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Social Work and Social Care Section, Health Services Research Department, Institute of Psychiatry, and Social Care Workforce Research Unit, King's College London
Social Work and Social Care Section, Health Services Research Department, Institute of Psychiatry, and Social Care Workforce Research Unit, King's College London
Social Work and Social Care Section, Health Services Research Department, Institute of Psychiatry, London
Royal College of Psychiatrists' Research Unit, London, UK
Correspondence: Dr Sherrill Evans, Box 032, Social Work and Social Care Section, Health Services Research Department, David Goldberg Centre, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. E-mail: S.Evans{at}iop.kcl.ac.uk
Declaration of interest None. Funding detailed in Acknowledgement.
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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Aims To examine the prevalence of stress and burnout, and job satisfaction among mental health social workers (MHSWs) and the factors responsible for this.
Method A postal survey incorporating the General Health Questionnaire, Maslach Burnout Inventory, Karasek Job Content Questionnaire and a job satisfaction measure was sent to 610 MHSWs in England and Wales.
Results Eligible respondents (n=237) reported high levels of stress and emotional exhaustion and low levels of job satisfaction; 111 (47%) showed significant symptomatology and distress, which is twice the level reported by similar surveys of psychiatrists. Feeling undervalued at work, excessive job demands, limited latitude in decision-making, and unhappiness about the place of MHSWs in modern services contributed to the poor job satisfaction and most aspects of burnout. Those who had approved social worker status had greater dissatisfaction.
Conclusions Stress may exacerbate recruitment and retention problems. Employers must recognise the demands placed upon MHSWs and value their contribution to mental health services.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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Studies of other professional groups have shown that stress commonly arises where one has little control (decision latitude) over one's work (Karasek, 1979). Higher levels of decision latitude are associated with a greater sense of personal accomplishment and satisfaction (Joseph & Conrad, 1979). Workers with high job demands, low decision latitude and low support at work are the most stressed (Karasek, 1979). These factors have not been studied in relation to one key member of multidisciplinary mental health teams - mental health social workers. This national study fills that gap and complements a parallel study of psychiatrists conducted using the same methodology (Pajak et al, 2003).
The study aimed to: (a) characterise the mental health social work workforce in terms of demography, experience, job content, workload, working environment, health and well-being; and (b) explain the nature and direction of associations between these explanatory variables and mental health, burnout and job satisfaction.
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METHOD |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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Dependant variables
The General Health Questionnaire (GHQ-12;
Goldberg, 1992) is a
dimensional indicator of common mental disorder
(Goldberg & Huxley, 1992) from which a summed score is produced; higher scores indicate poorer mental
health. It has satisfactory psychometric properties
(Goldberg, 1992) and has been
widely used on various occupational health samples
(Banks et al, 1980;
Banks & Jackson, 1982),
including mental health professionals
(Prosser et al,
1996).
Burnout is defined as exhaustion resulting from excessive demands on energy and resources. The Maslach Burnout Inventory (Maslach & Jackson, 1986) is the most widely used measure of burnout and has previously been used in mental health services research (Prosser et al, 1996). This 22-item, 6-point anchored Likert scale has three components: ‘emotional exhaustion’ (the depletion of emotional resources, leading workers to feel unable to give of themselves at a psychological level); ‘depersonalisation’ (negative, cynical attitudes and feelings about clients); and reduced ‘personal accomplishment’ (evaluating oneself negatively, particularly with regard to work with clients). Burnout exists when the thresholds for each sub-scale are reached (emotional exhaustion 521; depersonalisation 58; personal accomplishment 428; Prosser et al, 1996).
Job satisfaction was measured by a single-item, standardised rating of ‘satisfaction with your current job’, rated using the seven-point ‘delighted-terrible’ scale (Andrews & Withey, 1976).
