Pathways to Mental Health Care: The Role of Religion and Spirituality in Help Seeking for Psychosis

Abstract

Numerous studies have emphasized the vital role of religion and spirituality in living with and receiving care for mental health challenges. To illuminate the diversity of religious and spiritual responses to psychosis, the authors conducted a narrative literature review with three religious worldviews to illustrate how religious and spiritual traditions can shape meaning making, help seeking, and coping among individuals experiencing first-episode psychosis. Christian, Muslim, and Indigenous American traditions differ widely in their explanatory models, the role of spiritual leaders in care pathways, and their degree of alignment with psychiatric systems. Rather than assuming a single model of care, the authors aimed to explore culturally informed, reciprocal approaches to support effective and respectful engagement (for individuals experiencing first-episode psychosis to whom religion is important) between the medical model and religious or spiritual care. The authors suggest that collaborative models between clinicians and religious or spiritual healers, rooted in humility and bidirectional learning, are essential for building trust and improving access to care. This work highlights the need for pluralistic and coconstructed approaches to early intervention that respect cultural frameworks rather than overwrite them.

In the United States, 80% of individuals identify as spiritual, religious, or both; of these, 22% identify as spiritual but not religious, 48% as religious and spiritual, and 10% as religious but not spiritual (1). Religion and spirituality offer unique perspectives on mental health, ranging from purely medical to purely religious or spiritual.

Culture has been defined as the “beliefs and customs shared by groups of people in a particular time and place” (2). Religion embodies beliefs, practices, values, and rituals that connect individuals to the transcendent (e.g., God, a higher power, or ultimate truth) and is shaped by cultural traditions (3). Religion involves supernatural factors, beliefs about life after death, rules of social behavior, and rituals that foster and strengthen communication with the transcendent and enhance community and responsibility. The concept of spirituality includes aspects that exist outside of organized religious frameworks. Spirituality encompasses personal inquiry into fundamental questions about life, meaning, and one’s relationship to the sacred or to a higher power (4). Spiritual values (e.g., kindness, gratitude, compassion, joy, and connection with nature) tend to be generic and can be cultivated via most religions and through nonreligious actions (5). Individuals may define themselves as having a high level of spirituality but a low level of religiosity (6).

Broadly, spirituality and religion have been associated with lowered anxiety, stress, and depression (7). However, the relationship with psychosis appears to be more complex. Whereas religiosity may weaken the negative effects of self-stigma among individuals experiencing psychosis (8), delusions with religious content have been linked to poorer prognosis, more severe symptoms, and greater medication use (9). By contrast, nonpsychotic religious beliefs have generally been correlated with more favorable outcomes, including improved coping with psychotic symptoms (6).

In this narrative review, we examined the multifaceted role of religion and spirituality in influencing how individuals and communities understand, give meaning to, and respond to psychosis, as well as in shaping pathways for help seeking and coping. To illuminate the diversity of religious and spiritual responses to psychosis, we focused on three distinct groups: Christian, Muslim, and Indigenous American and tribal communities. These groups were selected because they offer varied theological, cultural, and historical frameworks that influence how psychotic experiences are understood and managed. Narrative reviews offer broad, integrative synthesis and, unlike systematic reviews, do not require detailed reporting of search terms or databases (9). We approached this review with the understanding that the clinical mental health system is only one of many frameworks for responding to psychological distress. Our aim was not to determine a single correct pathway to care; instead, we aimed to explore how different religious and spiritual worldviews construct meaning around psychosis and how these constructions shape decisions, relationships, and outcomes. Throughout this review, we sought to promote models of care that are collaborative and culturally responsive rather than assimilative or prescriptive.

