Chaplains can be a key treatment resource in secular workplaces

Purpose

Recently, a person with chronic suicide ideation, reached out to me as a chaplain. I took them immediately to medical treatment and stayed with them in the ensuing hours as they told their story to four (4) medical doctors. Later when the psychiatrist told the patient, they could “voluntarily” participate in much needed in-patient treatment, due the chronic illness identified, or be force to stay. They were unwell but also trying to make sense of what had occurred and keep their primary relationships going. I had the privilege of being in the treatment room and being able to encourage longer-term voluntary participation. The psychiatrist advised that the active participation of the patient in treatment was improved management of symptoms, the lessening of ideation and return to work.

In support of leaders who grapple with many issues primary amongst them are the health and safety of their staff, the purpose of this reflective paper advances the notion that pastoral care as expressed by chaplains is a key resource for leaders. This is because of the chaplains’ primary role of caring for ill and suffering people at work. This occurs irrespective of and with deep respect for a person’s personal faith and belief systems.

Noting that affected staff stand in need of all available healing and treatments, the paper examines and debunks some rather limiting notions about chaplaincy-led pastoral and spiritual care. It also engages with the notion that some leaders avoid or undervalue spirituality and meaning issues however much the research says such inner connotations are vital. Consequentially, this may exclude chaplains, perhaps due to assumed religious connotations yet are unaware that people of all faiths and traditions actively engage with chaplains across many jurisdictions.

To say that chaplaincy is (just) about religion misses its real world usefulness in many aspects of responding to workplace stress, illness and injury. So, if we are to consider pastoral and spiritual care again we must acknowledge the extensive debate taking place in emergency service and other first responder workplaces where some leaders say chaplains only offer religious practitioner skills that are increasingly less needed in the 21st century. This is arguably an awareness and evidence issue and partially because “studies have not adequately defined chaplain interventions, nor sufficiently documented the clinical practice of chaplains”.

Mentioning “soul” acknowledges the debates about religious and non-religious spirituality in the 21st century, the tendency amongst some to actively ignore of oppose spirituality at work and how some leaders debunk chaplaincy as being just for a few in the workplace. These views include statements such as chaplains (are/just):

• for believers or seek to convert people
• conduct religious ceremonies
• used by those “few” who hold to a faith-based belief system

If we too easily place pastoral care and chaplaincy into a pejorative “religious basket” not only do we ignore significant research, we also run the risk of not offering the fullest responses to illness, injury and stress. Perhaps we are dealing with unconscious or active anti-religious issues or simply a lack of knowledge that prevents placing the sufferer or ill person at the centre of treatment.

Spirituality and meaning-related choices are important in resilience building, preparation for onerous duties such as deployments and afterwards when healing is needed. In fact, before the onset of illness, “physical, mental, social, and spiritual self-rated health statuses were all found to be associated with an individual’s predisposition to depression and suicidal ideation”.

Chaplaincy: beyond contested or ignored towards being a helpful, professional resource

I have read a lot lately about the contested space of utilising initiate pastoral and spiritual care in triaging and delivering longer-term responses to mental injury, mental health and trauma. There is also conjecture as to whether spiritual and pastoral responses are even needed. However, significant evidence shows that chaplains are undervalued and that not using chaplains would lessen support options, degrade care, reduce employee engagement and/or lead to poorer treatment regimes.

What does the latest research and current practice say?

In treatment and research circles, people may experience injurious symptoms of a belief, inner or deeply personal nature that are not readily related to medical or psychological modalities. In fact, there is significant, indeed “greater recognition that trauma (in its various forms) can cause much deeper inflictions and afflictions than just physiological or psychological harm, for there may also be wounds affecting the ’soul’ that are far more difficult to heal – if at all.”

Overall, the identification and treatment field is complex and in addition to identifiable symptoms, there are also relational or values based issues in play, for example; “the person with PTSD will likely have anxiety about relationships, including issues with trust and abandonment”. These are inherently psychological issues as much as they can be spiritual or pastoral concerns.

Highlighting the use of chaplains, an extensive review of literature, and to debunk speculation about chaplains, found that overwhelmingly chaplains were a useful resource. A review of 482 papers showed:

“60 resources that specifically noted moral injury and chaplains (or other similar bestowed title). The majority of these resources were clearly positive about the role (or the potential role) of chaplains with regard to mental health issues and/or moral injury”.

Thinking then in terms of proficiency, chaplaincy has recently been advanced in applied research as an “empirically rigorous healthcare profession”. Further explaining the professional nature chaplains in terms of sense-making and spirituality, they said:

“Meaning is important because we have discovered through clinical practice that many individuals define spirituality through other terms—including love, relationships, community and belonging”.

