Biostats 400 words Discussion (ANOVA)

BackgroundBackground PreviousresearchPreviousresearch suggests that socialworkers experiencesuggests that socialworkers experience

highlevels of stress and burnout butmosthighlevels of stress and burnout butmost

remain committedtotheir work.remain committedtotheir work.

AimsAims To examinethe prevalence ofTo examinethe prevalence of stress and burnout, andjob satisfactionstress and burnout, andjob satisfaction

amongmentalhealth socialworkersamongmentalhealth socialworkers

(MHSWs) andthe factorsresponsible for(MHSWs) andthe factorsresponsible for

this.this.

MethodMethod ApostalsurveyincorporatingApostalsurveyincorporating the General Health Questionnaire,the General Health Questionnaire,

Maslach Burnout Inventory,Karasek JobMaslach Burnout Inventory,Karasek Job

Content Questionnaire and ajobContent Questionnaire and ajob

satisfactionmeasure was sentto 610satisfactionmeasure was sentto 610

MHSWsin England and Wales.MHSWsin England and Wales.

ResultsResults Eligiblerespondents (Eligiblerespondents (nn¼237)237) reportedhighlevels of stress andreportedhighlevels of stress and

emotionalexhaustion andlowlevels of jobemotionalexhaustion andlowlevels of job

satisfaction; 111 (47%) showed significantsatisfaction; 111 (47%) showed significant

symptomatologyand distress, whichissymptomatologyand distress, whichis

twicethelevelreportedbysimilar surveystwicethelevelreportedbysimilar surveys

of psychiatrists.Feelingundervalued atof psychiatrists.Feelingundervalued at

work, excessivejob demands, limitedwork, excessivejob demands, limited

latitudein decision-making, andlatitudein decision-making, and

unhappiness aboutthe place of MHSWsinunhappiness aboutthe place of MHSWsin

modern services contributedtothe poormodern services contributed tothe poor

job satisfaction andmost aspects ofjob satisfaction andmost aspects of

burnout.Those who had approved socialburnout.Those who had approved social

worker statushadgreaterdissatisfaction.worker statushadgreaterdissatisfaction.

ConclusionsConclusions StressmayexacerbateStressmayexacerbate recruitment andretentionproblems.recruitment andretentionproblems.

Employersmustrecognisethe demandsEmployersmustrecognisethe demands

placedupon MHSWs andvaluetheirplacedupon MHSWs andvaluetheir

contributionto mentalhealth services.contributionto mentalhealth services.

Declaration of interestDeclaration of interest None.None. Fundingdetailedin Acknowledgement.Fundingdetailedin Acknowledgement.

With 81% of local authorities in the UKWith 81% of local authorities in the UK

reporting problems recruiting and retainingreporting problems recruiting and retaining

social workers, staffing is more problematicsocial workers, staffing is more problematic

in social work than in any other profes-in social work than in any other profes-

sional group (Employers’ Organisation &sional group (Employers’ Organisation &

Provincial Employers’ Organisations,Provincial Employers’ Organisations,

2002). High vacancy (5–16%) and turn-2002). High vacancy (5–16%) and turn-

over rates (7–30%) contribute to staffover rates (7–30%) contribute to staff

shortages, excessive workloads and relianceshortages, excessive workloads and reliance

on temporary staff, making modern socialon temporary staff, making modern social

work practice increasingly difficult (Eborallwork practice increasingly difficult (Eborall

& Garmeson, 2001). Work pressures can& Garmeson, 2001). Work pressures can

lead to burnout – a combination of emo-lead to burnout – a combination of emo-

tional exhaustion, depersonalisation andtional exhaustion, depersonalisation and

low personal accomplishment. Few studieslow personal accomplishment. Few studies

have examined burnout in social workershave examined burnout in social workers

(Siefert(Siefert et alet al, 1991; Ross, 1993; Zunz,, 1991; Ross, 1993; Zunz,

1998; Lloyd & King, 2002) but commit-1998; Lloyd & King, 2002) but commit-

ment to their work and service users, evenment to their work and service users, even

when under severe stress, was reaffirmedwhen under severe stress, was reaffirmed

in two UK studies (McLean & Andrew,in two UK studies (McLean & Andrew,

2000; Eborall & Garmeson, 2001).2000; Eborall & Garmeson, 2001).

Studies of other professional groupsStudies of other professional groups

have shown that stress commonly ariseshave shown that stress commonly arises

where one has little control (decision lati-where one has little control (decision lati-

tude) over one’s work (Karasek, 1979).tude) over one’s work (Karasek, 1979).

Higher levels of decision latitude are asso-Higher levels of decision latitude are asso-

ciated with a greater sense of personalciated with a greater sense of personal

accomplishment and satisfaction (Josephaccomplishment and satisfaction (Joseph

& Conrad, 1979). Workers with high job& Conrad, 1979). Workers with high job

demands, low decision latitude and lowdemands, low decision latitude and low

support at work are the most stressedsupport at work are the most stressed

(Karasek, 1979). These factors have not(Karasek, 1979). These factors have not

been studied in relation to one key memberbeen studied in relation to one key member

of multidisciplinary mental health teams –of multidisciplinary mental health teams –

mental health social workers. This nationalmental health social workers. This national

study fills that gap and complements astudy fills that gap and complements a

parallel study of psychiatrists conductedparallel study of psychiatrists conducted

using the same methodology (Pajakusing the same methodology (Pajak et alet al,,

2003).2003).

The study aimed to: (a) characteriseThe study aimed to: (a) characterise

the mental health social work workforcethe mental health social work workforce

in terms of demography, experience, jobin terms of demography, experience, job

content, workload, working environment,content, workload, working environment,

health and well-being; and (b) explainhealth and well-being; and (b) explain

the nature and direction of associationsthe nature and direction of associations

between these explanatory variables andbetween these explanatory variables and

mental health, burnout and job satisfaction.mental health, burnout and job satisfaction.

METHODMETHOD

DesignDesign

A multi-method design was adopted. Ques-A multi-method design was adopted. Ques-

tionnaire content was informed by twotionnaire content was informed by two

focus groups involving practising socialfocus groups involving practising social

workers from the South London andworkers from the South London and

Maudsley NHS Trust. Three structured,Maudsley NHS Trust. Three structured,

standardised instruments were added tostandardised instruments were added to

the questionnaire, prior to piloting withthe questionnaire, prior to piloting with

social workers, who were ineligible for thesocial workers, who were ineligible for the

main study. Following minor revisions,main study. Following minor revisions,

the questionnaire was included in athe questionnaire was included in a

national postal survey of a randomlynational postal survey of a randomly

selected sample of mental health socialselected sample of mental health social

workers in England and Wales. The samplingworkers in England and Wales. The sampling

frame is described below. Participants wereframe is described below. Participants were

asked to return the questionnaire in aasked to return the questionnaire in a

stamped addressed envelope within 1 month.stamped addressed envelope within 1 month.