ROLE OF RELIGION AND SPIRITUALITY IN UNDERSTANDING PSYCHOSIS

The DSM-5-TR (10) defines psychosis as a constellation of symptoms, including hallucinations (or changes in perception), delusions (unusual beliefs), disorganized speech or behavior, and negative symptoms. Psychosis may occur as part of a general medical or mental health condition or may emerge as a primary psychiatric condition (11, 12). In its more impactful manifestations, psychosis can affect education, job opportunities, and economic stability. Owing to its complex social, health, and treatment-related factors, psychosis is associated with higher mortality rates (13).

Psychosis symptoms are often deeply distressing and lead individuals to seek explanations through familiar frameworks (e.g., familial, cultural, or spiritual). These unique and often idiosyncratic meaning-making systems shape how people understand adversity and guide individuals’ responses to unfamiliar or unwanted experiences. Barriers, including stigma, unfamiliarity with mental health services, and low biomedical mental health literacy, influence when and whether individuals seek professional care (14-19). Religion, as a personal and cultural system of meaning, may play an important role in these decisions and interpretations. Accordingly, we next discuss how religious and cultural interpretations of psychosis influence help-seeking behavior and perceptions of care.

CULTURAL AND RELIGIOUS FRAMEWORKS IN MEANING MAKING AND HELP SEEKING

Across cultures, individuals hold a variety of explanatory models for mental wellness and unwellness. These models may serve as personal frameworks for understanding the origins, progression, and treatment of mental health challenges (20); each model offers a different explanation for the causes and experiences of psychosis. For example, the clinical concept of duration of untreated psychosis, with longer duration often associated with poorer clinical outcomes (21, 22), assumes the need for prompt medical treatment, reflects the assumptions of biomedical models, and may not capture culturally grounded pathways to healing. In many traditions, however, psychosis is addressed through spiritual, relational, or ritual practices that do not align with biomedical timelines. These alternative practices suggest that the end point for duration of untreated psychosis could be understood more broadly, going beyond the point where medication and formal treatment are started, to include when someone first receives support in a religious or spiritual setting.

The social model emphasizes external contributors to distress (e.g., poverty, unemployment, or social disruption) (23). Psychological trauma, including early life adversity (e.g., abuse, neglect, or bullying), has also been linked to the development of psychosis (24). Medical models focus on biological and genetic risk factors, whereas the biopsychosocial model integrates the biological, psychological, and social influences (25). However, religion and spirituality have often been viewed as peripheral influences, rather than as core components, in causal models. This exclusion can lead providers to overlook meaningful aspects of a person’s identity, potentially resulting in less effective and less culturally responsive care.

In cultures in which religion and spirituality are central to daily life, these frameworks often shape interpretations of what are clinically defined as psychotic symptoms (26). Research (27, 28) has documented a range of spiritually based attributions for distress, including beliefs that psychosis represents a test from God; punishment for sin; weak faith; divine will; or spiritual interference, such as evil spirits. These explanations have been found in various contexts, such as among Pakistani communities (29), U.K. Black African and minoritized ethnic groups (30), and U.S. Muslims (31, 32). In many Indigenous Native American and Eastern traditions, general medical illnesses are also explained within frameworks that link health to spiritual and emotional balance, reflecting a more integrated approach to well-being (33).

In a study of U.K. Black African and Caribbean service users with nonaffective psychosis, the experience was often attributed to spiritual, biological, substance-related, or biopsychosocial causes (34). A systematic review (35) found that spiritual beliefs frequently provide coping strategies, as well as causal explanations, and may influence individuals’ willingness to engage in treatment for psychosis. Belief systems and outcomes are shaped by dynamic interactions between individuals’ experiences, societal attitudes, and broader cultural contexts (36, 37). Thus, distress may be amplified in environments where spiritual interpretations are stigmatized or dismissed.

HELP-SEEKING PATHWAY, RELIGIOUS COPING, AND THE ROLE OF SPIRITUAL COMMUNITIES

For individuals experiencing first-episode psychosis, pathways to care are often complex, nonlinear, and shaped by individual and systemic factors (e.g., gender, age, race-ethnicity, socioeconomic status, and cultural context) (38, 39). Initial support is often sought through family, faith-based institutions, and religious or spiritual leaders.

