Sources of stress experienced by occupational therapists and social workers in mental health settings

Sources of stress experienced byoccupational therapists and socialworkers in mental health settings

CHRIS LLOYD Senior Lecturer, Division of Occupational Therapy,University of Queensland, Australia

KRYSS McKENNA Senior Lecturer, Division of Occupational Therapy,University of Queensland, Australia

ROBERT KING Senior Lecturer, Department of Psychiatry, University ofQueensland and the Park School of Mental Health, Australia

ABSTRACT: This study examined the sources of stress experienced by occupa-tional therapists and social workers employed in Australian public mental healthservices and identified the demographic and work-related factors related to stressusing a cross-sectional survey design. Participants provided demographic and work-related information and completed the Mental Health Professionals Stress Scale. Theoverall response rate to the survey was 76.6%, consisting of 196 occupational thera-pists and 108 social workers. Results indicated that lack of resources, relationshipsand conflicts with other professionals, workload, and professional self-doubt werecorrelated with increased stress. Working in case management was associated withstress caused by client-related difficulties, lack of resources, and professional self-doubt. The results of this study suggest that Australian occupational therapists andsocial workers experience stress, with social workers reporting slightly more overallstress than occupational therapists.

Key words: mental health, stress, case management, occupational therapists,social workers

Introduction

A number of writers have examined the impact of mental health reforms onthe individual therapist, specifically in terms of stress (Cushway and Tyler,1994, 1996; Prosser et al., 1996; Onyett et al., 1997) and burnout (Harper andMinghella, 1997; Prosser et al., 1999; Reid et al., 1999a, b). Stress can lead toburnout (Maslach et al., 1996), absenteeism (Fagin et al., 1995), high jobturnover (Onyett et al., 1997), poor job satisfaction and morale (Prosser et al.,

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1996; Brooker et al., 1999), and reduced performance and efficiency (Dunnand Ritter, 1995; Maslach et al., 1996). Cotton and Fisher (1995) explainedthat the increase in stress-related difficulties can be linked to the changingnature of work. They identified this as including the increased pace of change,structural reform processes, changing work practices, adapting to newtechnologies, competing situational demands, multiskilling, flattening oforganizational structures, and loss of job security. These factors exert pressureon the adaptive capability of individuals and, cumulatively, increase the levelof work environment strain to which individuals are subjected.

The development of community mental health teams has required staff toadapt to new roles, responsibilities and hierarchies (Shepherd et al., 1996).This has occurred with limited training or preparation to assume these newroles (Cowan, 2000). It has been suggested that newly established communityservices may result in a higher degree of stress for staff which may be a conse-quence of change rather than the nature of community work itself (Prosser etal., 1996). Working in the community has been identified as more stressfulthan working in inpatient services and has been associated with poorer mentalhealth in health care workers (Prosser et al., 1996, 1999). Reasons postulatedfor this include the burdensome nature of the work (Meldrum and Yellowlees,2000), the experience of conflicting demands (Reid et al., 1999a), role blurring(Brown et al., 2000), the high level of responsibility involved in communitywork (Reid et al., 1999a), and inadequate provision of resources (Harper andMinghella, 1997), training, and supervision (Reid et al., 1999b).

Other work-related sources of stress for members of community mentalhealth teams reportedly include work overload (McLeod, 1997), largecaseloads (Kipping and Hickey, 1998), bureaucracy (Harper and Minghella,1997), administrative demands (McLeod, 1997), and managing competingdemands on time (Meldrum and Yellowlees, 2000). Resource shortages, such asthe availability of suitably skilled staff (McLeod, 1997), access to communityresources, and difficulties with other services, can also be sources of pressure formental health professionals (Harper and Minghella, 1997; Meldrum andYellowlees, 2000). At a client level, taking responsibility for clients (Meldrumand Yelowlees, 2000), fears of violence (Kipping and Hickey, 1998), workingwith difficult clients (McLeod, 1997), and lack of progress have been reportedas sources of stress (Reid et al., 1999a).

