Chaplaincy and Mental Health Care in Aotearoa New Zealand: An Exploratory Study

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.     

Pain Control and Chaplaincy in Aotearoa New Zealand

This paper summarizes the results of 100 New Zealand health care chaplains with regard to their involvement in issues concerning pain control within the New Zealand health care context. Both quantitative (via survey) and qualitative methods (in-depth interviewing) were utilized. The findings of this study indicated that approximately 52 % of surveyed hospital chaplains had provided some form of pastoral intervention directly to patients and/or their families dealing with issues concerning pain and that approximately 30 % of hospital chaplains had assisted clinical staff with issues concerning pain. NZ chaplaincy personnel involved in pain-related issues utilized a number of pastoral interventions to assist patients, their families and clinical staff. Differences of involvement between professionally stipended hospital chaplains and their volunteer chaplaincy assistants are noted, as are the perspectives of interviewed chaplains about their pastoral interventions with issues relating to pain. Some implications of this study with respect to chaplaincy utility, training and collaboration with clinical staff are noted, as are comparisons with international findings.     

Health Care Chaplains and their Role on Institutional Ethics Committees: An Australia Study

This paper presents the results of the largest Australian pastoral study concerning the perceptions of health care chaplains about their involvement on hospital research ethics committees (also known in some contexts as institutional ethics committees). Survey results from over 300 Australian health care chaplains indicated that nearly 90% of chaplains believed there was merit in chaplains serving on hospital research ethics committees, yet only a minority (22.7%) had ever participated on such committees. Data from in-depth interviews is also presented exploring the reasons for the lack of participation and the varying opinions regarding the role, appropriateness, and value of chaplains on ethics committees. Some implications of this study with respect to chaplaincy, hospital research ethics committees, health care institutions, ecclesiastical institutions, and government responsibilities are discussed.     

Chaplain–Physician Consultancy: When Chaplains and Doctors Meet in the Clinical Context

This paper summarizes the perspectives of 327 Australian health care chaplains concerning their interaction with physicians within the clinical context. In general terms the findings indicated that nearly 90% of chaplains believed that it was part of their professional role to consult with physicians regarding patient/family issues. Differences of involvement between volunteer and staff chaplains, Catholic and Protestant, male and female chaplains and the type of chaplaincy training are noted, as are the perspectives of chaplaincy informants regarding their role in relation to physicians. Some implications of this study with respect to chaplaincy utility and training are noted.     

Organ Procurement and Health Care Chaplaincy in Australia

As part of an Australian national project, quantitative data via a survey were retrospectively obtained from 327 Australian health care chaplains (staff and volunteer chaplains) to initially identify chaplaincy participation in various bioethical issues—including organ procurement. Over a third of surveyed staff chaplains (38%) and almost a fifth of volunteer chaplains (19.2%) indicted that they had, in some way, been involved in organ procurement issues with patients and/or their families. Nearly one-fifth of staff chaplains (19%) and 12% of volunteer chaplains had also assisted clinical staff concerning various organ procurement issues. One hundred of the surveyed chaplains volunteered to an interview. Qualitative data were subsequently coded from 42 of the chaplains who had been involved in organ procurement requests. These data were thematically coded using the World Health Organization ‘Pastoral Intervention Codings’ (WHO-PICs). The qualitative data revealed that through a variety of pastoral interventions a number of chaplains (the majority being staff chaplains) were engaged in the critical and sensitive issues of organ procurement. It is argued that while such involvement can help to ensure a holistic and ethically appropriate practice, it is suggested that chaplains could be better utilized not only in the organ procurement process but also for the training of other chaplains and clinicians.     

Confidentiality and Mental Health/Chaplaincy Collaboration

Confidentiality can both facilitate and inhibit working relationships of chaplains and mental health professionals addressing the needs of service members and veterans in the United States. Researchers conducted this study to examine opportunities for improving integration of care within the Department of Defense (DoD) and Department of Veterans Affairs (VA). Interviews were conducted with 198 chaplains and 201 mental health professionals in 33 DoD and VA facilities. Using a blended qualitative research approach, researchers identified several themes from the interviews, including recognition that integration can improve services; chaplaincy confidentiality can facilitate help seeking behavior; and mental health and chaplain confidentiality can inhibit information sharing and active participation on interdisciplinary teams. Cross-disciplinary training on confidentiality requirements and developing policies for sharing information across disciplines is recommended to address barriers to integrated service delivery.     

Memoirs of a Guard-Researcher: Deconstructing the Games Inmates Play Behind the Prison Walls

Recent media reports have attempted to shed light on correctional officers who end their careers in disgrace for either having sexual relationships with prisoners or for smuggling contraband into correctional facilities. In this article, I take an autoethnographic approach, reflecting on my seven years as a “guard-researcher” and demonstrate through real-life examples how inmates identify the weak links among prison employees, subtly feel them out, and then untiringly persist in establishing these inappropriate relationships. This article shows how seemingly benign gestures of inmates are actually calculated moves taken to gain leverage and exploit their marks, the weak correctional staff members, who fall for these tricks.     

