Koenig (Reference Koenig2008) discusses important principles for working therapeutically with the spiritual dimensions for our service users’ well-being. However, several points need highlighting.

Of course one should respect religious beliefs. As an old age psychiatrist in London seeing people at home, I have to be aware of what to do if offered coffee in a Muslim home during Ramadan, who looks after the mandir in Hindu households and of the dates and social impact of Jewish holidays. I have had to respond to letters from Catholic priests ‘she needs a psychiatrist, not an exorcist’ and avoid sending Muslims appointments for midday on Friday. In a multi-faith society there is much to learn to avoid pitfalls which could be interpreted as lack of respect.

Most of us have little experience of taking a spiritual history as distinct from asking about religion. Neither Koenig nor Hollins (Reference Hollins2008) direct us to Sarah Eagger's guidance on the College website saying just how to do this (www.rcpsych.ac.uk/PDF/DrSEaggeGuide.pdf).

We cannot work with mental health trained chaplains in our area; there aren't any. Recent guidance (Department of Health, 2003) details specific provision for mental health. However, the first stage of implementation is related to numbers of beds. In this age of community care and bed reductions, this is unrealistic. If the first stage has to be implemented before the community-focused second stage, we still have a long wait for an essential service.