Rees and Smith (1991) found that occupational therapists were under morestress than the majority of other professional groups in health care andperceived higher levels of pressure from their relationships with other peoplein the workplace than any other professionals. Similarly to occupational thera-pists, social workers reportedly feel very pressured by their work (Jones et al.,1991; Collings and Murray, 1996). They have expressed frustration withworkloads (Farley, 1994) and pressure related to planning and reaching worktargets (Collings and Murray, 1996).

In Australia, major changes have occurred in the organization and delivery

82 Lloyd, McKenna and King

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of mental health services (Whiteford et al., 1993). This has involved estab-lishing community-based services where they previously did not exist. Acuteservices have been mostly transferred from stand-alone psychiatric institutionsto general hospitals and integrated as part of the mainstream health care system(Commonwealth Department of Health and Ageing, 2002). Few resources havebeen invested at the national level to address the workforce implications ofchanges in service delivery (National Mental Health Strategy EvaluationSteering Committee, 1997). With limited empirical data available, it is unclearhow staff are coping with the challenges posed by new models of care.

This paper presents one component of a larger study examining work activ-ities (Lloyd et al., 2004) among occupational therapists and social workers inmental health. This aspect of the study sought to: (1) identify the sources ofpressure that contribute to stress experienced by occupational therapists andsocial workers working in mental health settings, and (2) identify demographicor work-related factors that are related to these sources of pressure.

Method

Preliminary contact was made with inpatient and community-based publicmental health services in the Australian States and Territories based on a listprovided by the State Department of Health. Senior occupational therapistsand social workers in these services were contacted by mail and asked toinform staff about the study and to invite those interested to contact theresearcher by phone or email. Interested participants were sent a surveypackage with a stamped, self-return envelope. Non-responders received twosubsequent mailouts of the package. The package consisted of a backgroundinformation questionnaire and the Mental Health Professionals Stress Scale(MHPSS; Cushway et al., 1996).

Measures

Background information questionnaire

This questionnaire gathered information about participants’ age and genderand work-related details. The latter included discipline, length of professionalexperience, time in their current position, work activities (percentage of timespent in clinical activities, research and evaluation; administration; supervisionand training; community development and consultation; and professionaldevelopment and education), client group (percentage of time spent withchildren, youths aged 13–17, adults under 65 years, and adults over 65 years),and the type of team or service in which they worked (percentage of time spentin intake and assessment, psychiatric crisis and treatment, acute inpatientservices, case management, mobile intensive treatment services, long-terminpatient rehabilitation services, and community-based rehabilitation).

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Mental Health Professionals Stress Scale (MHPSS)

The MHPSS, a seven subscale, 42-item scale was used to measure participants’stress (Cushway et al., 1996). The subscales comprise workload, client-relateddifficulties, organizational structures and processes, relationships and conflictswith other professionals, lack of resources, professional self-doubt, andhome–work conflict. The MHPSS provides a total score as well as sevensubscale scores that can be used to identify specific sources of stress for mentalhealth professionals. Each item is scored on a scale from 0 = does not apply tome, to 3 = does apply to me; however it is the mean item score for each subscalethat is calculated (total subscale/6) rather than the total subscale score. Higherscores indicate higher levels of self-reported stress. All of the seven subscaleshave an acceptable internal consistency with Cronbach’s alphas ranging from0.60 to 0.87. Cronbach’s alpha for the total MHPSS scale is 0.87 for clinicalpsychologists and 0.94 for mental health nurses (Cushway et al., 1996). TheMHPSS is headed ‘Sources of pressure at work’. The word stress was omittedfrom the questionnaire because of potential confounding difficulties associatedwith people’s differing interpretations of stress (Cushway et al., 1996). TheMHPSS is self-administered and takes about 10 minutes to complete.

