Reasons for job burnout in MHPs

There are different sources of burnout in MHPs. Constant worry and focus on patient’s problems may lead therapists to neglect their own well-being and own situation. Burnout may also happen as a result of mismatches or person–job imbalances (Leiter & Maslach, Reference Leiter and Maslach2004), such as when MHPs have more patients than they can manage and help effectively or when the compensation does not equate the efforts. MHPs who are under pressure to meet conflicting or contradictory demands (from supervisors, patients, or clients) from multiple authorities or to meet demands that contradict their own values and ethics may not exercise effective job control (Leiter & Maslach, Reference Leiter and Maslach2004). Additionally, MHPs who do not receive support or help from others at work, who do not have emotional exchanges, who don’t socialize with coworkers, or who have unresolved or chronic conflicts with others at work lose a sense of community, which may result in isolation, frustration, and poor interpersonal relationships (Leiter & Maslach, Reference Leiter and Maslach2004). When MHPs perceive unfairness at work (e.g., inequity of workload or pay, disrespect, cheating, favorability, harassment, or bullying), they are likely to lose their respect and self-worth and alienate themselves from the community.

There are also organizational factors that contribute to MHPs’ burnout, including changes in workload and working conditions, time urgency, low autonomy, poor management, inadequate supervision, work-life conflict, inadequate rewards and unfair treatment, incivility, unpredictability, safety concerns, and the lack of control over services (Bowden etal., Reference Bowden, Smith, Parker and Boxall2014; Maslach & Leiter, Reference Maslach and Leiter2016; Upadyaya etal., Reference Upadyaya, Vartiainen and Salmela-Aro2016; Veage etal., Reference Veage, Ciarrochi, Deane, Andresen, Oades and Crowe2014; Yanchus etal., Reference Yanchus, Periard and Osatuke2017). Economic fluctuations add to the financial strain that MHPs experience, on top of the stress due to job instability and understaffing (Honberg etal., Reference Honberg, Kimball, Diehl, Usher and Fitzpatrick2011; Sørgaard etal., Reference Sørgaard, Ryan, Hill and Dawson2007). Finally, medical errors, incompetent procedures, and mediocre mental health services are primary ethical concerns that lead to the sense of unfairness in mental health organizations.

Signs of burnout in MHPs

When therapists feel that they do not have the emotional resources that are needed to show empathy or understanding of others, they show negative and cynical attitudes toward clients and a tendency to self-evaluate negatively with respect to their work with clients (Maslach & Jackson, Reference Maslach and Jackson1981; Maslach & Leiter, Reference Maslach and Leiter2008). There are also physical (e.g., cardiovascular diseases, hypertension, high cholesterol) and psychological (e.g., anxiety, low self-esteem, guilt feelings, and low tolerance of frustration and insomnia) signs of burnout (Salvagioni etal., Reference Salvagioni, Melanda, Mesas, González, Gabani and Andrade2017). Not only MHPs but also their clients are adversely affected by burnout: empathy toward the patients and the quality of care are reduced (Aronsson etal., Reference Aronsson, Theorell, Grape, Hammarström, Hogstedt, Marteinsdottir and Hall2017; Volpe etal., Reference Volpe, Luciano, Palumbo, Sampogna, Del Vecchio and Fiorillo2014); unhelpful and rejecting feelings toward patients emerge (Holmqvist & Jeanneau, Reference Holmqvist and Jeanneau2006); and tardiness, spacing out during sessions, declines in active listening and canceling sessions are observed.

How to prevent job burnout

One approach to preventing burnout is to reduce factors that contribute to burnout (i.e., demands) and to increase resources that reduce stress (see the job demands–resources theory by Bakker & Demerouti, Reference Bakker, Demerouti, Chen and Cooper2014). There are preventative measures that MHPs can take and interventions that organizations can implement to combat burnout.