Dependant variablesDependant variables

The General Health Questionnaire (GHQ–The General Health Questionnaire (GHQ–

12; Goldberg, 1992) is a dimensional12; Goldberg, 1992) is a dimensional

indicator of common mental disorderindicator of common mental disorder

(Goldberg & Huxley, 1992) from which a(Goldberg & Huxley, 1992) from which a

summed score is produced; higher scoressummed score is produced; higher scores

indicate poorer mental health. It has satis-indicate poorer mental health. It has satis-

factory psychometric properties (Goldberg,factory psychometric properties (Goldberg,

1992) and has been widely used on various1992) and has been widely used on various

occupational health samples (Banksoccupational health samples (Banks et alet al,,

1980; Banks & Jackson, 1982), including1980; Banks & Jackson, 1982), including

mental health professionals (Prossermental health professionals (Prosser et alet al,,

1996).1996).

Burnout is defined as exhaustion result-Burnout is defined as exhaustion result-

ing from excessive demands on energy anding from excessive demands on energy and

resources. The Maslach Burnout Inventoryresources. The Maslach Burnout Inventory

(Maslach & Jackson, 1986) is the most(Maslach & Jackson, 1986) is the most

widely used measure of burnout and haswidely used measure of burnout and has

previously been used in mental health ser-previously been used in mental health ser-

vices research (Prosservices research (Prosser et alet al, 1996). This, 1996). This

22-item, 6-point anchored Likert scale has22-item, 6-point anchored Likert scale has

three components: ‘emotional exhaustion’three components: ‘emotional exhaustion’

(the depletion of emotional resources,(the depletion of emotional resources,

leading workers to feel unable to give ofleading workers to feel unable to give of

themselves at a psychological level); ‘de-themselves at a psychological level); ‘de-

personalisation’ (negative, cynical attitudespersonalisation’ (negative, cynical attitudes

and feelings about clients); and reducedand feelings about clients); and reduced

‘personal accomplishment’ (evaluating one-‘personal accomplishment’ (evaluating one-

self negatively, particularly with regardself negatively, particularly with regard

to work with clients). Burnout existsto work with clients). Burnout exists

when the thresholds for each sub-when the thresholds for each sub-

scale are reached (emotional exhaustionscale are reached (emotional exhaustion

5521; depersonalisation21; depersonalisation 558; personal8; personal accomplishmentaccomplishment 4428; Prosser28; Prosser et alet al, 1996)., 1996).

Job satisfaction was measured by aJob satisfaction was measured by a

single-item, standardised rating of ‘satis-single-item, standardised rating of ‘satis-

faction with your current job’, rated usingfaction with your current job’, rated using

the seven-point ‘delighted–terrible’ scalethe seven-point ‘delighted–terrible’ scale

(Andrews & Withey, 1976).(Andrews & Withey, 1976).

7 57 5

B RI T I SH J OUR N AL O F P SYC HI AT RYB R I T IS H J O UR N A L O F P SYC HIAT RY ( 2 0 0 6 ) , 1 8 8 , 7 5 ^ 8 0( 2 0 0 6 ) , 1 8 8 , 7 5 ^ 8 0

Mental health, burnout and job satisfaction amongMental health, burnout and job satisfaction among

mental health social workers in England and Walesmental health social workers in England and Wales

SHERRILL EVANS, PETER HUXLEY, CLAIRE GATELY, MARTIN WEBBER,SHERRILL EVANS, PETER HUXLEY, CLAIRE GATELY, MARTIN WEBBER, ALEX MEARS, SARAH PAJAK, JIBBY MEDINA, TIM KENDALLALEX MEARS, SARAH PAJAK, JIBBY MEDINA, TIM KENDALL and CORNELIUS KATONAand CORNELIUS KATONA

E VANS E T ALE VANS E T AL

Explanatory variablesExplanatory variables

The main variables used to explain theThe main variables used to explain the

dependent variables were the nature of thedependent variables were the nature of the

job and the immediate context in whichjob and the immediate context in which

it took place. The Karasek Job Contentit took place. The Karasek Job Content

Questionnaire (Karasek, 1979) providedQuestionnaire (Karasek, 1979) provided

standardised sub-scale ratings of decisionstandardised sub-scale ratings of decision

latitude, psychological job demands andlatitude, psychological job demands and

social support in the workplace (fromsocial support in the workplace (from

supervisors and co-workers). Other stand-supervisors and co-workers). Other stand-

ardised ratings related to feelings aboutardised ratings related to feelings about

the employer, the place of social work inthe employer, the place of social work in

modern mental health services, governmentmodern mental health services, government

policy on mental health and the proposedpolicy on mental health and the proposed

new Mental Health Act. The questionnairenew Mental Health Act. The questionnaire

also included data relating to demographicsalso included data relating to demographics

and personal characteristics such as qualifi-and personal characteristics such as qualifi-

cations and job history, and objective andcations and job history, and objective and

subjective questions about work contextsubjective questions about work context

and environment.and environment.

The sampleThe sample

There is no readily available samplingThere is no readily available sampling

frame from which to draw a sample offrame from which to draw a sample of

mental health social workers or approvedmental health social workers or approved

social workers (ASWs); therefore a sam-social workers (ASWs); therefore a sam-

pling frame was generated through thepling frame was generated through the

Association of Directors of Social Services.Association of Directors of Social Services.

Directors provided contact details for theirDirectors provided contact details for their

leading manager for mental health services,leading manager for mental health services,

who was asked to provide a complete list ofwho was asked to provide a complete list of

current mental health social work staffcurrent mental health social work staff

(excluding emergency duty teams, agency(excluding emergency duty teams, agency

staff and managers). A one-in-five samplestaff and managers). A one-in-five sample

was selected from the list of names pro-was selected from the list of names pro-

vided by each council with social servicesvided by each council with social services

responsibilities using the Statistical Packageresponsibilities using the Statistical Package

for the Social Sciences (SPSS) randomfor the Social Sciences (SPSS) random

sample generator, limiting the number ofsample generator, limiting the number of

participants in each council to four.participants in each council to four.

Of the 171 councils with social servicesOf the 171 councils with social services

responsibilities in England and Wales, 145responsibilities in England and Wales, 145

were willing to participate (85%); 109 ofwere willing to participate (85%); 109 of

these 145 (75%) provided a list of theirthese 145 (75%) provided a list of their

mental health social workers within themental health social workers within the

deadline. Preliminary analyses indicateddeadline. Preliminary analyses indicated

that responding authorities did not differthat responding authorities did not differ

from non-responding authorities in termsfrom non-responding authorities in terms

of authority type (county, unitary, metro-of authority type (county, unitary, metro-

politan, London borough) or the Nationalpolitan, London borough) or the National

Audit Office’s (2002) comprehensive per-Audit Office’s (2002) comprehensive per-

formance analysis (a star rating system offormance analysis (a star rating system of

service quality) results for adult services.service quality) results for adult services.

