“We Are Indians in a Land Led by Scandinavians”: Leveraging the Value of Religion and Spirituality to Reduce Health Inequities in Collaboration with Secular Mental Healthcare

Abstract

Health inequities affect minoritized and racialized populations worldwide. These populations tend to rely on their spiritual beliefs, practices, and faith communities for coping and support. At the same time, the mental health systems and their practitioners draw on secular models of illness and emotional distress to understand and treat mental disorders. The strategies recommended to reduce disparities in mental health should recognize the fundamental worldview differences, a decolonizing frame of reference that includes spirituality, and a task-sharing approach grounded in cultural humility. Following a review of the evidence, a model is proposed to leverage the value of spirituality in mental health care.

1. Introduction

The admittedly stereotypical saying about Indians (highly religious) and Scandinavians (highly secular) regarding religion and spirituality captures the historical tension between the secular worldview of mental healthcare systems (Koenig and Larson 2001) and the populations they serve, particularly minoritized groups (Dispenza et al. 2024). The populations most affected by health inequities tend to embrace explanatory models of emotional distress and healing rooted in worldviews primarily informed by their religious beliefs and spiritual practices and in the context of their faith communities (Bedi 2018). This article suggests that there is a way to close the existing gap and reduce disparities in mental health by fostering a collaboration between the secular worldview of the mental health system and the worldviews informed by spirituality and religion, addressing not only the discord between providers and populations, but also the deficits in provider totals and training.

2. Methodology

This paper employed a conceptual and integrative theoretical approach to examine the role of religious actors in reducing disparities in mental healthcare. Rather than presenting empirical data, the analysis synthesizes insights from the psychology of religion, public health, and health disparities research to develop a framework for understanding how faith-based engagement can promote equitable access to mental health services. Guided by the Social Determinants of Health framework, the analysis conceptualizes religious actors as community-based agents embedded within broader social, cultural, and structural contexts that can contribute to enhanced care. The social determinants of health refer to the non-medical factors that impact the health status of entire populations. The geographic location where a person is born, the quality of education the person receives, their socioeconomic status, gender, sexual identity, ethnic and cultural self-identification, (Braveman et al. 2011), and even more dramatically, their racial background, differentiate the quality and level of health of racialized and minoritized populations. These are the same populations that are most affected by inequity in mental health care (Williams and Mohammed 2013).

It is crucial that racialized and minoritized communities be the focus of attention, as structural obstacles to equity in mental health are present and active, yet often times imperceptible. More specifically, we apply the principles guiding the reduction in inequity by promoting multisectoral partnerships, enhancing the coordination of care between the mental health system and religious actors, increasing access to appropriate levels of care drawing on culturally relevant strategies, promoting best practices in mental health and spiritual care, and systematically collecting data to refine and improve the desired outcomes. In addition to the structural processes recommended, we offer a critical review of the role of implicit philosophical differences between the guiding assumptions of mental health systems and spiritual communities as well as identify potential conceptual tools to facilitate a true partnership.

Through a process of theoretical synthesis and critical reflection, the paper integrates these themes into a conceptual model linking religious engagement to pathways of access, cultural congruence, and social support in mental healthcare. This methodology allows for the development of a normative and practical framework that can inform future empirical research and policy initiatives aimed at reducing mental health disparities through collaboration with religious actors.

2.1. The Promise of and the Obstacles to Collaboration

At the present time, significant barriers stand in the way of concretizing this collaboration. The secular intellectual and institutional environments that espouse a worldview that has historically excluded spirituality and religion as legitimate partners (Bryant 2024; Comas-Díaz et al. 2024) is reluctant to relinquish a position of dominance, as evidenced in the relative absence of a critical appraisal of the philosophical foundations that shape its intervention models (Bedi 2018; Maura and Weisman de Mamani 2017), the faith gap between practitioners and their patients (Vieten et al. 2023), the sparse training on this subject in the graduate education of mental health clinicians (Vieten and Lukoff 2022), and even the funding for psychosocial support in humanitarian contexts (Fayard et al. 2025). Three conceptual tools may facilitate the process of cooperation, namely cultural humility, task sharing, and a decolonial frame of reference.