Statistical analyses

Data were analysed using the Statistical Package for the Social Sciences(SPSS, Version 11) software. An alpha level of 0.05 was used to determinesignificance. Means, standard deviations, ranges and frequencies were obtainedfor demographic and work-related variables. Independent sample t-tests wereconducted to determine if there were differences between the occupationaltherapy and social work participants in terms of work activities, client groups,and service types.

To identify the factors that affected the dependent variables (DVs) (meanitem score for each of the MHPSS subscales: workload; client-related diffi-culties; organizational structures and processes; relationships and conflictswith other professionals; lack of resources; professional self-doubt; andhome–-work conflict) the General Linear Model (GLM) procedure throughSPSS was used. A separate GLM was run for each of the DVs with thecontinuous independent variables (IVs) (percentage of time spent in clinicalwork; percentage of time spent in all other non-clinical activities; andpercentage of time spent in case management, acute and rehabilitationservice settings) entered as co-variates, and the categorical IVs, discipline andage, entered as a fixed factors. Gender could not be included as an IV becausethere were relatively few males in the sample (18.8%). The IV, percentage oftime spent in all non-clinical activities, was calculated by summing thepercentages across each of the work activities apart from clinical activities(namely, research and evaluation; administrative duties; supervision;


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community development and consultation; and professional developmentand education). The IV, percentage of time spent in acute service settings,was calculated by summing the percentages for time spent in intake andassessment, psychiatric crisis and treatment services, and acute inpatientservices. The IV, percentage of time spent in rehabilitation service settings,was calculated by summing the percentages for time spent in extendedtreatment services and rehabilitation. Percentage of time spent in mobileintensive treatment services was not included as an IV since few participantsworked in this area for more than a day per week (4.9%). Time spent workingwith various client groups was also not considered because few participantsworked with children (5.9%) and youths (10.2%) for more than a day perweek, and those who did were predominantly social workers.

The models were screened for main effects of each IV and their interac-tions. The final best model was selected by progressive elimination ofnon-significant (at p ≤ 0.05) variables until only the significant main effectsand their interactions remained. The assumption of normality was made dueto the large sample size.

Results

Demographic characteristics of participants

The return sample consisted of 196 occupational therapists with a responserate of 78.1% (196 of 251) and 108 social workers with a response rate of 74%(108 of 146). There were 57 (18.8%) males and 247 (81.3%) females. Theoccupational therapy sample consisted of 18 (9.2%) males and 178 (90.8%)females and the social work sample consisted of 39 (36.1%) males and 69(63.9%) females. Most participants were in the 20–30 year age bracket. Theoccupational therapists were younger with 117 (59.7%) being in this agebracket compared to 18 (16.7%) social workers. Occupational therapy partici-pants had worked in their current position for a mean of 2.7 years (SD 46.6months, range 1–312) and in mental health for a mean of 7.5 years (SD 94.7months, range 1–468). Social work participants had been involved in mentalhealth for a similar time (mean 7.4 years, SD 67.7 months, range 3–300) buttheir mean time spent in their current position, 3.8 years (SD 45.7 months,range 1–216) was significantly longer than occupational therapists (t = –2.38,df = 302, p = 0.02).

Work activities

The percentage of time participants spent in each of the work activities isdisplayed in Table 1. Analysed using independent sample t-tests, no significantdifferences were found between the percentage of time spent in these workactivities by occupational therapists and social workers.


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Client group

The percentage of time spent by participants with their primary client group isdisplayed in Table 2. Social workers spent significantly more time workingwith children (t = –2.92, df = 302, p = 0.0001) and youths (t = –2.92, df = 302,p = 0.004). Occupational therapists worked significantly more with adultsunder 65 years of age (t = 3.44, df = 302, p = 0.0007).