Predicting physically violent misconduct in prison: A comparison of four risk assessment instruments

Violence in correctional facilities is an important issue for both prisoners and prison staff. Risk assessment instruments have demonstrated their accuracy in predicting the risk of (re) offending and institutional violence in psychiatric settings, but less is known about their ability to predict violent misconduct in prison. The present study applied four risk assessment instruments (Structured Assessment of Protective Factors for violence risk, Historical Clinical Risk Management‐20, Psychopathy checklist – Revised, and Violent Risk Appraisal Guide) to 52 violent offenders in a Swiss prison in order to evaluate the instruments' predictive validities. Outcomes were instances of physically violent, other and any misconduct as recorded in prison files during the 12 months following the prisoners' assessments. Approximately 15% of offenders committed physically violent misconduct and approximately 42% committed any misconduct. The results show that mainly dynamic assessment tools are as good predictors of physically violent misconduct as mainly static assessment tools. Targeting dynamic factors could increase the effectiveness of interventions to reduce the risk of physical violence in prison.     

Abortion and Health Care Chaplaincy in Australia

This paper summarizes the results gained from quantitative and qualitative research involving 327 Australian health care chaplains with regard to their involvement in abortion issues within the health care context. The findings indicate that approximately 20% of surveyed chaplains had provided some form of pastoral intervention to patients and/or their families dealing with issues of abortion and that approximately 10% of chaplains had assisted clinical staff with issues concerning abortion. There was found to be no-statistically significant difference with regard to the number of catholic chaplains compared with protestant chaplains or staff chaplains compared with volunteer chaplains involved in abortion issues. Analysis using the WHO Pastoral Intervention codings highlighted a variety of issues encountered by chaplains and the non-judgmental pastoral care used by chaplains when assisting those dealing with abortion. Some implications of this study with respect to patient and clinical staff support are suggested. Dr. Lindsay Carey, M.App.Sc., Ph.D.: National Research Fellow, Australian Health & Welfare Chaplains Association & Faculty Associate, Palliative Care, School of Public Health, La Trobe University, Melbourne, Australia. Dr. Christopher Newell, AM, Ph.D.: Associate Professor, School of Medicine, University of Tasmania, Hobart, Australia.     

Pray Tell: The Who, What, Why, and How of Prayer Across Multiple Faiths

Although prayer is one of the most common chaplain interventions, there is a dearth of information pertaining to prayer in the chaplaincy literature. This study was therefore conducted to obtain basic information from professional chaplains about their use of prayer with patients. Eight professional chaplains participated in a 90-min focus group to discuss, among other things, the nature of chaplain prayers, the context in which they prayed, and who should initiate prayer. They also discussed differing religious perspectives about prayer, the strengths and limitations of different types of prayers, and praying with patients from concordant or discordant faiths.     

Intimate partner violence in prisoners: Toward effective assessment and intervention

This paper reviews the significant challenges that are involved in the development of services for perpetrators of intimate partner violence who are in prison. It is suggested that difficulties in accurately identifying intimate partner violence, reliably assessing risk of re-offense, and in identifying offending behavior programs that meet the specific needs of prisoners have limited the development of services in this area. As a result it is argued that unique and complex victim related issues that arise during incarceration and post-release are not adequately recognized in current correctional assessment and case management systems. Four avenues for future research and service development in this area are identified, with a view to developing the role that correctional services have to play in preventing intimate partner violence.     

Providing Pastoral Care for the Elderly in Long Term Care Facilities Without a Chaplain Utilizing Coordinated Congregational Resources

Elderly persons living in long term care facilities are often separated from or have no pastoral care sources. Spiritual care by chaplains was not available in any of the six nursing homes in Wausau, Wisconsin. Twelve Lutheran congregations in the area worked out a plan to provide the necessary pastoral care. The congregations formed a coordinating agency, Greater Wausau Christian Services, Inc. Through the services of one staff person, the director, who enlisted the lay and pastoral resources of the participating congregations, pastoral care was provided. Worship led by the pastors, meaningful visits made by trained and supervised lay people, and the availability of a trained chaplain became a reality for nearly seven hundred residents in the six long term care facilities.     

Prison pastoral care: The seer as a new paradigm

The purpose of this essay is twofold: to review two existing paradigms (the Priest and the Prophet) of pastoral care with prisoners; to propose a new paradigm (the Seer). The prison chaplain has been traditionally identified as a priest or a prophet. The change of pastoral setting from parish to prison is a drastic one that requires a paradigm shift. Incarceration is understood in terms of liminality which is a transitional period of a life re-ordering. To those in liminality, the Seer as a divine visionary of hope comes to reawaken a sense of God's presence and aims at renewing of covenant faith.This article is an edited version of an address presented by the author to the Chaplains of Tennessee Department of Corrections at their annual meeting in January 1990.     