It is well-documented that minoritized and racialized groups receive mental healthcare of a lower quality, even when relevant factors, such as similar health coverage, are present. “Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare” (cited in Stubbe 2020, p. 49). To decrease the negative impact on minoritized and racialized groups, practitioners are encouraged to adopt an attitude of cultural humility, namely, intentionally engaging their patients in a manner that exceeds basic respect and honors their beliefs, values, and practices including explanatory models of illness and healing shaped by culture and religion (Stubbe 2020). Recent theoretical developments have moved beyond a shift in attitude to the adoption of a decolonizing perspective on the understanding of mental distress and the interventions that are better suited for these populations. Decolonization poses a challenge to the epistemic foundations and the practices of mainstream psychology. Instead, it proposes an upstream process emerging from minoritized and racialized communities’ self-understanding about explanatory models of illness and how to best respond to their needs (Santana et al. 2025). It follows that religious and spiritual worldviews, practices, and practitioners should be at the table on how best to address the mental health needs of these populations. In practical terms, the idea of partnership with spiritual leaders and communities as “task shifting” should give way to “task sharing”. Task shifting was conceived as an approach to address the mental health needs of communities with limited resources by providing training and supervision to non-specialized providers (Purgato et al. 2020). Task shifting implies a hierarchical position where the worldview, knowledge, and practices of secular mental health systems supersede and dictate the acceptable sources of knowledge and practice over those of religious practitioners. “Task sharing”, on the other hand, enacts the principles of cultural humility and interacts with a decolonized understanding of mental distress and how to alleviate it (Raviola et al. 2019) by partnering with spiritual leaders as possessing valuable knowledge and skill to address emotional problems (Hoeft et al. 2018). For a true partnership to emerge, both mental health systems and professionals as well as spiritual leaders and communities need to collaborate with an attitude of cultural humility regarding knowledge and methodologies, given the growing demand to address mental health needs around the world, which exceed the available resources (World Health Organization 2022b), and the preference of many to seek assistance from spiritual leaders and faith communities when experiencing emotional distress (Dimmick et al. 2022). What role could religion and spirituality play in mitigating the overwhelming needs in the communities they serve? We first summarize the clinical relevance of spirituality for mental health, then, we describe a rationale to foster the collaboration between the secular and religious communities to reduce health disparities, and finally, we offer recommendations based on field work and experience.

2.2. The Reality of Mental Health Care Around the World

“Among its many impacts, the COVID-19 pandemic has created a global crisis for mental health, fueling short- and long-term stresses and undermining the mental health of millions. For example, estimates put the rise in both anxiety and depressive disorders at more than 25% during the first year of the pandemic. At the same time, mental health services have been severely disrupted and the treatment gap for mental health conditions has widened… In all countries, mental health conditions are highly prevalent. About one in eight people in the world live with a mental disorder… In addition to being pervasive and costly, mental health conditions are also severely underserved. Mental health systems all over the world are marked by major gaps and imbalances in information and research, governance, resources and services.” (World Health Organization 2022b, pp. 16, 17). In summary, the needs exceed the demand, and among the limited resources is the scarcity of available mental health professionals. While the WHO report highlights the structural deficits, it fails to address the cultural gap between the providers and recipients of mental health services. That is, it does not identify the substantial difference in worldviews that are crucial to patient engagement and improved outcomes (Maura and Weisman de Mamani 2017). The report acknowledges the importance of including community stakeholders and the value of having a multisectoral approach, which presumably could include spiritual leaders and their communities.

2.3. The Relevance of Religion/Spirituality and Faith Communities in Mental Health

While psychiatric conditions do not discriminate based on specific demographics, it does disproportionately affect the poor, the minoritized, and racialized groups compared with more privileged social categories (World Health Organization 2022a). The World Health Organization (2022a, p. 7) has highlighted the impact of the social determinants of health on the mental health of racialized and minoritized populations around the world. “Structures of disadvantage, marginalization, exclusion and discrimination that have historical roots and present-day manifestations drive socioeconomic and health inequities… linked to racism, racial discrimination and intersecting forms of social exclusion”. Minoritized groups have in common the significant negative impact of health disparities and their reliance on faith-based resources to address these needs (Yamada et al. 2020). Faith communities often are the de facto front-line providers of mental health services for racialized populations (Bolger and Prickett 2021).

