Table 2.

Clinical considerations based on MISTIC framework

MISTIC theme pair	Clinical relevance	Clinical approaches and some potential questions
Meaning-making and Identity (MI)	Understanding the centrality of spirituality for some people's identities, lives and mental health. Spirituality is central to some people's identities and how they make sense of mental health difficulties and other experiences. Being open and actively exploring the important role spirituality may play in helping someone to make sense of their illness is a means of supporting recovery.	Being aware that people's spiritual experiences and beliefs may form a core part of their identity and their understanding of their mental health difficulties and/or recovery. Asking questions about the importance of spirituality in someone's life. Asking if religion or spirituality help them to make sense of what is happening and if so how. Asking if religion or spirituality are confusing and if so how.
Service provision and Talk about it (ST)	Practical ways services can meet spiritual needs. What services and practitioners can practically do to facilitate meeting people's spiritual needs and adopting an open approach towards communication about the topic.	Offering a pro-active yet sensitive approach in addressing the subject if someone would like this. Exploring people's spiritual needs whilst using services. Offering people the opportunity to talk about their spirituality and needs, and listening with sensitivity, empathy and open-mindedness. Listening non-judgmentally with care within a person-centred (rather than expert-driven and problem-solving) approach, giving the person space to express themselves, their own experiences and expertise.
Interaction with symptoms and Coping (IC)	Awareness of challenges and coping strategies. Understanding that spirituality can interact with mental health in complex and sometimes confusing ways and that people may employ a variety of spiritual practices and strategies to cope.	Exploring how people's spirituality and/or practices may be challenging or helpful. Asking about what spiritual and religious practices are used or have been used in the past. Asking questions about whether and how these practices are helpful or challenging. Asking questions about whether and how spirituality and religion help with coping. Asking questions about whether and how spirituality and religion lead to struggles or difficulties.