Explanatory variables
The main variables used to explain the dependent variables were the nature
of the job and the immediate context in which it took place. The Karasek Job
Content Questionnaire (Karasek,
1979) provided standardised sub-scale ratings of decision
latitude, psychological job demands and social support in the workplace (from
supervisors and co-workers). Other standardised ratings related to feelings
about the employer, the place of social work in modern mental health services,
government policy on mental health and the proposed new Mental Health Act. The
questionnaire also included data relating to demographics and personal
characteristics such as qualifications and job history, and objective and
subjective questions about work context and environment.
The sample
There is no readily available sampling frame from which to draw a sample of
mental health social workers or approved social workers (ASWs); therefore a
sampling frame was generated through the Association of Directors of Social
Services. Directors provided contact details for their leading manager for
mental health services, who was asked to provide a complete list of current
mental health social work staff (excluding emergency duty teams, agency staff
and managers). A one-in-five sample was selected from the list of names
provided by each council with social services responsibilities using the
Statistical Package for the Social Sciences (SPSS) random sample generator,
limiting the number of participants in each council to four.
Of the 171 councils with social services responsibilities in England and Wales, 145 were willing to participate (85%); 109 of these 145 (75%) provided a list of their mental health social workers within the deadline. Preliminary analyses indicated that responding authorities did not differ from non-responding authorities in terms of authority type (county, unitary, metropolitan, London borough) or the National Audit Office's (2002) comprehensive performance analysis (a star rating system of service quality) results for adult services.
There were 610 questionnaires (plus diaries) distributed. Staff in 88 authorities responded (52% of all councils with social services responsibilities, 61% of those willing to participate, and 81% of those providing a list within the deadline). There were 462 questionnaires returned (76%) but 125 of these (27%) were ineligible because they did not match the specified inclusion criteria (i.e. they were from students, managers or members of emergency duty teams). There were 237 (39%) questionnaires eligible for inclusion in the analysis, giving an adjusted response rate of 49% (237/(6107125) x100). The real response rate is probably higher given that more than a quarter of the questionnaires returned were ineligible, assuming that a similar proportion of non-responders would have been ineligible.
Statistical analysis
Data were analysed using SPSS for Windows, version 11.0. Descriptive
statistics were used to describe the sample in terms of personal
characteristics, work context and environment, health, well-being and job
satisfaction.
One-way analysis of variance (ANOVA; with Bonferroni correction, to allow for multiple comparisons) was used to examine between-group differences in GHQ total score, Maslach sub-scores and job satisfaction. The independent variables for these ANOVAs were constructed by classifying each of the Karasek sub-scales (job demands, decision latitude and social support) into categorical variables representing low, medium and high scores, according to recommended thresholds (Karasek, 1979). The GHQ total was computed using both the GHQ scoring method and the Likert method, to facilitate comparison with previous studies.
A series of linear regression models was constructed (using the ‘enter’ method) to explain the variance in the main dependent variables, and the relative magnitude and direction of their associations with job demands, decision latitude and social support, when other confounding and mediating effects were controlled for. The model assumed that each of the dependent variables was associated directly with job demand, decision latitude and social support but that these associations might be confounded by work context/environment and subjective feelings about that environment, but mediated by personal characteristics. Each model included:
The number of variables entered was kept within recommended limits (total cases=8 x number of variables in the model+50 cases; Tabachnick & Fidell, 2001).
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RESULTS |
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Eighty-three per cent (n=197) of the sample worked full-time. Respondents worked a mean of 43 h (s.d.=7.0) per week (8393 h/195 workers), an excess over contracted hours of approximately 6 per week per worker. Thirty-nine per cent of the working week was spent in face-to-face contact with service users or carers and 29% on administration (partly owing to limited support). Respondents reported a mean of 15 h (s.d.=10.9) on duty during the working week. The mean job tenure with the current employer was 7.6 years (s.d.=7.0), although not necessarily in mental health work for the whole period. Respondents were experienced workers with a mean of 11.9 years (s.d.=8.7) since social work qualification. Sixty-eight per cent of the sample (n=162) were active ASWs; most of the remainder (referred to in the results as non-ASWs) were awaiting ASW training. ASWs had been approved for a mean of 7.0 years (s.d.=6.0) and were older than non-ASWs (mean age 48 (s.d.=8.2) v. 42 years (s.d.=10.0)).
