Mental health, "burnout" and job satisfaction in a longitudinal study of mental health staff

Exploring the Usability of a Community Resiliency Model Approach in a High Need/Low Resourced Traumatized Community

This study tested the usability of a non-stigmatizing community-based trauma intervention delivered by trained community members. The Community Resiliency Model (CRM) was taught to a high-crime, low-income community designated as a Mental Health Provider Shortage Area (19 MPSA score). Five groups of Latino, African-American, LGBTQ, Asian Pacific Islander, and Veteran participants (N-57) with a history of complex/cumulative traumas and untreated posttraumatic stress undertook a five-day 40-h CRM training with master trainers. Measures included Treatment Relevance, Use and Satisfaction (TRUSS), Brief CRM Questionnaire (Brief CRM), and Symptom Questionnaire (SQ). Participant preparedness to teach CRM to others was high (98%) and sustained at the 3-6 months follow-up with 93% reporting a daily use. Pre-to post comparison analyses showed a significant decrease in distress indicators and increase in wellbeing indicators. CRM's high usability holds promise for a broader, low cost and sustainable implementation in traumatized and under-resourced communities.

Prevalence of stress, burnout, and job satisfaction among mental healthcare professionals in Jeddah, Saudi Arabia

Objective

To assess the levels of stress, burnout, and job satisfaction among mental healthcare professionals in Jeddah City, Saudi Arabia.

Methods

A cross-sectional study was conducted on mental healthcare professionals in Jeddah between January 2017 and October 2018. Sociodemographic characteristics and levels of stress, burnout, and job satisfaction were assessed using the Perceived Stress Scale-14 (PSS-14), Maslach Burnout Inventory (MBI), and Job Satisfaction Scale (JSS). Descriptive statistics were used. Independent sample t-test, one-way ANOVA, Mann-Whitney, and Kruskal-Wallis tests were conducted to assess for effects of demographic variables on the perceived stress score, emotional exhaustion (EE) score, depersonalization (DP) score, professional accomplishment (PA) score, and the job satisfaction score (JSS).

Results

A total of 107 participants were included (50.5% men; 49.5% women) with response rate of 79.2%. Prevalence of stress was 56.1%. High levels of emotional exhaustion and depersonalization were present among 41 (38.3%) and 26 (24.3%) of the respondents, respectively, while high score of low personal accomplishment were present among 61 (57%) respondents. In terms of job satisfaction, 25 (23.4%) were satisfied and 74 (69.2%) were indecisive. Male participants’ emotional exhaustion score (27±12) was significantly higher than females (22 ±10), (t(105) = 1.99, p-value = 0.049). Also, participants with a monthly income above SR 20,000 had significantly higher total job satisfaction (p-value = 0.041).

Conclusions

Our findings suggest rates of stress and burnout among mental health professionals that warrant attention, with less than one-quarter of the participants being satisfied with their jobs. Further studies are needed to expand the findings and to explore the contributing factors. Additionally, interventions should be established by authorities to address the increasing rates of stress and burnout.

Lashing out: emotional exhaustion triggers retaliatory incivility in the workplace

Incivility in the workplace is a growing problem in many workplaces that can detrimentally affect employees and organisations. Despite this increasing problem, the current literature on incivility lacks an integrated theoretical model to explain engaged and retaliated incivility in the workplace. To address this gap, we tested a model which incorporated both Spiral Theory of Incivility with Conservation of Resource Theory to explain the underlying processes involve in the relationship between engaged and retaliatory workplace incivility. Specifically, retaliatory incivility was hypothesised as an influencing factor, work withdrawal and job dissatisfaction as consequences, and emotional exhaustion as a moderator. A total of 875 employees in multinational organisations across three countries were panel surveyed. The overall result from the Structural Equation Modelling (SEM) indicated that the fit indices for the proposed model fulfilled all recommended levels. Importantly, emotional exhaustion was found to be the trigger point in the negative spiral of workplace incivility. Theoretical implications and practical considerations were discussed.

Clinical Supervision of Mental Health Services: A Systematic Review of Supervision Characteristics and Practices Associated with Formative and Restorative Outcomes

In this review, the authors examined supervision characteristics and practices associated with formative (e.g., skill development) and restorative (e.g., well-being) provider outcomes. We used qualitative review to summarize supervision characteristics associated with desired outcomes. Then, we applied a distillation approach (Chorpita et al., 2005) to identify practices associated with formative and restorative outcomes. The most common practices for promoting formative outcomes were corrective feedback, discussing intervention, and role play. Findings indicate several supervision strategies have demonstrated empirical support for improving formative outcomes. However, more rigorous research is needed in community settings, particularly for understanding which strategies improve restorative outcomes.

Burnout syndrome among psychiatrists in Egyptian mental health hospital

Background

Burnout is a special type of work-related stress—a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity (Lancet 388:2272-2281, 2016).

Burnout is a syndrome of state of emotional exhaustion, depersonalization, and feelings of low personal accomplishment (Maslach C and Jackson S, Maslach burnout inventory manual, 1986).

Burnout syndrome leads to severe problems. It may cause psychosomatic problems, family and marital conflicts, and substance misuse and also may result in complications such as late coming and early leaving of employees, quitting, having frequent medical reports, and the lack of productive and constructive ideas and criticism in the occupational settings (Sayil et al, Kriz Dergisi, Cilt 5, Say 1:2 ss.71-77, 1997).