There were 610 questionnaires (plusThere were 610 questionnaires (plus

diaries) distributed. Staff in 88 authoritiesdiaries) distributed. Staff in 88 authorities

responded (52% of all councils with socialresponded (52% of all councils with social

services responsibilities, 61% of thoseservices responsibilities, 61% of those

willing to participate, and 81% of thosewilling to participate, and 81% of those

providing a list within the deadline). Thereproviding a list within the deadline). There

were 462 questionnaires returned (76%)were 462 questionnaires returned (76%)

but 125 of these (27%) were ineligiblebut 125 of these (27%) were ineligible

because they did not match the specifiedbecause they did not match the specified

inclusion criteria (i.e. they were from stu-inclusion criteria (i.e. they were from stu-

dents, managers or members of emergencydents, managers or members of emergency

duty teams). There were 237 (39%) ques-duty teams). There were 237 (39%) ques-

tionnaires eligible for inclusion in the ana-tionnaires eligible for inclusion in the ana-

lysis, giving an adjusted response rate oflysis, giving an adjusted response rate of

49% (237/(61049% (237/(61077125)125)�100). The real re-100). The real re- sponse rate is probably higher given thatsponse rate is probably higher given that

more than a quarter of the questionnairesmore than a quarter of the questionnaires

returned were ineligible, assuming that areturned were ineligible, assuming that a

similar proportion of non-responderssimilar proportion of non-responders

would have been ineligible.would have been ineligible.

Statistical analysisStatistical analysis

Data were analysed using SPSS for Win-Data were analysed using SPSS for Win-

dows, version 11.0. Descriptive statisticsdows, version 11.0. Descriptive statistics

were used to describe the sample in termswere used to describe the sample in terms

of personal characteristics, work contextof personal characteristics, work context

and environment, health, well-being andand environment, health, well-being and

job satisfaction.job satisfaction.

One-way analysis of variance (ANOVA;One-way analysis of variance (ANOVA;

with Bonferroni correction, to allow forwith Bonferroni correction, to allow for

multiple comparisons) was used to examinemultiple comparisons) was used to examine

between-group differences in GHQ totalbetween-group differences in GHQ total

score, Maslach sub-scores and job satisfac-score, Maslach sub-scores and job satisfac-

tion. The independent variables for thesetion. The independent variables for these

ANOVAs were constructed by classifyingANOVAs were constructed by classifying

each of the Karasek sub-scales (jobeach of the Karasek sub-scales (job

demands, decision latitude and socialdemands, decision latitude and social

support) into categorical variables repre-support) into categorical variables repre-

senting low, medium and high scores,senting low, medium and high scores,

according to recommended thresholdsaccording to recommended thresholds

(Karasek, 1979). The GHQ total was com-(Karasek, 1979). The GHQ total was com-

puted using both the GHQ scoring methodputed using both the GHQ scoring method

and the Likert method, to facilitateand the Likert method, to facilitate

comparison with previous studies.comparison with previous studies.

A series of linear regression models wasA series of linear regression models was

constructed (using the ‘enter’ method) toconstructed (using the ‘enter’ method) to

explain the variance in the main dependentexplain the variance in the main dependent

variables, and the relative magnitude andvariables, and the relative magnitude and

direction of their associations with jobdirection of their associations with job

demands, decision latitude and socialdemands, decision latitude and social

support, when other confounding andsupport, when other confounding and

mediating effects were controlled for. Themediating effects were controlled for. The

model assumed that each of the dependentmodel assumed that each of the dependent

variables was associated directly withvariables was associated directly with

job demand, decision latitude and socialjob demand, decision latitude and social

support but that these associations mightsupport but that these associations might

be confounded by work context/environ-be confounded by work context/environ-

ment and subjective feelings about thatment and subjective feelings about that

environment, but mediated by personalenvironment, but mediated by personal

characteristics. Each model included:characteristics. Each model included:

(a)(a) total scores for each of the Karasek sub-total scores for each of the Karasek sub-

scales;scales;

(b)(b) work context and environment vari-work context and environment vari-

ables, specifically social work vacancyables, specifically social work vacancy

rate within the team, number of extrarate within the team, number of extra

hours worked per week, case-load,hours worked per week, case-load,

time spent on duty (the social worktime spent on duty (the social work

equivalent of first on call for ASWs orequivalent of first on call for ASWs or

time spent providing emergencytime spent providing emergency

response to new referrals at the officeresponse to new referrals at the office

base), and being a member of an inte-base), and being a member of an inte-

grated teamgrated team (a dummy variable);(a dummy variable);

(c)(c) subjective variables relating to feelingssubjective variables relating to feelings

about pay, being valued, the place ofabout pay, being valued, the place of

social work in mental health servicessocial work in mental health services

and the proposed mental health bill;and the proposed mental health bill;

(d)(d) personal characteristic variables forpersonal characteristic variables for

age, gender, length of time in thisage, gender, length of time in this

post, number of days sick taken in thepost, number of days sick taken in the

past year and whether active as anpast year and whether active as an

ASW (dummy).ASW (dummy).

The number of variables entered wasThe number of variables entered was

kept within recommended limits (totalkept within recommended limits (total

casescases¼8866number of variables in thenumber of variables in the model+50 cases; Tabachnick & Fidell,model+50 cases; Tabachnick & Fidell,

2001).2001).

RESULTSRESULTS

Personal characteristicsPersonal characteristics

Sixty-one per cent (Sixty-one per cent (nn¼145) of respondents145) of respondents were female. Most of the sample was agedwere female. Most of the sample was aged

under 50 (under 50 (nn¼133, 58% of the 228 respon-133, 58% of the 228 respon- dents who answered this question) and thedents who answered this question) and the

mean age was 46 years (s.d.mean age was 46 years (s.d.¼9.2). Only9.2). Only 10% (10% (nn¼24) of the sample were from min-24) of the sample were from min- ority ethnic or other cultural groups; 2%ority ethnic or other cultural groups; 2%

((nn¼5) were Black Caribbean and 1%5) were Black Caribbean and 1% ((nn¼2) Black African, the rest were from2) Black African, the rest were from other European countries, America or Aus-other European countries, America or Aus-

tralia. Demographically, our sample oftralia. Demographically, our sample of

mental health social workers included moremental health social workers included more

females, was older and more ethnicallyfemales, was older and more ethnically

diverse than participants in a large surveydiverse than participants in a large survey

of generic social workers (McLean &of generic social workers (McLean &

Andrew, 2000).Andrew, 2000).

