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• To acknowledge the importance of mental health professionals’ well-being in the workplace
• To identify factors that can support mental health professionals to work around service constraints
• To find out how staff coped with working in a new community service for children and young people during the pandemic
Background There is a lack of research into the workplace well-being of community mental health professionals. Given children and young people’s increasing needs for mental health support in the wake of the coronavirus disease 2019 pandemic, it is timely to explore the workplace well-being of community mental health teams.
Aim To explore the workplace well-being of staff working in a new integrated community mental health service for children and young people.
Method Eleven mental health professionals from a range of disciplines took part in the study. The 11 participants completed an online questionnaire and the Professional Quality of Life (ProQOL) scale, which measures levels of compassion satisfaction, burnout and secondary traumatic stress. Three of them also took part in an individual semi-structured interview.
Findings Participants felt hopeful and optimistic about the future of the service, felt supported by managers and peers, and wanted to enhance their skills to meet children and young people’s increasingly complex needs within the constraints of a service offering brief interventions. Participants displayed high levels of compassion satisfaction, low levels of burnout and particularly low levels of secondary traumatic stress.
Conclusion Emotionally supportive leadership, a culture of continuous learning and peer support may reduce the uncertainty felt by community mental health staff about a new service and create optimism about the future, which may in turn contribute to workplace well-being.
Mental Health Practice. doi: 10.7748/mhp.2023.e1652
Peer reviewThis article has been subject to external double-blind peer review and has been checked for plagiarism using automated software
Correspondence Conflict of interestNone declared
Parry S, Eve Z, Brockway A et al (2023) Exploring the workplace well-being of staff at a new integrated community mental health service for children and young people. Mental Health Practice. doi: 10.7748/mhp.2023.e1652
FundingThe Department of Health and Social Care provided funding for the Mental Health and Wellbeing Hub and its evaluation
Published online: 20 June 2023
The importance of workplace well-being has been amplified by the coronavirus disease 2019 (COVID-19) pandemic, particularly in relation to front-line workers (Wong et al 2020, Parry et al 2021). According to Schulte et al (2015), there are various definitions of ‘occupational (workplace) well-being’, but in general it is regarded as a ‘summative term used to describe a flourishing worker who benefits from a safe, supportive workplace, engages in satisfying work, and enjoys a fulfilling work life’.
Mental health professionals tend to report lower levels of job satisfaction and higher levels of work-related stress and burnout than colleagues in other professions (Walsh and Walsh 2001, Lloyd et al 2002, Dollard et al 2012), which can have a negative effect on their quality of life and on patient outcomes (Priebe et al 2004, Grandey et al 2012, Coates and Howe 2015). Emotional exhaustion among mental health professionals working with young people, for example, has been found to reduce productivity and increase fatigue-related mistakes (Coates and Howe 2015).
Risk factors for burnout among mental health professionals include role ambiguity, complex bureaucratic processes and a lack of consistency between their personal values and the values of the organisation they work in (Leiter and Maslach 2000, Veage et al 2014, Coates and Howe 2015). Protective factors against burnout include effective team working, freedom to express emotions among colleagues and valuing one’s work (Lasalvia et al 2009, Grandey et al 2012, Sancassiani et al 2015).
Early brief interventions for young people in the community have been described as an essential part of the process of recovering from the negative mental health effects of the COVID-19 pandemic (Galea et al 2020). Such interventions are most likely delivered by the community mental health workforce. However, there is a scarcity of literature on the well-being of mental health professionals who work in community settings.
These professionals generally provide face-to-face support to service users and frequently lead on complex aspects of care – such as critical decision-making, risk assessment and risk management – in environments that are often marked by structural and procedural uncertainties (Sancassiani et al 2015) and do not meet the professionals’ needs, leading to job-related stress and reduced well-being (Glasberg et al 2007). Although therapeutic interactions between mental health professionals and service users can be characterised by satisfaction and joy, research has suggested that such interactions can also result in professionals experiencing frustration and disappointment at their inability to provide the quality of service they wish they could provide, often due to inadequate resources (Priebe and Reininghaus 2011, Sancassiani et al 2015). Over time, exposure to stress and distress can lead to depersonalisation, burnout and reduced workplace well-being (Evans et al 2006, Lasalvia et al 2009, Galletta et al 2016).
This article reports the findings of a small-scale study that explored workplace well-being in a mental health team working in a new integrated community mental health service for children and young people in north-west England. The study took place between November 2020 and February 2021, which was during the second UK lockdown.
To explore the workplace well-being of staff working in a new integrated community mental health service for children and young people.
The service, called the Mental Health and Wellbeing Hub (‘the Hub’), started in 2019. It uses a collaborative and community-based approach to the delivery of early brief interventions to children and young people with mild-to-moderate mental health issues aged between eight years and 18 years. It operates on Monday to Thursday evenings between 4pm and 9pm and on Saturday morning, and offers a range of one-to-one support services, therapeutic programmes and well-being sessions delivered by mental health professionals from various disciplines.