So, we aimed to estimate the rate of occurrence of burnout among a sample of psychiatrists in one of the governmental psychiatric hospitals in Egypt.

Results

Result shows that 56.2% of study sample were males and 43.8% were females. Their mean age was 32 ± 6, and 57.5% were married and 42.5% were single. Mean score of emotional exhaustion was 28.25 ± 10.45 (high). Mean score of depersonalization was 8.5 ± 6.1 (moderate). Mean score of personal accomplishment was 31.78 ± 8.5 (low)

Conclusion

Burnout rate among psychiatrists of Al-Abbassia Hospital is higher than in western countries. Marriage and sleeping in home have protective effects. There is a significant association between high number of working hours per week and quality of the relationship with seniors and burnout.

Job Burnout Among Mental Health Staff at a Veterans Affairs Psychosocial Rehabilitation Center

Mental health providers who serve clients with severe mental illness may be particularly prone to job burnout given the nature of the work. This study examined levels of job burnout among mental health providers who serve clients with severe mental illness. Forty-two mental health staff at a Veterans Affairs psychosocial rehabilitation center completed an online survey that assessed burnout and work-life balance. Maslach Burnout Inventory (MBI) scores were compared to published scores of workers in other professions. Participants reported moderate MBI Emotional Exhaustion, Depersonalization, and Personal Accomplishment scores and overall had lower burnout scores than other healthcare providers and service workers. Being younger and white were associated with higher MBI Emotional Exhaustion scores. These findings suggest job burnout among mental health staff is a concern that should be closely monitored even among staff who express a sense of personal accomplishment from the work.

A cross-sectional study investigating the associations of person-organisation and person-group fit with staff outcomes in mental healthcare

OBJECTIVES

Organisational and workplace cultures are fundamental determinants of health systems performance; through better understanding of the dimensions of culture there is the potential to influence them, and subsequently improve safety and quality of care, as well as the experiences of both patients and staff. One promising conceptual framework for studying culture in healthcare is person-environment (P-E) fit. Comprising person-organisational (P-O) and person-group (P-G) components, P-E fit is defined as the extent to which individuals are compatible with their work environment. The aim of this study was to examine the associations of P-O and P-G fit with staff outcomes in mental healthcare.

SETTING AND PARTICIPANTS

Participants (n=213) were staff and volunteers at 31 primary mental health facilities across six states of Australia.

PRIMARY AND SECONDARY OUTCOME MEASURES

Staff outcomes, comprising burnout (depersonalisation and emotional exhaustion), job satisfaction and work stress.

DESIGN

A multidimensional survey tool was used to measure P-O and P-G fit, and staff outcomes. Multiple regression analyses were used to test the associations between fit and outcome measures.

RESULTS

The regression analyses indicated that, based on a Bonferroni adjusted alpha value of α=00417, P-O fit accounted for 36.6% of the variability in satisfaction (F=8.951, p≤0.001); 27.7% in emotional exhaustion (F=6.766, p≤0.001); 32.8% in depersonalisation (F=8.646, p≤0.001); and 23.5% in work stress (F=5.439, p≤0.001). The P-G fit results were less conclusive, with P-G fit accounting for 15.8% of the variability in satisfaction (F=4.184, p≤0.001); 10.0% in emotional exhaustion (F=2.488, p=0.014); 28.6% in depersonalisation (F=8.945, p≤0.001); and 10.4% in work stress (F=2.590, p=0.032). There was no statistically significant increase in the variability accounted for when the interaction term of P-O and P-G fit was added to the regression.

CONCLUSIONS

The findings highlight that staff's perception of their workplace and organisational culture can have implications for staff well-being.

Breaking bad and difficult news in obstetric ultrasound and sonographer burnout: Is training helpful?

Background

Sonographers report high levels of burnout. For those working in obstetric ultrasound, one frequently cited stressor is the delivery of bad or difficult news. Training in news delivery may reduce sonographer stress levels, but no studies have investigated sonographer experiences of this training.

Aims

To investigate sonographer experiences of difficult news delivery training and preferences for training techniques, and to assess whether news delivery training is associated with lower burnout and higher wellbeing.

Methods

A cross-sectional survey measured occupational characteristics, news delivery training experiences and preferences, burnout (on two dimensions of exhaustion and disengagement), and general mental wellbeing.

Results

Ninety sonographers (85 female; mean age = 47) responded. The majority of participants thought training in difficult news delivery had improved their practice. Preferred training techniques were observation of clinical practice and receiving service-user input. Eighty per cent of participants were experiencing exhaustion, 43.3% were experiencing disengagement and 88.9% could be classed as having a minor psychiatric disorder. Having received difficult news delivery training was associated with lower levels of disengagement, even when other variables were controlled for.

Discussion

News delivery training is perceived to be effective by sonographers and may help to reduce sonographer burnout levels.

Are Burnout Syndrome and Depression Predictors for Aggressive Behavior Among Mental Health Care Professionals?

AIM

This study aims to examine the possible relation between depression and burnout as predictors to aggressive behaviors among mental healthcare professionals.

METHODS

For the purposes of this study 72 mental health care professionals were recruited and were evaluated in three questionnaires which were provided to them online. Firstly regarding depression, the Center for Epidemiologic Studies Depression Scale (CES-D) was administered, secondly, concerning burnout, Maslach Burnout Inventory (MBI) was applied and finally, regarding aggression, the Aggression Questionnaire (GAQ) was employed. Statistical data analysis was performed using the IBM SPSS Statistics Version 19. The level of statistical significance was set at up at 0.05.

