Organizational conditions that influence work engagement and burnout: A qualitative study of mental health workers

"Early in the morning, there's tolerance and later in the day it disappears" - The intersection of resource scarcity, stress and stigma in mental health and substance use care in South Africa

Stress is a challenge among non-specialist health workers worldwide, particularly in low-resource settings. Understanding and targeting stress is critical for supporting non-specialists and their patients, as stress negatively affects patient care. Further, stigma toward mental health and substance use conditions also impacts patient care. However, there is little information on the intersection of these factors. This sub-analysis aims to explore how substance use and mental health stigma intersect with provider stress and resource constraints to influence the care of people with HIV/TB. We conducted semi-structured interviews (N=30) with patients (n=15) and providers (n=15, non-specialist health workers) within a low-resource community in Cape Town, South Africa. Data were analyzed using thematic analysis. Three key themes were identified: (1) resource constraints negatively affect patient care and contribute to non-specialist stress; (2) in the context of stress, non-specialists are hesitant to work with patients with mental health or substance use concerns, who they view as more demanding and (3) stress contributes to provider stigma, which negatively impacts patient care. Findings highlight the need for multilevel interventions targeting both provider stress and stigma toward people with mental health and substance use concerns, especially within the context of non-specialist-delivered mental health services in low-resource settings.

Can Measurement-Based Care Reduce Burnout in Mental Health Clinicians?

Burnout is a syndrome characterized by mental and emotional fatigue or exhaustion, depersonalization, and a lessened sense of personal accomplishment and efficacy. Burnout leads to negative consequences for mental health clinicians and for mental health care organizations. Measurement-based care (MBC) is a clinical process in which clinicians and clients use patient-generated data, also called treatment feedback, to collaboratively monitor mental health care and to inform goal-setting and treatment planning. We propose that MBC may improve the experience of care for both clients and clinicians, and ultimately protect against each of the three components of burnout. When combined with other organizational changes, adoption of MBC may support organizational level efforts to reduce burnout in mental health services.

Liaison psychiatry practitioners' views on accessing aftercare and psychological therapies for patients who present to hospital following self-harm: multi-site interview study

BACKGROUND

Timely provision of aftercare following self-harm may reduce risks of repetition and premature death, but existing services are frequently reported as being inadequate.

AIMS

To explore barriers and facilitators to accessing aftercare and psychological therapies for patients presenting to hospital following self-harm, from the perspective of liaison psychiatry practitioners.

METHOD

Between March 2019 and December 2020, we interviewed 51 staff members across 32 liaison psychiatry services in England. We used thematic analyses to interpret the interview data.

RESULTS

Barriers to accessing services may heighten risk of further self-harm for patients and burnout for staff. Barriers included: perceived risk, exclusionary thresholds, long waiting times, siloed working and bureaucracy. Strategies to increase access to aftercare included: (a) improving assessments and care plans via input from skilled staff working in multidisciplinary teams (e.g. including social workers and clinical psychologists); (b) supporting staff to focus on assessments as therapeutic intervention; (c) probing boundaries and involving senior staff to negotiate risk and advocate for patients; and (d) building relationships and integration across services.

CONCLUSIONS

Our findings highlight practitioners' views on barriers to accessing aftercare and strategies to circumvent some of these impediments. Provision of aftercare and psychological therapies as part of the liaison psychiatry service were deemed as an essential mechanism for optimising patient safety and experience and staff well-being. To close treatment gaps and reduce inequalities, it is important to work closely with staff and patients, learn from experiences of good practice and implement change more widely across services.

Helping the Helpers: Adaptation and Evaluation of Stress First Aid for Healthcare Workers in the Veterans Health Administration During the COVID-19 Pandemic

BACKGROUND

Early interventions are needed to support the behavioral health of healthcare staff in the context of the COVID-19 pandemic. Stress First Aid (SFA) is a self-care and peer support model for reducing burnout and stress that is designed for use in high-stress occupations.

METHODS

We conducted a mixed-methods evaluation of an SFA program in the Veterans Health Administration (VHA). This brief, multi-session, didactic program was adapted for hospital workgroups. Program attendees completed a survey assessing implementation outcomes, burnout, stress, mood, and SFA skills at the beginning (N = 246) and end (n = 94) of the SFA program and a subgroup (n = 11) completed qualitative feedback interviews.