A national survey of health care administrators' views on the importance of various chaplain roles

A random sample of hospital administrators throughout the United States was surveyed about their views on the importance of eleven chaplain roles and functions. The 494 respondents fell into three categories: (1) directors of pastoral care departments (N = 132); (2) administrators of hospitals that have a pastoral care department (N = 180); and (3) administrators of hospitals that do not have a pastoral care department (N = 182). All three groups considered all eleven roles to be relatively important, although administrators of hospitals that do not have a pastoral care department gave lower ratings, overall. Meeting the emotional needs of patients and relatives were seen as chaplains most important roles, whereas performing religious rituals and conducting religious services were seen as least important by all three groups. In all but a few instances, the level of importance that administrators assigned to the various roles were positively related to their ratings of their own religiousness and spirituality (r's = .11 to .26, p < .05).     

Pastoral Care in Aged Care Settings: Role and Challenges

Journal of Religion and Health - This mixed methods study explored challenges faced by pastoral care workers. A development phase preceded an on-line survey completed by chaplains and pastoral...     

Provision of spiritual and pastoral care facilities in a high-security hospital and their increased use by those of Muslim compared to Christian faith

The relationship between religion and psychiatry remains controversial amongst British psychiatrists. We looked at the provision of spiritual and pastoral care facilities in a high-security hospital and the role of faith chaplains with particular reference to the Muslim minority group. There was a significantly higher uptake of pastoral care services amongst those of Muslim faith compared to Church of England and Roman Catholic Christians. Possible reasons for this are discussed. Resources allocated for the Muslim faith group were limited and heavily dependent on the availability of the Muslim faith chaplain. Our study highlighted the need for clearly defined standards for the provision of spiritual and pastoral care within high-secure psychiatric hospitals, and by implication other NHS psychiatric settings, a re-examination of the role of the faith chaplain in relation to the clinical team, and raised questions about the equitable allocation of resources between various faith groups within the hospital.     

The Experiences of Women in Prison

Summary

Women in prison represent a neglected population. The facilities and the services offered to female inmates are based primarily on models derived from male inmates. The need for this approach to change is increasingly recognized because the number of women in the correctional system is increasing at an alarming rate, the criminal profile of female inmates is distinct, and independently because the racial and ethnic composition of the female prisoners is shifting. In the present study, the needs of women prisoners were studied from a variety of theoretical perspectives: relational, diversity, and developmental. Focus groups and questionnaires were conducted with 54 women incarcerated in a minimum security correctional facility for men and women in a Northeastern state. The women's developmental histories reflected high-risk conditions and early trauma. From the ease with which these women responded to questions about their main relationships (i.e., closeness and mutuality) with visitors and other inmates, it is clear that they are struggling but maintaining a relational context in their lives despite being incarcerated. Most women had children, and retained custody of their children, which has strong implications for their children's development. The findings suggested a number of important policy and service implications which differed for ethnic/racial groups.     

Experiences and consequences on prison police's well-being

In view of the deep crisis affecting Italian prisons and the urgent need to review the sense and meaning of this institution, initiatives promoting innovative custodial and rehab practices are increasing. Our study refers to one of the most advanced Italian prisons as far as prisoners' rehabilitation and re-education are concerned, with activities such as open cells, prisoners' self-organization of recreational–cultural activities, promotion of cooperative working activities both inside and outside the prison, in order to study if and how this detention culture change has caused organizational transformations which affect the professional well-being of operators who manage inmates in penal institutions. A qualitative study involving 15 correctional officers working in the three most critical departments of the building that host the so called “protected” prisoners (long-lasting sentences, drug addicts, and sex offenders) investigates the subjects' experiences and representations of their role and organizational life aspects indicating their professional well-being.     

Correctional treatment for co-occurring disorders: results of a national survey

The significant expansion of correctional populations in the last decade, coupled with the gradual erosion of community treatment infrastructure and health insurance, have brought greater attention to the needs of offenders who have co-occurring mental health and substance use disorders. Individuals with co-occurring disorders frequently cycle through acute care facilities in the community and increasingly are placed in jails or prisons. Approximately 16% of inmates in correctional facilities have major mental health disorders (Bureau of Justice Statistics, 1999), and a large majority of these inmates have co-occurring substance use disorders. Few studies have examined the effectiveness of correctional treatment for co-occurring disorders, and there is little information available regarding clinical and programmatic approaches used with this population. The current study provides findings from a comprehensive national survey of co-occurring disorder treatment programs in correctional settings. A total of 20 co-occurring disorder treatment programs from 13 state correctional systems were identified and surveyed. Many of the programs featured modified therapeutic communities, but there was significant diversity in the duration of treatment and type of services provided. Several unique structural and clinical modifications to treatment have been developed in these settings. Implementation of co-occurring disorder treatment programs has led to enhanced collaboration with prison health services and community supervision and treatment agencies, and greater use of interdisciplinary staff to provide outreach and case management services. Research is now being conducted to examine outcomes in several of these correctional treatment programs.