Spotlight on Mental health

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Development of a Long Standing Implementation Partnership between Mental Health Services and HSR&D: Integrating Mental Health and Chaplaincy
across VA and DoD
George L. Jackson, Ph.D., MHA Center for Health Services Research in Primary Care, Durham VA Medical Center
Jason A. Nieuwsma, Ph.D. Associate Director, VA Mental Health and Chaplaincy
Heather A. King, Ph.D. Center for Health Services Research in Primary Care, Durham VA Medical Center
VA HSR&D Cyber Seminar – October 16, 2017

1. Why link mental health and chaplain services 2. Mental Health and Chaplaincy program 3. Evaluation example – VA/DoD Joint Incentive
Fund (JIF) project
 Learning collaborative  Mental Health Integration for Chaplain Services (MHICS)
training program
4. Partnership impact – Example of a new project examining moral injury in rural veterans

Poll Question
Have you ever worked with healthcare chaplains? ___Yes ___No

What is a Chaplain?

Chaplain Training:
 In general (e.g., military): Divinity school (e.g., M.Div.) and/or Ordination and/or Equivalent (along w/ “endorsing body”)
 Healthcare chaplains: Clinical Pastoral Education (CPE, typically 4 units), plus above


VA Chaplains

Military Chaplains


Work in healthcare settings and provide care almost exclusively to patients with identified health problems.

Work mainly in non-healthcare settings where the focus is on maintaining a resilient, fully functioning, ready military force.

Staffing Based on a medical center's size and complexity.

Based on number of service members in a command as well as the command's mission.

Why Integrate Mental Health & Chaplaincy?
 People who are suffering turn to clergy / chaplains.
 Spirituality and health are related in meaningful ways, with particularities for Service members and Veterans.
 Integration between mental health and chaplaincy is suboptimal, and much remains to be learned.

Self-Rated Religious Coping

On a scale of 0-10, how much do you use religion to cope?
(Responses from 337 consecutively admitted patients to Duke Hospital)

None (0)

5% 5%

Small to moderate

extent (0.1-4.9)


The most important factor (10)

Moderate to large extent (5.0-7.4)

Large extent or more (7.5-9.9)

Koenig, H.G. (1998). Religious attitudes and practices of hospitalized medically ill older adults. International Journal of Geriatric Psychiatry, 13, 213-224.

Spirituality & Mental Health Linkages
• Loss of faith associated with:1,2
– Depression – Anxiety – Social isolation – Sense of foreshortened future – Increased sense of life’s fragility – Increased depression in veterans
in treatment for PTSD – Higher utilization of VA mental
health services
• Lack of forgiveness associated with:3
– More severe PTSD – More severe depression – More severe anxiety
1. Koenig, H. G., D. B. Larson, et al. (2001). Handbook of religion and health. New York, Oxford University Press. 2. Fontana, A. and R. Rosenheck (2004). Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD. Journal of Nervous and Mental Disease 192: 579-584. 3. Witvliet, C. V. O., K. A. Phipps, et al. (2004). Posttraumatic mental and physical health correlates of forgiveness and religious coping in military veterans. Journal of Traumatic Stress 17: 269-273.

Why Do Veterans with PTSD Turn to VA?
“That is, veterans’ motivation for continued pursuit of mental health services does not appear to be primarily greater symptom relief or more social contact. Rather, the specificity of paths to the number of therapy sessions from guilt and change in religious faith suggests that a primary motivation of veterans’ continuing pursuit of treatment is their search for a meaning and purpose to their traumatic experiences. In this regard, they
appear to be looking to their therapists and, perhaps, the VA system as a whole to provide the answers and a sense of belonging to a larger whole that is no longer being fulfilled sufficiently by their religious faith.”
Fontana & Rosenheck (2004). Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD. The Journal of Nervous and Mental Disease, 192, 579-584.

Program Support

Mental Health Services (MHS) in VA
Central Office

VISN 6 Mental Illness Research, Education and Clinical Center

Keith G. Meador, MD, ThM, MPH Director

VA National Chaplain Center Durham VA HSR&D Veterans Engineering Resource Center (VERC)

Defense Centers of Excellence (DCoE) National Center for PTSD Defense Suicide Prevention Office Contractors & other collaborators

Why We Collaborate

Understand the relationship between mental health and chaplaincy

Develop and evaluate programs to enhance relationship between mental health and chaplaincy

Spread promising practices and enhance related science with the goal of enhancing the lives of Veterans and Service members, including reducing suicide risk

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Spotlight on Mental health