Health and well-being of staff in substance use services: The case of Scotland

Abstract

Background: Addressing high rates of drug and alcohol mortality requires a sustained commitment to supporting a resilient and skilled substance use workforce. Employee well-being in wider health and social care has been the subject of much empirical research, however there is a dearth of evidence specific to professionals working in substance use services.

Methods: Data were derived from a cross-sectional survey of publicly-funded drug and alcohol services operating in Scotland during autumn 2021. Nested semi-log regression models estimated the associations between workplace characteristics and workforce composition, and the main outcome measure: non-Covid sickness absence. Qualitative data were analysed using thematic analysis.

Results: 88 services, representing 43% of Scotland's drug and alcohol services, were included in the study. Factors significantly and positively associated with non-Covid sickness absence in multivariable analysis included average caseload per whole-time equivalent and number of whole-time equivalent clinical roles. Descriptive statistics show that vacancy rates and caseloads are comparatively higher in statutory services, and are also higher for clinical than non-clinical positions.

Conclusion: This study revealed that and burnout leading to sickness absence are serious issues for frontline staff in drug and alcohol services, and these worsened during the Covid-19 pandemic. This research provides a foundation for validating the current findings via future large-scale longitudinal studies, and improving the well-being of people delivering health and social care services in substance use settings.

Keywords

Substance use service design workforce staff well-being

Highlights

• Countries around the world are seeing increases in drug mortality and morbidity.

• Data on the health and wellbeing of health and social care professionals delivering services in drug and alcohol services is lacking.

• Increases in caseload size per frontline employee, and number of clinical employees, were both associated with increases in non-Covid 19 sickness absence.

• Future workforce planning and service design must prioritise the health and wellbeing of clinical and non-clinical employees in drug and alcohol services.

Introduction

Increases in mortality and morbidity related to substance use have been observed around the world in recent years. These trends are particularly acute in Scotland, where numbers of drug-and alcohol-related deaths are consistently higher than those of England and Wales, and the rest of Europe.^1,2 To address these issues, the Scottish Government has announced a National Mission³ which includes commitments to facilitate access to treatment and support, as well as improve frontline drug services (including the third sector). Meeting the growing demand for drug and alcohol services requires a sustained commitment to supporting a resilient and skilled substance use workforce.

Stress, burnout and sickness absence in health and social care

There is a vast body of literature highlighting the challenges to health and well-being that people delivering health and social care services experience. Mental issues are prevalent in human service occupations,⁴ and factors associated with increased stress include demanding workloads,^5,6 high caseloads⁷ and roles involving public contact.⁸ Sustained occupational stress is associated with not just mental health issues, burnout, diminished cognitive function and depression but also physical health issues.^9,10 Previous research has also found that health workers experiencing high stress levels can adopt behaviours which often lead to negative health outcomes such as greater alcohol consumption.¹¹

Excessive psychological and physical demands leading to diminished wellbeing are strong predictors of turnover intention,¹² and they also play a role in driving sickness absence.^13,14 Sickness absence occurs for a variety of reasons, however mental health conditions – including stress, depression and anxiety – are leading causes of absenteeism, accounting for nearly 10% of overall work absences in the UK in 2022.¹⁵ Mental health issues have also been found to be a stronger predictor of workplace absenteeism compared to physical ill-health.¹⁴ Significantly, work-related stress and burnout leads to higher levels of sickness absence in the future, even after controlling for the effects of age, gender, occupation, and previous absence.⁹

Sickness absence resulting from stress and burnout is a particularly acute problem in health in social care. Amongst National Health Service staff, nearly 40% of sickness absence is attributable to work-related stress.¹⁶ Moreover, stress-related absence in this sector is estimated to be 46% higher than the UK average, and costs the NHS up to £400 million annually.⁶ While the sources of stress are numerous and depend on the profession, one meta-analysis identified high occupational demands amongst nurses (e.g. caseloads) as a predictor of sickness absence.¹⁷ The evidence further suggests that absenteeism is an important indicator of low wellbeing in the workplace generally,¹⁸ but especially in health and social care settings.¹⁹ The challenges posed by the Covid-19 pandemic will continue to not only increase demand for services but also exacerbate mental health issues amongst the working population in coming years.^7,14

