Burnout in secure forensic mental health services for young people: a mixed methods approach

Abstract

Occupational burnout is highly prevalent in mental health services and has a deleterious effect upon the psychological wellbeing of staff. Few studies have explored burnout in inpatient settings; those that have do not address the possible systemic impact. This study aimed to explore burnout and emotional reactions to behaviour that challenges in a secure forensic mental health service for young people; a specialised environment in which severe and frequent incidences of aggression and violence occur.

Following a systematic review of burnout literature pertaining to inpatient mental health services, an empirical study was conducted using a convergent parallel mixed method design. Forty three staff members were recruited to the quantitative strand and ten were recruited to the qualitative strand. Emotional Reactions to Challenging Behaviour Scale (ERCBS) and Maslach Burnout Inventory (MBI) instruments were used.

A significant moderate positive correlation was found between emotional exhaustion and negative emotional reactions to behaviour that challenges. This relationship was mediated by general self-efficacy, which buffered the effect of emotional exhaustion on negative responses to behaviour that challenges; responses found to be detrimental to the relational environment. ‘Young People Blame Themselves’ was explored as a relational barrier and maintaining factor in occupational burnout. In ‘You Want Someone You Recognise’ and ‘We Lack That Consistency’ a high ratio of agency staff and a lack of operational consistency were identified as occupational stressors.

Emotional exhaustion is associated with negative emotional reaction to challenging behaviour. Interventions should be targeted towards developing staff self-efficacy, through the use of reflective practice and ecological changes that enhance team-working and feelings of safety on the ward. When on the ward, staff should be mindful of young people’s predisposition towards attribution bias. Future studies need to give greater consideration to systemic outcomes associated with burnout.

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Identifiers

ORCID for Nick Maguire: orcid.org/0000-0003-4295-8068

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