Stress and Burnout in Social W ork: Research Summary

1. Stress and Burnout in Social Work: Research Summary Dr Martin Webber, Anniversary Reader in Social Work International Centre for Mental Health Social Research

2. In the news… International Centre for Mental Health Social Research

3. How do you measure stress? • Subjective self-report: • How stressed do you feel at work? • Not at all / a little / moderately / very • “Almost all of the social workers who responded to our online survey said they feel moderately or very stressed (96%)” – CC 2013 • How close do you feel to burning out? • Not at all / a little / moderately / very • “Two in ten respondents said they feel “very close” to burning out and needing to take time off” – CC 2013 • Objective self-report: • Have you taken time off due to work-related stress or depression in the past year? • Yes / No • “Three in ten social workers told us they have taken time off work due to work-related stress or depression in the past year” – CC 2013 International Centre for Mental Health Social Research

4. How do you measure stress? • Standardised measures - e.g. Maslach Burnout Inventory (Maslach & Jackson 1986) • 22 items with same response options: Never / A few times a year or less / Once a month or less / A few times a month / Once a week / A few times a week / Every day • e.g. “I feel emotionally drained from my work” / “I feel used up at the end of the workday” • Three component scales: emotional exhaustion, depersonalisation and personal accomplishment • Burnout exists when certain thresholds are reached for each scale • Scores on scales don’t mean much by themselves, but can be used to facilitate comparisons within or between samples • “Mental health social workers were more emotionally exhausted and more depersonalised than the average mental health worker but experienced more personal accomplishment.” (Evans et al 2005) International Centre for Mental Health Social Research

5. Who responds? • “Our online survey was filled in by 1,047 frontline social workers, 132 assistant team managers and team managers, 16 senior managers, 40 support workers, 35 students and 57 people who defined themselves as “other”, e.g. consultant social workers, IROs and AMHPs.” – CC 2013 • Response bias • People who are too busy/stressed/burnt out to fill in surveys don’t do it – leads to an under-estimation of levels of stress • People who are stressed fill them in as a means of communicating their distress - leads to an over-estimation of levels of stress • If the sample is selected non-randomly, there is an increased risk of bias • But this risk is reduced in large samples which can be more representative of target population International Centre for Mental Health Social Research

6. Local authority social work • Survey of 5 LA SSDs (n=1,276) (Balloch et al 1995, 1998) • Interviewed social workers, social work assistants, residential home managers, other managers, home care workers, residential workers 1994-5 • Measured stress using General Health Questionnaire (GHQ) • Residential home managers had highest GHQ scores, followed by social workers. Home care workers had lowest. • Amongst social workers, those working with older people had highest GHQ scores followed by those working with people with mental health problems or severe learning disabilities • Rates of physical or verbal assaults were very high, particularly amongst residential workers • Being expected to do things which were not part of the job and being unclear about what you were expected to do (all or most of the time) was associated with higher GHQ score but not violence International Centre for Mental Health Social Research

7. Local authority social work • Survey of two LA SSDs (n=1,237) (Coffey et al 2009): • 36% staff suffering mental distress (GHQ) • Children & families division – highest level of absenteeism and poorest well-being • But children & families social workers did not report lower levels of satisfaction than other workers • Themes from qualitative interviews: • Organisational culture and function • Control • Lack of resources • Responsibility for people • Rate and pace of change International Centre for Mental Health Social Research

8. Local authority social work • Survey of LA social workers in Wales (n=998) (Evans & Huxley 2009) • 45.5% feel mostly or always valued in their role • 45.2% feel satisfied or very satisfied with their employer • 61.1% feel satisfied or very satisfied with their job • 24.6% are seeking alternative employment • 74.1% feel pay does not reflect duties International Centre for Mental Health Social Research

9. Job satisfaction • Study of child welfare workers (n=232) in Canada found high levels of burnout (Emotional Exhaustion, MBI) and high levels of job satisfaction (Harvey et al 2003) • This has also been found in other studies in Canada (Bennett at al 2005; Mandell et al 2013), US (Vinokur-Kaplan 1991; Anderson 2000) and UK (Coffey et al 2009) • Review of research on social work stress (Collins 2008): • Social work is in top 20 groups that enjoy high job satisfaction (Rose 2003) • Positive problem-solving coping strategies include planning, suppression of competing activities and social support – associated with increased job satisfaction (Un & Harrison 1998) • Women are better at seeking out and providing support for themselves than men, which reduces stress (Taylor et al 2000) International Centre for Mental Health Social Research

10. Mental health social workers • Systematic review found MHSWs suffer higher levels of stress than other mental health professionals (Coyle et al 2005), because of: • Role conflict or ambiguity • Statutory responsibilities • Low personal achievement • High workload • Not being valued • More recent UK and US studies of MHSW have similar findings to this review (Acker 2009,2010; Acker & Lawrence 2009) International Centre for Mental Health Social Research

11. Mental health social workers • National survey of mental health social workers collected data in 2002 found high levels of stress, burnout and common mental disorder amongst Approved Social Workers: • ASWs were more burnt out than mental health social workers without statutory duties and 52% met threshold for probable common mental disorder (Evans et al 2005) • Mental health social workers had higher rates of common mental disorder than psychiatrists (47% vs. 25%) and were more burnt out (Evans et al 2006). Reasons include: • high job demands • not feeling valued • long hours • low decision latitude • current position of MHSW International Centre for Mental Health Social Research