Service type

The percentage of time that participants spent working in different services orteams is displayed in Table 3. There were significant differences in thepercentage of time spent by occupational therapists and social workers in thetype of service or team in which they worked. Social workers spent a signifi-cantly greater percentage of time involved in intake and assessment (t = –4.27,df = 302, p = 0.0001), psychiatric crisis and treatment services (t = –3.68, df =302, p = 0.0003), and case management (t = –3.52, df = 302, p = 0.0005).There was a significant difference in the percentage of time spent by occupa-tional therapists working in rehabilitation services compared to social workers(t = 6.47, df = 302, p = 0.0001).


TABLE 1: Mean percentage of time spent in work activities by occupational therapy andsocial work participants (n = 304)

Work Occupational therapists Social workersactivity Mean (%) SD Range Mean (%) SD Range

Clinical 58.7 19.0 0–98 59.6 21.5 5–98Research 3.4 4.4 0–30 2.8 5.7 0–50Administration 18.2 12.7 0–60 20.3 16.0 1–75Supervision 8.3 7.4 0–45 7.2 9.0 0–60Community 5.1 6.4 0–35 4.8 6.3 0–60Education 6.2 5.0 0–40 5.6 4.2 0–20

TABLE 2: Mean percentage of time spent working with different primary client groups byoccupational therapists and social workers

Client Occupational therapists Social workersgroup Mean (%) SD Range Mean (%) SD Range

Children 1.0 7.8 0–80 7.9 17.6 0–60Youth 5.0 17.7 0–100 12.0 23.6 0–100Adults 78.8 34.7 0–100 63.3 42.6 0–100Adults 65+ 13.2 28.4 0–100 13.9 29.9 0–100

NB Not all percentages reported by participants totalled 100%

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Stress

In terms of all items of the MHPSS for the 278 participants, the mean itemscore was 1.4 (SD = 0.4, range = 0–2.43). Twenty-six surveys providedincomplete data and were excluded from the analysis. Table 4 providesmean MHPSS subscale item scores and the mean overall score for occupa-tional therapy and social work participants in this study, compared to datareported by Cushway et al. (1996) on clinical psychologists (n = 154) andnurses (n = 111).

In comparison to scores reported for clinical psychologists and nurses,the occupational therapy and social work participants in this study reportedslightly more overall stress. Lack of resources, and relationships andconflicts with other professionals were the two subscales that showed thelargest mean differences, with the occupational therapists and socialworkers experiencing more stress in these areas than the Cushway et al.(1996) samples.

GLMs showed that the participants’ profession (occupational therapy orsocial work), age, and the extent to which they worked in case managementwere the variables that affected mean item scores on some of the MHPSSsubscales, as described below.

Workload

Analysed using GLM, the overall best model was significant F(1, 298) = 16.55,p < 0.001). Participants’ profession influenced scores on the MHPSS workloadsubscale, with social workers experiencing a higher mean item workload score(mean 1.6, SD 0.7) than occupational therapists (mean 1.2, SD 0.7).


TABLE 3: Mean percentage of time working in a specific service type or team by occupational therapists and social workers

Occupational therapists Social workersService Mean % SD Range Mean % SD Range

Intake 6.1 10.7 0–70 12.7 16.3 0–60Crisis 2.7 9.6 0–100 7.8 15.0 0–100Acute inpatient 19.1 35.3 0–100 22.5 38.3 0–100CM 27.2 34.5 0–100 42.0 36.0 0–100MITS 5.4 20.3 0–100 2.4 13.1 0–100Long-term inpatient 4.4 16.4 0–100 2.2 11.4 0–100Rehabilitation 25.8 36.3 0–100 2.6 11.6 0–100

Key: Intake = intake and assessment; crisis = psychiatric crisis and treatment services; Long-term inpatient = long term inpatient rehabilitation services; CM = case management; MITS= mobile intensive treatment services; rehabilitation = community-based rehabilitationNB Not all percentages reported by participants totalled 100%

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Client-related difficulties

Analysed using GLM, the overall best model was significant F(3, 295) = 8.14,p < 0.001). Participants’ age (p < 0.001), profession (p < 0.01), and the inter-action of these two variables (p < 0.05), as well as the extent to whichparticipants worked in a case management service (p < 0.05), influenced themean item score on the MHPSS client-related difficulties subscale. Specifi-cally, the youngest social workers scored a mean item score of 2.2 (SD 0.3) onthis subscale compared to the oldest social workers (mean 0.9, SD 0.6) and theyoungest (mean 1.2, SD 0.4) and oldest (mean 0.8, SD 0.6) occupationaltherapists. The relationship between age and client-related difficultieshowever was not linear.