The interrelated nature of stress and burnout, mental health issues and absenteeism on employee wellbeing has important implications for capacity and service delivery in health and social care. It is therefore of interest to evaluate factors driving the prevalence of stress-induced sickness absence. However there is a dearth of literature in how these issues have manifested specifically in drug and alcohol services. This is an important knowledge gap for several reasons. First, the sector is comparatively heterogeneous, comprising services in statutory and voluntary settings, as well as clinical and non-clinical employees (advocacy workers, peer support workers, etc), volunteers and people with lived/living experience. Second, the substance use workforce faces distinct challenges: for example, recruiting and retaining qualified staff (especially in rural/remote areas) is a persistent issue. Individual employees also typically contend with fluctuating caseloads and varying degrees of complexity with individual cases, often leading to high levels of stress and burnout.²⁰ These factors suggest a greater vulnerability amongst professionals working in substance use compared to other healthcare settings.²¹ Finally, these services often operate in constrained spending environments. Previous research in Scotland has linked government funding cuts to drug and alcohol services between 2015 and 2017²² with increased risk of drug mortality, especially in deprived communities.²³ However, there is little empirical data on the extent to which, and ways in which, these and other challenges have specifically impacted staff delivering substance use services.

To summarise, the associations between stress, burnout and sickness absence, as an indicator of low well-being in the health and social care workforce, is well-established. While there is recognition that staff in drugs and alcohol services face particular operational, financial and service delivery challenges, there is a lack of evidence on how this pattern of sickness absence due to workplace stress/burnout has manifested itself specifically in these settings. Given high levels of drug and alcohol-related mortality and morbidity in Scotland elsewhere, understanding the challenges specifically for this workforce is vital.

Materials and methods

National survey

Scottish Government undertook a mixed-methods programme of research which involved synthesizing existing datasets and generating new data to gain a greater understanding of the drug and alcohol workforce in Scotland.²⁴ As part of this research a survey was undertaken of all the publicly-funded drug and alcohol services currently operating in Scotland (with the except of residential rehabilitation services, which were the subject of separate research²⁵), the first survey of its kind^. This paper discusses key quantitative and qualitative findings from the survey, which relate specifically to the evaluation of workloads and workforce composition, staff well-being, and the relationships between these factors and sickness absence in this sector. It was hypothesised that services with higher caseloads and vacancy rates would be correlated with greater absenteeism at the service level.

Study design and sample

The survey was carried out by the Scottish Government. Building on previous mixed-methods research approaches for process improvement in health and social care,²⁶ the data-validation variant of convergent design²⁷ was employed to simultaneously collect data via closed, numeric (i.e. quantitative) and open-ended (qualitative) questions. It drew on research commissioned as part of an independent review of drugs for the UK Government, published in July 2021.²⁸ Colleagues in Public Health England and the UK Department of Health and Social Care provided their survey materials, following which a working group comprising Scottish Government statisticians, social researchers and policy personnel was convened to assess the survey’s validity and reliability, and tailor it to the Scottish context as necessary. As a final layer of quality assurance, piloting took place with members of the target population to ensure the survey questions and format overall were fit for purpose.

Invitations to participate were distributed via the Questback platform to a named person – typically a service manager or team leader – in each of the 206 services listed on the Scottish Drug & Alcohol Information System (DAISy).²⁹ DAISy is a national database developed to collect information on drug and alcohol referrals, waiting times and outcomes. It is used by all services which are contracted by Alcohol and Drug Partnerships (ADPs) – which are responsible for commissioning and developing local strategies for tackling problem substance use based on local needs – and includes statutory and voluntary organisations from every NHS board in Scotland. ADP Coordinators were also notified of the survey ahead of distribution to services. This survey therefore targeted all publicly-funded drug and alcohol services currently operating in Scotland. Government Social Research Ethical Assurance for Social and Behavioural Research was completed before the survey was run.