RESULTS

The results showed that depression is considered to be a statistically significant predictor of aggressive behaviors. However, burnout was not found to be a statistically significant predictor of aggression. In addition, a statistically significant relationship was found between burnout and depression.

CONCLUSIONS

It seems to be of essential importance for mental healthcare professionals to be provided with support and assistance in order to diminish the potential high-stress levels and in that way to overcome depression and burnout of those who work in mental health settings.

Burnout in mental health professionals: A systematic review and meta-analysis of prevalence and determinants

This study aimed to estimate the level of burnout in mental health professionals and to identify specific determinants of burnout in this population. A systematic search of MEDLINE/PubMed, PsychINFO/Ovid, Embase, CINAHL/EBSCO and Web of Science was conducted for original research published between 1997 and 2017. Sixty-two studies were identified as meeting the study criteria for the systematic review. Data on the means, standard deviations, and prevalence of the dimensions of burnout were extracted from 33 studies and included in the meta-analysis (n = 9409). The overall estimated pooled prevalence for emotional exhaustion was 40% (CI 31%-48%) for depersonalisation was 22% (CI 15%-29%) and for low levels of personal accomplishment was 19% (CI 13%-25%). The random effects estimate of the mean scores on the Maslach Burnout Inventory indicate that the average mental health professional has high levels of emotional exhaustion [mean 21.11 (95% CI 19.98, 22.24)], moderate levels of depersonalisation [mean 6.76 (95% CI 6.11, 7.42)] but retains reasonable levels of personal accomplishment [mean 34.60 (95% CI 32.99, 36.21)]. Increasing age was found to be associated with an increased risk of depersonalisation but also a heightened sense of personal accomplishment. Work-related factors such as workload and relationships at work, are key determinants for burnout, while role clarity, a sense of professional autonomy, a sense of being fairly treated, and access to regular clinical supervision appear to be protective. Staff working in community mental health teams may be more vulnerable to burnout than those working in some specialist community teams, e.g., assertive outreach, crisis teams.

Satisfaction and burden of mental health personnel: data from healthcare services for substance users and their families

Objective:

To evaluate satisfaction and burden of mental health personnel providing mental health services for substance users and their families.

Method:

Five hundred twenty-seven mental health workers who provide treatment for substance users in five Brazilian states were interviewed. Data on sociodemographic characteristics and measures of satisfaction (SATIS-BR) and burden of mental health personnel (IMPACTO-BR) were collected.

Results:

Type of mental health service and educational attainment were associated with degree of satisfaction and burden. Therapeutic community workers and those with a primary education level reported being more satisfied with the treatment offered to patients, their engagement in service activities, and working conditions. Workers from psychosocial care centers, psychosocial care centers focused on alcohol and other drugs, and social care referral centers (both general and specialized), as well as workers with a higher education, reported feeling overburdened.

Conclusion:

This study offers important information regarding the relationship of mental health personnel with their work. Care providers within this sample reported an overall high level of job satisfaction, while perceived burden differed by type of service and educational attainment. To our knowledge, this is the first study with a sample of mental health professionals working with substance users across five Brazilian states.

Prevalence and correlates of burnout in health professionals in Ecuador

BACKGROUND

Although burnout is a widespread phenomenon among healthcare professionals, there are no studies about its prevalence in Ecuador. This study assesses the prevalence of burnout syndrome among Ecuadorian healthcare professionals and examine the relationship with their personal and organizational characteristics.

METHODS

A total of 2404 healthcare professionals (average age 40.0years; 68.4% women) from the capitals of all 24 provinces in Ecuador participated in this study. Trained psychologists assessed the presence of burnout by applying the Maslach Burnout Inventory. Sociodemographic variables, emotional distress, social support and coping styles as well as organizational variables were also collected.

RESULTS

Of all healthcare professionals surveyed, 2.6% presented burnout syndrome. By dimensions, 17.2% of the participants presented a high level of emotional exhaustion, 13.5% of depersonalization, and 18.2% had reduced personal accomplishment. Being non-mestizo, being classified as a probable case of mental disorder and using more passive coping were associated with a greater probability of presenting burnout; having >10years of experience was associated with a lower probability of burnout.

CONCLUSIONS

A significant number of active health professionals suffer from burnout. It is necessary to develop effective psychotherapeutic interventions for those who have the syndrome and to evaluate potential prevention strategies in those who have not yet developed it.

Predictors of Burnout among Community Therapists in the Sustainment Phase of a System-Driven Implementation of Multiple Evidence-Based Practices in Children's Mental Health

Burnout among community mental health (CMH) therapists has been associated with poorer therapist health, high agency turnover, poorer client outcomes, and compromised quality of care. Recent mandates to learn and implement multiple evidence-based practices (EBPs) within CMH settings are intended to improve the quality of community care, yet there is mixed evidence concerning the impacts on workforce burnout. The current study sought to identify correlates of therapist emotional exhaustion, a key aspect of burnout, during the sustainment phase of a system-driven implementation of multiple EBPs in children's mental health services. We hypothesized that high workload and unfavorable organizational climate would relate to therapist emotional exhaustion, but that positive experiences with EBPs adopted would relate to lower exhaustion. Although agency-level indices of organizational climate were unrelated to exhaustion, a multilevel model revealed that therapists' weekly work hours, caseload, and number of EBPs delivered were associated with increased emotional exhaustion. Additionally, activities associated with the EBP implementation efforts (e.g., hours spent in EBP-related activities, supervision or consultation, or outcome monitoring), were not associated with emotional exhaustion. Therapists' knowledge and confidence delivering EBPs and their positive perceptions of EBPs were protective against emotional exhaustion, but these perceptions did not buffer the risks associated with heavy workload. Findings point to implementation strategies to prevent burnout and associated turnover that compromise the returns on investments in EBP implementation.

Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions

Rising levels of burnout and poor well-being in healthcare staff are an international concern for health systems. The need to improve well-being and reduce burnout has long been acknowledged, but few interventions target mental healthcare staff, and minimal improvements have been seen in services. This review aimed to examine the problem of burnout and well-being in mental healthcare staff and to present recommendations for future research and interventions. A discursive review was undertaken examining trends, causes, implications, and interventions in burnout and well-being in healthcare staff working in mental health services. Data were drawn from national surveys, reports, and peer-reviewed journal articles. These show that staff in mental healthcare report poorer well-being than staff in other healthcare sectors. Poorer well-being and higher burnout are associated with poorer quality and safety of patient care, higher absenteeism, and higher turnover rates. Interventions are effective, but effect sizes are small. The review concludes that grounding interventions in the research literature, emphasizing the positive aspects of interventions to staff, building stronger links between healthcare organizations and universities, and designing interventions targeting burnout and improved patient care together may improve the effectiveness and uptake of interventions by staff.

Associations between Age, Years in Post, Years in the Profession and Personal Experience of Mental Health Problems in UK Mental Health Nurses

Nurses' mental health is of paramount importance, both in terms of patient safety and the sustainability of the workforce. Age, years in the profession, in post and personal experience or exposure to mental health problems are relevant to the mental health nursing workforce crisis in the United Kingdom. This study aimed to determine the relationship between age, years in the profession and post and self-reported experience of mental health problems using an online cross-sectional survey of 225 UK mental health nurses. Number of years in post was inversely correlated with overall experience of mental health problems, particularly living with someone else with mental health problems. Those with experience of living with someone with mental health problems had significantly fewer years of professional experience than those without. This article discusses possible explanations for this phenomenon and makes the case for future research on the topic.

'What vision?': experiences of Team members in a community service for adults with intellectual disabilities

BACKGROUND

In the UK, the closure of 'long-stay' hospitals was accompanied by the development of community teams (CTs) to support people with intellectual disabilities (IDs) to live in community settings. The self-reported experiences of staff working in such teams have been neglected.

METHODS

Focusing on a single county-wide service, comprising five multi-disciplinary and inter-agency CTs, we measured perceptions among the health care and care management Team members of (1) their personal well-being; (2) the functioning of their team; and (3) the organisation's commitment to quality, and culture.

RESULTS

Almost three-quarters of the questionnaires were returned (73/101; 72%). The scores of health care practitioners and care managers were very similar: (1) the MBI scores of more than half the respondents were 'of concern'; (2) similarly, almost four in ten respondents' scores on the Vision scale of the TCI were 'of concern'; (3) the perceived commitment to quality (QIIS-II Part 2) was uncertain; and (4) the organisational culture (QIIS-II, Part 1) was viewed as primarily hierarchical.

DISCUSSION

The perceived absence of a vision for the service, combined with a dominant culture viewed by its members as strongly focussed on bureaucracy and process, potentially compromises the ability of these CTs to respond proactively to the needs of people with IDs. Given the changes in legislation, policy and practice that have taken place since CTs were established, it would be timely to revisit their role and purpose.

[Work satisfaction and exhaustion among psychiatrists in psychiatric emergency services]

BACKGROUND AND AIM

Psychiatric emergency services (PES) have recently occupied a new and growing place in the landscape of mental health services. However, few data are available on the way psychiatrists practice in the PES. Our aim was to survey psychiatrists working in PES, focusing on their job satisfaction and the theoretical models they use in their everyday practice.

METHOD

We sent a survey to a sample of 508 psychiatrists working in PES in France.

RESULTS

Two hundred and thirty-seven psychiatrists returned the survey, yielding a response rate of 47%. On a 0 to 10 scale, the mean level of job satisfaction was 6.7 (SD: 1.92). Participants reported that facing a variety of clinical situations and playing a key-coordinating role in the mental health system were the two most specific features of emergency psychiatry. The main sources of dissatisfaction were organizational issues and stressful clinical experiences, including violence or hostility. Sixty-three percent (n=150) of participants reported using more than two theoretical models in their practice, while the use of crisis models was reported by almost 40% of them. When assessed for suggestions to improve the PES, the majority of participants indicated that efforts should be focused on organizational factors.

CONCLUSION

While emergency psychiatry could appear as an ungrateful practice, the majority of psychiatrists who responded to our survey reported satisfaction with their work and highlighted its unique particularities. Future research and collaborations are needed to identify organizational models of PES and their better integration in mental health networks.

Occupational Therapy in Mental Health: Managing Stress and Burnout

Stress and burnout for human service workers has received increasing attention over a number of years. It has been suggested that health care professionals may be particularly at risk of stress and burnout because of the amount and type of direct client contact that makes up their work.