Eighty-three per cent (Eighty-three per cent (nn¼197) of the197) of the sample worked full-time. Respondentssample worked full-time. Respondents

worked a mean of 43 h (s.d.worked a mean of 43 h (s.d.¼7.0) per week7.0) per week (8393 h/195 workers), an excess over con-(8393 h/195 workers), an excess over con-

tracted hours of approximately 6 per weektracted hours of approximately 6 per week

per worker. Thirty-nine per cent of theper worker. Thirty-nine per cent of the

working week was spent in face-to-faceworking week was spent in face-to-face

contact with service users or carers andcontact with service users or carers and

29% on administration (partly owing to29% on administration (partly owing to

limited support). Respondents reported alimited support). Respondents reported a

mean of 15 h (s.d.mean of 15 h (s.d.¼10.9) on duty during10.9) on duty during the working week. The mean job tenurethe working week. The mean job tenure

with the current employer was 7.6 yearswith the current employer was 7.6 years

(s.d.(s.d.¼7.0), although not necessarily in7.0), although not necessarily in mental health work for the whole period.mental health work for the whole period.

Respondents were experienced workersRespondents were experienced workers

with a mean of 11.9 years (s.d.with a mean of 11.9 years (s.d.¼8.7) since8.7) since social work qualification. Sixty-eight persocial work qualification. Sixty-eight per

7676

BURNOUT A MONG MENTAL HE ALTH S OC IAL WORK E R SBURNOUT AMONG MENTAL HE ALTH S OCIAL WOR K E R S

cent of the sample (cent of the sample (nn¼162) were active162) were active ASWs; most of the remainder (referred toASWs; most of the remainder (referred to

in the results as non-ASWs) were awaitingin the results as non-ASWs) were awaiting

ASW training. ASWs had been approvedASW training. ASWs had been approved

for a mean of 7.0 years (s.d.for a mean of 7.0 years (s.d.¼6.0) and were6.0) and were older than non-ASWs (mean ageolder than non-ASWs (mean age¼4848 (s.d.(s.d.¼8.2)8.2) vv. 42 years (s.d.. 42 years (s.d.¼10.0)).10.0)).

Work context and the workingWork context and the working environmentenvironment

Respondents worked in teams that had aRespondents worked in teams that had a

mean of 16.5 (s.d.mean of 16.5 (s.d.¼8.2) members (median8.2) members (median 14; mode 12; range 4–40). Integrated teams14; mode 12; range 4–40). Integrated teams

tended to be larger, having a mean of 18tended to be larger, having a mean of 18

members (s.d.members (s.d.¼8.1). The mean case-load8.1). The mean case-load was 24.3 (s.d.was 24.3 (s.d.¼13.1; median 24; mode13.1; median 24; mode 25; range 1–70). Ten per cent (25; range 1–70). Ten per cent (nn¼24) had24) had case-loads of over 40. Members ofcase-loads of over 40. Members of

integrated teams had somewhat largerintegrated teams had somewhat larger

case-loads (meancase-loads (mean¼24.7; s.d.24.7; s.d.¼11.2) than11.2) than members of smaller specialist (e.g. assertivemembers of smaller specialist (e.g. assertive

outreach) teams (meanoutreach) teams (mean¼18.1; s.d.18.1; s.d.¼11.6).11.6). Sixty-three per cent of staff (Sixty-three per cent of staff (nn¼150)150) reported doing additional work to coverreported doing additional work to cover

for absent (primarily owing to sick leave)for absent (primarily owing to sick leave)

colleagues or for staff vacancies. Res-colleagues or for staff vacancies. Res-

pondents reported being unable to takepondents reported being unable to take

time off in lieu for working out of officetime off in lieu for working out of office

hours, because of pressure of work andhours, because of pressure of work and

the vacancy situation. Seventy per centthe vacancy situation. Seventy per cent

((nn¼166) of respondents thought that their166) of respondents thought that their current grade did not reflect the duties theycurrent grade did not reflect the duties they

performed and 43% (performed and 43% (nn¼102) felt102) felt undervalued at work.undervalued at work.

Health and well-beingHealth and well-being

Forty-seven per cent (Forty-seven per cent (nn¼111) of respon-111) of respon- dents scored 4 or above on the GHQ–12,dents scored 4 or above on the GHQ–12,

indicating a potential psychological dis-indicating a potential psychological dis-

order. When the lower cut-off for the iden-order. When the lower cut-off for the iden-

tification of probable common mentaltification of probable common mental

disorders (2/3) was used, the GHQ–12-disorders (2/3) was used, the GHQ–12-

positive rate rose to 55% (positive rate rose to 55% (nn¼130). Using130). Using

the Likert scoring method, the mean scorethe Likert scoring method, the mean score

was 26.9 (s.d.was 26.9 (s.d.¼6.0).6.0). Table 1 shows that mean scores onTable 1 shows that mean scores on

each of the Maslach Burnout Inventoryeach of the Maslach Burnout Inventory

sub-scales were higher than the reportedsub-scales were higher than the reported

mental health category norms (Maslach &mental health category norms (Maslach &

Jackson, 1986). Mental health social work-Jackson, 1986). Mental health social work-

ers were more emotionally exhausted anders were more emotionally exhausted and

more depersonalised than the average men-more depersonalised than the average men-

tal health worker but experienced moretal health worker but experienced more

personal accomplishment. They were alsopersonal accomplishment. They were also

more emotionally exhausted than psychia-more emotionally exhausted than psychia-

trists in the parallel study (Pajaktrists in the parallel study (Pajak et alet al,,

2003) but were less depersonalised and2003) but were less depersonalised and

experienced less personal accomplishment.experienced less personal accomplishment.

Nevertheless, only 8% of respondents metNevertheless, only 8% of respondents met

the threshold for burnout as defined abovethe threshold for burnout as defined above

((nn¼18).18). Approved social workers reportedApproved social workers reported

taking more sick leave (meantaking more sick leave (mean¼12 days,12 days, s.d.s.d.¼30.1) than non-ASWs (mean30.1) than non-ASWs (mean¼7 days,7 days, s.d.s.d.¼12.4). The rate for ASWs was skewed12.4). The rate for ASWs was skewed by three cases of more than 90 days’by three cases of more than 90 days’

sickness but the difference between ASWssickness but the difference between ASWs

and non-ASWs just failed to reach signifi-and non-ASWs just failed to reach signifi-

cance (cance (tt¼771.91 (229),1.91 (229), PP¼0.057). Never-0.057). Never- theless, the mean duration of sick leavetheless, the mean duration of sick leave

for ASWs was twice that for psychiatristsfor ASWs was twice that for psychiatrists

(Pajak(Pajak et alet al, 2003). Approved social work-, 2003). Approved social work-

ers were also more likely than non-ASWsers were also more likely than non-ASWs

to report taking unspecified stress-relievingto report taking unspecified stress-relieving

medications (10% (medications (10% (nn¼16)16) vv. 7% (. 7% (nn¼5)),5)), another non-significant difference (another non-significant difference (ww22¼0.630.63 (1),(1), PP¼0.30).0.30).