Work context and the working environment
Respondents worked in teams that had a mean of 16.5 (s.d.=8.2) members
(median 14; mode 12; range 4-40). Integrated teams tended to be larger, having
a mean of 18 members (s.d.=8.1). The mean case-load was 24.3 (s.d.=13.1;
median 24; mode 25; range 1-70). Ten per cent (n=24) had case-loads
of over 40. Members of integrated teams had somewhat larger case-loads
(mean=24.7; s.d. 11.2) than members of smaller specialist (e.g. assertive
outreach) teams (mean=18.1; s.d. 11.6). Sixty-three per cent of staff
(n=150) reported doing additional work to cover for absent (primarily
owing to sick leave) colleagues or for staff vacancies. Respondents reported
being unable to take time off in lieu for working out of office hours, because
of pressure of work and the vacancy situation. Seventy per cent
(n=166) of respondents thought that their current grade did not
reflect the duties they performed and 43% (n=102) felt undervalued at
work.
Health and well-being
Forty-seven per cent (n=111) of respondents scored 4 or above on
the GHQ-12, indicating a potential psychological disorder. When the lower
cut-off for the identification of probable common mental disorders (2/3) was
used, the GHQ-12-positive rate rose to 55% (n=130). Using the Likert
scoring method, the mean score was 26.9 (s.d.=6.0).
Table 1 shows that mean scores on each of the Maslach Burnout Inventory sub-scales were higher than the reported mental health category norms (Maslach & Jackson, 1986). Mental health social workers were more emotionally exhausted and more depersonalised than the average mental health worker but experienced more personal accomplishment. They were also more emotionally exhausted than psychiatrists in the parallel study (Pajak et al, 2003) but were less depersonalised and experienced less personal accomplishment. Nevertheless, only 8% of respondents met the threshold for burnout as defined above (n=18).
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Approved social workers reported taking more sick leave (mean 12 days,
s.d.=30.1) than non-ASWs (mean=7 days, s.d.=12.4). The rate for ASWs was
skewed by three cases of more than 90 days' sickness but the difference
between ASWs and non-ASWs just failed to reach significance (t=-1.91
(229), P=0.057). Nevertheless, the mean duration of sick leave for
ASWs was twice that for psychiatrists
(Pajak et al, 2003).
Approved social workers were also more likely than non-ASWs to report taking
unspecified stress-relieving medications (10% (n=16) v. 7%
((n=5)), another non-significant difference (
2=0.63
(1), P=0.30).
Job satisfaction
Forty-seven per cent (n=111) of respondents were at least
‘mostly satisfied’ with their current job but 35% (n=83)
were ambivalent and 19% (n=43) were dissatisfied; the mean job
satisfaction rating was 4.4 (s.d.=1.2, range 1-7). Far fewer people were
satisfied with their employer, 22% (n=52) being at least
‘mostly satisfied’, 37% ambivalent (n=88) and 41%
(n=98) dissatisfied (mean=3.7, s.d.=1.2, range 1-7).
Over a quarter of respondents (28%, n=66) had a strong or very
strong desire to leave their present post and 21% (n=48) had specific
plans to do so. A strong or very strong desire to leave one's job was related
to ASW status: 33% of ASWs compared with 19% of non-ASWs wanted to leave
(2=9.6 (3), P <50.05).
Associations with mental health, burnout and job satisfaction
The ANOVA results presented in Table
2 demonstrate that low decision latitude and high job demands were
associated with poor mental health (determined by higher GHQ-12 scores) and
emotional exhaustion. Conversely, greater decision latitude and lower job
demands were associated with higher levels of job satisfaction. Low social
support was also associated with emotional exhaustion whereas medium or high
social support were associated with greater job satisfaction. Few job content
characteristics were associated with personal accomplishment or
depersonalisation.
