A survey of burnout among Australian mental health occupational therapists and social workers

Abstract. Background: This study investigated the extent to which occupational therapists and social workers employed in Australian mental health settings are affected by burnout. Method: Questionnaires were sent to occupational therapists and social workers who had indicated that they were interested in participating in the study. An overall response rate of 76.6% (n = 304) was achieved. The outcome measure was the Maslach Burnout Inventory (comprising emotional exhaustion, depersonalisation and personal accomplishment scales). Results: There were no significant differences, with respect to any of the three burnout scales, between occupational therapists and social workers. Both groups experienced high emotional exhaustion, moderate depersonalisation, and high personal accomplishment. Levels of burnout were not significantly different between inpatient and community staff. Conclusions: These results suggested that, while occupational therapists and social workers reported emotional exhaustion, there was less evidence of depersonalisation and they reported very high personal accomplishment in their work. Results are congruent with those of previous studies and it is argued that the focus of future research should be on identifying characteristics of mental health work that contribute to emotional exhaustion.     

PTSD diagnosis and treatment for mental health clinicians

This article focuses on four issues: PTSD assessment, treatment approaches, therapist issues, and current controversies. Important assessment issues include the trauma history, comorbid disorders, and chronicity of PTSD. Effective intervention for acute trauma usually requires a variant of critical incident stress debriefing. Available treatments for chronic PTSD include group, cognitive-behavioral, psychodynamic, and pharmacological therapy. Therapist self-care is essential when working with PTSD patients since this work may be functionally disruptive and psychologically destabilizing. Current controversies include advocacy vs. therapeutic neutrality, eye movement desensitization and reprocessing (EMDR), the so-called false memory syndrome, and the legitimacy of complex PTSD as a unique diagnostic entity.Matthew J. Friedman is Executive Director of the National Center for PTSD, VAM & ROC, White River Jct., VT and is affiliated with the Departments of Psychiatry and Pharmacology, Dartmouth Medical School, Hanover, NH.     

How mental health clinicians view community treatment orders: a national New Zealand survey

OBJECTIVE: To determine New Zealand mental health clinicians' views about community treatment orders, indications for their use, their benefits, problems and impact on patients and therapeutic relationships. METHOD: A national survey of New Zealand psychiatrists and a regional survey of non-psychiatric community mental health professionals for comparison. RESULTS: The great majority of NZ psychiatrists prefer to work with community treatment orders as an option. They consider they are used properly in most cases, can enhance patients' priority for care, provide a structure for treatment, support continuing contact and produce a period of stability for patients during which other therapeutic changes can occur. They consider these orders can harm therapeutic relationships, especially in the short term, but when used appropriately their overall benefits outweigh their coercive impact. The other mental health professionals surveyed have similar views. A minority of clinicians do not support their use. CONCLUSIONS: The precise impact of community treatment orders on patients' quality of life remains an open question. Until that matter is more clearly resolved, New Zealand law should continue to authorise compulsory outpatient care, provided it is carefully targeted and adequate community services are available.     

Referral follow-up by clinicians in a community mental health center.

In 1973 a study was conducted at the Western Psychiatric Institute in Pittsburgh to assess the extent of discrimination by clinicians against chronically ill clients in establishing initial treatment arrangements. Forty referrals (all simulated) were assigned to the center's five treatment teams; 20 of the referrals suggested a mild disorder, and 20 suggested a severe and chronic disorder. Premature termination of the study reduced the sample size from 40 to 29, and the findings regarding discrimination were inconclusive. However, the study revealed the unexpected finding that 34 per cent of the referrals received no follow-up. The author discusses the implications of that finding in relation to the basic principles of community mental health, and also to the large amounts of resources allocated to increasing service utilization in the center under study.     

A collaborative-interactive model for mental health consultation: Teacher inservice education by psychiatric clinicians

Primary prevention of emotional disorders is often cited as a goal in community mental health consultation. The daily contact with children and parents by the classroom teacher can yield effective prevention, if the teacher is appropriately prepared to act as a resource, and by clinicians given an awareness of emotional difficulties in children and their parents. Though consultation is often described as facilitative of change, typically discussions of such programs emphasize technique rather than content. Presented here is acollaborative model based upon a didactic input of humanistic psychology, upon which educator and clinician draw as they become allies in pursuit of answers to questions raised in current examples from the teacher's classroom experience. Excerpts and results of the model's effectiveness are given.     

