. We may hear responses like, well, she's really nice. And then we might want to dig deeper. Okay, what is nice? What do you mean? What are the behaviors? Ask more questions. Dig deeper. You might hear something like, well, he always does what he says he's going to do. Like, well, he always does what he says he's going to do. Yeah. A more direct question, of course, is what are some guidelines for personal conduct that you try to follow? It generally helps if you provide your own examples first. You may share something like, such as treating others the way you want to be treated. Something very familiar to people, and they start to understand and catch on very quickly about what it is we're talking about. Respect yourself. Treat others with respect or respect the environment. Again, these are questions that I've used in workshops for two decades, and they do facilitate discussion quickly. They're not difficult or complicated. Now, another approach is to do a values inventory, of which there are numerous lists and worksheets available online. Ideally, the inventory is completed in dialogue with the mental health professional, allowing the provider to gain insight and understanding of the individual's values, rather than making assumptions about their responses. Values have different meanings to different people, so having someone fill out a worksheet and turn it in is just not sufficient. The goal here is really to gain a deeper understanding. Following these discussions, then, mental health professionals are more equipped to support patients and consumers to turn those values into concrete terms and achievable goals. This is known as values-based recovery planning. It's an approach that fosters better communication, recognizes consumer priorities, and builds on the intrinsic motivation of the individual. Both quadrant one and two of the spiritual health framework can be continually revisited in the ongoing process of treatment and recovery. We can discuss motivation. If a patient or consumer seems unmotivated, return to those responses in quadrant one, what matters to you the most and what keeps you going. Discuss how or even if their current goals are connected to those responses. People's answers in quadrant one are never, take medication daily. But this is often one of the things that the people around them overemphasize. We need to understand how or if taking medication daily is even connected to the thing that matters most to that person. Discuss discrepancies. If an individual has listed adventure as something they value in quadrant two, but they have no experience, no opportunities for new experiences, this may be contributing to a sense of discouragement, discontentment, or even depression. If an individual places high value on living a life of adventure, but their medication makes them lethargic, there is a significant discrepancy there. They're not experiencing life according to the thing that they value the most. It's not our job to change or modify their values, but rather to support them in identifying goals that support what they consider, as Marshall Linehan called it, a life worth living. All right, so the third quadrant. The third quadrant is a sense of community, which shows up in green. The need to belong, also known as belongingness, refers to the human emotional need to affiliate with and be accepted by members of a group. A sense of community involves more than simply being acquainted with other people. It is centered on belongingness, gaining acceptance, attention, and support from members of the group, as well as providing the same attention to other members. In Maslow's hierarchy of needs, belongingness is part of one of his major needs that motivate human behavior. The hierarchy is usually portrayed as a pyramid with more basic needs at the base and more complex needs near the peak. The need for love and belonging lie at the center of the pyramid as part of social needs. A 2020 study in college students found a positive link between a sense of belonging and greater happiness and overall well-being, as well as an overall reduction in negative mental health outcomes, including anxiety, depression, hopelessness, loneliness, social anxiety, and suicidal thoughts. Studies have shown that those who have higher belongingness also have higher self-esteem, greater empathy for others, are more trusting, sociable, and collaborative, and consequently, others are more open to trusting and cooperating with them. As social beings, humans thrive in a supportive community. The National Alliance on Mental Illness, or NAMI, identifies three beneficial elements that having a community provides. Belonging, having a sense of community helps people to be their true selves while embracing their most positive qualities. Support. When we're feeling down or struggling with something, having someone to talk to can help us work through our emotions and feel safe. And purpose. Back to quadrant one. In communities, people not only gain support, but they give it as well. Helping others can give our lives meaning and purpose. Dutch Catholic priest, professor, writer, and theologian, Henry Nouwen, said the best of community does give one a deep sense of belonging and well-being. And in that sense, community takes away loneliness. For those who are unfamiliar with him, Nouwen's interests were rooted primarily in psychology, pastoral ministry, spirituality, social justice, and community. After nearly two decades of teaching at academic institutions, including the University of Notre Dame, Yale Divinity School, and Harvard Divinity School, Nouwen went on to work with individuals with intellectual and developmental disabilities in Ontario. He has an award named for him, the Henry Nouwen Leadership Award, given out by the American Association on Intellectual and Developmental