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Table 3 shows the results of multivariate analyses that examined whether the effects of decision latitude, job demands and social support were independent of work context/environment, subjective feelings and personal characteristics, and explored which other variables contributed to the explanation of the dependent variables.
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The results suggested that high job demands and low decision latitude were independently associated with poor mental health but high GHQ-12 scores were also associated with the number of additional hours worked per week and not feeling valued by the employer.
High emotional exhaustion was also associated directly with higher job demands but not with low decision latitude or low social support, when features of the work environment, personal characteristics and subjective feelings were controlled for. These results suggest that the original associations between emotional exhaustion and these aspects of job content (based on ANOVAs) might have been confounded. Personal accomplishment was associated with high decision latitude, suggesting that it was not confounded with the other explanatory factors. Depersonalisation was still not associated with any aspect of job content (decision latitude, job demands and social support) but was associated with dissatisfaction about the role of mental health social work in the current mental health services, not feeling valued by the employer and being male.
Finally, job satisfaction was associated directly with lower job demands and higher decision latitude but not with social support, when other explanatory variables were included in the model. Being valued by their employer and positive feelings about the role of social work in current mental health services were also associated with job satisfaction, whereas being active as an ASW was associated most strongly with job dissatisfaction. These results suggest that personal characteristics, aspects of the working environment or feelings about that environment might confound the univariate association between job satisfaction and social support.
The model explained similar amounts of variance in emotional exhaustion and job satisfaction, less in mental health and little of the variance in other aspects of burnout.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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High levels of stress and emotional exhaustion among the workforce are a concern and likely to contribute further to the high vacancy rates associated with recruitment and retention problems within the social work profession (Eborall & Garmeson, 2001; Employers' Organisation & Provincial Employers' Organisations, 2002). One might have expected to find a direct association between team vacancy rates and stress/emotional exhaustion but these relationships failed to appear. This might be due to the low level of actual vacancies in most teams - 65% of participants reported no social work vacancies in their team. Nevertheless, 63% of respondents provided cover for absent colleagues, which may have included training or sick leave, not simply for vacant posts. The practice of using agency workers to cover vacancies in teams may have reduced the vacancy rates reported. Further research is required to determine whether the practice of employing agency staff, at higher rates of pay than statutory sector employees and without statutory responsibilities, exacerbates job dissatisfaction, burnout and recruitment and retention problems.
The high levels of job dissatisfaction and dissatisfaction with the employer give further cause for concern. The burden of statutory responsibilities associated with the ASW function under the Mental Health Act 1983 also emerged as an important factor in job dissatisfaction (although this finding is unlikely to be applicable outside the UK where social workers do not carry these responsibilities). Perhaps as a consequence, ASWs take slightly more sick leave than non-ASWs and take sick leave at twice the rate of psychiatrists (Pajak et al, 2003). It is worrying that 20% of our sample had a strong desire to leave their current post and 21% had specific plans to do so.
Social workers make a significant contribution to the work of community mental health teams, offering a unique perspective and currently providing a unique role through the ASW function, but they are a scarce and declining resource. This is in stark contrast to many other countries, notably the USA, where social workers are the main professional group in mental health services, but also closer to home in Northern Ireland, where the rates (per 1000 population) of social workers in mental health services are three times those in England and Wales (Department of Health, Social Services and Public Safety, 2004). Employers and central government will need to consider ways of improving conditions for mental health social workers, focusing on how to make staff feel valued, enhancing decision latitude, reducing job demands and reconsidering the role of social work within current mental health services, as these features were also associated with job satisfaction.
