Faith and Mental Health: Why It Belongs in the Conversation

In psychiatry, we often speak about person-centred care — treatment that sees you as more than a diagnosis.

Yet many patients experience that mental health professionals feel uncertain about how to include faith in consultations. Clinicians may worry about overstepping professional boundaries, feel unsure how to raise the topic respectfully, or feel ill-equipped to respond when religious or spiritual concerns arise. At times, faith is simply avoided. Many clinicians receive limited formal training in how to explore these areas sensitively and ethically. Discomfort is often about uncertainty, not disregard.

Yet, both international and South African professional bodies acknowledge that overlooking faith can limit good psychiatric practice.

The World Psychiatric Association (WPA) advises psychiatrists to explore spirituality and religion as part of comprehensive assessment, recognising that these may shape a person’s identity, coping, meaning-making and treatment preferences.

Similarly, the South African Society of Psychiatrists (SASOP) supports culturally competent, patient-centred care that includes religious and spiritual perspectives when they are relevant to the patient.

If faith shapes how you understand your life and your struggles, then respectful, patient-centred mental healthcare should make space for that.

Why This Matters in South Africa

Globally, around 84% of people identify with a religion. In South Africa, more than 80% identify as Christian. And for many people, faith is not a side issue – it shapes identity, family life, moral decisions, community belonging and how illness is understood. Research shows that most of the world population consider religious and spiritual values, beliefs and practices to be relevant to their health and that they want these to be part of their health care. (WPA).

Faith can influence:

• How you interpret symptoms
• How you understand guilt, shame or hope
• Whether you accept or decline medication
• Where you seek support
• What recovery means to you

For example, a person with strong religious conviction who develops depression may interpret it as spiritual failure, or worry that taking medication reflects a lack of faith. These are not simply “wrong ideas” to be dismissed. They are deeply held beliefs that deserve thoughtful, respectful conversation.

A Shifting Relationship Between Faith and Psychiatry

Historically, religion and mental health were not separate spheres. Across cultures and centuries, experiences of emotional suffering, unusual perceptions, despair or fear were understood through spiritual, moral and communal frameworks. Religious institutions were often central to care, interpretation and support.

It was only in the late 19th and early 20th centuries, particularly with the rise of psychoanalysis and more secular scientific models, that parts of psychology and psychiatry began to move away from religious explanations. Some influential theorists were explicitly critical of religion, and for a period, faith was often viewed with suspicion within mental health disciplines.

Over the past few decades, however, this sharp separation has softened. Research has increasingly shown that for many people, spirituality and religion are important aspects of identity, coping and meaning-making, and that incorporating them into treatment may improve outcome. As a result, modern psychiatric guidance has shifted toward more holistic, culturally informed care.

A Biopsychosocial-Spiritual Approach in Practice

A biopsychosocial-spiritual approach does not assume that faith is always central, nor that it is irrelevant. It is patient-centred and recognises that, particularly in South Africa, faith, culture and worldview often shape how people understand suffering, healing and recovery.

There are two distinct, but related, ways that faith may be included in mental healthcare.

1. Spiritual Assessment / Cultural Formulation

As part of a routine psychiatric or psychological assessment, a clinician may explore your spiritual or religious background in the same way they explore your family history, work life or cultural context.

They may ask questions such as:

• “How does your faith or worldview influence how you understand what you’re experiencing?”
• “Are there spiritual or cultural practices that bring you comfort or meaning?”
• “Is there anything about your treatment that feels difficult to reconcile with your beliefs?”
• “Would you like your faith community to be part of your support system?”

This is often referred to as a spiritual assessment or cultural formulation.

It is not the same as faith-based therapy, and it also does not require the clinician to share your faith.

Its purpose is to ensure that your care is respectful, collaborative and aligned with what matters to you. Proper training allows all mental health professional to be able to explore these areas sensitively and ethically.

2. Faith-Integrated Psychological Interventions: A Specialised Approach

Alongside the above, there is growing research into psychological therapies that intentionally incorporate a patient’s religious framework. These include, for example, adaptations of cognitive behavioural therapy (CBT) or acceptance-based approaches that thoughtfully incorporate the spiritual language, texts and practices of the client’s faith into their therapy process, which are linked to superior outcomes for religious patients when delivered by trained professionals. (Koenig et al). Faith-integrated therapy is considered to be a more specialised intervention that should ideally be delivered by clinicians who are both properly trained in the therapeutic model used and who are knowledgeable about the patient’s faith tradition.

Faith-integrated therapy may be appropriate when:

• A patient specifically requests therapy that explicitly incorporates their faith
• Religious beliefs are central to the person’s distress or recovery
• There are complex concerns such as scrupulosity, religious trauma, spiritual abuse or doctrinal conflict

Faith-integrated therapy does not necessarily require the therapist and patient to share the same faith. What matters most is clinical competence and a sound understanding of the patient’s religious framework.

That said, many patients prefer a shared-faith therapeutic relationship. Shared faith can improve understanding and enhance trust and nuance, particularly when beliefs and practices are central to the work.

Conclusion

Thoughtful mental healthcare makes room for the whole person. It seeks to understand how belief shapes experience, relationships and treatment decisions, and, when appropriate, gently integrates faith in ways that remain clinically responsible and ethically grounded. When this is done well, treatment feels coherent rather than divided, and it allows recovery to unfold in a way that honours both sound medical practice and the deeper sources of meaning, hope and direction that sustain people through difficult seasons.