Faith communities and religion, with their profound influence on individuals and societies, play a crucial role in promoting health and well-being, particularly in the realm of mental health. By providing individuals with a sense of purpose, community support, coping mechanisms, and a framework for finding meaning in life, religion and faith communities can play a significant role in improving mental health. Religion can promote positive mental health outcomes such as happiness, optimism, hope, and gratefulness while mitigating negative outcomes such as depression, anxiety, and substance abuse (Koenig et al. 2023). Faith communities can also provide much-needed support not only during times of difficulties such as grief or loss, but also during everyday life. Furthermore, reliance on religious and spiritual coping contributes to mitigating the severity of symptoms for several psychiatric conditions (e.g., depression, suicidality, substance use, post-traumatic stress disorder, anxiety, and psychosis, see Huguelet 2020; Lopez et al. 2023; Lucchetti et al. 2021).

Conversely, there is also a significant body of research that shows a bidirectional relationship between religion and mental health in that negative religious coping has a deleterious impact on the severity of psychiatric symptoms such as anxiety, depression, paranoid ideation, obsessive compulsiveness, somatization, suicidality, and an overall lower quality of life (see Table 1). The clinical significance of what is referred to as spiritual struggles cannot be underestimated, particularly in populations with psychiatric disorders. Spiritual and religious struggles are defined as tensions, conflicts, and strains in what individuals deem as sacred. Research has shown that spiritual struggles are ubiquitous across religious traditions and even present in individuals self-identified as agnostic but who grew up in a religious environment. Although spiritual struggles are frequent in the general population, the severity of psychiatric symptoms is worse when the tension is not resolved. In other words, someone who is clinically depressed will experience an increased severity in the symptoms of depression if struggling with spiritual issues (Pargament and Exline 2021).

Table 1. Ways in which religion and spirituality contribute to psychological distress.

Divine struggles	Anger, sadness, disappointment as one perceives to have been abandoned, punished or no longer loved by God
Demonic struggles	Attribution that one’s problems are caused or influenced by evil spiritual forces
Doubt-related struggles	Feeling confused and troubled by one’s religious beliefs and practices
Moral struggles	Tension and guilt about believing that one is failing to live up to the moral standards of the religious teachings
Struggles of Ultimate Meaning	Wonder whether one’s life has any meaning or consequence in the world
Interpersonal struggles	Conflict in a church, with other members, clergy or the organized religion. Feeling isolated, criticized, mistreated, or offended by fellow religionists

Source: Adapted from Exline (2013).

Therefore, clinicians and faith leaders should be equally aware of the broad influence religion holds over mental health. Unless clinicians are attentive to their clients’ worldviews and explanatory models of their distress, they will not be as effective. The types of spiritual struggles are described in Table 1.

An unfortunate example of spiritual struggles, including divine, moral, doubt-related, and interpersonal struggles, can present for marginalized groups with intersectional identities that do not conform to the religious group’s beliefs. For example, sexual minorities who draw on spiritual resources face unique challenges as the social context in many faith communities can be negative and potentially harmful (Lockett et al. 2023). While spiritual struggles present across diverse spiritual communities (Christian, Jewish, Hindu, Buddhist and Muslim), age, gender, and socioeconomic status (Abu-Raiya et al. 2015; Phillips et al. 2009), they can be particularly deleterious to sexual minorities (Huffman et al. 2020). Engaging faith-based organizations to reduce stigma is crucial given their central position and influence among their members (Codjoe et al. 2021).

In practical terms, the secular worldview embedded in the providers’ models of care is likely to miss the crucial relevance of spirituality (both positive and negative) in the lives of some of their neediest patients. Additionally, faith leaders should be attuned to signs of emotional distress stemming from spiritual struggles.

3. The Role of Religion/Spirituality in Reducing Disparities in Mental Health

Addressing disparities requires an integrated, systemic as well as clinical approach that considers the barriers that perpetuate inequity as well as the development of means to overcome them (Braveman et al. 2011; Herrawi et al. 2022). The literature on this topic is sparse. For instance, Maura and Weisman de Mamani (2017) pointed to the critical role of religious actors in the reduction in disparities and mental health, while Villatoro et al. (2016) identified pathways for cooperation in the education, prevention, and pastoral care of Latinx parishioners, acknowledging the absence of systemic processes to support a partnership. To our knowledge, there are no other published studies on this issue. This section explores the rationale and evidence that support the inclusion of religion and spirituality in the reduction in mental health disparities and development of further research.