Job satisfactionJob satisfaction

Forty-seven per cent (Forty-seven per cent (nn¼111) of res-111) of res- pondents were at least ‘mostly satisfied’pondents were at least ‘mostly satisfied’

with their current job but 35% (with their current job but 35% (nn¼83)83) were ambivalent and 19% (were ambivalent and 19% (nn¼43) were dis-43) were dis- satisfied; the mean job satisfaction ratingsatisfied; the mean job satisfaction rating

was 4.4 (s.d.was 4.4 (s.d.¼1.2, range 1–7). Far fewer1.2, range 1–7). Far fewer people were satisfied with their employer,people were satisfied with their employer,

22% (22% (nn¼52) being at least ‘mostly52) being at least ‘mostly

satisfied’, 37% ambivalent (satisfied’, 37% ambivalent (nn¼88) and88) and 41% (41% (nn¼98) dissatisfied (mean98) dissatisfied (mean¼3.7,3.7, s.d.s.d.¼1.2, range 1–7).1.2, range 1–7).

Over a quarter of respondents (28%,Over a quarter of respondents (28%,

nn¼66) had a strong or very strong desire66) had a strong or very strong desire to leave their present post and 21%to leave their present post and 21%

((nn¼48) had specific plans to do so. A strong48) had specific plans to do so. A strong or very strong desire to leave one’s job wasor very strong desire to leave one’s job was

related to ASW status: 33% of ASWs com-related to ASW status: 33% of ASWs com-

pared with 19% of non-ASWs wanted topared with 19% of non-ASWs wanted to

leave (leave (ww22¼9.6 (3),9.6 (3), PP550.05).0.05).

Associations with mental health,Associations with mental health, burnout and job satisfactionburnout and job satisfaction

The ANOVA results presented in Table 2The ANOVA results presented in Table 2

demonstrate that low decision latitudedemonstrate that low decision latitude

andand high job demands were associatedhigh job demands were associated

with poor mental health (determined bywith poor mental health (determined by

higher GHQ–12 scores) and emotionalhigher GHQ–12 scores) and emotional

exhaustion. Conversely, greater decisionexhaustion. Conversely, greater decision

latitude and lower job demands werelatitude and lower job demands were

associated with higher levels of job satis-associated with higher levels of job satis-

faction. Low social support was alsofaction. Low social support was also

associated with emotional exhaustionassociated with emotional exhaustion

whereas medium or high social supportwhereas medium or high social support

were associated with greater job satisfac-were associated with greater job satisfac-

tion. Few job content characteristics weretion. Few job content characteristics were

associated with personal accomplishmentassociated with personal accomplishment

or depersonalisation.or depersonalisation.

Table 3 shows the results of multivari-Table 3 shows the results of multivari-

ate analyses that examined whether theate analyses that examined whether the

effects of decision latitude, job demandseffects of decision latitude, job demands

and social support were independent ofand social support were independent of

work context/environment, subjective feel-work context/environment, subjective feel-

ings and personal characteristics, andings and personal characteristics, and

explored which other variables contributedexplored which other variables contributed

to the explanation of the dependentto the explanation of the dependent

variables.variables.

The results suggested that high jobThe results suggested that high job

demands and low decision latitude weredemands and low decision latitude were

independently associated with poor mentalindependently associated with poor mental

health but high GHQ–12 scores were alsohealth but high GHQ–12 scores were also

associated with the number of additionalassociated with the number of additional

hours worked per week and not feelinghours worked per week and not feeling

valued by the employer.valued by the employer.

High emotional exhaustion was alsoHigh emotional exhaustion was also

associated directly with higher job demandsassociated directly with higher job demands

but not with low decision latitude or lowbut not with low decision latitude or low

social support, when features of the worksocial support, when features of the work

environment, personal characteristics andenvironment, personal characteristics and

subjective feelings were controlled for.subjective feelings were controlled for.

These results suggest that the original asso-These results suggest that the original asso-

ciations between emotional exhaustion andciations between emotional exhaustion and

these aspects of job content (based onthese aspects of job content (based on

ANOVAs) might have been confounded.ANOVAs) might have been confounded.

Personal accomplishment was associatedPersonal accomplishment was associated

with high decision latitude, suggesting thatwith high decision latitude, suggesting that

it was not confounded with the other expla-it was not confounded with the other expla-

natory factors. Depersonalisation was stillnatory factors. Depersonalisation was still

7 77 7

Table 1Table 1 Features of burnout in mental health professionalsFeatures of burnout in mental health professionals

Dependent variableDependent variable MHSWsMHSWs

((nn¼237)237) ConsultantConsultant

psychiatristspsychiatrists

((nn¼181)181)11

Mental healthMental health

category normscategory norms

((nn¼730)730)22

Maslach Burnout Inventory sub-scale score: mean (s.d.)Maslach Burnout Inventory sub-scale score: mean (s.d.)

Emotional exhaustionEmotional exhaustion 26.3 (10.1)26.3 (10.1) 24.2 (11.3)24.2 (11.3) 16.9 (8.9)16.9 (8.9)

DepersonalisationDepersonalisation 7.3 (5.2)7.3 (5.2) 8.5 (6.1)8.5 (6.1) 5.7 (4.6)5.7 (4.6)

Personal accomplishmentPersonal accomplishment 33.9 (6.8)33.9 (6.8) 36.0 (5.7)36.0 (5.7) 30.9 (6.4)30.9 (6.4)

MHSWs, mental health social workers.MHSWs, mental health social workers. 1. Data from Pajak1. Data from Pajak et alet al, 2003., 2003. 2. Data from Maslach & Jackson,1986.2. Data from Maslach & Jackson,1986.

E VANS E T ALE VANS E T AL

not associated with any aspect of job con-not associated with any aspect of job con-

tent (decision latitude, job demands andtent (decision latitude, job demands and

social support) but was associated with dis-social support) but was associated with dis-

satisfaction about the role of mental healthsatisfaction about the role of mental health

social work in the current mental healthsocial work in the current mental health

services, not feeling valued by the employerservices, not feeling valued by the employer

and being male.and being male.

Finally, job satisfaction was associatedFinally, job satisfaction was associated

directly with lower job demands and higherdirectly with lower job demands and higher

decision latitude but not with social sup-decision latitude but not with social sup-

port, when other explanatory variablesport, when other explanatory variables

were included in the model. Being valuedwere included in the model. Being valued

by their employer and positive feelingsby their employer and positive feelings

about the role of social work in currentabout the role of social work in current

mental health services were also associatedmental health services were also associated

with job satisfaction, whereas being activewith job satisfaction, whereas being active

as an ASW was associated most stronglyas an ASW was associated most strongly

with job dissatisfaction. These results sug-with job dissatisfaction. These results sug-

gest that personal characteristics, aspectsgest that personal characteristics, aspects

of the working environment or feelingsof the working environment or feelings

about that environment might confoundabout that environment might confound

the univariate association between jobthe univariate association between job

satisfaction and social support.satisfaction and social support.

The model explained similar amounts ofThe model explained similar amounts of

variance in emotional exhaustion and jobvariance in emotional exhaustion and job

satisfaction, less in mental health and littlesatisfaction, less in mental health and little

of the variance in other aspects of burnout.of the variance in other aspects of burnout.