The survey was open for 6 weeks between November and December 2021, during which periodic reminders were sent to increase response rates. The covering letter explained the voluntary nature of this survey, whilst ensuring confidentiality, anonymity and compliance with EU General Data Protection Regulations. Hard copies were provided upon request.

Dependent variable

The dependent variable for this analysis was the number of sick days taken over the past 6 months. To account for the non-normally distributed data this variable was log-transformed for analysis. Although this survey was run during the pandemic, sickness absence related to Covid-19 was coded by NHS Scotland as ‘special leave’.³⁰ This study therefore only captures non-Covid sickness absence.

Independent variables

Given the lack of national-level data on Scotland’s drug and alcohol services, this survey sought to elicit information across a range of domains broken down by service type and location. Workforce characteristic variables were number of employees and number of vacancies, measured in whole-time equivalents (WTE) to account for part-time employment. This enabled the calculation of a vacancy rate,³¹ an indicator of a given service’s sustainability and capacity to deliver care.³² Data was also captured on caseloads per service and per WTE. Workforce composition variables included number of WTEs employed by role type: medical, nursing, psychology, non-clinical, ‘other’ and volunteers.

Qualitative data

The survey included a selection of open-ended questions to enable the collection of service-level qualitative information. Rather than query workforce characteristics and composition directly, these questions were framed more generally around service capacity (‘In terms of delivery, what level of capacity do you think your service is at? Please explain:’) as well as service delivery (‘Please use this space to outline any views on how the workforce in drug and alcohol services could be improved:’). This was intended to assess how the data collected in open-ended questions corroborate the quantitative data without unduly influencing respondents to speak about particular topics.³³

Analytical strategy

All quantitative data were analysed using R version 3.6.3. Initially, descriptive statistics were presented for each measures, with medians and inter-quartile ranges calculated for data with non- normal distributions. Standard multiple linear regression was performed to examine the relationship between workforce characteristics (vacancy rates, caseloads per WTE), workforce composition (role type) and the main outcome variable (number of sick days taken in the last 6 months). All methodological assumptions for linear regression were assessed and met. It was hypothesised that workforce characteristics would predict the number of sick days taken, so a regression model with these variables alone was examined first. The second step was creating an additional ‘nested’ model which included all the variables from the first model, in addition to workforce composition variables. These models were then compared using Analysis of Variance (ANOVA). The significance level was set at p < .05 for all analyses.

In keeping with the convergent study design, the open-ended qualitative text responses were concurrently coded and analysed using thematic analysis. The data were first collated and then a process of familiarization with the data was undertaken through close reading multiple times, actively seeking patterns. The process of coding the data was then undertaken. This was done in a hierarchical manner with broad themes first identified, and then further coding into sub-themes undertaken. The thematically coded data were then reviewed and analysed. Peer debriefing with another researcher on the project was undertaken throughout this process to verify the validity of the coding and analysis.³⁴ As was expected, key themes emerged relating to vacancy rates, caseloads and sickness absences. Further analysis of the data was then undertaken within these key themes to identify if the type of service provider was relevant.

Results

89 survey responses were received, only one of which was discarded due to incompleteness. Thus the final dataset contained 88 responses from across 12 of 14 NHS health boards, representing 43% of all Scotland’s alcohol and drug services (Table 1). This is broadly in line with previous surveys conducted via digital means in healthcare contexts.^35,36 The only areas with non-respondents were NHS Shetland and NHS Borders, which had a total of 2 and 1 services on DAISy respectively

Table 1.

Descriptive statistics of respondents to survey of drug and alcohol services.