Primary prevention in community mental health centers: A survey of current activity

About half of the current activity in consultation and education services of community mental health centers can be classified as primary prevention. Using a framework that distinguishes between institutionallevel interventions (caretaker training and program consultation) and individuallevel interventions (dealing with developmental or situational crises) data are presented from 43 community mental health centers on (a) specific target populations that are tapped by primaryprevention activities and (b) content of the activities. Illustrative activities are described and explanations of current trends are posited. Current programming trends in primary prevention reflect the state of the art today and the findings in this paper have implications for the future promotion of primary prevention activity.This paper, presented at the Great Lakes Forum on Primary Prevention, Erie, Pennsylvania, May, 1976, is based on a study of Prevention Programs in CMH Centers, supported by NIMH grant MH25351. The authors wish to acknowledge the contribution of Paul K. Woodburn, M.SW.     

Diagnosis and treatment of mental disorders: a survey of Singapore mental health professionals

Background: A series of surveys of mental health literacy have been undertaken in Australia, involving members of the general public as well as general practitioners and mental health professionals, whereby respondents consider vignettes of depression and of schizophrenia, offer a diagnosis and rate a series of possible interventions for their judged helpfulness. A similar survey was undertaken in Singapore and is reported in this paper. Methods: The survey was undertaken at a large state psychiatric hospital with staff (psychiatrists, allied health professionals, psychiatrically and generally trained nursing staff) rating a vignette of mania, in addition to the vignettes derived in Australia for depression and schizophrenia, and with the Australian intervention options extended somewhat to respect Singapore facilities. Results: Responses of those in the four professional groups were compared. The psychiatrists were highly accurate in generating diagnoses, other staff somewhat less so for diagnosing depression (with a percentage instead choosing a diagnosis of stress) and mania (with a percentage instead diagnosing a schizophrenic condition). Reported helpfulness ratings identified those interventions judged consensually as likely to be helpful or harmful, as well as establishing some differences across the four professional groups. Conclusions: The consensus decisions of helpful treatments for depression and schizophrenia revealed very similar findings to judgements made by Australian professionals. The treated outcome of schizophrenia was judged as somewhat worse than that for mania and depression. While non-medical staff differed from psychiatrists in judging the comparative utility of some drug interventions and lifestyle issues, there was clear evidence of a relatively dominant `medical model' to recommended treatments, while traditional healing practices and services were rated as distinctly unhelpful. Accepted: 12 August 1999     

A national survey of violence experienced by community mental health researchers

  Background: In recent years there has been a vigorous debate concerning the relationship between violence and mental illness. Psychiatric hospital staff are especially likely to experience violence. `Detached staff ' working in the community appear to be at greatest risk. The present study examines reported aggression towards field-based community mental health researchers (CMHRs). It aimed to investigate the nature and extent of violence experienced by CMHRs, to establish which CMHR characteristics act as precipitators of violent incidents and to identify training needs. Methods: This national survey, conducted between December 1997 and March 1998 at the Department of Mental Health, University of Exeter, used a postal questionnaire circulated among CMHRs working in England, Scotland and Wales. Results: Whilst this study did not achieve comprehensive coverage of all eligible CMHRs, it indicates that, even allowing for response bias, occupational violence is not uncommon among CMHRs: 51% (n=33) ever experienced at least one verbally violent incident, 9% (n=6) a mildly violent incident and 2% (n=1) a severely violent incident. In the 12 months preceding the study, 45% of CMHRs (n=29) had experienced at least one verbally violent incident and 8% (n=5) a mildly violent incident. Male CMHRs are more likely (P < 0.05) to experience violence than their female counterparts. Conclusions: The findings indicate a need to improve existing safety training, procedures and awareness among this occupational group. Additional comparative research among other community-based groups is, however, required. Accepted: 19 December 2000     

A comparative mental health literacy survey of psychiatrists and other mental health professionals in Singapore