Disabilities, Religion and Spirituality Division. Nouwen and other researchers help us understand that it is through community that we can have the sense that I am not alone. There are others like me. I have something to offer, and I can be my true self here. So how can we support the individuals we serve in developing a strong sense of community? The ability to develop a sense of community often comes through becoming involved with a group of, quote-unquote, like-minded people. Many times, the isolation that a person feels is related to not having found such a group. These days, people often refer to this as, quote, finding your tribe. Finding your tribe is about joining a group that allows you to feel like one of them. These are people who share your interests. They're glad to welcome you into their circle, and when they say, we, you feel that means you too. The first step in assisting an individual in finding their tribe is helping them find themselves. In other words, quadrant two, in which we support individuals in identifying and clarifying their own values and principles. This helps them know what they're looking for in this so-called tribe. They may find that sense of community in clubs, faith groups, 12-step programs, or support groups. In supporting others to fill out this third quadrant, you may ask them questions like, where do you feel a sense of belonging? Or where can you go to be with people who have similar values as you? Or where do you feel comfortable being yourself? We can use the spiritual health framework to do a checkup, if you will. And as you might imagine, the responses to these questions may all be nowhere. This exploration provides both the provider and the consumer in the ability to recognize a need, a weakness in their spiritual health. Quadrant three is often the area in which individuals are most challenged. Those with serious mental illnesses simply don't feel like they belong anywhere. This is a real need and one which deserves attention and support by mental health professionals. Having completed quadrant two, values and principles, equips us to better facilitate this discovery. Oftentimes individuals with mental health conditions, especially serious mental illnesses, are encouraged to quote unquote, find community among others with mental health conditions. But this is making a huge assumption that all people with mental health conditions share the same values. We can feel a sense of belonging through sharing a common struggle, mental illness, but often it's very difficult to feel comfortable being yourself when you are among people who don't have similar values as you. Mental health support groups do have their place, but they don't necessarily fill this need for a sense of community. And I would say beyond just support groups, but drop-in centers, clubs, and et cetera. So making it personal for a moment, I can share some of my values from quadrant two, include things like safety, spirituality, of course, selflessness, peace, empathy, excellence, and service. Many times I felt these and other of my core values were actively discouraged or in conflict when I participated in mental health support groups and other such settings. And honestly, as a mental health professional now, I understand why that would be. But it wasn't until I began attending a recovery program at a church that I began to feel that sense of belonging that fills this need or this gap in our spiritual health. Mental health professionals who understand the values and principles of the individuals they serve are better able to support their discovery of places where they can go to begin to fill that need for a sense of belonging. Okay, so the fourth and final quadrant is spiritual practices. Research has shown that spiritual practices, like all these other areas, promote wellness and recovery and can be a source of comfort, healing, and positive coping during difficult times. Spiritual practices are very personal. What works for one person can actually be stressful for another person. Spiritual practices can arise from spiritual beliefs and may be affected by spiritual beliefs. As with all other aspects of the spiritual health framework, spiritual practices must be discussed in a person-centered, exploratory manner. Mental health professionals must not impose their spiritual practices on others. One practice that is very common in mental health settings are things that fall under the general category of meditation and often guided meditation. For myself, as a former mental health consumer, I found guided meditation to be more than slightly distressing. In the worst of my illness, I suffered from extreme dissociative episodes and guided meditation was an avenue or a pathway for dissociation. Anytime a mental health professional opened a session with, first, we're going to start with a meditation, I had panic attack because I had experienced that as a pathway to dissociation. This is why it's so important that we are careful not to assume that what one practice is going to be applicable or useful or helpful for all persons. Some practices have become so common in mental health that we do make those assumptions and we really must be cautious. In completing the spiritual health framework with an individual, we might begin quadrant by asking them, what spiritual practices could you discover from the other sections of this spiritual health framework? For example, if they identified family, as we've talked about before in quadrant one, as one of the things that matters to them most, then we might ask, have you ever considered that spending time with family is, in some ways, a spiritual practice for you? Of course, many people already utilize various spiritual practices, so it may be less of a discovery process and more of identifying and naming those practices. A direct question, of