Measure	Totals
Number of survey recipients (services)	206
Number of valid survey responses	88
Response rate	43%
Number of health boards reporting	12 of 14
Total employees reported (WTE)	1,572.8
Total vacancies reported (WTE)	152.2
Sector-wide vacancy rate	8.8%
Median WTE employees per service (IQR)	11 (5–22.5)
Median WTE vacancies per service (IQR)	0.25 (0–2)
Median caseload per service (IQR)	80 (10–320)
Median caseload per WTE per service (IQR)	20 (2–45)
Median days lost to sickness (IQR)	34 (3.9–175)

Organisations of every type responded to the survey, with third sector organisations representing the greatest share of respondents (37.5%), followed by NHS organisations (26.1%). Several ADP coordinators also responded. They are ideally positioned to provide key strategic insights given their roles in commissioning services as well as coordinating efforts between local partners including health boards, local authorities, police and voluntary agencies.

Vacancy rates

The 88 services who responded to the survey reported an aggregated total of 1,572.8 WTEs employed as of 1 November 2021. Total vacancies numbered 152.2 WTEs. These figures give a sector-wide vacancy rate of 8.8%, which are broken down by NHS board, service type and professional category in Table 2. The data show that vacancy rates varied widely across the sector. The highest rates belonged to Forth Valley (17.9%), Tayside (13.7%) and Highland (13.2%), while respondents from Fife and Orkney reported no vacancies. Although Greater Glasgow & Clyde reported the greatest absolute vacancy total, the comparatively high number of services in that region meant the vacancy rate amounted to 8.4%

Table 2.

Employment and vacancy totals across all respondents (as of 1 November 2021).

Category	Variable	Reported employment	Reported vacancies	Reported total capacity	Vacancy rate
Total	-	1,572.8	152.2	1,725.0	8.8%
Health Board	Forth valley	114.7	25.0	139.7	17.9%
	Tayside	96.6	15.3	111.9	13.7%
	Highland	122.9	18.7	141.6	13.2%
	Lothian	221.5	22.3	243.8	9.2%
	Greater Glasgow & Clyde	446.3	41.0	487.4	8.4%
	Ayrshire & Arran	185.3	12.8	198.1	6.5%
	Western Isles	16.0	1.0	17.0	5.9%
	Grampian	182.1	10.3	192.4	5.4%
	Lanarkshire	113.7	4.7	118.4	4%
	Dumfries & Galloway	27.8	1.0	28.8	3.5%
	Fife	41.0	0.0	41.0	0%
	Orkney	5.0	0.0	5.0	0%
Organisation type	ADP	18.5	3.0	21.5	14%
	NHS	365.8	41.1	406.9	10.1%
	Health and social care partnership	375.4	37.5	412.9	9.1%
	Integrated service	190.8	17.7	208.5	8.5%
	Third sector	577.3	49.1	626.4	7.8%
	Local Authority	45.0	3.7	48.8	7.7%
Profession	Psychology	32.2	7.2	39.4	18.3%
	Medical	67.9	13.3	81.2	16.4%
	Nursing	419.5	44.6	464.1	9.6%
	Non-clinical	974.7	87.1	1,061.8	8.2%
	Other*	78.5	-	-	-

*Note: Vacancy information was not sought for roles in the ‘Other’ category.

Employment and vacancy figures also varied by service type. NHS organisations reported vacancy rates of 10.1%, with health and social care partnerships (HSCPs¹) close behind at 9.1%. While third sector organisations reported the highest absolute number of vacancies, their vacancy rate was second-lowest in the sector (7.8%), just ahead of Local Authority services (7.7%).

Vacancies were more pronounced in certain roles. Psychology roles had the highest vacancy rates across the sector (18.3%), followed by medical roles (16.4%). There was asubstantial gap in vacancy rate between these two categories and nursing (9.6%), however nursing positions comprise by far the greatest employment totals amongst clinical roles. Finally, non-clinical roles comprised the greatest share of employment and the lowest vacancy rates.

