Mental health, "burnout' and job satisfaction among hospital and community-based mental health staff D Prosser, S Johnson, E Kuipers, G Szmukler, P Bebbington and G Thornicroft The British Journal of Psychiatry 1996 169: 334-337 Access the most recent version at doi:10.1192/bjp.169.3.334
References
Reprints/ permissions You can respond to this article at Email alerting service Downloaded from
Article cited in: http://bjp.rcpsych.org/cgi/content/abstract/169/3/334#otherarticles To obtain reprints or permission to reproduce material from this paper, please write to
[email protected] http://bjp.rcpsych.org/cgi/eletter-submit/169/3/334 Receive free email alerts when new articles cite this article - sign up in the box at the top right corner of the article or click here bjp.rcpsych.org on July 15, 2011 Published by The Royal College of Psychiatrists
To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/subscriptions/
British Journal of Psychiatry (1996), 169, 334—337
Mental Health, ‘¿Burnout' and Job Satisfaction among Hospital and Community-Based Mental Health Staff DAVIDPROSSER,SONIAJOHNSON,EUZABETHKUIPERS,GEORGESZMUKLER, PAULBEBBINGTONand GRAHAMTHORNICROFT
Background.Concernshavebeenexpressed thatstaffburnoutmaymakecommunity mental healthcare difficultto sustain.This studycomparesstressand job satisfactionbetween community and hospital-based staff. Method. The GHQ-12,the MaslachBurnoutInventoryanda job satisfaction measurewere usedto study160InnerLondonstaff. Results. Community staff scored significantly higher on the GHQ-12 and the ‘¿emotional exhaustion' component of the Maslach Burnout Inventory than hospital-based in-patient, day care or out-patient staff. Satisfaction did not vary significantlybetween settings. Conclusions. These results may be explained in several ways. Community work may be inherently more stressful than hospital work, or may currentlybe stressful because of inadequate resources, training or supervision. The results may also reflect widespread recent changes in community services or the specific effects of working in a deprived area
The Health of the Nation (Secretary of State for Health, 1992) identifies health promotion in the workplace as a priority. Investigation of the welfare of mental health staff is particularly important.
Outcome variables The following outcome measures were used:
With the move to community care, these staff have
experienced some of the greatest changes in the National Health Service (NHS). The development of community mental health teams has required staff to adapt to new roles, responsibilities and hierarchies. The threats of suicide or violence by patients are potent sources of stress for mental health staff in any setting, but pressures related to these may be particularly intense in the community. Debate continues about resources for community care, and whether teams currently have enough staff to provide a service for all the people with severe mental illnesses who are living in the community. Observations that model community pro grammes may not always maintain initially good results have led some to suggest that staff ‘¿burnout' may make community care difficult to sustain over long periods (Dedman, 1993; Audini et al, 1994). The current study examines the hypothesis that levels of ‘¿burnout' are higher and job satisfaction lower among community mental health staff than among hospital-based staff.
(a) The 12-item version of the General Health Questionnaire (GHQ-12, scored by Likert method) (Goldberg & Williams, 1988), which has been used as a measure of general psychological well-being among a range of occupational samples including health pro fessionals (Firth-Cozens, 1990). (b) The Maslach Burnout Inventory (Maslach & Jackson, 1986), which is the most widely used instrument for measuring ‘¿burnout' in the caring professions and has been used in other mental health services research (Carson et al, 1995; Onyett
et a4 1995). Components
measured are: ‘¿emotional exhaustion' (deple tion of emotional resources, leading workers to feel unable to give of themselves at a psychological level); ‘¿depersonalisation' (negative, cynical attitudes towards clients); and reduced ‘¿personal accomplishment' (evaluating oneself negatively, particularly with regard to work with clients). (c) The job satisfaction section from the Job Diagnostic Survey (Hackman & Oldham, 1975), which consists
of five items, each
measured on a seven-point Likert scale, a higher score representing greater general job
Method The questionnaire used had two main components.
satisfaction.
334
MENTALHEALTHAND JOBSATISFACFIONOF MENTALHEALTHSTAFF Explanatory variables The potential explanatory variables measured were:
335
multiple regression was then carried out to examine confounding from the other explanatory variables, and to construct models explaining the variance in the outcome measures. All other potential explana tory variables were entered in the regression model before adding work setting. All variables with more than two categories were converted into binary dummy variables, apart from age, which was entered as a continuous variable.
(a) Work setting (divided into three categories: community-based services, in-patient wards, and day care or out-patient services at the main hospital site). (b) Level of experience (less than 2 years in current profession, 2—5years, or more than 5 years). (c) Time in current job (less than 1 year, 1—2 years or more than 2 years). Results (d) Profession (nurse, psychiatrist, psychologist, social worker or occupational therapist). The mean scores for the sample as a whole were Sector. 11.8 (standard deviation (s.d.) 5.0) for the GHQ-12 (f) Seniority (whether in a senior or junior (Likert) and 6.1 (s.d. 6.4) for the job satisfaction position). item. For the Maslach Burnout Inventory, the (g) Demographic variables —¿ age, sex, ethnicity, mean scores were 22.9 (s.d. 11.1) for ‘¿emotional marital status and whether there are any exhaustion', 7.5 (s.d. 5.7) for ‘¿depersonalisation' children at home. and 33.5 (s.d. 6.6) for ‘¿personal accomplishment'. The results of testing our main hypotheses are shown in Table 1. There were significant differences Sample between mean scores for the three work settings on exhaustion' The sample consisted of all clinical mental health the GHQ-12 and on the ‘¿emotional staff in three geographical mental health sectors in component of the Burnout Inventory, with com south London. Community-based models of care munity staff having the highest mean scores. had been initiated at various stages over the However, there were no significant differences for ‘¿personal accomplishment' or previous 3 years in these sectors, with significant ‘¿depersonalisation', changes in service functioning and organisation still job satisfaction. When multiple regression models were con taking place in all three sectors. Local levels of structed to examine possible confounding from social deprivation are high. Questionnairies were sent to all staff, and the other explanatory variables, work setting confidentiality was assured, 121 out of 160 staff remained significant in the models for GHQ-12 returned questionnaires (76% response rate). There score and ‘¿emotionalexhaustion'. The significant was no significant difference between responders predictors of high scores on each outcome variable identified by the multiple regression models were as and non-responders for main work setting. The sample included 71 nurses (59% of sample), follows: 23 psychiatrists
(19%), nine occupational
therapists
(7%), nine nursing assistants (7%), six social workers (5%) and three psychologists (2%). Twenty-nine (24%) were based mainly in the community, 50 (41%) on wards and 42 (35%) in day care or out patientsetlings on themain hospital site. Eighty (66%) had been in theircurrentjob for less than 2 years.The meanagewas33years,and69(57%)werefemaleand 84(69%) white. Analysis SPSS for Windows was used for all analyses (Norusis, 1993). One-way analysis of variance was used to examine the main hypotheses regarding differences between work settings in mean GHQ scores, in the three components of the Maslach Burnout Inventory and in job satisfaction. Stepwise
(a) GHQ-l2 score: community work setting is associated with high score (P=0.002); adjusted R2 for overall model= 0.08, F=0.002.
(b) ‘¿Emotional exhaustion': community work set ting (P=0.Ol);
white ethnicity
(P=0.004);
adjustedR2=0.13, P=0.0004. (c) ‘¿Depersonalisation': not having children at home (P=0.0005); white ethnicity (P=0.007); profession other than occupational therapist (P=0.02); adjusted R2=0.21, P