Families play a pivotal role in initial responses to psychosis, interpreting emerging symptoms through culturally rooted frameworks and often attempting to manage distress within the social and family contexts (38). In collectivist cultures, these attempts may involve consulting community elders or religious or spiritual healers, typically prior to contact with formal mental health systems—thus reflecting shared decision making and a communal approach to healing. Fridgen et al. (40), in a study of individuals at clinical high risk for psychosis and of individuals with first-episode psychosis, found that family members were the most common first source of support.

In the United States, individuals experiencing psychosis often turn to these accessible and familiar community or religious institutions, and frequent religious service attendance has been associated with lower psychological distress (41). In areas with ample resources, this support may be balanced with care from mental health providers. However, in low- and middle-income countries with fewer licensed providers, religious communities may represent the only available source of care (42).

Traditional or faith-based healers (e.g., prayer houses, priests, herbalists, and clergy) often provide direct and in-direct care and may serve as the first point of contact for seeking care (43-45). Although not always identified as help seeking in traditional research, support rooted in cultural practices can foster positive outcomes by addressing distress without pathologizing individuals or their valued cultural communities.

Differences in worldviews between individuals, families, and providers can create tension when explanatory models for mental distress do not align. The dismissal of religious or cultural interpretations, or the perceived refusal of medical and spiritual authorities to engage across frameworks, can reinforce stigma and contribute to delays in accessing pathways to care. For example, Shadid et al. (46) found that ideological conflict between families and psychiatrists was associated with a sixfold increase in the delay of help seeking; when the conflict involved a spiritual leader and a psychiatrist, the delays extended to >2 years on average. Even when individuals do engage with medical care, religious and spiritual beliefs often remain central to meaning making but may go undisclosed because of concern about being judged or misunderstood. This pattern of partial disclosure and concealment, which is common in religious and spiritual communities when stigma is anticipated, can further limit communication and complicate engagement across care settings. In practice, clinicians rarely spend time deciding whether pluralistic pathways exist, but rather on whether and how to engage with the pathways that are already shaping an individual’s care.

Peteet (47) described a conceptual framework of religiously reinforced stigma, influenced by factors such as fundamentalist thinking, communal bonding, misattribution of psychopathology, and negative experiences with secular providers. These dynamics emphasize the importance of mental health providers adopting a collaborative approach that respects and integrates religious and secular perspectives on mental health, bridging divides without dismissing the value of traditional or spiritual frameworks for understanding mental health challenges. Because traditional healers are often sought out for various health concerns, they can serve as valuable partners in public health efforts.

Recognizing the motivations and experiences of the individuals who are experiencing stress, and asking about their perceptions and understanding of what is happening and what has prompted them to seek help, is crucial. Certain psychotic spectrum experiences may intersect with religious beliefs; this relationship may occur independently of participation with a religious or spiritual community and may affect engagement with informal and formal care pathways. Experiences, delusions, and hallucinations with religious or supernatural themes can be experienced as positive or negative. For example, individuals may believe that they have special powers granted by God, are controlled by malevolent spirits, or may have a mix of positive and negative religious-themed delusions. In a review of the literature, Grover et al. (48) found that such delusions are comparably more pervasive than are other forms of delusions and that although people with these experiences value religion as much as those without them, these individuals typically have less support from religious communities.

The three religions discussed below reflect great variation in explanatory models, levels of stigma, first-line support, and trust in psychiatry and professional mental health care. Understanding that these groups are not monolithic is crucial; instead, they represent a mosaic of diverse societies, cultures, traditions, and experiences. Individuals within these groups come from a variety of racial, ethnic, and national back-grounds, each contributing distinct religious and spiritual practices and having varied migration histories and countries of origin. Other religious groups, and the intersectionality between religion and culture, are discussed in the online supplement to this article.