3.1. Worldviews and Clinical Care

Most world religions provide a frame of reference for human flourishing and derailment. In other words, religious worldviews often include explanatory models of illness and healing (Dein 2018), in contrast with the scientific worldview that excludes supernatural agents, activities, or events. The worldview of mental health practitioners tends to exclude or ignore religious ideas and practices (Ayvaci 2017; Maura and Weisman de Mamani 2017; Shafranske 2013; Slife et al. 2017), thus imposing a worldview on their patients and debilitating the potential value of their interventions.

Research shows that religious coping is an important protective factor for racialized populations affected by intersectional issues of racism and poverty (Ellison et al. 2012, 2008, 2017; Ellison and Flannelly 2009; Upenieks et al. 2023). Failing to recognize the strengths and resilience embraced by minoritized groups undermines culturally relevant paths to promote and prevent mental illness in populations at risk (Ungar and Theron 2020).

3.2. Models of Care

There are pragmatic reasons as racialized communities tend to seek mental health treatment through their faith communities (Derr 2016; Maura and Weisman de Mamani 2017; Hays and Lincoln 2017; NeMoyer et al. 2019; Wang et al. 2003). Furthermore, religious people tend to cope with emotional distress by relying on spiritual strategies (Lucchetti et al. 2021; Pargament and Exline 2021; Pomerleau et al. 2020). Failing to cooperate with spiritual leaders and faith-based organizations perpetuates a system of segregation that limits access to more complex levels of care for populations carrying the intersectional burden of the social determinants of health (Shim 2021).

Inequities may be reduced when providers understand the explanatory models of illness and healing and adapt their therapeutic approach to be culturally relevant (Balboni et al. 2022; Duggal and Sriram 2022; Hartog and Gow 2005), thereby reducing the dropout rates and improving the quality and outcomes from the care received (Rosmarin et al. 2013; Turner et al. 2019). Initial attempts to decolonize psychotherapeutic practices (Bryant 2024) and the adaptation of psychological therapies to religious populations are showing promising results (Bouwhuis-Van Keulen et al. 2024; Koenig et al. 2015; Richards et al. 2023; Weisman de Mamani et al. 2023). Understanding the spiritual worldview of racialized communities is essential to the development of the providers’ cultural competencies (Vieten and Lukoff 2022).

Taken together, all of these factors, including differing worldviews, coping strategies, and explanatory models, make for a strong clinical rationale for paying attention to religion and including faith communities in addressing mental health inequities. The systemic secularism in the mental health system presents a challenge for the implementation of spiritually sensitive care.

4. “Indians and Scandinavians” Collaborating to Reduce Inequities in Mental Health Care

Some of the most frequently cited strategies to reduce health disparities relevant to mental health at the meso and micro levels include the development of multisector partnerships, coordination of care across community and health systems, increasing access to care, enhancing the providers’ cultural competency, implementing best practices, systematic data collection to inform clinical outcomes, and instituting policies to ensure sustainability (Kerkhoff et al. 2022). Each of these strategies needs to be considered as an interlocking and necessary component. Each one also presents both a promise and a challenge to the effective participation of faith communities in the larger mental health system, necessitating growth from both “Indians” and “Scandinavians”. What follows is a brief discussion on ways to foster collaboration through concrete examples highlighted in italics.

4.1. Development of Multisector Partnerships

Faith-based organizations, mental health systems, and their respective practitioners have a long-standing and bidirectional measure of skepticism and mistrust (Idler et al. 2019). The mistrust may be based on the different worldviews, explanatory systems of health and healing, historical prejudice, and racism in the delivery of healthcare.

Furthermore, the professional sector is perceived to operate from a one-sided perspective, as the “owners of the truth”, that is, having a privileged position vis-à-vis spiritual practitioners, instead of utilizing a collaborative approach informed by cultural humility. Promoting and developing trust based on the principles of available science, cultural humility, and the decolonization of models of care is essential (Sue et al. 2024).