FINDINGS

Program acceptability, appropriateness, and feasibility were rated highly. From pre- to post-SFA, the impact of the pandemic on stress and anxiety, as well as proficiency in supporting peers increased. Qualitative findings suggest the program provided a shared language to discuss stress, normalized stress reactions, met a need for stress management tools, and helped staff feel valued, empowered, connected with each other. Staff reported being more aware of their stress, but SFA was insufficient to address many of the systemic sources of burnout and stress.

CONCLUSIONS AND APPLICATIONS TO PRACTICE

While the SFA program was well received, the impact of brief programs is likely to be modest when implemented in the middle of an ongoing pandemic and when burnout arises from chiefly from systemic sources. Lessons learned during the program implementation that may guide future efforts are discussed.

Green human resources management: A novel tool to boost work engagement

Increasing environmental awareness in business life has given way to Green Human Resources Management practices. The positive corporate image created by GHRM is encouraging for many employees and boosts their work engagement. GHRM practices make employees feel proud about their organization and creates a value-based ground for working in their current companies. Actually, internalized green inclinations of organizations, namely, value alignment between an organization and an employee, can make their employees feel greater psychological ownership about their companies, leading to greater engagement as it is suggested in social identity theory. Being inspired from psychological ownership literature, in this study, it is assumed that being exposed to Green Human Resources Management practices can make employees feel higher levels of work engagement and psychological ownership can have a mediator effect in this relationship. The model has been a tested model among 255 Turkish white-collar employees working in a manufacturing sector. Analyses have been carried out using the AMOS structural equation program and the PROCESS program. Results confirmed the above assumptions, confirming the assumptions of social identity theory and revealed the existence of mediator effect in the relationship between GHRM and work engagement of employees, illuminating the importance of GHRM for employees' positive attitudes toward their organization.

The Impact of Quality of Work Organization on Distress and Absenteeism among Healthcare Workers

The quality of work organization may be responsible not only for reduced productivity but also for an increased risk of mental and physical disorders. This study was aimed at testing this hypothesis. Workers of a local health unit in Italy were asked to fill out the Work Organization Assessment Questionnaire (WOAQ) during their periodic medical examinations in the second half of 2018. On the same occasion, they also completed the Demand/Control/Support (DCS) measure of job strain, the Effort/Reward Imbalance (ERI) questionnaire, and the General Health Questionnaire (GHQ12) to assess psychological health. A total of 345 workers (85.8%) completed the survey. Linear regression analysis showed that the quality of work organization was inversely proportional to psychological health problems (p < 0.001). Occupational stress, measured both by job strain and ERI, was a moderating factor in this relationship. The relationship between the WOAQ and psychological health, moderated by job strain or ERI, remained highly significant even after adjustment for sex, age, social support, and overcommitment. Regression models explained over 40% of the shared variance of the association between quality of work organization and psychological health. The quality of work organization significantly predicted the risk of sickness absence for musculoskeletal disorders (OR = 0.984, CI95% 0.972-0.996) and for other health problems (OR = 0.977, CI95% 0.967-0.988). A continuous improvement of work organization must consider not only the clients' or production needs but also the well-being of workers.

Impacto da Percepção de Suporte Organizacional e Capital Psicológico no Bem-Estar no Trabalho

Resumo Este estudo teve por objetivo testar um modelo no qual o bem-estar no trabalho (BET) é explicado pela percepção de suporte organizacional e capital psicológico. Trata-se de estudo quantitativo, corte transversal e correlacional, no qual a amostra foi composta por 227 trabalhadores, sendo a maioria do sexo feminino (57,7%), na faixa etária de 29 anos e com prevalência de curso superior incompleto e completo representando 65,2% dos participantes. A maioria atua na iniciativa privada (68,3%) e não ocupa cargo de chefia. Foram utilizados instrumentos fidedignos e com índicio de validade relativos aos construtos investigados. Para análise de dados, utilizaram-se estatística descritiva, testes de comparação de médias (Teste t e ANOVA) e análise de regressão múltipla (método padrão). Entre os resultados, identificou-se que otimismo, autoeficácia/esperança (capital psicológico) e a percepção de suporte organizacional são variáveis explicativas das vivências de BET. Portanto o modelo não foi confirmado na íntegra, pois resiliência não apresentou relações significativas com bem-estar. Além disso, somente otimismo revelou poder explicativo sobre afetos positivos, afetos negativos e realização (dimensões de BET). Destaca-se que capital psicológico demonstrou maior peso na predição de BET que percepção de suporte organizacional, exceto no caso de afeto negativo. Os resultados indicam que tanto variáveis individuais quanto variáveis contextuais são importantes para explicar a prevalência de BET.