Christianity: Diverse Interpretations and Pathways to Care

Despite Christianity’s prevalence in the United States, we found only limited literature on Christian beliefs about psychosis from the viewpoint of people with lived experience. As of 2020 (49), 64% of the U.S. population identified as Christian, and evangelical Protestant and Catholic were the largest denominations (50). The specific beliefs and practices of each denomination vary. Existing literature (51) has suggested that some individuals identifying as Christian and experiencing psychosis may wrestle with understanding their experiences through a secular or supernatural lens. Other studies, which did not specifically recruit individuals experiencing psychosis, have found that some U.S. Christians interpret experiences of psychosis through the lens of the supernatural. For example, two U.S. studies (52, 53), with almost entirely Christian samples, found that approximately 30% of the sampled individuals agreed that possession by evil spirits could cause psychosis. One of these studies (52) also found that, when presented with vignettes describing “ambiguous psychotic-like spiritual presentations,” individuals with a higher degree of Christian religiosity were more likely to interpret these as religious experiences than as a psychiatric condition, unless the individual was a mental health professional.

More broadly, certain tenets of Christianity may influence the interpretation of mental health experiences in general and may increase, or decrease, willingness to engage in treatment. For example, some Christian communities may have stigmatizing beliefs that attribute the source of mental health challenges as spiritual trials or failures to be resolved through spiritual means, such as prayer or acts, rather than through mental health services (54-56). Whereas some denominations endorse supernatural explanations, others actively support usage of psychiatric care. By contrast, there are also examples of approaches within U.S. Christian communities that demonstrate connection between mental health care delivery and the Christian faith, such as pastoral care and counseling, biblical counseling, integrationism, Christian psychology, and the Institute for the Psychological Sciences (57). Research by Luhrmann et al. (58) has shown that not all hallucinatory-like experiences are considered signs of psychosis. In some Christian communities, particularly in charismatic and evangelical traditions, believers intentionally cultivate internal sensory experiences during prayer, such as hearing God’s voice or imagining his presence. These experiences are shaped by cultural and spiritual practices that encourage a porous boundary between consciousness and spirit. Importantly, these events are typically rare, brief, meaningful, and nonintrusive, in contrast to the more intrusive, repetitive voices associated with psychosis. Luhrmann and colleagues’ work highlights how culturally shaped spiritual experiences can resemble psychotic symptoms but function differently in people’s lives. This work (58) underscores the need for clinicians to distinguish culturally normative spiritual experiences from symptoms of psychosis. Furthermore, there is no one-size-fits-all approach. For example, individuals of Christian faith may interpret the coping mechanism of mindfulness as being in opposition to their faith or as a practice supported by Christian tradition (59).

Cultural and religious practices within Christian communities vary widely by denomination and in beliefs about evil, possession, and prayer. We advocate for collaborative, culturally responsive care that honors these perspectives and supports recovery.

Islam: Holistic and Faith-Based Pathways to Support

An estimated 3.45 million Muslims live in the United States (60). During hardship or psychological distress, devout Muslims may rely on religion for support, consistent with Islamic teachings that emphasize self-care and treatment seeking, because health is considered a gift from God. Mental health approaches are typically holistic, integrating medical, psychological, religious, and spiritual perspectives. Historical examples of Islamic faith-based care include the bimaristan, a mental health care center established in 707 CE by Caliph al-Walid Ibn Abdul Malik that offered a comprehensive range of services for individuals with mental health challenges. Services included recreation, mentoring, and support for community reintegration after discharge from the center, alongside medical treatment and involvement of religious leaders to provide spiritual guidance (61).