An example of decolonization includes convening community stakeholders from the public mental health sector, spiritual communities, and academic organizations to understand each other’s needs, values, and resources, which resulted in the development of strategies to reduce disparities in a collaborative context (Rodriguez 2009). Helping those with the highest needs (in one case, undocumented immigrants, in another case, rural communities) resulted in increased access, coordination of care, and joint training involving spiritual leaders and mental health providers.

4.2. Coordination of Care

Spiritual leaders are often perceived primarily as gatekeepers and not as partners (Vaidyanathan et al. 2021). For instance, among the recommendations developed by a highly respected organization to reduce health disparities, it stated the following concerning the role of faith communities in the mental health among the Latinx population in the State of California: “Participants also described their preference for seeking support from church priests, pastors, or other nontraditional service providers in times of emotional crisis. Overall, the participants believed that churches were in a better position than agencies to effectively disseminate mental health information to the community. One strategy envisions persuading church leaders to become involved by providing them with information and training regarding mental health illness and interventions” (Aguilar-Gaxiola et al. 2012, p. 32). In most cases, there is no coordination of care, as spiritual providers are not perceived as sharing in the task of caring for the community. Task sharing is only recently emerging as an accepted concept, in contrast to the previous notion of “task shifting”, in which professional providers retain a position of privilege, both conceptual and operational, while “shifting” the direct care to others with minimal training (Mongelli et al. 2020).

Following the meetings with key stakeholders, spiritual leaders were provided with basic training on mental health issues and basic helping skills using an evidence-based intervention developed by the World Health Organization (“Problem Solving +”, World Health Organization 2018). Once the training was completed, a “network of care” was developed to continue identifying specific communities in need of services, have ongoing bidirectional consultation on cases, and facilitate access to higher levels of care as needed.

4.3. Increase Access to Care

If there is limited trust, no established pathways for coordination of care, or ignorance of preference for services by faith-communities (Wang et al. 2003), individuals may lack timely and seamless access to mental healthcare. However, working in a collaborative environment will enhance the competencies of both mental health clinicians and spiritual helpers for the benefit of the patient. Establishing “networks of care” may facilitate transitions to appropriate levels of care while maintaining the support of the patient’s faith community. Increased access to care can also be facilitated by the implementation of community-based interventions to promote resilience and the early identification of those needing higher levels of care.

In an example of this coordination, convened stakeholders identified stigma, cultural dissonance (different illness explanatory models), and mistrust among undocumented immigrants as barriers to access mental healthcare. Mental health fairs were organized on days of worship (highest rate of attendance), in which a brief screen for depression was administered to all in attendance. With the support of the spiritual leader, the results of the screener were explained to those in attendance, encouraging individuals falling in the clinical range to see a mental health professional for a brief consultation and referral. Approximately 10% of those in attendance were seen by a mental healthcare provider on the church’s premises and given a referral for follow-up in about two weeks, as opposed to the two-month wait had they followed regular channels.

4.4. Cultural Competency

For many, their religion and spirituality provide the idioms of emotional distress, a narrative to explain mental illness, and the trusted resources to mitigate the impact of psychiatric conditions. Furthermore, racialized minorities have a distinct preference for including a spiritual perspective in their treatment (Dimmick et al. 2022). However, mental health professionals are rarely trained to address these issues in their work (Vieten and Lukoff 2022). In fact, a study found a high frequency (39%) of religious microaggressions during treatment, resulting in a negative therapeutic alliance—the most important predictor of psychotherapeutic outcomes (Trusty et al. 2022). While mental health professionals and the general population place a different value on religion and spirituality (Dein 2018), there is a growing interest in gaining skills to address this dimension of diversity (Vieten et al. 2023).

Training programs have been developed to enhance competencies in religion and spirituality (Pearce et al. 2019), however, a crucial missing link is the training that takes place during clinical education (Hathaway et al. 2022). What is not implemented systematically during the shaping of clinical competencies is less likely to be part of clinical practice. Furthermore, specific training to address the intersectionality of religion and racialized groups is missing (Captari et al. 2022). Finally, while clergy are often the front-line providers, they may also lack the skills needed to be optimally effective in areas of mental health (Anthony et al. 2015).