Significant international literature and research related to the US Army and Veterans Administration, shows that chaplaincy as an expression of spiritual and pastoral care is in fact, a significant and helpful resource. Chaplaincy care is activated or requested by people of faith, no faith and generally, significant numbers of ill and injured soldiers and veterans who may keep issues of belief to themselves. This is partially because chaplains work with issues of inner values, meaning, loss, trust and despair, which if chronic or ongoing can adversely affect one seeking and engaging with treatment.

Recently, and as a representative example, workplace spirituality and meaning were found to be positively associated with worker engagement and improved mental health outcomes. This research explicitly stated that “employee mental health concerns can be addressed by promoting workplace spirituality, improving employee engagement strategies and implementing organizational justice”.

Practice

Not only in research but in practice, one notes that in some countries, such as the United States, chaplains are integrated within treatment regimes and deemed to be highly effective. In fact, Young (2019) says pointing to the immediate, healing, purposeful and multi-faceted role of the chaplains:

“There are many benefits for having trained law enforcement chaplains working with their police departments in their local communities. I have had many police chiefs of various police departments tell me that they didn’t know how they did without police chaplains in the past. In the midst of difficult and sometimes tragic situations chaplains can provide spiritual guidance where it is sought, a positive, hopeful spirit and presence where it is needed, and a non-judgmental listening ear where an officer needs to talk, and a voice reminding officers that their work as officers has a real purpose and does make a difference in people’s lives”.

Researchers – in a paper published in a psychiatric journal – highlight the challenges amongst health disciplines and actually names the lengths some will go to limit or ignore the scope of chaplains because of the assertion that their clinical skills are paramount:

“No doubt some clinicians, for the purpose of seeking to maintain and extend their professional boundaries, will believe their unilateral conceptual frameworks of addressing moral injury are exclusively correct; they will prefer frameworks that are not truly holistic, failing to endorse a multidisciplinary approach. Some will attempt to exclude or minimize the role of chaplains or clergy down to occasional referrals or argue that the chaplaincy role can be accomplished by non-religious personnel or even replace the chaplain with an empty chair!”

Research shows that chaplains contribute effectively to interdisciplinary approaches to care. Of note, chaplains can spend considerable time with a patient over the longer term, whereas the medical doctor may not be able to. Chaplains work conjunction with other disciplines and in the main, are highly trained not to proselytise but more pointedly work sensitively across belief and faith systems. Of note, a US Navy study, found that 85% of personnel either “agreed” or “strongly agreed” that their “chaplain/pastoral care service was best qualified to treat their spiritual/moral injury”. This augments other forms of treatment. Again, it is noted that military leaders say that “the chaplain is often the most accessible person in the ‘personal support plan. This is particularly relevant when a doctor is not readily available”.

Dealing with meaning and self-worth are core to a chaplains praxis and in fact in terms of holistic care they can “shift the clinician’s diagnostic thinking and illuminate other potential treatment options”. This could lead to the bold(er) work of chaplains assessing options and suggesting additional interventions as challenging as this may be and as much as it involves more applied research to test it as an assertion. Yet if done well, meaning, spiritual interventions and personal pastoral care could support medical and psychological care and in particular, strengthen self-esteem, healing, reconnecting to communities and relationship restoration in ways that the person deem important.

Research shows that a chaplain can be efficacious because they intentionally connect and check in on people. They could discover that they have missed treatment appointments. Chaplains can also advise leaders that it is important to not use guilt as a motivator, but rather stress that circumstances, response or other factors contributed to or led to an injury or illness. The pastoral carer can assure the leader that they support them while simultaneously caring about the injured ill person personally and is invested in their personal relationship.

In terms of meaning making, (re) connections, symptoms reduction and healing, it was indicated from comprehensive research that a chaplain can assist in a number of areas including those that complement treatment and restore relationships:

• Anxiety reduction: Interventions involving for example spiritual chanting/mantram repetition, prayer, breathing exercises, music
• Grief work: Assisting with a member’s grieving given effects of trauma and loss of who he or she use to be and will never be again
• Forgiveness: Assistance with acceptance of guilt, sin, confession, forgiveness and self-forgiveness, absolution, blessing
• Reconnection: Reconnection and reframing of meaning in life with God, with individuals and/or previously associated communities (e.g. religious community).

Further, chaplains, being trained in applied spirituality, reflective practice, sense-making and compassion use interdisciplinary approaches to help people explore how support self-care and meaningful sense-making can assist psychological treatment(s).

Devise and offer workplace education

Chaplains, in my experience are very willing to work with leaders and human resource managers in terms of awareness and training. Further research could include the development of training mechanisms that extend leaders’ and human resource practitioners’ awareness and engagement with psycho-spiritual sense-making and pastoral care issues.

