I was amazed and alarmed to read Koenig's article on religion and mental health (Reference KoenigKoenig, 2008), and the President's lukewarm support of the article (Reference HollinsHollins, 2008), as it presents no scientific evidence that any of the suggested working practices improve patient care. The few figures it uses are not supported by other studies. Koenig claims that only 1.4% of the British population are atheists. His source is the World Christian Database, hardly an unbiased source of information. This low figure has no face validity to anyone working in this country. A recent study (Reference Huber and KleinHuber & Klein, 2008) funded by the conservative Bertelsmann Institute looked at religious beliefs in 18 countries (eight of them European) across both high-income and low- and middle-income countries. It used a very broad definition of religion and spirituality focusing on Pollack's work on the belief in the transcendence as the core of substantial spirituality (Reference Pollack, Schreiber and SchreiberPollack, 2000). In other words, it looks for the belief in something spiritual that may or may not be related to formal religion. They professionally polled tens of thousands of people in the 18 countries making it by far the largest and most comprehensive study into the subject so far.

Their findings confirms Britain to be among the least spiritual countries of the 18 examined, across a wide range of factors including prayer, church attendance, personal religious experience, religious reflection, pantheistic influence, etc. It finds that across European Christians more than 10% of those who formally belong to a church do not believe in anything spiritual at all. This makes census data potentially quite unreliable when it comes to assessing people's real religious believes. In Britain, 19% of those polled were classed to be highly religious, 43% as religious and 38% as non-religious using a broad definition of spirituality; 55% of Britons consider prayer to be non-significant for their lives and only 33% have personal religious experiences.

Far from religion being pervasive throughout the majority of society, in Britain at least the opposite seems to be the case. Moreover, there is already a well-organised provision of support for people who follow organised religion in all hospitals with easy access to religious elders and prayer rooms. However, no provision exists for non-believers who look at questions of meaning of life and morality in a non-spiritual way. It is this group that is disadvantaged rather than those who follow organised religion. It follows that rather than insisting on getting a ‘spiritual history’ of each service user we should show respect to those who can discuss the meaning of life without spirituality and find a solution to identify and facilitate their needs in an increasingly secular society.