DISCUSSIONDISCUSSION

The most striking findings of the survey areThe most striking findings of the survey are

the very high levels of stress and emotionalthe very high levels of stress and emotional

exhaustion in the sample. Mean GHQ–12exhaustion in the sample. Mean GHQ–12

scores for mental health social workersscores for mental health social workers

were almost double the highest rate re-were almost double the highest rate re-

ported by Prosserported by Prosser et alet al (1996), which was(1996), which was

for community-based mental health staff.for community-based mental health staff.

The GHQ-positive rate was 47% usingThe GHQ-positive rate was 47% using

the cut-off of 4, which was almost doublethe cut-off of 4, which was almost double

the rate for consultant psychiatrists (25%;the rate for consultant psychiatrists (25%;

PajakPajak et alet al, 2003) and nearly three times, 2003) and nearly three times

the level in the general population (17%;the level in the general population (17%;

Department of Health, 1995). Similarly,Department of Health, 1995). Similarly,

mean scores for emotional exhaustion weremean scores for emotional exhaustion were

higher than for psychiatrists (Pajakhigher than for psychiatrists (Pajak et alet al,,

2003) and mean scores on all three burnout2003) and mean scores on all three burnout

sub-scales were higher than norms for thesub-scales were higher than norms for the

mental health workforce (Maslach & Jack-mental health workforce (Maslach & Jack-

son, 1986). The main determination of theson, 1986). The main determination of the

high rates of stress and emotionalhigh rates of stress and emotional

exhaustion appear to be high job demandexhaustion appear to be high job demand

and not feeling valued for the work thatand not feeling valued for the work that

you do. Other factors, such as number ofyou do. Other factors, such as number of

hours worked, decision latitude and feel-hours worked, decision latitude and feel-

ings about the way in which social workings about the way in which social work

is perceived within mental health services,is perceived within mental health services,

are also important determinants of stressare also important determinants of stress

and features of burnout.and features of burnout.

High levels of stress and emotionalHigh levels of stress and emotional

exhaustion among the workforce are a con-exhaustion among the workforce are a con-

cern and likely to contribute further to thecern and likely to contribute further to the

high vacancy rates associated with recruit-high vacancy rates associated with recruit-

ment and retention problems within thement and retention problems within the

social work profession (Eborall & Garme-social work profession (Eborall & Garme-

son, 2001; Employers’ Organisation &son, 2001; Employers’ Organisation &

Provincial Employers’ Organisations,Provincial Employers’ Organisations,

2002). One might have expected to find a2002). One might have expected to find a

direct association between team vacancydirect association between team vacancy

rates and stress/emotional exhaustion butrates and stress/emotional exhaustion but

these relationships failed to appear. Thisthese relationships failed to appear. This

might be due to the low level of actualmight be due to the low level of actual

vacancies in most teams – 65% of partici-vacancies in most teams – 65% of partici-

pants reported no social work vacancies inpants reported no social work vacancies in

their team. Nevertheless, 63% of respon-their team. Nevertheless, 63% of respon-

dents provided cover for absent colleagues,dents provided cover for absent colleagues,

which may have included training or sickwhich may have included training or sick

leave, not simply for vacant posts. Theleave, not simply for vacant posts. The

practice of using agency workers to coverpractice of using agency workers to cover

vacancies in teams may have reduced thevacancies in teams may have reduced the

vacancy rates reported. Further research isvacancy rates reported. Further research is

required to determine whether the practicerequired to determine whether the practice

of employing agency staff, at higher ratesof employing agency staff, at higher rates

7 87 8

Table 2Table 2 Variation in mental health, burnout and job satisfaction scores (mean (s.d.)) according to job decision latitude, job demand and social support in the workplaceVariation in mental health, burnout and job satisfaction scores (mean (s.d.)) according to job decision latitude, job demand and social support in the workplace

Dependent variableDependent variable Karasek decision latitudeKarasek decision latitude Karasek job demandKarasek job demand Karasek social supportKarasek social support

LowLow

((nn¼68)68) MediumMedium

((nn¼31)31) HighHigh

((nn¼81)81) ANOVAANOVA LowLow

((nn¼63)63) MediumMedium

((nn¼81)81) HighHigh

((nn¼85)85) ANOVAANOVA LowLow

((nn¼58)58) MediumMedium

((nn¼94)94) HighHigh

((nn¼81)81) ANOVAANOVA

GHQ^12 Likert scoreGHQ^12 Likert score 29.2*29.2*

(6.6)(6.6)

26.726.7

(5.6)(5.6)

25.025.0

(5.1)(5.1)

FF¼9.719.71 (d.f.(d.f.¼2, 225)2, 225) PP550.0010.001

25.225.2

(5.5)(5.5)

25.425.4

(5.1)(5.1)

29.6*29.6*

(6.4)(6.4)

FF¼14.9514.95 (d.f.(d.f.¼2, 224)2, 224) PP550.0010.001

28.528.5

(6.7)(6.7)

26.426.4

(6.0)(6.0)

26.326.3

(5.4)(5.4)

FF¼2.932.93 (d.f.(d.f.¼2, 228)2, 228) PP¼0.0550.055

Maslach Burnout InventoryMaslach Burnout Inventory

Emotional exhaustionEmotional exhaustion 29.7*29.7*

(10.4)(10.4)

25.325.3

(9.4)(9.4)

24.924.9

(10.0)(10.0)

FF¼5.005.00 (d.f.(d.f.¼2, 221)2, 221) PP¼0.0080.008

21.521.5

(10.0)(10.0)

24.124.1

(9.7)(9.7)

31.8*31.8*

(7.9)(7.9)

FF¼25.4425.44 (d.f.(d.f.¼2, 219)2, 219) PP550.0010.001

29.8**29.8**

(10.9)(10.9)

24.224.2

(10.0)(10.0)

26.126.1

(8.9)(8.9)

FF¼5.535.53 (d.f.(d.f.¼2, 223)2, 223) PP¼0.0050.005

DepersonalisationDepersonalisation 8.88.8

(6.1)(6.1)

6.96.9

(4.4)(4.4)

6.96.9

(4.9)(4.9)

FF¼3.203.20 (d.f.(d.f.¼2, 221)2, 221) PP¼0.0430.043

6.46.4

(4.5)(4.5)

7.57.5

(5.0)(5.0)

7.97.9

(5.7)(5.7)

FF¼1.531.53 (d.f.(d.f.¼2, 219)2, 219) PP¼0.2190.219

8.48.4

(6.1)(6.1)

6.76.7

(4.8)(4.8)

7.37.3

(4.8)(4.8)

FF¼1.641.64 (d.f.(d.f.¼2, 224)2, 224) PP¼0.1950.195

Personal accomplishmentPersonal accomplishment 31.631.6

(6.2)(6.2)

33.433.4

(7.0)(7.0)

36.6*36.6*

(5.9)(5.9)

FF¼11.5611.56 (d.f.(d.f.¼2, 217)2, 217) PP550.0010.001

32.432.4

(7.8)(7.8)