OBJECTIVE: The objectives of this study are, first, to replicate and extend an Australian approach to assessing mental health literacy by studying a sample of Singapore mental health professionals, and to focus on differences between judgements made by the psychiatrists in comparison with the other mental health professionals. Second, to compare the psychiatrists' judgements with those of Australian psychiatrists. METHOD: The Australian questionnaire, assessing responses in relation to vignettes of major depression and to schizophrenia was extended by adding a third vignette of mania, and by the addition of several region-specific response options. Nearly 500 questionnaires were distributed to representative staff (psychiatrists, nurses and allied health) of a large psychiatric institution in Singapore, with a response rate of 81%. Psychiatrists' judgements were compared with all other hospital staff, and with Australian psychiatrists' judgements. RESULTS: The two principal contrast groups (Singapore psychiatrists and other Singapore mental health professionals) differed slightly in terms of diagnostic accuracy. The psychiatrists differed in favouring a more professionally focused model of intervention, while both professional groups viewed traditional healers and their practices as distinctly unhelpful. Direct comparison of psychiatrist ratings generated in Singapore and in Australia revealed quite similar response profiles. CONCLUSIONS: In addition to generating data of some intrinsic importance, comparison with Australian survey data allows the potential impact of regional and cultural differences, as well as of varying psychiatric practices, to be identified. Responses identified more similarities than differences in the judgements of the psychiatrists from the two countries.     

A multi-perspective survey of mental health consumer needs

Conclusions There is extensive evidence that perspectives on mental health consumer needs vary widely between consumers and other stakeholders-administrators, practitioners, and family members. Traditional methods of determining mental health consumer needs, based on professional input only, have inhibited program development. While progress has been achieved when shared goals have been identified, it has also been inhibited by a lack of known areas of consensus between stakeholder groups.Surveys provide a cost-effective step toward documenting shared views from stakeholders who have the greatest stake in influencing the size and direction of the mental health service system. Identifying shared views is necessary to coordinate stakeholder efforts. The most encouraging result of the surveys is that there are many areas of consensus and thus the potential exists for the stakeholders to coordinate their efforts toward shared goals to better meet important consumer needs by prioritizing services, improving practitioner training, and coordinating advocacy.     

Building mental health literacy: opportunities and resources for clinicians

Youth mental health is increasingly recognized as a key concern with significant impact on youth and society. School is the one setting where professionals are consistently available to monitor how children are functioning and learning and intervene and support. School psychiatry has expanded beyond individual mental health problems to school-wide and community issues including school violence, sexual harassment, bullying, substance abuse, discrimination, and discipline. This article describes the importance of mental health literacy in health outcomes and research in school-based mental health programs to better position the clinician to advocate at the individual and/or system level.     

A national survey of associate degree mental health programs

Associate degree mental health programs have developed rapidly since their inception 6 years ago and now constitute an important, new source of manpower. This paper is a report on the first national survey of these programs and illustrates their development by states. Data are included on current student enrollments in these programs, number of graduates, percentage of graduates employed, estimates of future numbers of graduates, constraints on programs' continued development, and other related variables.This study was supported by a National Institute of Mental Health (NIMH) grant (MH 12741) from the Experimental and Special Training Branch.     

Ethnic matching of clients and clinicians and use of mental health services by ethnic minority clients

OBJECTIVES: Research in the United States has indicated that matching clients from a minority group with clinicians from the same ethnic background increases use of community mental health services and reduces use of emergency services. This study assessed the effects of matching clients from a non-English-speaking background with bilingual, bicultural clinicians in a mental health system in Australia that emphasizes community-based psychiatric case management. METHODS: In an overall sample of 2,935 clients served in the western region of Melbourne from 1997 to 1999, ethnic minority clients from a non-English-speaking background who received services from a bilingual, bicultural case manager were compared with ethnic minority clients who did not receive such services and with clients from an English-speaking background. The clients' engagement with three types of services-community care teams, psychiatric crisis teams, and psychiatric inpatient services-was assessed. RESULTS: Compared with ethnic minority clients who were not matched with a bilingual clinician, those who were matched generally had a longer duration and greater frequency of contact with community care teams and a shorter duration and lower frequency of contact with crisis teams. Clients born in Vietnam who were matched with a bilingual clinician had a shorter annual mean length of hospital stay and a lower annual mean frequency of hospital admission than Australian-born clients. CONCLUSIONS: The benefits of matching clients with psychiatric case managers on the basis of ethnic background include a lower level of need for crisis intervention and, for clients from some ethnic groups, fewer inpatient interventions. These Australian results support findings of the effectiveness of client-clinician ethnic matching in the United States.