12. 2012 AMHP survey • Sample = 504 AMHPs in England • 483 social workers (95.8%) • 19 nurses (3.8%) • 2 occupational therapists (0.4%) • Approximate response rate = 9.8% (9.6% for social work AMHPs and 16.8% for non-social work AMHPs) • 60% female • Mean age = 47 years • 87% white British / 4% white European / 9% BME • Median length of AMHP / ASW experience = 7 years • 83% worked in a mental health team or EDT • 47% worked in urban or suburban areas International Centre for Mental Health Social Research

13. 2012 AMHP survey Mean caseload = 18 people Mean days on AMHP rota per month = 5.5 Mean number of AMHP assessments conducted in last 3 months = 11 Mean number of people detained in last 3 months = 6.5 55% do not feel valued by their employer 40% do not wish to continue as an AMHP or are unsure about it Only 6% met threshold for burn out on MBI, but they were all social workers 44% met threshold for common mental disorder International Centre for Mental Health Social Research

14. 2012 AMHP survey • Significant differences between social work and non-social work AMHPs, after controlling for confounding factors: • Social work AMHPs had been practising as and AMHP/ASW longer than non-social work AMHPs • Non social work AMHPs felt more positive about their AMHP duties than social workers • There were no other significant differences, including in rates of common mental disorder and burnout • Lack of differences likely to be a result of small sample of non social work AMHPs International Centre for Mental Health Social Research

15. 2012 AMHP survey • Variables associated with having a common mental disorder, after controlling for confounding factors: • Younger age • Larger caseloads • Higher emotional exhaustion (MBI) • Higher depersonalisation (MBI) • Lower personal accomplishment (MBI) • Feeling less happy about non-AMHP duties • Not feeling valued by employer • Feeling unsure about continuing as an AMHP • Interestingly, workload associated with AMHP duties is not associated with common mental disorder International Centre for Mental Health Social Research

16. 2012 AMHP survey Free text themes: “… Increased time taken to ascertain bed availability leads to delay… Coordinating ambulance and police assistance…is an even greater headache…Because of the above issues (amongst others) assessments…often continue for hours after my usual finish time. This can become stressful as it impacts on my personal life and ability to be well-rested for the next days’ work.” (Respondent 427) International Centre for Mental Health Social Research

17. 2012 AMHP survey Free text themes: “ … it is still expected that I carry a full caseload, perform other duties (e.g. CMHT duty) on same frequency as non-AMHP colleagues. Constantly behind with paperwork tasks. Regularly working extra hours (non-paid) to ‘catch up’” (Respondent 33) International Centre for Mental Health Social Research

18. 2012 AMHP survey Free text themes: “AMHP duty has always had a positive impact on my non-AMHP duties as it assists with developing a deeper level of assessment and engagement” (Respondent 62) International Centre for Mental Health Social Research

19. 2012 AMHP survey Free text themes: “AMHP duties make my day to day role more tolerable … AMHP duty allows me to complete a single piece of work from start to finish and … feel as if I have done something … beneficial …” (Respondent 439) International Centre for Mental Health Social Research

20. 2012 AMHP survey Free text themes: “…find it rewarding to help make people safe / have a role in maintaining liberty and dignity. Keeps me in a job …” (Respondent 187) International Centre for Mental Health Social Research

21. In summary Social work is unusually demanding among human service professions in terms of workload, task complexity and quality of management (Tham & Meagher 2009) Stress in social work is particularly associated with statutory functions (Evans et al 2006) Emotional labour of social work contributes to stress and burnout (Gregor 2010) Higher personal distress is associated with higher compassion fatigue and burnout amongst clinical social workers (Thomas 2013) Peer support, good supervision and a supportive working environment help to alleviate stress and promote well-being (Kim & Stoner, 2008) Social workers are very resilient in the face of high job demands (Hudson & Webber 2012) More research is needed about the effectiveness of supportive or preventive interventions which can alleviate stress and promote well-being International Centre for Mental Health Social Research

22. Why bother? • Outcomes of looked after children (Pritchard & Williams 2009) • 438 looked after male children (LAC) were compared with 215 males permanently excluded from school (PEFS) aged 16-24 • Both groups from similar socio-economic backgrounds • 44% LAC vs 64% PEFS committed an offence • 22% LAC vs 28% PEFS committed 11 or more offences • 20% of LAC offenders vs 39% PEFS offenders had at least one conviction for violent crime against the person • Rates of violent and sexual crime against LAC were significantly higher than PEFS • 1 LAC vs 2 PEFS committed murder • 0 LAC vs 2 PEFS committed suicide International Centre for Mental Health Social Research

23. Final words “While we understand that heavy caseloads are often the reality of social work practice, it is of the utmost importance that social workers are properly supported to carry out their role, in line with the Standards for Employers of Social Workers. This means high-quality continuing professional development, and protected time for reflective supervision with a senior social worker each month” Anne Mercer, Professional Advisor The College of Social Work International Centre for Mental Health Social Research

24. Contact details Email: martin.webber@york.ac.uk Tel: 01904 321203 ICMHSR: www.york.ac.uk/spsw/research/icmhsr/ Blog: www.martinwebber.net Twitter: @mgoat73 International Centre for Mental Health Social Research