For workers in the field of mental health, additional stressors are present owing to organisational restructuring and new models of care. Mental health occupational therapists may be vulnerable to stress and burnout owing to the nature of their work, the types of client they see, the changed work environment and professional issues. It is recommended that occupational therapists become aware of the factors contributing to stress and burnout and develop strategies to maintain their wellbeing in the workforce.

Is Discrepancy between Actual and Preferred Work Activities a Factor in Work-Related Stress for Mental Health Occupational Therapists and Social Workers?

In the Western developed nations, the changing pattern of mental health care provision has necessitated mental health staff adopting new approaches to service delivery across a diverse and expanding range of service settings. The impact of changed service delivery on Australian mental health professionals is an area that has not been well studied. The aim of the study was to identify the current clinical work activities performed by occupational therapists and social workers and whether there was a discrepancy between the actual and preferred work activities. The study also aimed to identify whether any discrepancy between their actual and preferred clinical work activities was associated with higher levels of stress.

A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers in Australian mental health services was conducted. A work activities scale developed specifically for this study and the Mental Health Professionals Stress Scale were used to measure actual and preferred work activities and stress respectively.

Both groups experienced a discrepancy between their actual and preferred work activities, with the occupational therapists and the social workers mostly wanting to undertake a diverse range of activities to a significantly greater extent than they currently were. As predicted, stress was associated with the discrepancy between the kind of work that the participants wanted to do and the kind of work that their job actually entailed. Health workers require assistance to adapt to their new work roles and to achieve a balance between generic and discipline-specific competencies. This has implications for education and professional training.

Mental health workers’ views about their suicide prevention role

Aim

Mental Health workers bear responsibility for preventing suicide in their client group. Survey studies have indicated that staff can be seriously adversely affected when a client suicides. The aim of the current study is to describe and evaluate the effects on mental health (MH) workers of their ongoing role in managing suicidal behaviours and to identify the thoughts and feelings associated with this role.

Method

A survey was administered to 135 MH workers via an on-line self-report vehicle. The survey comprised standardised measures of anxiety and burnout as well as a questionnaire developed for this study concerning perceptions and attitudes to suicide and suicide prevention.

Results

Factor analysis of 12 retained items of the questionnaire identified three factors: 1) preventability beliefs (beliefs about suicide being always and/or permanently preventable); 2) associated distress (stress/anxiety about managing suicidal behaviour); and 3) the prevention role (covering views about personal roles and responsibilities in preventing suicidal behaviours). Analysis of these factors found that many MH workers experience an elevation of stress/anxiety in relation to their role in managing suicidal behaviours. This distress was associated with the emotional exhaustion component of burnout. Measures showed adverse responses were higher for outpatient than inpatient workers; for those who had received generic training in suicide prevention: and for those who had experienced a workplace related client suicide.

Conclusion

There is a need for the development of appropriate self-care strategies to alleviate stress in MH workers exposed to suicide.

Experiences of Detention under the Mental Health Act for Adults with Anorexia Nervosa

People with Anorexia Nervosa are often resistant to treatment and can be detained under the Mental Health Act. Detention can be distressing for some client groups; however, there is little research to explore how people with Anorexia Nervosa experience detention and how these experiences impact on recovery. This study utilized a qualitative methodology to develop a model for understanding how people perceive, experience and process detention under the Mental Health Act. Data from 12 participants was analysed using constructivist grounded theory. Four overarching categories conceptualize their experience over time: 'the battle', 'the bubble', 'stepping out of the bubble' and 'the anorexic self'. Within each overarching category are further subordinate categories that represent the nuances of the data. The resultant model is discussed in relation to the literature, whilst recommendations have been made to embed person-centred, recovery practice into inpatient services. Copyright © 2015 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

People detained under the mental health act with anorexia nervosa often respond by engaging in a battle with clinicians. This follows by the person withdrawing into a 'bubble' where the individual starts to feel some relief that they are no longer in control of their eating, but this competes with the lack of self and the emerging anorexic self. Clinicians need to be aware that individuals detained may have mixed feelings about their hospital admission.

Strategies for Managing Difficult Clinical Situations in Between Sessions

Therapists often have to deal with situations that make them uneasy to leave their clients on their own. They can go home and wonder what their clients are doing, whether they are safe, have a place to stay, even whether or not they are fighting. These thoughts can be overwhelming for the therapist. They may think about their clients' safety, they may also be worried about their own professional way of dealing with these situations, and its implications for them as clinician. The aim of this paper is to assist therapists to manage their own anxiety and to help them help their clients in between sessions in difficult situations such as suicidality, child abuse and neglect, intimate partner violence, crisis and stress management.

Challenges in mental health nursing: working in institutional or community settings?

Professional environments likely affect patient safety, quality of care provided, and nurses' satisfaction and retention. The aim of this study was to explore mental health nurses' perceptions of their professional practice environment and examine differences in perceptions between nurses working at institutions and those practising in community care. The methodology used was descriptive and comparative. The sample consisted of 248 mental health nurses working within the public sector (76% response rate) drawn from a psychiatric hospital (n = 163) and community settings (n = 85). We administered the Revised Professional Practice Environment (RPPE) questionnaire. Comparisons of the two groups were made using eight subscales of the RPPE. The results indicated that mental health nurses' ratings of their practice environment were slightly positive (M = 2.69; range = 1-4). Nurses working in a psychiatric hospital perceived the professional practice environment more negatively (M = 2.66) than their colleagues in community care (M = 2.73). A t-test comparison revealed statistically significant differences between the two groups within subcategories of work motivation (P = 0.04) and leadership and autonomy (P = 0.03). Nurses working in the community gave higher ratings in comparison with their colleagues working in institutional settings. In conclusions, an in-depth analysis of differences in practice environments is required to define causes of these differences and how they might influence nurses' abilities to provide quality care.