The mean item score for participants who worked in case management100% of their time was 1.4 (SD 0.5) compared to 1.1 (SD 0.6) for those whoworked in case management less than full-time.

Lack of resources

Analysed using GLM, the overall best model was significant F(1, 297) = 7.57,p < 0.01). The extent to which participants worked in case management influ-enced the mean item score on the MHPSS lack of resources subscale, withthose who worked in case management 100% of their time having a meanscore of 1.8 (SD 0.7) compared to 1.3 (SD 0.7) for those who worked in casemanagement less than full-time.


TABLE 4: Means and standard deviations for clinical psychologists, nurses, occupationaltherapists, and social workers of mean item scores for each of the MHPSS subscales andoverall (0 = does not apply to me, 3 = does apply to me)

Psychologists Nurses Occupational Socialtherapists workers

Subscale M(SD) M(SD) M(SD) M(SD)

Workload 1.8 (0.6) 1.3 (0.7) 1.2 (0.7) 1.6(0.7) Client 0.9 (0.5) 1.2 (0.6) 1.0 (0.5) 1.2 (0.6)Organization 1.3 (0.7) 1.6 (0.7) 1.4 (0.7) 1.5 (0.7)Conflict 0.9 (0.6) 1.1 (0.7) 1.9 (0.7) 2.0 (0.7)Resources 1.0 (0.5) 1.6 (0.8) 2.2 (0.7) 2.3 (0.7)Doubt 1.2 (0.6) 1.2 (0.6) 1.1 (0.6) 1.0 (0.6)HWC 0.8 (0.5) 0.9 (0.6) 0.6 (0.5) 0.7 (0.5)MHPSS overall mean 1.1 (0.3) 1.3 (0.5) 1.3 (0.4) 1.5 (0.4)

Key: Client = client-related difficulties; Organization = organizational structures andprocesses; Conflict = relationships and conflicts with other professionals; Resources = lackof resources; Doubt = professional self-doubt; HWC = home–work conflict (adapted fromCushway et al., 1996)

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Professional self-doubt

Analysed using GLM, the overall best model was significant F(2, 298) = 10.02,p < 0.001). Participants’ age (p < 0.001) and the extent to which they workedin a case management service (p < 0.001) influenced scores on the MHPSSprofessional self-doubt subscale. The youngest participants had a mean itemscore of 1.5 (SD 0.5) on this subscale compared to the oldest participants(mean 0.7, SD 0.5), although again the relationship between age and profes-sional self-doubt was not linear.

The mean item score for participants who worked in case management100% of their time was 1.2 (SD 0.5) compared to 1.1 (SD 0.6) for those whoworked in case management less than full-time.

GLMs indicated that there were no significant effects of the IVs on themean item scores for the subscales of organizational structures and processes,relationships and conflicts with other professionals, and home–work conflict.

Discussion

This study sought to identify sources of pressure and demographic or work-related factors that contribute to stress experienced by occupational therapistsand social workers working in mental health settings. The findings reported inthis study indicate that both occupational therapists and social workers wereexperiencing stress associated with the work context, specifically, in the areasof lack of resources, relationships and conflicts with other professionals,workload, and professional self-doubt. Demographic and work-related factors,namely age, profession, and the extent of involvement in case management,were related to stress caused by workload, lack of resources, professional self-doubt, and client-related difficulties. Social workers reported slightly moreoverall stress than did occupational therapists.