Caseloads

In addition to staffing, the survey asked respondents to report caseloads. For this research, a caseload corresponded to the number of service users being managed by each frontline employee. Caseloads varied substantially, with organisations reporting totals ranging from 5 to 1,405 service users. Further, caseloads per frontline staff also depended on service size, type and location.

Figure 1 shows average caseloads by WTE employee broken down by service type. Staff at HCSPs and NHS organisations reported the highest median caseloads per WTE employee, at 46 and 28 respectively. Note that these two organisation types had amongst the highest vacancy rates, as shown in Table 2. These data also speak to the diversity of service size, as evidenced by the wide interquartile ranges of both NHS and integrated services. Although third sector organisations had comparatively lower average caseloads, there were several outliers exceeding 50 service users per WTE.

Figure 1.

Average service user per WTE employee by organisation type.

In the qualitative data, high levels of caseloads and referrals were directly highlighted as issues in over one in five responses. Respondents also highlighted the increasing levels of complexity in individual cases:²⁴

“Demands of service are higher than workforce. Patient’s[sic] requiring higher outreach for crisis response and engagement. Caseload’s are 30-40% higher what would be workable for amount of enquiries and problems encountered with our vulnerable patient group.”

“There is no give in the system when there is sickness staff are having to manage other staff’s caseloads as well as their own.”

“We are managing caseloads of staff on maternity leave and long term absence.”

Employee well-being

Respondents specifically outlined the resource implications of fluctuating caseloads. First, service users with multiple complex needs require higher levels of support, and over longer periods of time. As one service succinctly remarked, “Caseload number does not reflect complexity”. Others explained further:²⁴

“We work with increasingly complex individuals who along with significant drug or alcohol issues may also have statutory requirements of engagement from C&F[children and families] and CJ[criminal justice]. Many of our SU [service users] have complex multiple physical and MH[mental health] needs and there may be issues around capacity.”

Survey respondents spoke at length about how increasing workloads were leading to mental and physical health issues, attrition and burnout amongst frontline workers. Over 10% of respondents flagged how these factors specifically impacted staff sickness, which itself has a cascading effect: overworked employees become progressively more stressed, which leads to them taking more sick days, which necessitates other staff managing their caseloads, which leads to stress amongst those employees, which results in more sick days taken, and so on. Sickness absence can also lead to increased expenditure on supplementary staff, such as medical locum and agency nurses,³⁷ which could prove detrimental for service delivery in sectors (such as substance use) which have historically suffered from funding shortfalls.²³

The data also showed that all but one of those organisations highlighting staff sickness were either NHS or HSCPs, emphasising the health service component of this issue. As one NHS organisation noted:²⁴

“At one point in summer 2021 the team only had one registered nurse and team lead covering caseload for a team of 8. Team lead is not supposed yo[sic] have a casleoas[sic]. Most of their work was not completed ans[sic] they are also supposed to support another team tooo[sic].. This then lead to burnout of one team members[sic]. The team has always been sitting with vacancies or long term sick since may[sic] 2019 with between 2 and 6 staff short… It is very stressful at times”

Factors influencing absenteeism

Standard multiple linear regression was conducted to examine the factors that influenced absenteeism in Scotland’s drug and alcohol. The first model assessed workplace characteristics, including size of caseloads per WTE employee and vacancy rates. The second model incorporated workforce composition, including number of WTE employees by role type (Table 3). Of the 88 survey respondents, only the 74 that entered a value for the question “How many days have been lost to sickness amongst paid employees over the past 6 months” were included.

Table 3.