Nationwide survey of work environment, work-life balance and burnout among psychiatrists in Japan

BACKGROUND

Psychiatry has been consistently shown to be a profession characterised by 'high-burnout'; however, no nationwide surveys on this topic have been conducted in Japan.

AIMS

The objective of this study was to estimate the prevalence of burnout and to ascertain the relationship between work environment satisfaction, work-life balance satisfaction and burnout among psychiatrists working in medical schools in Japan.

METHOD

We mailed anonymous questionnaires to all 80 psychiatry departments in medical schools throughout Japan. Work-life satisfaction, work-environment satisfaction and social support assessments, as well as the Maslach Burnout Inventory (MBI), were used.

RESULTS

Sixty psychiatric departments (75.0%) responded, and 704 psychiatrists provided answers to the assessments and MBI. Half of the respondents (n = 311, 46.0%) experienced difficulty with their work-life balance. Based on the responses to the MBI, 21.0% of the respondents had a high level of emotional exhaustion, 12.0% had a high level of depersonalisation, and 72.0% had a low level of personal accomplishment. Receiving little support, experiencing difficulty with work-life balance, and having less work-environment satisfaction were significantly associated with higher emotional exhaustion. A higher number of nights worked per month was significantly associated with higher depersonalisation.

CONCLUSIONS

A low level of personal accomplishment was quite prevalent among Japanese psychiatrists compared with the results of previous studies. Poor work-life balance was related to burnout, and social support was noted to mitigate the impact of burnout.

Personal and Team Morale in Health Services: Distinct and Measurable Concepts

This article has two aims: to assess whether personal and team morale are distinctive concepts and to develop valid single-item measures of both on the assumption that they are ordinary language, singular concepts. It thus examines the interrelationship and validity of measures of personal and of team morale, using data from a survey of a sample of 1,886 mental health staff across England. A single-item measure of personal morale is shown to be distinct from a single-item measure of team morale. Initially their correlation is examined, and the relative proportions of variance at the individual and team levels are shown to differ. Second, the measure of personal morale is found to correlate strongly with a selection of scales conventionally used to measure individual staff well-being. Third, the core components of the Karasek model of strain, job demands, control and support are related to this single-item personal morale rating. Fourth, personal morale is shown to mediate a relationship between these job characteristics and self-reported absences. Team morale is shown to be more closely associated with measures of team characteristics than is the personal morale measure, and less with the individual job characteristics. Such validated single-item measures have considerable potential usefulness in health services (and beyond), especially if we are to monitor the impact of the ever-increasing changes associated with increased competition and restructuring.

Morale in the English mental health workforce: questionnaire survey

BACKGROUND

High-quality evidence on morale in the mental health workforce is lacking.

AIMS

To describe staff well-being and satisfaction in a multicentre UK National Health Service (NHS) sample and explore associated factors.

METHOD

A questionnaire-based survey (n = 2258) was conducted in 100 wards and 36 community teams in England. Measures included a set of frequently used indicators of staff morale, and measures of perceived job characteristics based on Karasek's demand-control-support model.

RESULTS

Staff well-being and job satisfaction were fairly good on most indicators, but emotional exhaustion was high among acute general ward and community mental health team (CMHT) staff and among social workers. Most morale indicators were moderately but significantly intercorrelated. Principal components analysis yielded two components, one appearing to reflect emotional strain, the other positive engagement with work. In multilevel regression analyses factors associated with greater emotional strain included working in a CMHT or psychiatric intensive care unit (PICU), high job demands, low autonomy, limited support from managers and colleagues, age under 45 years and junior grade. Greater positive engagement was associated with high job demands, autonomy and support from managers and colleagues, Black or Asian ethnic group, being a psychiatrist or service manager and shorter length of service.

CONCLUSIONS

Potential foci for interventions to increase morale include CMHTs, PICUs and general acute wards. The explanatory value of the demand-support-control model was confirmed, but job characteristics did not fully explain differences in morale indicators across service types and professions.

Burnout of registered nurses in South Africa

AIM

The aims of this study were to validate the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) for registered nurses in South Africa and to analyse the differences between the levels of burnout of different biographical groups.

BACKGROUND

The nursing profession is seen as a stressful and emotionally demanding profession, which makes nurses susceptible to burnout.

METHOD

A cross-sectional survey design with a stratified random sample (n = 818) was used. The MBI-HSS and a biographical questionnaire were administered.

RESULTS

Exploratory factor analysis resulted in a three-factor structure of burnout, consisting of emotional exhaustion, depersonalization and personal accomplishment. Construct equivalence and reliability of the three factors were confirmed. Significant differences were found in burnout levels with regard to language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

CONCLUSIONS

The MBI-HSS showed acceptable validity and reliability for South African nurses. Burnout is associated with specific factors, including language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

IMPLICATIONS FOR NURSING MANAGEMENT

The use of the MBI-HSS is recommended to assess burnout of nurses in South Africa. Organisations employing nurses should intervene to prevent and/or manage burnout.