My chaplaincy leadership experience in military and civilian settings shows how chaplains can offer training in how personal, situational, and contextual factors influence one’s willingness or not to enact meaningful treatment, self-care, self-acceptance, and healing.

There is risk in not offering the fullest care and treatment. Moreover, it is well established in practice although not well understood in leadership practice nor literature let alone psychological research that chaplains encourage the stressed and suffering about to make self-care choices and to separate/detach meaningfully from issues and symptoms. It has even been indicated by senior management that chaplains are key, first responders and vital in the provision of ongoing holistic support to the most at risk. With these factors this mind, I briefly explore just two pertinent issues related to treatment and spirituality:

A key risk to care and treatment: An emergency service worker may find it difficult to share an inner belief or morally injurious event/situation to a first responder such as psychological first aid responder. This can be because feelings of fear, guilt and shame are associated with the presenting issue.

Debunking a myth: “You have to be religious to see a chaplain”.

Everyone whether they are religious or not, seeks to make sense of work and life. This is about “meaning-making,” and “it’s prevalent in the lives of most individuals”. It may not be immediately apparent that illness, injury or trauma disturbs or disrupts someone’s values, world-view or simply how they act in the world

 

Recommendations

The treatment of physical and mental health injury and illnesses including PTSD is not an exact science. A multi-dimensional approach early can identify the best form of treatment. This paper has highlighted the use of chaplains as a key first responder who can offer ongoing and interdisciplinary support to the most at risk. In terms of this, and without wishing to criticise existing and vital mental health care, I offer some positive recommendations for consideration:

For leaders and health practitioners

• Multi-dimensional care: recalling the trauma and moral injury concepts, a multidimensional approach to supporting ill and suffering member is vital.
• Use chaplains as part of holistic treatment responses to mental health illness and injury. These include grief, moral injury, inability to forgive others/self, trauma, loss of relational connections (family, unit, significant others). Of note: It is not clear how often treatment plans and case-conferencing processes include pro-active healing and forgiveness steps in the treatment mix.
• Chaplains are often a useful first responder: Leaders across industries including police and civilian are encouraged to note that military leaders state “the unit chaplain is often the most accessible person in the ‘personal support plan. This is particularly relevant when a doctor is not readily available”.
• Chaplains remain connected when the injured/ill may be closed off to others: Recognise that chaplains provide insights and access to an individual who may be closing themselves off to others. People are our highest priority, so we must embrace all capabilities, especially those that contribute to wellness and safety.
• Chaplains work respectfully across belief and non-belief systems: Leaders are encouraged to engage with the fact that people trust chaplains irrespective their faith stance. Chaplains are often a key and localised first responder—yet it is not clear just how often the ensuing treatment system incorporates pastoral care.
• Research says that treatment needs to be multi-dimensional – body, mind and spirit: Interventions must include the widest range of pastoral and mental health-related professionals, which includes chaplains and other members of the clergy. There is a key risk, that despite significant and growing research to the contrary that mental health planning processes may be inadvertently overlooking the place of pastoral care, especially to do with meaning, healing, relational forgiveness and compassion.
• Chaplains work sensitively with families and external groups: We must take note, from military leaders’ observations, experience, and feedback, that chaplaincy has a demonstrable effect in its pro-active work with families and those in external treatment.
• Education: All including leaders and Psychological First Aid responders be taught about psycho-spiritual and meaning-related issues – as these can be an under-recognised in treatment approaches
Resourcing
• Leaders are urged to consider deploying fully resourced chaplaincy teams to focus on providing immediate and longer term pastoral and spiritual presence with a person with illness, injury or PTSD – this is done without a religious agenda. Rather, the chaplain is engaged to gently, appropriately be pro-active in his or her provision of spiritual care to those with illness or injury.

Finally, Chaplains often hear personal stories and narratives as people make sense of the situation and they relate stories of physical injury, relational impairment or personal despair. Pastorally, this can mean the person’s story is told repeatedly and people could get caught in one even unhelpful version of the story and its outcome.

Aspects where a chaplain is able to offer additional support or augment treatment include:

• explicit engagement with and honouring of the person/the family’s story, needs, spirituality and meaning-making stance (including of a non-religious nature)
• address self-blame, remorse and self-judgement
• be a non-judgement, compassionate figure in extraordinary and traumatic situations • Offer rituals especially to do with healing and forgiveness
• Offer pastoral presence – caring, non-abandonment and trustworthiness

Download this paper (Academic version, with references)

Academia Letters, June 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Peter Devenish-Meares, devenip@hotmail.com Citation: Devenish-Meares, P. (2021). Reflective paper for leaders: Chaplains can be a key treatment resource in secular workplaces. Academia Letters, Article 1032. https://doi.org/10.20935/AL1032.