Children and young people attend the Hub either through self-referral or via referral from another service. Following an initial assessment with a mental health professional, for which the Strengths and Difficulties Questionnaire (SDQ) (Goodman 1997) may be used, the child or young person is typically offered two to six sessions of an appropriate intervention. The Hub offers an element of flexibility in that, at the end of the intervention, children and young people enter a ‘holding’ rather than a discharge process so that additional support can be provided if required. Children and young people with more complex mental health issues are referred for specialist support from local Child and Adolescent Mental Health Services (CAMHS).
Following discussions with the Hub’s leadership team to determine what elements of staff workplace well-being they wanted to explore, and a literature review of integrated community mental health services, the authors developed six concept categories (communication, relationships, ‘hub’, leadership, experience and environment) which informed questions for an online questionnaire and a semi-structured interview schedule. The same questions were used for the questionnaire and the interview schedule. The questionnaire and interview schedule also contained demographic questions, but no demographic information is included in this article because the small sample size means that it could contain identifying characteristics.
• Workplace well-being among mental health staff working in a new community service can be sustained by nurturing their optimism and hopefulness
• Support from managers and peers can create a safe base that allows mental health professionals to work creatively
• A culture of continuous learning can sustain mental health staff’s curiosity and promote their professional development
• Access to training can support mental health staff to develop their skills and instil a sense of hope for the future
The authors also used the Professional Quality of Life (ProQOL) scale, which is a 30-item self-report Likert-type scale that measures professional quality of life on three subscales (Stamm 2010):
• Compassion satisfaction (pleasure derived from being able to do one’s work well).
• Burnout (exhaustion, frustration, anger and depression related to work).
• Secondary traumatic stress (feeling fear in relation to work-related primary or secondary trauma).
Participants are asked to rate the statements within each subscale (from 1= ‘never’ to 5= ‘very often’). Raw scores for each subscale can range from ten to 50. The ProQOL scale has been found to be a reliable instrument with internal consistency, reflected by a Cronbach’s alpha of 0.88 for compassion satisfaction, 0.75 for burnout and 0.81 for secondary traumatic stress (Stamm 2010).
All 11 members of the Hub’s team of mental health professionals were invited to complete the online survey and ProQOL scale and take part in an individual semi-structured interview. A link to the survey was circulated to the team by email via the team leader. The link took participants to a secure online survey platform hosting the participant information form and consent form as well as all survey questions. All 11 staff members agreed to take part in the study and completed the questionnaire and the ProQOL scale. Three of them also volunteered to take part in an interview. The interviews took place online via a secure teleconference software programme.
Content analysis is most often used to analyse written qualitative data, so this method was selected to explore participants’ responses to the survey and interviews. Since only three interviews had been conducted, the transcribed interview data and survey data were combined in a qualitative text analysis (Kuckartz 2019). An inductive analysis of participants’ survey and interview data led to the development of conceptual and data-driven categories, which were refined throughout the analytical process by two members of the research team. Coding was led by characteristics of theoretical interest, illustrated by direct quotes from the survey and interviews to remain close to the data, and emerging themes were inductively explored. Finally, an analysis of the categories within the emerging themes led to the final synthesis and the emergence of three final themes. Table 1 shows the content analysis matrix.
The authors sought and received ethical approval from the Health Research Authority and from the Manchester Metropolitan University research ethics committee. Participants provided consent via the online consent form and were made aware that the findings would be published in a future report. To preserve the confidentiality and anonymity of participants as much as possible, participants were invited to approach the research team if they wished to take part in an interview rather than the other way around. Participants were also invited to provide a pseudonym that would identify their quotes in the future report. In this article, numbers are used instead of pseudonyms to further protect participants’ anonymity.
Three final themes emerged from the content analysis:
• A dynamic, developing, imperfect Hub… with great potential.
• Safe base, safe space, collaborative support.
• Bridges for resilience and working within the walls of the service.
These themes are discussed below.
At the time when the study was undertaken, the Hub was a new service developing in real time and participants described feeling uncertain about what it was and what it might become. However, they did not suggest that this uncertainty negatively affected their well-being. Rather, the uniqueness of the service and its potential in terms of what it could offer to the local community, as well as participants’ optimism about what it might achieve, appeared to support hopefulness. One aspect of the Hub that provided participants with satisfaction in their work was the ‘feel’ of the service – its perceived friendliness and relaxed nature – which may have supported, and been supported by, staff’s workplace well-being.
An important factor in relation to participants’ workplace well-being was the support they provided to each other. Participants perceived that within the informal peer support system, there was freedom for them to be emotionally vulnerable without fear of prejudice and that they would receive empathic collegiate support. Additionally, the line management system offered supervision and a protected reflexive space, providing staff with emotional support and guidance as well as with opportunities to seek advice on professional development and refine their skills, which promoted staff’s professional growth. Overall, participants described the Hub as a ‘safe space’ in which to work and a ‘safe base’ from which to develop professionally to enhance the quality of the service they delivered.
All participants had a university degree and three had also completed a postgraduate degree. However, despite participants’ relatively high level of qualifications, a desire for further training consistently emerged from the questionnaires and interviews. There was also a clear determination among participants to continue to improve the quality of care they provided to children and young people.