U.S. Muslims often incorporate biopsychosocial and spiritual perspectives in understanding mental health. Although generally relying on the biomedical model, they may also interpret mental health challenges through a spiritual lens. These challenges may be viewed as God’s will, a test, punishment, or spiritual possession and thus an opportunity to improve one’s connection with God (62). Many Muslims believe in supernatural forces, such as the evil eye, jinn, and magic—all referenced in the Quran (63). Denying these causes may be viewed as a lack of faith, which is often linked to mental health conditions. Research (64) has suggested that belief in biomedical concepts and Islamic spirituality can promote openness to mental health care among Muslims, highlighting how biological factors and Islamic spiritual values can coexist.

Muslim families, having emigrated from collectivist cultures, tend to maintain these values, viewing an individual’s crisis as a family matter that affects the entire community (65). This perspective often leads to a preference for seeking help from family or community because of mental health stigma. Driven by mistrust or fear of stigma, U.S. Muslims may turn to imams instead of traditional medical services (33, 66). This practice of including medical and spiritual treatments is often referred to as “pluralistic medicine” because multiple modalities are used (67). In the Abu-Ras et al. study (68), however, 94% of the sample consulted imams as counselors, with few seeking formal mental health care. Imams addressed issues such as anxiety and depression, but most of these religious leaders lacked biomedical training and referral knowledge, thus delaying access to Westernized care. Educational outreach in mosques and community centers may help reduce mental health stigma by affirming that seeking help aligns with Islamic teachings (66).

Muslims may move between medical and spiritual ways of making meaning, sometimes using one, sometimes combining several at once. Individuals may turn to traditional healing when biomedical treatments do not lead to improvement or when symptoms continue despite ongoing care (67).

Indigenous American Frameworks: Relational Healing and Spiritual Balance

The 574 federally recognized tribes, along with numerous nonfederally recognized tribes, encompass approximately 2.5 million Native American and Alaska Native people (69), highlighting the vast cultural diversity within this population. Blume (70) found that many Native American worldviews differ from Western ones in three key ways: all things are interconnected, meaning that there is no clear distinction between any human and the rest of creation; egalitarianism arises from interconnection, and as such, constructs of self-focus, independence, and autonomy are devalued; and relationships are key to defining psychological well-being, with wellness being closely related to balance and harmony across multiple levels, including the spiritual. This interconnectedness is key when considering the experience of what might be termed “psychosis” in these communities, where interconnectedness is thought to extend beyond the material to the spiritual. As Blume (70) wrote, “experiencing things that seem supernatural or having connections with unseen events is considered normative, not pathological or dysfunctional.”

Garcia et al. (71) emphasized the importance in Indigenous cultures of “competent discernment,” defined as “the ability to make accurate and wise decisions.” Additionally, they noted the distinction between Western psychology, where this skill is learned in the classroom and through learning placements, and Indigenous communities, where this skill is honed through learning from, and working with, community elders. Ultimately, Garcia and colleagues advocated for “wise discernment” by clinicians when drawing on frameworks for understanding psychosis and to ensure consultation with a community elder or an Indigenous clinician. In some tribes, meaning making regarding substance use, depression, and suicide may emphasize that these conditions are neither biological nor psychological. Instead, they are understood primarily through history, colonialism, and spiritual culture and highlight structural racism as embedded in the “Whiteman system” (72). Wellness, in this view, can be restored through a return to the ancestral “spiritual ways” that nurture the well-being of community members (73). Without careful attention, clinicians risk perpetuating colonialism and structural racism by imposing Westernized models of care.

Native American individuals often seek traditional healers to restore balance, harmony, and unity. Discordance is understood to result from imbalances between the inner and outer aspects of life. In a study examining usage patterns and practice implications among individuals treated by physicians in a Native American health center (74), 38% of the care recipients consulted a healer, and of those who did not, 86% reported that they would consider consulting one in the future.

RELIGIOSITY AND COPING WITH DISTRESS

Religious coping involves using religious beliefs, practices, and participation in faith-based communities to manage distress. Spiritually oriented practices may include rituals and interpersonal connection within one’s religious community (75). Specific acts may include making meaning of experiences through religious texts and tenets, engaging in individual and communal prayer, participating in shared rites, performing acts of service, seeking counseling from clergy, and seeking support from others of the same religious background or congregation.