course, works well for this. What spiritual practices do you use? Some individuals may benefit from being introduced to a variety of spiritual practices, providing them the opportunity to consider and experience new ways to strengthen their spiritual health. But again, with that caution, not to make an assumption that what works for one will work for all. It's important to note that our role is to listen and support an individual in identifying the spiritual practices that work best for them. We can do this by helping them connect those practices to the other aspects of their spiritual health framework, identified in quadrants one, two, and three. Things to consider may include inquiring about how this practice connects the individual with what matters to them most, how this practice can help keep them moving forward during particularly difficult or challenging times, and how this practice supports their core values and principles. In the fourth quadrant, it's important to include a discussion of how these practices help, because many people have been conditioned to utilize various practices that are not healthy and may even be a hindrance to their recovery. Spiritual practices sometimes get passed down to us. We may continue using them even though we've never consciously chose them. So by going through the things they've listed and talking about how it helps, sometimes the individual might discover that it doesn't help or that it's actually making things worse. Maybe that's a practice they might consider discontinuing or at least doing less of. This gives the individual the opportunity to make a choice, to choose those practices that are contributing to their wellness and recovery, practices that align with their values and principles, practices that add to their sense of belonging and give their lives meaning and purpose. The spiritual health framework can be used to help with so many aspects of person-centered care. It can help to increase patient or consumer engagement, to support identity development, to identify sources of positive coping, to collaboratively develop treatment goals based on what matters most to the individual, to develop what is known as spiritually augmented CBT for sustaining mental health and functional recovery, and so much more. Over the years, I've found that this framework takes the mystery out of spirituality and provides a concrete and generally non-threatening way to initiate and sustain the conversation. As we close, I hope that you are able to think differently about spirituality. It's not as complicated as we tend to make it and that you feel inspired to move forward, to act, encouraged to do something different in this space and to use this framework or at some framework. I have no stake in what framework you use, but just that you would begin to engage with individuals in this conversation. Here of course are my references. I do want to point out the World Psychiatry Position Statement and Pathways to Recovery Strengths-Based Recovery Self-Help Workbook is an outstanding resource, been around for a long time, and I encourage those who are not familiar with it to look it up. And I thank you so much. Thank you for such an interesting presentation and also for being vulnerable and honest. It's refreshing to see someone put themselves out there and kind of live out what they're actually sharing. Before I shift into some questions and answers, I want to take a quick moment and let everyone know that SMI Advisor is also accessible from your mobile device. Just use the SMI Advisor to access resources, education, upcoming events, complete mental health rating scales, and even submit your questions directly to our team of SMI experts. It's as easy as downloading the app, it's smiadvisor.org forward slash app. Okay, so I'm going to field the first question. Someone wants to know, how have you been most successful in introducing and discussing spiritual health with patients and consumers? What I've been most successful in doing is usually to start with, as I kind of mentioned at the beginning, let's start with a discussion of your perception of religion and spirituality. What are the similarities? What are the differences? And usually that starts to open the conversation and help individuals to make a distinction. And also usually starts to bring the tension down, right? Because it's actually a religion that causes the tension. And so often the minute we begin the conversation, there's high tension because they expect that the conversation is about religion. But when we have the conversation with, well, let's compare and contrast. What are similarities? What are differences? And not necessarily telling, but listening and allowing them to think through and consider how they would think of them differently. And then say, well, we're going to talk about this. We're talking about spirituality. And it's okay if for you, religion is part of your spirituality. But I want to comfort you in knowing that I'm not concerned about this. We're not getting involved or engaging in any kind of religious debate. And obviously our culture now is so sensitive to these issues that we have to be very careful that there's an understanding that we're not getting into this. It's okay if they want to talk about it, but I'm not talking about it. I'm not trying to bring in any of my religious ideologies or anything. I'm concerned about their spiritual wellbeing. That makes a lot of sense. You're speaking of that person-centered approach. So thank you for that. Another question that we have here is, have you experienced any challenges when someone only wants to adhere to spiritual principles and wants to dismiss any mental health symptoms? Oh, yeah, absolutely. And I think this can be more frequent than we actually realize. And again, kind of going to person-centered planning, if