Contrasting burnout, turnover intention, control, value congruence and knowledge sharing between Baby Boomers and Generation X

AIM(S)

This paper examines the contrasting role of work values for nurses from two generations: Baby Boomers and Generation X.

BACKGROUND

Differences among nurses regarding core values pertaining to their work has a potential to influence the quality of their work life. These differences may have implications for their vulnerability to job burnout.

EVALUATION

The analysis is based upon questionnaire surveys of nurses representing Generation X (n = 255) and Baby Boomers (n = 193) that contrasted their responses on job burnout, areas of work life, knowledge transfer and intention to quit.

KEY ISSUE(S)

The analysis identified a greater person/organization value mismatch for Generation X nurses than for Baby Boomer nurses. Their greater value mismatch was associated with a greater susceptibility to burnout and a stronger intention to quit for Generation X nurses.

CONCLUSION(S)

The article notes the influence of Baby Boomer nurses in the structure of work and the application of new knowledge in health care work settings. Implications for recruitment and retention are discussed with a focus on knowledge transfer activities associated with distinct learning styles.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding value differences between generations will help nursing managers to develop more responsive work settings for nurses of all ages.

Qualified and Unqualified (N-R C) mental health nursing staff--minor differences in sources of stress and burnout. A European multi-centre study

BACKGROUND

Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care.

METHODS

A total of 196 nursing staff --124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds--working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ).

RESULTS

(a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems.

CONCLUSION

The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).

Profissionais de saúde mental: manifestação de stress e burnout

Profissionais de saúde mental, trabalhando em ambiente com elevada demanda emocional, encontram-se vulneráveis ao stress. Neste trabalho, objetivou-se avaliar manifestação de stress, burnout, autopercepção quanto ao stress e ao trabalho em 25 profissionais de serviços substitutivos em saúde mental. Aplicaram-se os instrumentos Inventário de Sintomas de Stress para Adultos de Lipp, Maslach Burnout Inventory e Roteiro Complementar. Dos participantes, 36% apresentaram manifestação de stress, 44% avaliaram-se como muito estressados e 60% apresentaram alto esgotamento emocional. Para 60%, o trabalho foi avaliado como muito estressante. As dimensões esgotamento emocional e despersonalização apresentaram correlações negativas com a variável idade. Conclui-se que há necessidade de intervenções de suporte ao trabalhador, principalmente aos mais jovens, direcionadas ao desenvolvimento de estratégias de enfrentamento às situações estressantes do trabalho.

Job satisfaction and burnout among staff working in community-based personality disorder services

AIMS

To examine levels of burnout among staff working in community-based services for people with personality disorder (PD) and to explore factors which add to or lower the risk of burnout among people working in such services.

METHODS

In-depth interviews with staff working at 11 dedicated community-based personality disorder services in England together with a cross-sectional staff survey using the Maslach Burnout Inventory.

RESULTS

Levels of burnout were generally lower than those reported in previous studies among mental health workers and levels of personal accomplishment were higher. Staff reported positive as well as negative experiences of working with people with PD. Strong team-work, clear leadership and opportunities for reflective practice were thought to protect staff from burnout.

CONCLUSIONS

The low levels of burnout we found may reflect the early stage of the development of these services. However, it is also possible that working with people with PD does not in itself lead to burnout, especially when services are organized to share and contain work-related anxiety.

Burnout in the mental health workforce: a review

There are enormous concerns regarding the recruitment, retention, training, and performance of the behavioral health workforce. Paramount among these concerns is turnover, which causes disruption in continuity of care, diminishes access to care while a position remains vacant, and poses financial hardship on the provider organization through costs related to recruitment, orientation, and training of a new hire. There is frequent mention of burnout within the literature and among behavioral health managers as a potential cause of turnover. However, there is no recent or comprehensive review of burnout that examines the evidence surrounding its validity, utility, and potential relationship to turnover. The purpose of this paper is to provide such a review by examining the construct of burnout, methodological and measurement issues, its prevalence in the mental health workforce, correlates of burnout, and interventions to decrease it. The implications for provider organizations and recommendations for future research are identified.

Influence of perceived organisational factors on job burnout: survey of community mental health staff

BACKGROUND

Staff burnout is a critical issue for mental healthcare delivery, as it can lead to decreased work performance and, ultimately, to poorer treatment outcomes.

AIMS

To explore the relative weight of job-related characteristics and perceived organisational factors in predicting burnout in staff working in community-based psychiatric services.

METHOD

A representative sample of 2000 mental health staff working in the Veneto region, Italy, participated. Burnout and perceived organisational factors were assessed by using the Organizational Checkup Survey.

RESULTS

Overall, high levels of job distress affected nearly two-thirds of the psychiatric staff and one in five staff members suffered from burnout. Psychiatrists and social workers reported the highest levels of burnout, and support workers and psychologists, the lowest. Burnout was mostly predicted by a higher frequency of face-to-face interaction with users, longer tenure in mental healthcare, weak work group cohesion and perceived unfairness.

CONCLUSIONS

Improving the workplace atmosphere within psychiatric services should be one of the most important targets in staff burnout prevention strategies. The potential benefits of such programmes may, in turn, have a favourable impact on patient outcomes.

A Survey of Burnout of the Mental Health Occupational Therapy Staff in the Psychiatric Hospital, Bahrain

Emotional burnout is associated with decreased job performance and poor career satisfaction. It has special significance in mental health care settings, where clinicians experience psychological, emotional and physical stress. This study aimed to determine the extent to which occupational therapy staff employed in a Bahrain mental health setting were affected by burnout.