Previous research has found that social workers (Jones et al., 1991; Farley,1994; Collings and Murray, 1996) and occupational therapists (Rees andSmith, 1991; Alan and Ledwith, 1998) perceived their job to be verypressured. Social workers experienced slightly more workload stress thanoccupational therapists. A heavy workload has been a commonly citedsource of stress in a number of studies (Farley, 1994; Collings and Murray,1996; Harper and Minghella, 1997; Reid et al., 1999a). Heavy service usershave been found to be associated with workload burden (Meldrum andYellowlees, 2000).

It is unclear why social workers experienced more workload stress thanoccupational therapists in this study, although it may be linked to the type ofteam or service in which the participants worked. More social workers workedin acute services and case management than did occupational therapists whowere more likely to work in community-based rehabilitation and long-termrehabilitation inpatient treatment settings.


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Working in case management had a number of stressors associated with it,namely, client-related difficulties, lack of resources, and professional self-doubt.

Meldrum and Yellowlees (2000) suggested that one of the particular diffi-culties experienced by case managers working in community settings was thelevel of intensive care required when a client became acutely unwell. Casemanagers are expected to perform a diverse range of functions, working ontheir own, often with inadequate supervision, and in a community setting,which is under-resourced in terms of staffing, services, and access to hospitalbeds (Shepherd et al., 1996; Harper and Minghella, 1997; Meldrum andYellowlees, 2000).

Stress caused by lack of resources for occupational therapists and socialworkers was the subscale with the highest mean item scores. Working in a casemanagement role was associated with stress caused by lack of resources.Resource shortages that directly impact on clinical care, including availabilityof skilled staff and access to community resources such as supported accommo-dation, have been identified as stressors for mental health professionals(Harper and Minghella, 1997). In the study by Reid et al. (1999a), mentalhealth professionals identified a range of problems associated with lack ofresources. These included lack of administrative support, lack of clinical andspecialist services to which clients could be referred, an absence of adequatecommunity resources, and shortage of inpatient beds.

Stress caused by client-related difficulties was associated with working in acase management role, which may be attributable to the demanding nature ofthis work. Previous research has shown that there are certain difficult clientgroups for whom staff felt they lacked the required skills (Reid et al., 1999b).Contact with potentially threatening clients has been found to be a source ofstress which is compounded by a lack of resources, putting people at riskbecause of the nature of the client group (Cushway et al., 1996).

Occupational therapists and social workers experienced similar levels of stresscaused by professional self-doubt. Being younger was associated with more profes-sional self-doubt. Increased experience often attenuates work-related stress(Cushway and Tyler, 1994, 1996). Stress caused by professional self-doubt maynot be unexpected given that the roles and responsibilities of staff have changedwith restructuring of mental health services, and in many instances, staff have notreceived the training to equip them for required work activities (Cowan, 2000).

Meldrum and Yellowlees (2000) suggested that working in communitysettings can place a great deal of direct client responsibility on staff which mayexpose gaps in the skills of inexperienced staff. Cowan (2000) noted that staffoften move to community-based positions such as case management with littlepreparation or specialist skills. In previous research, it has been shown thatstaff identified gaps in their training and believed that training would enablethem to deal more effectively with their work demands (Reid et al., 1999b). Inthis study, participants experienced stress caused by professional self-doubtwhen working in case management. Case management tends to involve a


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diverse range of work activities. If staff are not prepared for these types of activ-ities and have inadequate professional supervision, they may doubt their abilityto deal effectively with the complex demands of their clients. It would beimportant to establish mechanisms for supervision and training in theworkplace and to identify whether these strategies can be promoted toalleviate stress at work.

In this study the area of work that was related to stress caused by relationshipsand conflicts with other professionals was working in case management.Community-based care, such as case management, requires negotiation with awide range of agencies and services to adequately address the complex needs ofclients seen by mental health professionals. Clients seen in mental health quiteoften live in poverty, experience inadequate social conditions and have a seriousmental illness (Harper and Minghella, 1997). With inadequate communityresources, it would be expected that there would be much competition andnegotiation to secure whatever resources are available (Shepherd et al., 1996). Itcould be anticipated that this would lead to frustration and conflict with otheragencies and services, if services were unable to be provided for clients.