we let our person-centered principles guide us as professionals, it's not as hard as we think it is, right? Oftentimes it's us allowing us to get out of our stuck frameworks, because we've been given a framework in our training, and those frameworks give us lenses through which we see everything we hear. Everything we hear, we see as symptoms and we see as ABC, right? We see it through those lenses. And so it's hard for us to get out of those frameworks when we've been taught these things. I have a niece that's in college taking psychology classes, and she sees the world through those lenses that all of us have been trained to see them through. And the truth is that that's one way of seeing the world. It's not the solid truth, right? It's just one way of seeing the world. And so if you have an individual who doesn't see the world that way, our job is to sit where they sit and understand better how they see the world, and then build their supports and their treatment from that framework. There's an excellent, there's a psychiatrist, I'm hoping my memory will bring his name back to me during this conversation, but there's a psychiatrist in California who has been working with people with serious mental illness his whole career, and he has done such a phenomenal job doing just what I'm talking about, kind of saying, just because that's not my training and not my framework doesn't mean that I can't sit where they sit and see it that way. And if I see it that way, I'm far better able to support them. Our job is not to disagree and tell them the way we see it. Our job is to see it the way they see it, because, you know, I can say this as a person of faith, as a person of faith, seeing the world through the lens of faith still helps me to work on, quote, unquote, symptoms, right? It's just through a different lens. And so it's our job as professionals to sit in a different seat and begin to see it the way they see it. Thank you for that. We have a few other questions, but I'm going to field one more. Someone is asking, have you had success implementing these tools when somebody is in the depth of their symptoms of severe mental health? Yeah, so that's a fabulous question. I've had several individuals that I've worked with who have been, as you put it, in the depths of their symptoms. And you know, depending on the situation, right, and what that means exactly, right? So in the depths of their symptoms, we can be talking about psychosis, we can be talking about depression, we can be talking about anxiety, right? So we talk about mania. And so it's different in different situations, right? So I talk about, and I'm very mindful of our time, 2.59, so I'm just going to talk briefly about one of those situations. You know, and so an individual actually was an employee of mine who has schizophrenia. And you know, it was actually through discovery of meaning and purpose that he actually went from a life of being basically in the living out his serious mental illness to being able to work full time for the government. So you know, meaning and purpose can change lives, right? But also progressively over time, unfortunately, his illness came back in full swing. And you know, as his supervisor, being able to even just relate to him around these quadrants and around this as the driving force, because I knew that it was meaning and purpose that got him well in the first place. And so being able to, you know, the thing about him was that he still was very highly motivated through his spiritual sense, and through those things that mattered to him the most, and through those things that he was very principled. And these are the things that I think sometimes with mental health professionals, we tend to forget, we get stuck on symptoms, and we get stuck on illness. And we forget that behind all of that, because that's in the front, but behind all of that is a person who is principled and motivated by values. And so we can actually relate to that person, what I saw in this employee, and again, this is just one of several I could share, but it's 301. But you know, that I saw this employee, those symptoms just start to diminish literally in front of my very eyes, because the real person starts to come forward. Thank you so much. That's the value of peer support services. So I'm going to move on, like you mentioned, with the Ready 301. So if anyone has any questions about this or any other topic related to evidence-based care for SMI, our clinical experts are now available for online consultations. Any mental health clinician can submit a question and receive a response from one of our SMI experts. Remember, consultations are free and completely confidential. SMI Advisor is just one of many SAMHSA initiatives that are designated to help clinicians implement evidence-based care. We encourage you to explore the resources available on the mental health addiction and prevention TTCs, as well as the National Center of Excellence for Eating Disorders and the Suicide Prevention Resource Centers. These initiatives cover a broad range of topics, anywhere from school-based mental health to all the opioid epidemic. To claim credit for participating in today's webinar, you'll need to have met the required attendance thresholds for your profession. Verification of attendance may take up to five minutes, then you'll be able to select next to advance and complete the program evaluation before claiming your credit. And lastly, please join us next week on June 16 of 2022 as Nanette Larson presents on the Utilization of Medication for Opioid Use Disorder in an Outpatient Setting. Again, this free webinar will be conducted on June 16 of 2022 from 3 to 4 p.m. Eastern Standard Time. Once again, thank you for joining and until next time, I hope everyone takes care.

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