Questionnaires were sent to all clinicians in the Psychiatric Hospital, Bahrain (n = 261). An effective response rate of 58% (n = 153) was achieved, with 13 of the responses being from the occupational therapy department. The research measure was the Maslach Burnout Inventory (MBI), comprising emotional exhaustion, depersonalisation and personal accomplishment.

The occupational therapy staff experienced a high level of emotional exhaustion, moderate depersonalisation and high personal accomplishment. They differed from other groups on the depersonalisation scale, scoring higher than any other professional group. The results are congruent with those of previous studies and it is proposed that the focus of future research should be on identifying causes of burnout.

The relationship between job stressors, hardy personality, coping resources and burnout in a sample of nurses: a correlational study at two time points

BACKGROUND

Nursing is considered as a risk profession with high levels of stress and burnout, and these levels are probably increasing.

OBJECTIVES

This study assessed temporal and cross-sectional relationships between job stressors, hardy personality and coping resources on burnout dimensions among nurses.

DESIGN

Temporal and cross-sectional effects were evaluated. A sample of 98 nurses from Portugal completed the Nursing Burnout Scale at two time points. The data were analysed using descriptive statistics, Pearson correlations, and hierarchical linear regression analyses regressing Wave 2 burnout dimensions.

RESULTS

The study confirmed the specific contribution of control and challenged hardy personality dimensions as the explanation of burnout. However, commitment did not show any effects in this study. Social support and active coping were also relevant predictors of burnout dimensions. Specifically, active coping had an inverse temporal effect on depersonalisation and lack of personal accomplishment. In relation to the burnout process, depersonalisation appeared as an antecedent of lack of personal accomplishment.

CONCLUSIONS

The present study is an initial step to comprehend the link between job stressors, hardy personality, coping resources and diminishing burnout.

Satisfaction and burnout among staff of crisis resolution, assertive outreach and community mental health teams. A multicentre cross sectional survey

BACKGROUND

The NHS Plan required extensive changes in the configuration of mental health services in the UK, including introduction of crisis resolution teams, CRTs. Little is known about the effects of these changes on mental health staff and their recruitment and retention.

AIMS

To assess levels of burnout and sources of satisfaction and stress in CRT staff and compare them with assertive outreach team (AOT) and community mental health team (CMHT) staff.

METHOD

Cross sectional survey using questionnaires, including the Maslach Burnout Inventory, the Minnesota Satisfaction Scale and global job satisfaction item from the Job Diagnostic Survey. All staff in 11 CRTs in 7 London boroughs were included.

RESULTS

One hundred and sixty-nine questionnaires were received (response rate 78%). CRT staff were moderately satisfied with their jobs and scores for the three components of burnout were low or average. Their sense of personal accomplishment was greater than in the other types of team.

CONCLUSION

Our results suggest that CRTs may be sustainable from a workforce morale perspective, but longer term effects will need to be assessed.

Community psychiatric nurses' experience of working with people who engage in deliberate self-harm

This paper reports on a study that explored community psychiatric nurses' experiences of working with people who self-harm. Interpretative Phenomenological Analysis was used with eight experienced community psychiatric nurses who participated in semi-structured interviews. Established quality control procedures were utilized including audit of the analysis process and validating the results with participants. The participants described struggling to conceptualize self-harm behaviour and generally reported finding working with people who self-harm stressful particularly in terms of managing the emotional impact upon themselves and the boundaries of their professional responsibilities in relation to managing risk. The therapeutic relationship was viewed as crucial and a variety of coping methods to manage the impact of the work, which had largely developed through 'on the job', experience were described. The results highlight the potential difficulties faced by community staff and can be translated into clear recommendations for training and support.

Relation between burnout syndrome and job satisfaction among mental health workers

AIM

To identify predictors of burnout syndrome, such as job satisfaction and manifestations of occupational stress, in mental health workers.

METHOD

The study included a snowball sample of 174 mental health workers in Croatia. The following measurement instruments were used: Maslach Burnout Inventory, Manifestations of Occupational Stress Survey, and Job Satisfaction Survey. We correlated dimensions of burnout syndrome with job satisfaction and manifestations of occupational stress dimensions. We also performed multiple regression analysis using three dimensions of burnout syndrome--emotional exhaustion, depersonalization, and personal accomplishment.

RESULTS

Stepwise multiple regression analysis showed that pay and rewards satisfaction (beta=-0.37), work climate (beta=-0.18), advancement opportunities (beta=0.17), the degree of psychological (beta=0.41), and physical manifestations of occupational stress (beta=0.29) were significant predictors of emotional exhaustion (R=0.76; F=30.02; P<0.001). The frequency of negative emotional and behavioral reactions toward patients and colleagues (beta=0.48), psychological (beta=0.27) and physical manifestations of occupational stress (beta=0.24), and pay and rewards satisfaction (beta=0.22) were significant predictors of depersonalization (R=0.57; F=13,01; P<0.001). Satisfaction with the work climate (beta=-0.20) was a significant predictor of lower levels of personal accomplishment (R=0.20; F=5.06; P<0.005).

CONCLUSION

Mental health workers exhibited a moderate degree of burnout syndrome, but there were no significant differences regarding their occupation. Generally, both dimensions of job satisfaction and manifestations of occupational stress proved to be relevant predictors of burnout syndrome.