Multiple linear regression analysis coefficients.a

Model	Predictors	LogCoefficients (CI 95%)	t-value	Adjusted R²
	(Intercept)	2.023***	5.55	0.18***
		(1.296–2.749)
Model 1	Average caseload/WTE employee	0.044***	4.226
		(0.023–0.064)
	Vacancy rate	−0.003	−0.183
		(-0.039–0.032)
Model 2	(Intercept)	1.927***	5.227	0.24***
		(1.191–2.662)
	Average caseload/WTE employee	0.030**	2.742
		(0.008–0.052)
	Vacancy rate	−0.006	−0.336
		(-0.040–0.027)
	Clinical roles (WTE)	0.066*	2.622
		(0.016–0.116)
	Non-clinical roles (WTE)	0.006	0.491
		(-0.017–0.031)
	Volunteer numbers	0.004	0.675
		(-0.008–0.052)

^aDependent variable: Log sick days taken over the last 6 months *p < .05; **p < .01; ***p < .001.

Model 1 was significant overall, with workplace characteristics explaining 18% of the variance in sick days taken (adj. R² = .18, p < .001). It also showed a significant relationship between average caseload per WTE (p < .001) and sickness absence. Interestingly there was a negative, albeit not statistically significant, relationship between vacancy rates and sickness absence.

The second model explored factors specific to workforce composition, whilst controlling for workforce capacity. It therefore comprised – in addition to the variables from Model 1 – clinical employee WTEs (medical, nursing, psychology), non-clinical employee WTEs, and volunteer numbers as independent variables. All variables were continuous. Model 2 was again significant, with workforce composition in addition to workplace characteristics explaining nearly a quarter of variance in sick days taken (adj. R² = .24, p < .001). Caseloads per WTE was significant again, however the relationship was slightly attenuated compared to Model 1 (p < .01). There was also a significant association observed between the number of clinical employees and sick days (p < .05), but not for non-clinical employees nor volunteers. Under Model 2, ceteris paribus, an increase in caseload per WTE resulted in 3.1% more sick days taken, and an increase in the number of clinical employees (nursing, medical or psychology) resulted in a 6.8% increase in sick days taken.

Finally, comparison of the two models by ANOVA showed a significant improvement in model fit when the variables in Model 2 were added (F [3, 68] = 3.1, p < .05). This suggests that the types of roles present in a particular service are a strong predictor of staff sickness above and beyond simply the number of staff employed or size of caseload at a service in the drugs and alcohol sector.

Discussion

The present cross-sectional survey undertaken by the Scottish Government was the first of its kind to assess the health and wellbeing of the substance use workforce in Scotland^. The quantitative and qualitative data were highly consonant, showing that members of the drugs and alcohol workforce experience myriad pressures and challenges, leading directly to worsened health and wellbeing, and ultimately increased levels of absenteeism. Multiple linear regression showed that caseload size and number of clinical employees were both positively and independently associated with increases in number of sick days taken. Qualitative data showed that staff sickness and absence due to physical and mental health issues resulting from increased workloads had a negative and cascading impact on staff and services. As staff sickness and absence increased, workloads were passed on to remaining staff, who in turn then experienced more sickness and sickness absence, and these issues were particularly severe in statutory services.²⁴

Caseloads varied dramatically across services, but the highest caseload rates were reported in statutory services. In addition to people who use drugs typically having complex health and support needs,³⁸ this may also be due to increased service provision leading to more people accessing services. Previous research in outpatient methadone clinics has linked expansion of treatment services with higher workloads and thus greater workforce pressures.³⁹ The qualitative data builds on this by highlighting how increasing caseload size and complexity were directly causing mental and physical health issues among frontline staff. While research in other health and social care settings has described the relationship between higher caseloads and prevalence of stress⁷ as well as absenteeism,¹⁴ the findings discussed here extend the literature by demonstrating a positive correlation between increasing caseloads and sickness absence specifically for drug and alcohol settings.

