Psych CASC / OSCE · Professional — spirituality and religion in psychiatry
Spiritual history and treatment negotiation — CASC communication station
MRCPsych/FRANZCP-style CASC: HOPE/FICA skills, risk, boundaries, explanatory model negotiation, and chaplaincy offer.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the outpatient psychiatry registrar reviewing a new referral. [1]
Candidate instructions. Build rapport. Assess suicide risk. Take a brief patient-led spiritual history (HOPE or FICA style). Explore how faith relates to depression and medication beliefs. Avoid proselytising and unconsented prayer. Offer spiritual care/chaplaincy with consent. Agree a collaborative plan that can include both clinical treatment and faith supports. [1][2][4]
Candidate scenario
Your patient is 48, male, Christian (he may name a denomination or say "I just believe"). GP referral: low mood, anhedonia, insomnia, passive death wishes for six weeks. He may say his church friends tell him antidepressants show weak faith. He may ask if you will pray with him. No acute medical issue. A hospital spiritual care practitioner can be offered if he agrees. [5]
Marking domains
- Respectful introduction and agenda setting
- Explicit suicide risk assessment (ideation, intent, plan, means, protective factors)
- Permission-based spiritual history using HOPE or FICA domains
- Exploration of positive coping vs spiritual struggle / negative religious coping
- Non-judgemental negotiation of medication/psychological care with his explanatory model
- Clear professional boundaries around prayer and proselytising
- Offer of spiritual care practitioner/chaplaincy with consent
- Collaborative plan, teach-back, empathy, time management [2][3][4][6]
Reveal assessor key
Open. Introduce role; explain purpose: understand his depression and what helps, including beliefs if he wishes. Check privacy. Ask preferred name. [1]
Risk. Passive/active ideation, intent, plan, means, prior attempts, substances, supports, safety tonight. [1]
Spiritual history. "Are there beliefs or practices that help you cope?" HOPE: hope/meaning; organised religion; personal practices; effects on care. Or FICA: faith, importance, community, address in care. Explore pastor/friends' messages without attacking his faith. [2][3][6]
Boundaries. If asked to pray: acknowledge importance; explain you can support involving spiritual care; avoid dual religious role or imposing your faith. [4][5]
Plan. Shared decision on antidepressant/therapy options; crisis contacts; optional spiritual care; GP follow-up; invite him to involve trusted faith supports if he wishes. Summarise in his words. [1][5]
Fails. Proselytising; mocking faith; skipping risk; forcing prayer; stereotyping "all Christians refuse tablets"; colluding with stopping all care without assessment. [4]
References
- [1]Moreira-Almeida A, Sharma A, van Rensburg BJ, et al. WPA Position Statement on Spirituality and Religion in Psychiatry World Psychiatry, 2016.PMID 26833620
- [2]Anandarajah G, Hight E Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment Am Fam Physician, 2001.PMID 11195773
- [3]Borneman T, Ferrell B, Puchalski CM Evaluation of the FICA Tool for Spiritual Assessment J Pain Symptom Manage, 2010.PMID 20619602
- [4]Poole R, Cook CCH, Song R, Robinson CA Psychiatrists' attitudes to professional boundaries concerning spirituality and religion: mixed-methods study BJPsych Open, 2023.PMID 37589193
- [5]Malviya S, Greenham J Exploration of Roles and Contribution of Spiritual Care Practitioners in Mental Health: An Australian Study J Relig Health, 2025.PMID 39862307
- [6]Weber SR, Pargament KI The role of religion and spirituality in mental health Curr Opin Psychiatry, 2014.PMID 25046080