34.134.1

(6.7)(6.7)

34.534.5

(5.9)(5.9)

FF¼1.761.76 (d.f.(d.f.¼2, 216)2, 216) PP¼0.1740.174

33.433.4

(7.4)(7.4)

34.034.0

(6.7)(6.7)

34.234.2

(6.6)(6.6)

FF¼0.220.22 (d.f.(d.f.¼2, 221)2, 221) PP¼0.8020.802

Job satisfactionJob satisfaction 3.6*3.6*

(1.3)(1.3)

4.54.5

(1.0)(1.0)

4.94.9

(1.1)(1.1)

FF¼24.4424.44 (d.f.(d.f.¼2, 225)2, 225) PP550.0010.001

4.64.6

(1.2)(1.2)

4.64.6

(1.1)(1.1)

3.9*3.9*

(1.2)(1.2)

FF¼9.079.07 (d.f.(d.f.¼2, 221)2, 221) PP550.0010.001

3.8*3.8*

(1.4)(1.4)

4.54.5

(1.1)(1.1)

4.74.7

(1.1)(1.1)

FF¼11.7111.71 (d.f.(d.f.¼2, 225)2, 225) PP550.0010.001

GHQ^12,General Health Questionnaire; ANOVA, analysis of variance.GHQ^12,General Health Questionnaire; ANOVA, analysis of variance. *Significantly different from both other categories when Bonferroni procedure applied.*Significantly different from both other categories when Bonferroni procedure applied. **Significantly different from medium-support category when Bonferroni procedure applied.**Significantly different from medium-support category when Bonferroni procedure applied.

BURNOUT A MONG MENTAL HE ALTH S OC IAL WORK E R SBURNOUT AMONG MENTAL HE ALTH S OCIAL WOR K E R S

of pay than statutory sector employeesof pay than statutory sector employees

and without statutory responsibilities,and without statutory responsibilities,

exacerbates job dissatisfaction, burnoutexacerbates job dissatisfaction, burnout

and recruitment and retention problems.and recruitment and retention problems.

The high levels of job dissatisfactionThe high levels of job dissatisfaction

and dissatisfaction with the employer giveand dissatisfaction with the employer give

further cause for concern. The burden offurther cause for concern. The burden of

statutory responsibilities associated withstatutory responsibilities associated with

the ASW function under the Mental Healththe ASW function under the Mental Health

Act 1983 also emerged as an important fac-Act 1983 also emerged as an important fac-

tor in job dissatisfaction (although thistor in job dissatisfaction (although this

finding is unlikely to be applicable outsidefinding is unlikely to be applicable outside

the UK where social workers do not carrythe UK where social workers do not carry

these responsibilities). Perhaps as a conse-these responsibilities). Perhaps as a conse-

quence, ASWs take slightly more sick leavequence, ASWs take slightly more sick leave

than non-ASWs and take sick leave at twicethan non-ASWs and take sick leave at twice

the rate of psychiatrists (Pajakthe rate of psychiatrists (Pajak et alet al, 2003)., 2003).

It is worrying that 20% of our sample had aIt is worrying that 20% of our sample had a

strong desire to leave their current post andstrong desire to leave their current post and

21% had specific plans to do so.21% had specific plans to do so.

Social workers make a significant con-Social workers make a significant con-

tribution to the work of community mentaltribution to the work of community mental

health teams, offering a unique perspectivehealth teams, offering a unique perspective

and currently providing a unique roleand currently providing a unique role

through the ASW function, but they are athrough the ASW function, but they are a

scarce and declining resource. This is inscarce and declining resource. This is in

stark contrast to many other countries,stark contrast to many other countries,

notably the USA, where social workers arenotably the USA, where social workers are

the main professional group in mentalthe main professional group in mental

health services, but also closer to home inhealth services, but also closer to home in

Northern Ireland, where the rates (perNorthern Ireland, where the rates (per

1000 population) of social workers in men-1000 population) of social workers in men-

tal health services are three times those intal health services are three times those in

England and Wales (Department of Health,England and Wales (Department of Health,

Social Services and Public Safety, 2004).Social Services and Public Safety, 2004).

Employers and central government willEmployers and central government will

need to consider ways of improving con-need to consider ways of improving con-

ditions for mental health social workers,ditions for mental health social workers,

focusing on how to make staff feel valued,focusing on how to make staff feel valued,

enhancing decision latitude, reducing jobenhancing decision latitude, reducing job

demands and reconsidering the role ofdemands and reconsidering the role of

social work within current mental healthsocial work within current mental health

services, as these features were also asso-services, as these features were also asso-

ciated with job satisfaction.ciated with job satisfaction.

LimitationsLimitations

The following factors should be consideredThe following factors should be considered

when interpreting these data:when interpreting these data:

(a)(a) the study was undertaken at a time ofthe study was undertaken at a time of

uncertainty for mental health socialuncertainty for mental health social

workers owing to the changing role ofworkers owing to the changing role of

the ASW and the proposals includedthe ASW and the proposals included

in the Draft Mental Health Bill, whichin the Draft Mental Health Bill, which

may have been reflected in our findings;may have been reflected in our findings;

(b)(b) self-selection and factors external to theself-selection and factors external to the

job might have contributed to highjob might have contributed to high

rates of stress within the workforce,rates of stress within the workforce,

although random selection and thealthough random selection and the

regression results suggest that theregression results suggest that the

impact was unlikely to be substantial;impact was unlikely to be substantial;

(c)(c) although acceptable, the return ratealthough acceptable, the return rate

from individual social workers suggestsfrom individual social workers suggests

that a degree of caution should be exer-that a degree of caution should be exer-

cised when interpreting the results;cised when interpreting the results;

(d)(d) the cross-sectional design of the studythe cross-sectional design of the study

means that causal direction cannot bemeans that causal direction cannot be

determined.determined.

ConclusionsConclusions

Multidisciplinary teams are the preferredMultidisciplinary teams are the preferred

model of mental healthcare provision, andmodel of mental healthcare provision, and

in the UK these now operate from inte-in the UK these now operate from inte-

grated health and social care ‘partnership’grated health and social care ‘partnership’

trusts. The present study highlights that:trusts. The present study highlights that:

the environments in which mental healththe environments in which mental health

social workers work are associated withsocial workers work are associated with

7 97 9

Table 3Table 3 Linear regression models explaining the association between of mental health, burnout and job satisfactionLinear regression models explaining the association between of mental health, burnout and job satisfaction

Dependent variableDependent variable Parameters for modelParameters for model Independent variablesIndependent variables

with significant effectswith significant effects

Direction of effectDirection of effect BetaBeta PP

Adjusted RAdjusted R22 FF PP

GHQ^12 Likert scoreGHQ^12 Likert score 0.190.19 3.53 (d.f.3.53 (d.f.¼17)17) 550.0010.001 Job demandsJob demands Higher for higher demandsHigher for higher demands 0.300.30 550.0010.001 Decision latitudeDecision latitude Higher for low latitudeHigher for low latitude 770.200.20 0.0130.013