Religious coping is common among individuals with mental health challenges in the United States. In one Los Angeles County mental health facility, >80% of 406 service users reported using religious practices, mostly prayer, to cope, especially during symptom exacerbations (76). Similarly, of 2,050 California service users, 80% agreed that spirituality was crucial to their mental health, with prayer (73%), meditation (47%), attending services (40%), and reading sacred texts (36%) considered helpful (77). Individuals with schizophrenia have also been reported to value religious coping more than the general population (78).

The literature has distinguished between helpful and unhelpful forms of religious coping. Helpful strategies include spiritual support, forgiveness, collaboration with a higher power, and benevolent interpretations. Unhelpful religious coping involves feelings of spiritual discontent, belief that one is being punished by God, religious conflicts, demonic interpretations, and doubt about God’s power (79). Helpful religious coping has been seen as protective, supporting recovery from schizophrenia (80), and has been linked to better quality of life, improved social functioning, and more favorable clinical outcomes (78). Conversely, unhelpful religious coping has been linked to poorer quality of life and more distress (81). Rosmarin et al. (82) found that participants with psychosis who used helpful religious coping reported greater reductions in depression and anxiety and increased well-being.

BUILDING COLLABORATIVE PATHWAYS BETWEEN FAITH AND MENTAL HEALTH SYSTEMS

This section offers recommendations for integrating religion and spirituality into the earliest phases of care for psychotic spectrum conditions. Outreach into religious and spiritual communities must be conducted through a lens of cultural humility and inquiry, with explicit attention to the risk of iatrogenic harm when culturally normative experiences are pathologized. In care for early-stage psychosis, collaboration (when occurring) can involve mental health clinicians engaging with the religious or spiritual leaders who are already part of the individual’s help-seeking pathways. Effective collaboration across these systems depends on relationships developed over time, supported by sustained dialogue about psychosis and reflecting mutual respect and bidirectional learning, rather than by attempts to impose clinical or reductionistic explanatory models. Models of care that acknowledge religious explanatory frameworks (without endorsing or erasing them) are more likely to foster trust and to support individuals and families navigating psychotic spectrum experiences across clinical and spiritual settings.

From a clinical standpoint, collaboration is less about agreement on causation than about responding to how care unfolds. Many individuals experiencing psychosis seek religious or spiritual support, regardless of clinician involvement—often before, alongside, or in place of psychiatric care. When these pathways remain disconnected, clinicians may have limited insight into the individual’s evolving beliefs, delayed awareness of clinical deterioration, and fewer opportunities to reengage when risk increases. In this context, collaboration functions as a pragmatic mechanism for maintaining communication and continuity in situations where delay or treatment refusal is already present.

Importantly, efforts to integrate mental health services into spiritual communities should avoid treating those communities primarily as referral sources. Collaboration with religious communities instead offers opportunities for learning and adaptation, allowing for coconstruction, rather than simply delivery of care. Such approaches shift the clinical frame from symptom correction toward meaning making, recognizing that religious frameworks often shape how individuals understand distress and recovery. When community leaders are seen as active partners in the process of care, individuals are more likely to feel understood and supported within the spiritual and clinical contexts.

Examples of bidirectional collaboration illustrate the operationalization of these principles. One such example of a workshop for a faith community is the suicide response training offered by the Stanford Muslim Mental Health and Islamic Psychology Lab (83). This program equips religious leaders with basic guidelines to help address mental health concerns and to normalize help seeking among Muslim individuals and their families. The religious leaders are later invited to participate in focus groups to provide the health care team with input into the community needs around the issue of suicide. The Khalil Center in California, a “community wellness center advancing the professional practice of psychology rooted in Islamic principles” (84), organizes programs, lectures, and events in collaboration with the Stanford Muslim mental health program to educate community members about mental health and to combat stigma. The clinicians and program staff illuminate how the Hadith (sayings of the Prophet Muhammad) and verses of the Quran encourage Muslims to care for their mental well-being and to seek treatment when ill (84). In these initiatives, collaboration is continuous and reciprocal, supporting shared learning rather than promoting biomedical models as inherently superior.

