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Milner, Katja (2023) “Did I look at the blackness, or did I look at the stars?” The role of spirituality in mental health and recovery. PhD thesis, University of Nottingham.

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Abstract

Spirituality in both religious and non-religious forms is an important component of mental health and recovery. Research demonstrates that many people would like to have their spiritual needs addressed within mental healthcare services. However a ‘spirituality gap’ exists in the difference in value placed on spirituality by professionals compared with service users, often resulting in people’s spiritual needs being neglected or poorly understood within clinical practice. A recovery approach to mental health care seeks to value and better understand lived experience. Supporting clinicians to better understand spirituality from the perspectives of people who experience mental health difficulties could help to bridge the spirituality gap and improve spiritual care within mental health services.

This thesis aims to address the gap in knowledge in two stages. First, exploring the experiences of spirituality among adults with mental health difficulties in published qualitative research through a qualitative systematic review. An electronic search of seven databases identified thirty-eight published studies which met the inclusion criteria. A thematic synthesis of the study findings identified six key themes: Meaning-making, Identity, Service-provision, Talk about it, Interaction with symptoms and Coping, which is presented as the acronym MISTIC. This is the first qualitative systematic review to explore the experiences of spirituality among adults with mental health difficulties and offers an evidence-based framework for developing holistic, strengths-focussed and person-centred approaches to mental health care.

The second approach employed within this thesis is an empirical study using a narrative methodology to explore the role of spirituality in the stories of adults who have current or previous experiences of mental health difficulties. An additional focus is employed, informed by systematic review findings, in exploring the way people use spirituality to find meaning in their experiences and how this process may develop over time. Thirty participants were interviewed and asked to share their stories of spirituality, mental health and recovery. A pluralistic emergent narrative thematic analysis approach was developed to explore superordinate themes of: Meaning making, Psychospiritual development and Spiritual connection.



Participant stories contained wisdom, challenge, beauty and a striking willingness and ability to articulate a dimension of life that can sometimes be considered taboo, nebulous or too overly subjective to have value. A salient finding not adequately addressed within empirical research was the articulation of meaning making for some participants as an internalised form of spiritual guidance. Another key finding was the importance of authenticity within the context of their psychospiritual growth. An emergent integrative factor relating to all superordinate themes was the concept of spiritual functionality. This highlighted how spirituality operated within participant experiences both to support and sometimes challenge or damage their mental health and recovery. Spiritual functionality could therefore be a useful concept within mental health and clinical contexts to advance understanding of sometimes highly subjective and nuanced spiritual and mental health experiences.

The outcomes of this thesis provide a number of knowledge contributions. These include the production of an original conceptual framework highlighting key themes pertinent to people who experience spirituality in the context of mental health and recovery. It also provides novel insights into the ways in which meaning making, psychospiritual development and spiritual connection may function within this context. It contributes towards the development of evidence, theory and training resources for clinicians and mental health services to enable better understanding and reduce stigma of people’s spiritual experiences in the context of mental health. A paradigm of healthcare delivery is highlighted which validates and integrates the spiritual dimension into an evolving recovery approach.

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Crawford, Paul Slade, Mike Edgley, Alison
Keywords:	Spirituality, religion, mental health, recovery
Subjects:	W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Nursing
Item ID:	76507
Depositing User:	Milner, Katja
Date Deposited:	13 Dec 2023 04:40
Last Modified:	13 Dec 2023 04:40
URI:	https://eprints.nottingham.ac.uk/id/eprint/76507

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