Europe's mental health strategyBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7561.210 (Published 27 July 2006) Cite this as: BMJ 2006;333:210
All rapid responses
Having read the Green Paper mentioned in this Editorial (1), while
applauding the proposal for such a strategy, I could not help noticing the
absence of any reference to spirituality in either document.
There is evidence (2) that for many spirituality is a key component in
both physical and mental health in terms of prevention of illness, speed
and degree of recovery, and of endurance of continuing distress and
disability. Its necessary inclusion in a mental health strategy would also
seem implicit in the literature of the World Health organization (3). The
relevance of this “Forgotten Dimension” to mental health is increasingly
frequently asserted (4, 5). The Royal College of Psychiatrists has
recently published a leaflet on the topic (6), and has a chapter devoted
to it in a forthcoming book (7).
Spirituality is arguably a universal and unifying concept, distinguishable
from religion, which has significant potential for being divisive (8). It
pertains to meaning and purpose in life, to people’s sense of
connectedness to the universe and to each other, and thereby to a healthy
sense of worth and belonging. It comes to the fore in times of illness,
mental illness and other adversity. Spirituality cannot easily therefore
be divorced from mental health, a point that I feel sure strategy-makers
would be wise to acknowledge openly.
Inalienably associated with values including those of wisdom, honesty,
kindness, tolerance, patience and compassion, when understood, the
relevance of spirituality is non-contentious, capable of uniting mature
religious believers and non-believers alike. A much more harmonious social
and political future for Europe and beyond is attainable within the space
of a few generations. Spirituality, characterized (to put it briefly) by
inclusive, non-dualistic and therefore non-partisan thinking, holds the
key, particularly if sensitively introduced to schools’ and colleges’
curricula (9, 10), as well as to the agendas of health and mental health
care. The argument for including at least some reference to it in the
proposed strategy seems convincing. Doubtless others will differ in their
views, but even these will agree that the subject in hand is worthy of the
deepest reflection - and that is, in itself, an exercise in spirituality.
1. Wahlbeck, K. & Taipale, V. (2006) Editorial: Europe’s mental health
strategy British Medical Journal; 333: 210-1.
2. Koenig H, McCullough M, & Larson D. (2001) Handbook of Religion and
Health. Oxford: Oxford University Press.
3. World Health Organization. (1998) WHOQOL and Spirituality,
Religiousness and Personal Beliefs: Report on WHO Consultation. Geneva:
4. Swinton, J. (2001) Spirituality and Mental Health Care: Rediscovering a
Forgotten Dimension. London: Jessica Kingsley.
5. Culliford L. (2002) Spiritual care and psychiatric treatment: an
introduction. Advances in Psychiatric Treatment; 8: 249-261
6. Royal College of Psychiatrists (2006) Spirituality and Mental Health
(‘Help is at Hand’ series). London: Royal College of Psychiatrists,
available at www.rcpsych.ac.uk (accessed 31.07.2006).
7. Royal College of Psychiatrists (2006, in press) The Mind: A User’s
Guide. London: Transworld.
8. Culliford L. (2002) Spirituality and Clinical Care. British Medical
Journal; 325: 1434-5
9. Hay, D, & Nye, R (1998, revised 2006) The spirit of the child.
London: Jessica Kingsley.
10. Tacey, D. (2004) The spirituality revolution. Hove: Brunner-Routledge.
Larry Culliford was a co-founder and remains on the executive committee of the Royal College of Psychiatrists’ ‘Spirituality and Psychiatry’ Special Interest Group
Competing interests: No competing interests
Wahlbeck and Taipale correctly observe that “mental stressors are
undoubtedly public health threats of increasing magnitude”. They urge the
European Commission to advocate inclusion of mental health “not only in
European public health policy but also in social and employment policy;
research policy; and freedom, justice, and security policies” - to which
list I would add “foreign policy”.
There is clearly a link between public health and foreign policy. The
almost surreal carnage witnessed on television screens - from Beirut to
Bagdad, and from Darfur to Mumbai - are manifestations of foreign policy
failures. So - when the madness is finally over, the phoenix will
magically rise from the ashes of destroyed roads and bridges, homes and
hospitals, trains and stations, farms and factories, and water, power and
sanitation facilities, and a new world order will emerge? What of the
horrendous toll in civilian casualties, the massive dislocations of men,
women and children with no homes and schools and livelihoods to return to,
and the longer-lasting mental health effects that are sure to follow and
set the stage for the next senseless cycle of violence?
War and disease may be part of the human condition, but the extent to
which we allow them to destroy life or degrade health is essentially
within our control. The epidemiology of war and violence can be understood
and managed. Indeed, foreign policy should not only include, but take a
leaf, from public health. The key to successfully tackling the twin
scourges of war and epidemics in the 21st Century is for the world to
shift from a reactive to a proactive mode, one that is focused on
prevention through effective policies that are firmly grounded in science
and ethics while being attentive to the frailties of human nature.
Competing interests: No competing interests