Closely related to caseloads is the matter of vacancies. Drug and alcohol services face specific challenges recruiting and retaining qualified staff, specifically in rural areas.²⁰ However the high vacancy rates reported in the descriptive data suggests that recruitment is difficult in both rural and urban areas. Vacancy rates were highest for statutory services and for clinical professions (nurses, clinicians, psychologists) compared to non-clinical roles, and the qualitative data also emphasised the negative impacts of long-term unfilled posts on other staff members – i.e. the ‘cascading’ of caseloads, and resulting increases in workplace stress. The fact that vacancies were especially acute for clinical roles, which require lengthy training programmes, means this issue will take time to address.⁴⁰ Moreover vacancy issues are by no means limited to the substance use sector. Sustainable workforce planning across all of health and social care requires carefully evaluating how the pipeline of skilled professionals (in clinical and non-clinical roles alike) can be more closely tailored to meet labour force demands, whilst accounting for geographic, funding and other obstacles.

These data did not evidence a relationship between service-level vacancy rates and sickness absence. This may be because higher vacancy rates equate to fewer staff relative to a given service’s capacity, and thus lesser volumes of absenteeism overall. On the other hand, there was a positive correlation between clinical role WTEs and number of sick days taken. This coheres with the descriptive and qualitative findings, and is the first time (to the authors’ knowledge) this relationship has been elucidated. This evidence together suggests that the employee-service user interface is a critical factor underpinning staff well-being. Moreover, sickness absence in substance use services is predicated to some extent on both the number and type of staff employed. This finding specific to the substance use workforce enhances existing research which has linked certain role types in frontline health and social care delivery to increased sickness absence.¹⁷ While future research ought to consider the respective pressures that different professions face, this should not belie the crucial role that non-clinical staff play in delivering drug and alcohol services.

The diminished health and wellbeing of people delivering substance use services also impacts people accessing them. Burnout and stress have previously been linked to poorer safety-related quality of care and diminished patient satisfaction in wider health and social care settings.^41,42 This has important consequences for drug and alcohol service users who are often already vulnerable and stigmatized. Research examining what people who access substance use services want from the workforce noted the importance of empathetic, non-judgmental and friendly workers with whom they can build consistent relationships.^43,44 Staff attitudes were also considered important, and people who used services reported engaging less successfully with staff who were negative.⁴⁴ The injurious impacts of work-related stress and burnout described here are therefore concerning, not just for individual employees and their employers, but also because of the negative repercussions for the recovery journeys of service users.

Finally, due consideration must be given to the settings in which these staff are operating. Drug and alcohol service providers often face substantial psychological and physical demands in their day to day jobs which makes this workforce particularly vulnerable relative to other health and social care professions.²¹ Although this survey did not specifically assess organisational culture, previous research has found leadership, interpersonal support and positive team dynamics to be important predictors of stress and mental health issues as well as sickness absence in health and social care.^5,11,17,45 Future research should consider the mediating role that relational and social factors play in wellbeing amongst the substance use workforce.

We acknowledge several limitations. The cross-sectional nature of this study prevents causal and temporal relationships from being inferred. Although the generalisability of the findings is enhanced by the fact that the survey was sent to every publicly-funded service in Scotland, the findings are predicated on the assumption that the responses were representative of the sector overall. Third, respondents self-selected which might introduce bias. Lastly, the nature of sickness absence was not queried in the survey, so it is not possible to ascertain the extent to which sickness rates reported were specifically due to stress and burnout. However, given the qualitative data it is reasonable to conclude that the findings on absenteeism presented here are related to workplace stress and burnout.

The drugs and alcohol workforce plays a crucial role delivering specialist health and social care services. This national examination of health and wellbeing of this workforce in Scotland highlighted that people working in these spaces – in addition to already working in physically and psychologically challenging environments – regularly face operational and strategic obstacles that impact their ability to deliver for service users. These include ballooning caseloads and increasing stress and burnout, which are materially worsening staff absences, especially for those working in clinical roles. Staff sickness absences negatively impact not only workers themselves but the services they work for and the clients they serve. The findings outlined here could play a crucial role in informing strategic thinking around current approaches to recruitment, retention and service design for the drugs and alcohol sector, which will help empower the workforce to more effectively deliver on behalf of service users.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Joshua Bird

Note

References

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