Feeling valuedFeeling valued Lower when more valuedLower when more valued 770.190.19 0.0240.024

Number of extra hoursNumber of extra hours

workedworked

Higher for more hours workedHigher for more hours worked 0.150.15 0.0370.037

Maslach Burnout InventoryMaslach Burnout Inventory

sub-scale scoresub-scale score

Emotional exhaustionEmotional exhaustion 0.300.30 5.45 (d.f.5.45 (d.f.¼17)17) 550.0010.001 Job demandsJob demands Higher for higher demandsHigher for higher demands 0.380.38 550.0010.001 Feeling valuedFeeling valued Lower when more valuedLower when more valued 770.160.16 0.0390.039

Feelings about the socialFeelings about the social

work rolework role

Higher for negative feelingsHigher for negative feelings 770.150.15 0.0500.050

Personal accomplishmentPersonal accomplishment 0.060.06 1.61 (d.f.1.61 (d.f.¼17)17) 0.0660.066 Decision latitudeDecision latitude Lower for lower latitudeLower for lower latitude 0.290.29 0.0010.001 DepersonalisationDepersonalisation 0.150.15 2.86 (d.f.2.86 (d.f.¼17)17) 550.0010.001 Feelings about the socialFeelings about the social

work rolework role

Higher for negative feelingsHigher for negative feelings 770.220.22 0.0100.010

Feeling valuedFeeling valued Higher when less valuedHigher when less valued 770.190.19 0.0240.024

GenderGender Lower for womenLower for women 770.180.18 0.0160.016

Job satisfactionJob satisfaction 0.320.32 6.08 (d.f.6.08 (d.f.¼17)17) 550.0010.001 Feeling valuedFeeling valued Higher when more valuedHigher when more valued 0.250.25 0.0020.002 Job demandsJob demands Lower for high demandsLower for high demands 770.220.22 0.0020.002

Decision latitudeDecision latitude Higher for high latitudeHigher for high latitude 0.210.21 0.0030.003

Active as an ASWActive as an ASW Lower for ASWsLower for ASWs 770.150.15 0.0290.029

Feelings about the socialFeelings about the social

work rolework role

Higher for positive feelingsHigher for positive feelings 0.150.15 0.0470.047

GHQ^12,General Health Questionnaire; ASW, approved social worker.GHQ^12,General Health Questionnaire; ASW, approved social worker.

E VANS E T ALE VANS E T AL

job dissatisfaction and poor mental health;job dissatisfaction and poor mental health;

many mental health social workers in thesemany mental health social workers in these

services are overstressed, emotionallyservices are overstressed, emotionally

exhausted and feel undervalued. Theseexhausted and feel undervalued. These

factors might exacerbate recruitment andfactors might exacerbate recruitment and

retention problems if employers continueretention problems if employers continue

to fail to recognise the demands placed onto fail to recognise the demands placed on

mental health social workers and to valuemental health social workers and to value

their contribution; a large proportion oftheir contribution; a large proportion of

mental health social workers have negativemental health social workers have negative

feelings about their current job, with manyfeelings about their current job, with many

having a strong desire to leave their currenthaving a strong desire to leave their current

post, which has implications for workforcepost, which has implications for workforce

planning; further research is required intoplanning; further research is required into

ways to decrease stress and improve jobways to decrease stress and improve job

satisfaction among mental health socialsatisfaction among mental health social

workers and ASWs, with the aim ofworkers and ASWs, with the aim of

improving recruitment and retention.improving recruitment and retention.

ACKNOWLEDGEMENTACKNOWLEDGEMENT

This study was funded by the DepartmentThis study was funded by the Department

of Health.of Health.

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8 08 0

CLINICAL IMPLICATIONSCLINICAL IMPLICATIONS

&& Many mental health social workers are overstressed, emotionally exhausted andMany mental health social workers are overstressed, emotionally exhausted and feel undervalued.These factors might exacerbate recruitment and retentionfeel undervalued.These factors might exacerbate recruitment and retention problems.problems.

&& Excessive job demands, limited latitude in decision-making and unhappiness aboutExcessive job demands, limited latitude in decision-making and unhappiness about the place of the mental health social worker in modern services contribute to poorthe place of the mental health social worker in modern services contribute to poor job satisfaction and burnout.job satisfaction and burnout.

&& Employers must recognise the demands placed on mental health social workersEmployers must recognise the demands placed on mental health social workers and value their contribution to mental health services.and value their contribution to mental health services.

LIMITATIONSLIMITATIONS

&& Self-selection and external factors might have contributed to the high rate ofSelf-selection and external factors might have contributed to the high rate of stress found among mental health social workers.stress found among mental health social workers.

&& The return rate suggests that caution should be exercised when interpreting theThe return rate suggests that caution should be exercised when interpreting the results.The cross-sectional study design means that causal direction cannot beresults.The cross-sectional study design means that causal direction cannot be determined.determined.

&& The study was undertaken at a time of uncertainty for mental health socialThe study was undertaken at a time of uncertainty for mental health social workers.workers.

SHERRILL EVANS,PhD,PETER HUXLEY,PhD, Social Work and Social Care Section,Health Services ResearchSHERRILL EVANS, PhD, PETER HUXLEY,PhD, Social Work and Social Care Section,Health Services Research Department, Institute of Psychiatry, and Social Care Workforce Research Unit,King’s College London;Department, Institute of Psychiatry, and Social Care Workforce Research Unit,King’s College London; CLAIRE GATELY,MSc,MARTIN WEBBER,MSc, Social Work and Social Care Section,Health Services ResearchCLAIRE GATELY,MSc,MARTIN WEBBER,MSc, Social Work and Social Care Section,Health Services Research Department,Institute of Psychiatry,London; ALEX MEARS,PhD, SARAH PAJAK,MSc,JIBBY MEDINA,MSc,TIMDepartment,Institute of Psychiatry,London; ALEX MEARS,PhD, SARAH PAJAK,MSc,JIBBY MEDINA,MSc,TIM KENDALL, MRCPsych,CORNELIUS KATONA, MD, FRCPsych, Royal College of Psychiatrists’ Research Unit,KENDALL, MRCPsych,CORNELIUS KATONA, MD, FRCPsych, Royal College of Psychiatrists’ Research Unit, London,UKLondon,UK

Correspondence: Dr Sherrill Evans,Box 032, Social Work and Social Care Section,Health ServicesCorrespondence: 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.Research Department,David Goldberg Centre,De Crespigny Park,Denmark Hill,London SE5 8AF,UK. E-mail: S.EvansE-mail: S.Evans@@iop.kcl.ac.ukiop.kcl.ac.uk

(First received 11February 2004; final revision 27 September 2004; accepted 7 October 2004)(First received 11February 2004; final revision 27 September 2004; accepted 7 October 2004)