An example of improved clinical training included mental health trainees deployed in primary care clinics at a public (secular) hospital serving poor and minoritized populations. The trainees were educated on how to conduct a spiritual assessment and provide behavioral health interventions consistent with the spirituality of the patient. The trainees came from secular graduate psychology programs, and in most cases were themselves agnostic or atheist. A year-long seminar on psychotherapy and spirituality and focused clinical supervision on how to provide spiritual and culturally sensitive care resulted in improved retention, treatment adherence, and mental health outcomes. The trainees themselves indicated that they had gained competencies in issues of cultural and religious diversity without compromising their own worldview.

4.5. Implementing Best Practices

Clinical practices that include religion and spirituality show multiple advantages across psychotherapy and psychopharmacology. Spiritually integrated psychotherapies have flourished in recent years (Richards et al. 2023). Studies consistently report greater symptom relief and spiritual well-being when compared with standard (secular) treatment (Captari et al. 2022) and highlight the importance of religion in the development of a therapeutic alliance (Terepka and Hatfield 2020). A strong therapeutic alliance is also important for maintaining adherence to psychotropic medication treatment (Wienke Totura et al. 2017). Paying attention to religious beliefs is an important factor, as these types of beliefs have been identified among the contributors to non-adherence (Semahegn et al. 2020). Despite these developments, spiritually integrated care still needs to move from the academic and research environments to the real-world of practice, particularly with racialized populations. Giving religion and spirituality a consideration similar to what is currently given (correctly) to race and identity would facilitate the dissemination and implementation of culturally congruent best practices.

Beyond clinical environments, it is crucial to implement strategies for promotion, prevention, and the early identification of mental health conditions. Faith communities and spiritual leaders have a deep presence and credibility among minoritized individuals to have an impact; however, they lack the resources typically available to the public sector. Stigma reduction efforts (Codjoe et al. 2021), mental health education campaigns, and increased access to care have all been documented when spirituality is considered and included (Perez et al. 2025). In one example of stigma reduction strategies, secular organizations utilized evidence-based strategies to decrease stigma for those suffering from the impact of trauma in war-torn communities by combining neuroscientific information (Almeida and Sousa 2022) with spiritually and culturally relevant content about trauma (e.g., reading the Psalms of lament; Koenig 2020; Temple and Kerlin 2022). After describing the behavioral and emotional impact of trauma, examples were given on how religious exemplars experienced major distress. Religious examples were followed by information on the neuroscience of emotional trauma, resulting in the participants being more open to learn evidence-based strategies to support their communities.

4.6. Systematic Data Collection to Inform Clinical Outcomes

Mental health treatment in general does not utilize systematic data collection to inform clinical practice and influence outcomes (Miller et al. 2015). Ideally, data collection would include the elements that are relevant to the reduction in health disparities, such as access to care, patient engagement, and adherence, from both the mental health system and spiritual leaders.

Following the stigma reduction strategy with spiritual leaders in contexts of armed conflict, qualitative research was conducted interviewing key stakeholders to gain a more granular understanding of how their views changed relative to pre-intervention levels. The results were utilized to design a more precise follow-up to support the spiritual leaders in addressing psychological trauma. The secular sponsoring organizations utilized the data to develop briefs to advocate for funding. Funding agencies for humanitarian efforts often deliberately avoid engaging religious communities due to concerns about proselytism (Fayard et al. 2025). However, the inclusion of spirituality in systematic data collection may lead to more targeted and efficacious funding.

4.7. Institutional Policies to Support Sustainability

What an organization requires is more likely to happen when mandated, not just recommended. The hospital accreditation agency in the United States used to require that a spiritual assessment be conducted with all admitted patients. It is unclear what impact the requirement had, if any. The Joint Commission no longer has this requirement (Koenig et al. 2023, p. 659). It is possible that by withdrawing this standard of care, the attention of practitioners to the spirituality of their patients may be less salient, and therefore less likely to be mined for patient care. On the other hand, chaplain support is an integral part of most inpatient facilities and in some outpatient settings (secular and faith-based). Several studies have documented the beneficial impact of chaplain care on mental health (Buelens et al. 2023; Jones et al. 2022; MacDonald 2017; Smigelsky et al. 2022; Wortmann et al. 2023). As is the case with community clergy, chaplains often deal with individuals with serious mental disturbance. While institutional policies to systematically include a patient-centric approach to religion and spirituality could help in addressing mental health disparities at the clinical level, to be meaningful, it would need to be embedded in a robust articulation of expected diversity and cultural competencies.

