International Journal of Social Psychiatry

Clearly, mental health professionals are subjected to similar organizational stressors as other workers. They also face additional emotional strain by the very nature of their professions in dealing with troubled persons often over extended periods of time. Further understanding of these problems and develop ment strategies, such as insight-oriented training, requires a greater appreciation of the interactions between home-work and the individual. This broader-based ongoing research is imperative not just to protect the health of the carers and their patients/clients but is, we believe, an ethical requirement. Best care can only be provided to others by carers who are themselves well.

The purpose of this paper is to review studies of burnout relating to mental health workers and to propose directions for future research. It will summarize findings with regard to established norms, demographic variables, possible antecedents and consequences of burnout, and burnout models tested with mental health workers. Comparison of group perceptions of burnout is facilitated by the fact that all the papers but one have used the Maslach Burnout Inventory (Maslach & Jackson, 1981, 1986). Strengths and weaknesses of the research will be analyzed and suggestions offered for extending research in this area.

In this paper we present data from three research studies on stress, coping and burnout in mental health nurses. All three studies used a range of self report questionnaires. Measures included a demographic checklist, the General Health Questionnaire (GHQ-28), the Maslach Burnout Inventory, the DCL Stress Scale and the Cooper Coping Skills Scale. In all, 648 ward based mental health nurses were surveyed. There were no significant differences between levels of psychological distress on GHQ Total Score, but there were differences in caseness rates. In Study 3, some 38% of nurses were found to score at or above the criterion for caseness. The main stressors for ward staff were to do with staff shortages, health service changes, poor morale and not being notified of changes before they occurred. Differences in coping skills were found across studies. The study group with the highest stress scores also had the lowest coping skills scores. This was also associated with significantly higher alcohol consumption and greater self reported sickness absence. Scores on the Maslach Burnout Inventory showed higher levels of burnout amongst nurses in Study 3. These three studies have confirmed that stress is a problem for ward based mental health nurses. Two main implications arise from this work. Firstly we need models of the stress process that are empirically based, and which help us identify the moderating variables that reduce the impact of stressors on nurses. Secondly, we need to utilise this knowledge to deliver stress management interventions for staff. We end by outlining a model which may help us both understand the process of stress causation, and move towards our goal of stress reduction.

A randomly selected group of consultant psychiatrists (n = 39) working within the NHS in Scotland was compared with a combined group of physicians and surgeons (n = 149) on several variables related to the stress process, including personality traits, coping strategies, psychological distress, burnout, job stress and work demands. Psychiatrists reported fewer clinical work demands (p < .001), and their mean personality scores were significantly different from physicians and surgeons by being high in neuroticism (p = .009), openness (p = .003) and agreeableness (p = .002), and low in conscientiousness (p = .04). Psychiatrists reported higher work-related emotional exhaustion (p = .03) and severe depression (p = .02). However, psychiatrists did not report more work-related stress than physicians and surgeons. Many stress-related variables were highly correlated within the group of psychiatrists, suggesting that there is a very general disposition to experience negative emotion (including job-related stress) in some individuals. Organisational and personal contributions to stress in the practice of psychiatry are considered. There are personality characteristics that might dispose some people toward psychiatry as a career and toward stress. However, there is no evidence to suggest that screening for admission to psychiatry in terms of per sonality or other psychological factors would be useful or advisable.

The experience of job stress and burnout in occupational therapy has received only scant attention in the literature, although occupational therapists (OTs) share a number of important characteristics with other health care professionals that leave them vulnerable to the experience of stress. In addition, this group has a number of unique personal and work-related characteristics that could serve to increase its risk profile. Little effort has been directed at delinaating work-related stressors or experienced levels of stress within different practice arenas of occupational therapy, even though some specialisms (e.g. mental health, forensic psychiatry, learning disabilities or paediatrics) are likely to be more emotionally demanding than others. There are a number of indicators which confirm that job stress is an issue for OTs, although some of the empirical data suggests that, on average, this occupational group experience less burnout than other human service professionals.

This paper summarises the findings of a series of studies of British clinical psychologists and discusses them in relation to the (mainly US) literature. Four main questions are addressed: (1) How stressed are clinical psychologists? (2) Which psychologists are most stressed? (3) What are the main sources of stress for clinical psychologists? and (4) What coping strategies are used by clinical psychologists? A figure summarises the main risk factors emerging from the literature which appear to be important mediators between the stressor and the psychological outcome variables. These are: (1) low job satisfaction; (2) low range of active coping strategies; (3) high use of avoidance coping strategies involving denial; (4) stressor not externalised and objectified; (5) stressor threatens other roles/relationships; (6) low experience in job; (7) no quality relationship with confidant(e)/poor quality relationship with partner; and (8) female.

A small opportunistic study of Stress and Expressed Emotion was undertaken with community mental health workers, who were all case managers or keyworkers to clients with severe mental illness. It was hypothesised that a range of EE ratings would be found in staff, and that they would have high levels of burnout and stress. Job satisfaction was also measured. Ten staff were interviewed about 28 clients. Thirty nine percent of interviewees were rated as high EE (7/10 staff were high EE about at least one client), with low EE interviews showing significantly more warmth. Emotional exhaustion, depersonalisation and GHQ levels were above norms for the general population, and were similar to those found in other inner city community teams, but were not related to EE levels. Nevertheless personal accomplishment and job satisfaction were high. High EE interviews were related to increased client symptomatology. Implications for long term community care are discussed.