Previous research has shown that one of the most common pressures experi-enced by mental health professionals arises from relationships with otheragencies and services (Harper and Minghella, 1997). Multidisciplinaryteamwork is important in the delivery of care to clients with a mental illnessand their families. The quality of service delivery may be marred by conflictswithin the team and the stress that this causes. It is necessary to foster collabo-rative relationships and liaison within the team and with other organizationswith whom they interact. An increased understanding of the causes of teamconflicts may lead to the development of strategies to overcome these.

Limitations of the study

There are a number of limitations that need to be considered when reviewingthe findings of this study. Firstly, there may be a response bias in the study relatedto the characteristics of the responders, since it is not known whether sources ofpressure and stress levels of the non-responders were different from responders.Secondly, the fact that a survey package was only sent to staff who had alreadyexpressed an interest in the study, may have influenced the results. This maylimit the generalizability of the findings beyond the study sample. Finally,because of the characteristics of the sample, it was not possible to consider theeffect of some independent variables on the stress outcomes (e.g. gender andclient group).

Future research

Future research could be directed towards surveying staff in the other key disci-plines in mental health to determine whether they are experiencing similar


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sources of pressure as occupational therapists and social workers. It would alsobe of interest to gain a further understanding of the nature of the workenvironment that contributes to stress caused by conflict and relationshipswith other professionals. There may be an advantage in using a qualitativedesign in identifying characteristics of the work environment that contributeto stress. Longitudinal research would also help by monitoring mental healthprofessionals’ stress experiences over time.

Conclusion

This study set out to identify factors that contribute to job stress in a sample ofAustralian occupational therapists and social workers, and to examine therelationship between demographic and work-related variables with stress. Thefindings revealed that occupational therapists and social workers experiencedsources of pressure in the current work environment. Specifically, the mostnotable stressors were lack of resources; relationships and conflicts with otherprofessionals; workload; and professional self-doubt. Participants who spentthe majority of their time working in a case management role experiencedstress associated with lack of resources, client-related difficulties, and profes-sional self-doubt. Social workers reported slightly more overall stress than didoccupational therapists. With the exception of professional self-doubt, socialworkers experienced slightly more stress on each of the MHPSS subscalescompared to occupational therapists. Occupational therapists and socialworkers make an important contribution to service delivery in mental healthservices. It is important to gain an understanding of the work roles theyundertake and the stress they experience with carrying out these roles. Thiswill provide information that could be useful in developing education andtraining and supervision strategies to alleviate stress in the workplace.

Acknowledgements

The authors would like to thank all the staff who gave their time to participatein the study and to Chris Foley for his administrative assistance.

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Prosser D, Johnson S, Kuipers E, Szmukler G, Bebbington P, Thornicroft G (1996). Mentalhealth, ‘burnout’ and job satisfaction among hospital and community-based mental healthstaff. British Journal of Psychiatry 169: 334–37.

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Reid Y, Johnson S, Morant N, Kuipers E, Szmukler G, Thornicroft G, Bebbington P, Prosser D


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(1999a). Explanations for stress and satisfaction in mental health professionals: A quali-tative study. Social Psychiatry and Psychiatric Epidemiology 34: 301–8.

Reid Y, Johnson S, Morant N, Kuipers E, Szmukler G, Bebbington P, Thornicroft G, Prosser D(1999b). Improving support for mental health staff: A qualitative study. Social Psychiatryand Psychiatric Epidemiology 34: 309–15.

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Address correspondence to Chris Lloyd, Division of Occupational Therapy, University ofQueensland, Q 4072, Australia. Email: [email protected]


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Sources of stress experienced by occupational therapists and social workers in mental health settings