Limitations
The following factors should be considered when interpreting these
data:
Conclusions
Multidisciplinary teams are the preferred model of mental healthcare
provision, and in the UK these now operate from integrated health and social
care ‘partnership’ trusts. The present study highlights that: the
environments in which mental health social workers work are associated with
job dissatisfaction and poor mental health; many mental health social workers
in these services are overstressed, emotionally exhausted and feel
undervalued. These factors might exacerbate recruitment and retention problems
if employers continue to fail to recognise the demands placed on mental health
social workers and to value their contribution; a large proportion of mental
health social workers have negative feelings about their current job, with
many having a strong desire to leave their current post, which has
implications for workforce planning; further research is required into ways to
decrease stress and improve job satisfaction among mental health social
workers and ASWs, with the aim of improving recruitment and retention.
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Clinical Implications and Limitations |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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LIMITATIONS
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ACKNOWLEDGMENTS |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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REFERENCES |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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Banks, M. H. & Jackson, P. R. (1982) Unemployment and risk of minor psychiatric disorder in young people: cross sectional and longitudinal evidence. Psychological Medicine, 12, 789 -798.[Medline]
Banks, M. H., Clegg, C.W., Jackson, P. R., et al (1980) The use of the General Health Questionnaire as an indicator of mental health occupational studies. Journal of Occupational Psychology, 53, 187 -194.
Department of Health (1995) Health Survey for England, 1994-5. London: Department of Health.
Department of Health, Social Services and Public Safety (2004) Inspection of Social Work in Mental Health Services. Belfast: Department of Health, Social Services and Public Safety.
Eborall, C. & Garmeson, K. (2001) Desk Research on Recruitment and Retention in Social Care and Social Work. London: Business and Industrial Market Research.
Employers' Organisation & Provincial Employers' Organisations (2002) Local Government Recruitment and Retention Survey. London: Employers' Organisation & Provincial Employers' Organisations.
Goldberg, D. (1992) General Health Questionnaire (GHQ-12). Windsor: NFER-Nelson.
Goldberg, D. & Huxley, P. (1992) Common Mental Disorder: A Bio-Social Model. London: Routledge.
Joseph, M. & Conrad, A. (1979) Social work influence on interdisciplinary ethical decision making in health care settings. Health and Social Work, 14, 22-30.
Karasek, R. (1979) Job demands, job decision latitude and mental strain. Implications for job redesign. Administrative Quarterly, 24, 285 -308.[CrossRef]
Lloyd, C. & King, R. (2002) Social work, stress and burnout: a review. Journal of Mental Health, 11, 255 -265.[CrossRef]
Maslach, C. & Jackson, S. E. (1986) Manual of the Maslach Burnout Inventory (2nd edn). Palo Alto, CA: Consulting Psychologists Press.
McLean, J. & Andrew, T. (2000) Commitment, satisfaction, stress and control among social services managers and social workers in the UK. Administration in Social Work, 23, 93-117.
National Audit Office (2002) Comprehensive Performance Assessment. Local Authority National Report. London: National Audit Office.
Pajak S., Mears, A., Kendall, T., et al (2003) Workload and Working Patterns in Consultant Psychiatrists. An Investigation into Occupational Pressures and Burdens. Project Report - June 2003. London: Royal College of Psychiatrists' Research Unit. http://www.rcpsych.ac.uk/cru/complete/workloadreport.pdf
Prosser, D., Johnson, S., Kuipers, E., et al
(1996) Mental health,’burnout’and job
satisfaction among hospital and community-based mental health.
British Journal of Psychiatry,
169, 334
-337.
Ross, E. (1993) Preventing burnout among social workers in the field of AIDS/HIV. Social Work in Health Care, 18, 91 -108.[CrossRef][Medline]
Siefert, K., Jayaratne, S. & Chess, W. (1991) Job-satisfaction, burnout and turnover in health care social workers. Health and Social Work, 16, 193 -202.
Tabachnick, B. G. & Fidell, L. S. (2001) Using Multivariate Statistics (4th edn). Boston: Allyn & Bacon.
Zunz, S. (1998) Resiliency and burnout: protective factors for human service managers. Administration in Social Work, 22, 39 -54.[CrossRef]
Received for publication February 11, 2004. Revision received September 27, 2004. Accepted for publication October 7, 2004.
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
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