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Beyond the Biopsychosocial Model – Is Spiritual Care the Final Frontier?

Words: 1499 – Elis-Llyr Treharne

Introduction

Spiritual care is increasingly recognised as an essential aspect of holistic healthcare, a long-overdue extension of the biopsychosocial model that promises to treat the person, not just the patient. Ideas once considered peripheral, like meaning and the role of human connection, are now entering mainstream discourse under the banner of ‘spiritual care’. This shift is echoed in healthcare policy through initiatives like social prescribing and the NHS Long Term Plan, which signal a broader move toward more personalised, relationship-based models of care.

Yet behind this vision lies a deeper, more unsettling question. If the healthcare system has historically marginalised or ignored the spiritual, what happens when it tries to institutionalise it? Can something so personal, fluid, and context-dependent survive contact with a system shaped by efficiency, standardisation, and clinical detachment? I argue that spiritual care is the final frontier in holistic healthcare, not only because it completes the model, but because its integration exposes the deeper cultural shifts the system has yet to make.

What is Spiritual Care?

Spiritual care resists easy definition. It is not confined to religion, nor does it rely on shared belief systems. Instead, it refers to the human search for meaning that is grounded in connection and shaped by our need for coherence, especially in moments marked by suffering or deep emotional vulnerability. In this way, spiritual care mirrors the principles of holistic care more broadly: an approach that sees health as more than the absence of disease and seeks to address the full spectrum of human experience—physical, psychological, social, and spiritual.

In practice, this might involve supporting a patient’s need to make sense of suffering. I remember caring for a patient on the day surgery unit, where a religious man paused to pray before his procedure. No one asked him about his spiritual needs, yet in that quiet moment of ritual, he expressed something deeply personal, an inner resource perhaps, or an act of grounding. It reminded me that spiritual care often reveals itself without being named, and that recognising it sometimes requires nothing more than noticing.

Relevance in Modern Healthcare

Its growing relevance today is evident in areas like oncology and end-of-life care, where patients often grapple not just with physical decline but questions of identity, legacy, and meaning—elements that medical management alone cannot address. I’ve seen spiritual needs surface in those quiet, uncertain spaces, after a prognosis is delivered, when treatment ends, or when pain no longer responds to medication. In those moments, I’ve seen patients and family often reach not for answers, but for meaning. It is precisely in these margins where explanations fracture and spiritual care finds its footing. Spirituality’s recent prominence in holistic policies and professional discourse suggests it is not just an addition to care, but a response to something long missing.

If spiritual care addresses what is most personal and intangible, then its ill-fitting within the current healthcare system is hardly surprising. Modern clinical environments are shaped by urgency, quantifiable outcomes, and institutional efficiency. Consultations are brief, workloads are high, and practitioners are often rewarded for decisiveness, not reflection. This echoes wider critiques of medical culture, where self-sacrifice and output often take precedence over presence and meaning, leading to burnout and disillusionment, as widely documented in UK clinical practice. This raises an often overlooked but critical point: the capacity to offer spiritual care depends not only on time and training, but on the clinician’s own inner resources. Holding space for others requires emotional presence, reflective capacity, and often, personal spiritual development. When clinicians cannot attend to their own well-being, including their own sources of meaning, it becomes harder to meet the spiritual needs of others in a way that feels genuine or sustaining. Within this framework, spiritual concerns often remain vague, difficult to voice, and nearly impossible to measure, making them hard to legitimise.

Challenges in Clinical Practice

As a nurse, I have felt the strain of wanting to stay with a patient who needed to talk, really talk, while knowing I had more medications to give and real-time documentation to do. When it is addressed, the current system’s capacity reduces spirituality to a brief question in an assessment form, outsourced entirely to chaplaincy services or included as part of a medical ethics question. While these mechanisms signal progress, they also expose a tension: the system that now welcomes spiritual care is the same one that was never designed to hold it. When the clinician’s own well-being is compromised, their ability to notice, respond to, or sustain spiritual encounters becomes harder to access. And so spiritual care remains both recognised and unreachable, visible in theory, but elusive in practice.