The broader literature on global mental health provides further evidence that collaboration between clinical and religious or traditional healing systems is feasible. Ae-Ngibise et al. (85) described collaborations among nurses, faith healers, and traditional healers, highlighting the need for open communication and respect for each other’s roles in care coordination. These clinicians have sometimes visited clients in healing settings and discussed treatment plans with spiritual healers to clarify when medical care is necessary, especially during acute phases of illness. Likewise, some of the faith and traditional healers have acknowledged the benefits of the biomedical approach, encouraging patients to combine hospital care with spiritual practices. Although challenges and skepticism exist, meaningful collaboration is possible and can improve continuity of care and outcomes for people with mental health challenges (85).

Across settings, evidence from collaborative models has shown that bidirectional partnerships between clinicians and religious or traditional healers do not tend to arise informally or spontaneously. Instead, they develop through deliberate clarification of roles and expectations. Collaboration typically begins with formal relationship building, such as contracts, written protocols, or the integration of healers into clinical settings. Once the relationship has been established, both sides may engage in joint training or observation to better understand each other’s approaches, followed by routine use of cross-referrals and shared discussions of clients’ treatment plans. Some programs include joint health-promotion activities, such as vaccination drives. Across these models, documentation and follow-up remain central, with each party retaining responsibility for their role in continued care (86).

Crucially, collaborative models do not require clinicians to relinquish professional judgment or to endorse nonmedical explanations, nor do they shift legal or clinical responsibility for care to religious or spiritual providers. Instead, collaboration can be understood as a parallel system of engagement, where clinicians retain responsibility for medical assessment and evidence-based treatment yet recognize that individuals may also seek meaning and healing through religious or spiritual frameworks. In practice, this collaboration calls for being explicit about risk and clinical responsibility, particularly when individuals decline medication or psychotherapy, recognizing that disengagement from care often occurs in the absence of collaborative pathways as well. In this article, we have outlined the conceptual foundations of such models; more applied examples and implementation considerations are being prepared for a follow-up article.

CONCLUSIONS

Religion and spirituality influence how psychosis is understood and acted on in many communities. Across Christian, Muslim, and Indigenous American and tribal traditions, psychotic experiences are interpreted through differing lenses that shape help seeking in ways that may not begin or end in clinical settings. These frameworks may affect ongoing treatment engagement and often remain active after contact with mental health services ends. Therefore, responses to psychosis frequently unfold across multiple contexts rather than within a single care system. When biomedical approaches are treated as the only valid frame, delayed entry into services or reluctance to follow treatment recommendations may be misread as resistance rather than evidence of care pathways already in use. Acknowledging this reality requires recognizing the limits of clinical authority over meaning making and help seeking. For early-stage psychosis care to remain responsive, psychiatric and allied providers must consider how meaning and responsibility are organized outside of clinical encounters, engaging in collaboration that involves working together with humility and building trust over time. Engagement with religious and spiritual communities offers a practical way to maintain continuity when care unfolds across parallel pathways; designing services with this reality in mind is essential to supporting access and relevance during the earliest phases of psychosis.

HIGHLIGHTS.

• Several studies have shown that religion and spirituality, through their explanatory models, coping practices, and community influences, can have important roles in psychosis care.

• Differing religions and cultures define and approach psychosis in distinct ways, shaping individuals’ help seeking and treatment pathways.

• The literature recommends that clinicians adopt bidirectional care models, in which mental health providers and religious or spiritual healers collaborate.