Suggested self-care methods include healthy diet; spiritual practice; regular exercise; time in nature; proper sleep; time with loved ones; regularly scheduled breaks; vacation away from work; hobbies and interests unrelated to work; avoidance of excessive work hours; participation in peer support; and relaxation activities such as mindfulness, meditation, yoga, reading, painting, and music (Case, Reference Case2001). One effective way of coping with burnout is self-compassion, which provides individuals with coping skills against distress and rumination by promoting awareness, resilience, a sense of interconnectedness, and community-mindedness, and by regulating emotions (McGowan, Reference McGowan2020; Neff, Reference Neff2003). There are also effective initiatives that are intended to enhance practitioners’ resilience and mindfulness, such as “Improving Access to Psychological Therapies” (IAPT; Clark, Reference Clark2011), which follows a stepped-care service model wherein low intensity, brief, and less restrictive interventions (e.g., guided self-help) are delivered first, followed by high intensity and lengthy interventions (e.g., cognitive-behavior therapy and counseling) based on patients’ needs and responses to treatment. A healthy balance among professional, social, and personal life needs maintenance, which comes with an awareness of ones’ emotional stress and challenges. It is recommended that MHPs engage in an ongoing practice of self-care and personal restoration.

There are also organization-directed interventions that can help to reduce burnout. Proper job training and education allow employees to strengthen their skills and self-efficacy and improve performance (Gilbody etal., Reference Gilbody, Cahill, Barkham, Richards, Bee and Glanville2006; Morse etal., Reference Morse, Salyers, Rollins, Monroe-DeVita and Pfahler2012). MHPs who have continuous training can keep on the cutting edge of the transforming mental health services and even become candidates for leadership positions. To reduce excessive workload demands, MHPs should be given an opportunity to negotiate workload and to set realistic career goals. Another important contributor to work exhaustion is lack of role clarity. It is critical for organizations to prepare job roles and descriptions for all employees and share this information transparently within the organization. To maintain organizational fairness and to reduce job demands, mental health institutions should directly address ethical and legal concerns by providing adequate orientation regarding coverage, billing, ethical and legal requirements, and standards; provide the necessary health care, billing, insurance, and other business-related resources; eliminate unnecessary bureaucratic procedures and delays; and have procedures for grievance or dispute resolution in place.

The opportunity to shape one’s work environment is critical for stress management. Control over decisions with respect to functions of a position, how you will perform tasks, prioritize work, setting own deadlines, or delegate responsibilities to others gives people job autonomy. Mental health organizations can consider ways in which professionals can have autonomy in their ability to customize their practice and work more efficiently with the organization. Mental health organizations are encouraged to eliminate unnecessary bureaucratic procedures and competing priorities, build strong relationships with the administration, develop an efficient organizational structure where different departments communicate and work well with each other.

Social support is critical in preventing burnout. It can stem from different sources, such as support from one’s workplace, coworkers, supervisor, and family. Support from the workplace can be provided in different ways, such as starting coworker support groups, offering continuing education opportunities to bolster competence, encouraging breaks and social hours, arranging physical activity opportunities, providing self-care training, and encouraging social support throughout the workday. When MHPs have what they need to bring the most value possible, they will be more equipped to safeguard their mental health. Support from family (including parents, partners, etc.) is critical because stressors from work and home may spill over such that stressors from home affect work performance and frustrations at work are often aired at home (Moore & Cooper, Reference Moore and Cooper1996). Supportive supervisors recognize the value of employees’ contributions, provide assistance and advice on how to handle conflicts, show appreciation, protect against mistreatment, and care for their well-being (Choi etal., Reference Choi, Cheong and Feinberg2012). Past research has shown that nurses who have supportive supervisors are more likely to use effective emotion regulation strategies under stress (Goussinsky & Livne, Reference Goussinsky and Livne2019). Finally, colleagues can be a source of social support: meeting colleagues worldwide, becoming a member of professional associations, and reading publications and stories where challenges in MHOs are discussed can create a sense of community, keeping the professionals engaged and informing them about recent developments in the field.