While the reduction in inequities in mental health care remains a global priority, the value of spiritual beliefs, practices, and communities as an active and vital partner in addressing them is yet to move beyond the phase of advocacy for its systematic inclusion. Specific language highlighting the value of spirituality has been included in documents prepared by, for instance, the United Nations Program Development (2022) on peacebuilding efforts, the World Health Organization on disaster preparedness (Hess et al. 2024; Winiger and Peng-Keller 2021), and for the defunct (for now) United States Institute of Peace (2021).

Table 2 summarizes the strategies for collaboration along with suggestions as to how these may contribute to the reduction in health inequities.

Table 2. Strategies to reduce health disparities and key recommendations to close the gap.

Development of Multisector Partnerships	Convene community stakeholders to understand perceived needs and develop trust
Coordination of Care	Highlight and implement the principles of cultural humility and “task sharing” with spiritual leaders
Increase Access to Care	Establish “networks of care” including spiritual leaders and mental health providers. Cooperate on community-based early intervention to promote emotional resilience, identifying those in need of higher levels of care
Cultural competency	Increase literacy on spirituality and religion for mental health clinicians, and literacy on mental health issues for spiritual leaders. Incorporate religion and spirituality in clinical education.
Implement best practices	Disseminate spiritually integrated strategies, attending to the individual and community, a religiously informed explanatory model of illness and healing.
Systematic Data Collection to Improve Clinical Outcomes	Systematically track the results of collaboration efforts with faith-based organizations in facilitating access to care and patient engagement when religion and spirituality are incorporated into treatment.
Institutional Policies to Support Sustainability	Systematic advocacy for the inclusion of specific language that recognizes the value of spirituality for the mental health of individuals and communities.

5. A Way Forward: “Indians and Scandinavians” Collaborating to Reduce Disparities in Mental Health Care

As it is apparent, each component of the strategies enumerated above would not work well in isolation. They are best conceived as an interlocking system with the clear goal of addressing and decreasing disparities in mental health. It would be naïve to believe that the shaping influence of worldviews would not have a significant, though unacknowledged, role in the real world (Ager et al. 2019; Clarke and Parris 2019). Worldviews are the riverbed that directs and shapes the course of the muddy river of human reality. It is there. It is consequential. However, it is not apparent. In the mental health space, worldviews shape the way human beings are conceptualized, flourish, and derail. Worldviews also organize the models of intervention, determining what is important and what is secondary or unnecessary. The worldviews, in the ultimate analysis, determine what and for how much something is included in a budget.

Faith-based organizations are uniquely positioned to play a substantial role in the prevention, early identification, and treatment of mental disorders. Their effectiveness can be significantly increased when embedded in a larger system that collaborates, supports, and provides a seamless path to facilitate access to appropriate levels of care and the reduction in disparities.

In summary, cooperation, to be successful, needs the following components:

• Stakeholders from faith communities and mental health systems cooperate in the development of a framework based on their common ground, mutual needs, and agreed-upon general principles of cultural humility and task sharing. The organizations involved transfer the agreement into actionable expectations for the systems they represent to facilitate implementation, dissemination, and accountability. A data collection strategy is agreed upon at this level and from the outset to inform and adapt the strategies being utilized.
• Implementation champions from faith communities and mental health systems articulate processes to build community resilience, facilitate the early identification of cases, and facilitate access to care.
• Literacy efforts are conducted jointly and independently to increase cultural competencies, disseminate best practices, and highlight the role of task sharing. Particular attention should be given to the points of contact where access to care is most likely to be needed. For instance, integrated behavioral care in primary care and specialty clinics dealing with chronic conditions, serving racialized minorities.
• Networks of care are implemented to facilitate ongoing cooperation and support.
• Stakeholders meet at an established frequency to continue to cultivate trust, monitor progress, and make the necessary institutional adjustments to ensure continuity, sustainability, and integrity of the efforts.