This drive to provide a high-quality service conflicted with participants’ reported struggles with the constraints of delivering a brief intervention service, which were exacerbated by increasingly complex referrals. It appeared that the time-limited nature of the interventions, increasing service user demand and the conscientiousness of staff were at odds with each other. The outcome was that participants appeared to want to enhance their skills in delivering brief interventions that would meet children and young people’s needs within the time allocation of the Hub model.
Further training and skills development appeared to offer staff a way of ‘building a bridge’ between having to work within the constraints of a fixed, short-term intervention model and wanting to deliver effective support to children and young people presenting with increasingly complex needs. The hopefulness and optimism about the service and about professional development gave participants a positive perspective on what they could and could not offer within the constraints of the Hub model.
The results of the ProQOL scale normality tests are shown in Table 2. The Shapiro-Wilk test conducted for each ProQOL subscale shows that data were non-significant (P>0.05), which suggests that the scores in all three subscales were normally distributed. The mean, SD and range of scores on the three subscales are shown in Table 3.
A one-sample t-test was conducted to investigate whether the mean compassion satisfaction score in the sample was significantly different from 42, a score indicative of high professional satisfaction. Overall, participants displayed high levels of compassion satisfaction, low levels of burnout and particularly low levels of secondary traumatic stress.
Participants’ ProQOL scores were compared between age groups. Participants’ mean age was 31 years (SD=11.594), so participants were divided into two age groups: those aged 29 years or younger and those aged 30 years or older. Independent groups t-test, Levene’s test and Mann-Whitney U test demonstrated significant differences for age and burnout scores (t(9)=2.555, P=0.031; U=3.500, P=0.042). These results suggest that older participants had lower levels of burnout than younger participants.
The findings of this study provide important insights into the workplace well-being of an integrated community mental health team, a vital but under-researched workforce that is likely to be integral to supporting children and young people to recover from the negative effects of the COVID-19 pandemic on their mental health.
Wu and Parker (2014) discussed how ‘secure base support’ from leaders could enhance staff’s ability to explore new working environments and tolerate uncertainties, for example those created by organisational change. In the present study, participants appeared to harness this secure base support to work flexibly and creatively around a system described by one of them as ‘designed to do something else, but we bought into it and kind of are bending ourselves to meet it, [rather] than it working for us’.
Furthermore, in the same way that ‘the treatment relationship… provides a secure base from which the client can make the necessary changes for a greatly expanded repertoire of self-capacities and relational skills’ (Pearlman and Courtois 2005), participants were able to use the secure base support from colleagues and line management to develop their skills, which in turn appeared to support their sense of professional growth and workplace satisfaction.
Overall, participants reported high levels of compassion satisfaction, but younger participants appeared to be more at risk of burnout than older participants. An exploration of ProQOL scores in nurses working in adolescent psychiatric intensive care units in the North of England found similar results, with a higher than expected overall compassion satisfaction score and a lower than expected overall burnout and secondary traumatic stress scores (Foster 2019). This is in contrast to the findings of a study of nurses at a secure forensic psychiatric unit in Norway, which found that nurses with a longer period of service experienced higher levels of secondary traumatic stress symptoms (Lauvrud et al 2009). Further mixed-methods and qualitative research would be useful to explore the reasons for this discrepancy and how to embed support mechanisms within workplace well-being initiatives.
Optimism for what the Hub might achieve for the population it serves appeared to compensate for uncertainty among participants and created hopefulness about the future of the service. Nurturing staff’s optimism about, faith in and hopefulness for the potential of a new service could therefore support the workplace well-being of front-line community mental health practitioners.
It emerged from the content analysis that the Hub’s leadership team and line management promoted a culture of continuous learning. Maintaining a culture of continuous learning could sustain staff’s curiosity and creativity, thus promoting workplace well-being and professional growth simultaneously. Additionally, facilitating access to training programmes could support staff to develop their skills in the short term and instil a sense of hope for the future.
The small sample size of this study is a limitation, but in relation to the ProQOL scale this may be partly offset by the use of multiple inferential statistical methods to interpret the results. Another limitation was the fact that there are risks associated with self-report measures in terms of data quality. However, the research team had a designated member who participants could contact to discuss any questions about the ProQOL scale, the survey and interview. The research team also held regular online drop-in sessions to enable participants to discuss the research process and raise any concerns. One strength of the study is that content analysis enabled the researchers to develop deductive and inductive themes that reflected the priorities for exploration set by study stakeholders and the experience-based perspectives of study participants.
This small-scale study conducted during the COVID-19 pandemic explored the workplace well-being of a team of mental health professionals working in a new integrated community mental health service for children and young people. Findings suggest that, alongside peer support, emotionally supportive leadership that promotes continuous learning and skills development can reduce staff’s uncertainty about a new service and create optimism and hopefulness about the service’s future and about staff’s professional development. It is possible that these aspects can contribute to workplace well-being, given that participants’ professional quality of life did not appear to be negatively affected by their experience of working in the Hub during the pandemic.
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