Even as spiritual care gains recognition, efforts to formalise it through clinical frameworks risk stripping it of the very qualities that make it meaningful. Once spiritual care enters the machinery of healthcare bureaucracy, it risks becoming another administrative task, shaped more by institutional process than patient meaning. Yet by its nature, spiritual care resists this kind of reduction. Research by Balboni et al. highlights that patients facing serious illness overwhelmingly value spiritual support, yet most report that their needs in this domain go unaddressed. This disconnect between desire and delivery underscores the limitations of protocol-driven care when addressing existential concerns. Spiritual care relies on human qualities like attentiveness and trust, things that cannot be automated or reduced to a code of practice. When the spiritual is filtered through institutional structures, it may be softened to fit professional boundaries or redefined in terms that feel safe and measurable.

Parallels can be drawn to how mindfulness, originally rooted in Buddhist spiritual practice, has been adapted into clinical interventions like CBT, which is often stripped of its ethical and philosophical depth to suit therapeutic frameworks. This example illustrates how spiritual concepts, once institutionalised, risk being sanitised in translation. Even well-intended tools, such as the HOPE spiritual assessment framework, designed to support clinicians in navigating spiritual conversations, can lose impact when reduced to a series of prompts rather than a starting point for genuine dialogue. This can lead to tokenism, where spiritual questions are asked but not truly heard, or where care is offered in form but not in spirit. Ironically, the desire to include can become a subtle act of exclusion, flattening depth to fit institutional constraints. In this way, the very act of integrating spiritual care into the clinical setting may risk neutralising its power, unless systems are willing to be changed by it, rather than merely absorbing it.

Examples of Meaningful Integration

Despite these tensions, there are examples within healthcare where spiritual care has been meaningfully integrated, not through formalisation alone, but through cultural shifts and relational depth. Palliative care, for instance, often makes room for conversations that move beyond symptoms, allowing patients to voice what matters most without pressure to resolve it. Guidance from NICE encourages this kind of holistic needs assessment in end-of-life care, recognising that psychological, social and spiritual wellbeing are core components of good clinical practice, not optional extras. Similarly, in mental health services and trauma-informed care, practitioners are increasingly trained to recognise existential distress as a valid and complex dimension of suffering. What these models share is not a perfected system, but a shift in posture: from intervention to accompaniment. Rather than trying to define or solve spirituality, they allow it to emerge naturally in response to the patient’s need. These practices suggest that spiritual care is not incompatible with healthcare, but it cannot be grafted onto existing structures without change. It must challenge clinicians to sit with uncertainty, to slow down when systems demand speed, and to value presence over productivity. Only in these conditions can spiritual care retain its integrity and contribute something truly different to the future of holistic health.

Conclusion

Ultimately, spiritual care may well be the next great horizon in holistic healthcare, but its success depends not on its inclusion alone, but on how it is approached. If the healthcare system seeks to integrate spirituality without examining the structures and values that previously excluded it, it risks turning a frontier into a facade. Spiritual care cannot be squeezed into rigid protocols or offered on a schedule without losing something essential. Its value lies precisely in what it resists: speed, standardisation, and certainty. To cross this frontier meaningfully, healthcare must be willing to change, not just in practice, but in culture. This means creating space for presence, embracing complexity, and allowing care to extend beyond what can be measured. Without such shifts, the system may claim to offer spiritual care while delivering only a shadow of it. The challenge, then, is not whether we can bring spirituality into healthcare, but whether we are prepared to let it transform the system in return. From nurse to doctor, these experiences will remain with me. They are the quiet lessons that won’t appear on any exam but shape the kind of clinician I hope to become: one who can sit with uncertainty, hold space for meaning, and let presence, not just protocol, lead the way.

References

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