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DOtl] 1007800127
h demol(2a0\l4a:211
so(Psychiarry 2)t
1,.,,,.'i',.,..1 :i:i',ji
11-1.'1;' ;
' RichardA' Powell
StefanPriebe'Walid K. H. Falioury' Karin Hoffmann

andjob perception
Morale mentalhealth
of community
in Berlinandlondon

9 SePrenber

exceeded rherhre.hold fora burnout 'ynd.rome andare

Absla<r lntrcductian Moraleand job P€rcePtionof workrng
\talfin communirvmenlalhealthcarema; n0uen'elea- o.'i""f.'rv f.- fr*r,"ble forsoLidllolkers'at;sfac'
ha' sut' i" i "ra"" i""ai."a h,gherburnour' loweriob
siUrtirv and qu,litv ot care.and romeresearch Being a pre
parlicularlyhiShburnouroi sldffin Ihe commu- rionandloherledmidentiry Psy(hidrrrsl
"mrv. Jia.Jhigt'.' t"orn ia.nrity. beinga
whrl'r 'o'iat worker
lhe aimsof rbisstudywereto:d) a5\ess mordle l e
in-Psychia- wa'a-oliaredwithhigherburnour andloweriobsatj-
i'ea'rnidentity, job satisfaciion and burnout, "ndhiShe-
and\oci'l workes r"ii;on.1.,t.t"' p';ait Ledlowerburnoul
iis',,.o*;'y p.y.t'iarri.nurses g'oup aad 'ire in-
ti'i,.i ".ahh Larein Berlin andLondonr i.irn ia*,ityluo..i* prorestional
i' i...'"ny
i",ri,.a ir pi.a .,;"g l, rnourandiob!aristacrion P<y-
between the group" and te*
.-r.'i"tii'r.i'i r*a""-lra much more farourable rore'
.ttitaclerr\ri'5Pla(eofworking and
lah.tft.t o.t.onut
' I exPlore whar g'oups.whilsr
it'- it'. o,t'",'" o ".p"tiquestionsrhjsdidnorholdrruein
o'"i"',i"L.f g-rp p*aicl morale:.and revealed universal as-
i"Ji,"t't"a!t'-l,tL'""iovableandstresctul aspecrsin- ii"iii". e"'**' ,"
"".it,."if' "t *i"yi'g a;re(rParient contd' r and dislik
i"i"i.*"., *""i""a * i-Portantin lhejriobsMetliodr i".v.t,1, "it" varrousviewsthatw-er especific
J 0 i"*ir'."",
i n a , l s q m e n r a i h e apl rr h
". piore'sional group or botb con'l'rio"
in eachof the 5ir grouPslresPonded to a poslalsurvey i;"; 'li; burnotall profes
""d ,*"it.a *,i"1ti.t per week usingpre formedcate- it'"'r."i'.'"r'i"t , p'"ltenifor iome' (are'and(o-
on "io*is-rp. in ..;nnr,nilymenlai heal$
*lri.ill.""p,io" "r piofe\sional rolewasas\essed be a group wlllrpanic
ontheMinne'ora .iri""?1".1;" Lo"aon"ppear ro
iheteam tdeirtllv
-i"ii.f".,i"ri Scalijobsatrsfdction Difierences between professional
i"t Scale,and burnout on the Maslach "r..r" i"* -*a" rhetocalion'dnd il remd;ns rrn'lear to
sevensimpleopen quesrion\were ntoui" a"pend on
Burnoutlnvenlory' relared a ndgeneral factors imPaclon tbe
i".Ji. eri.;t*. 'ir"l' t,sk(.skills rharstafjdidanddid ihaiertenr iob Answer'lo oPen
"oil..t .otp.,"n' in *pecrs thdrlhevdid anddid not moraleofmentalhealti professionals aspertt ottle
..iou in ,ft"i'tioU'*a "b'racles andfa'ronLhat caused "rf.i;""" i*."1 g.**t at wel'a"specrfic of which
dnall"js ii*;;;;:.;' i"";f",1'" p'"fesslonal sioup' some
;;:';i;;;. Ar'.." were\ubjecred ro contenr trainlngand su
i""':1.i"[*"' r"'.*i"l.ederelopment
l.;"e " p"tr*lori formedcategoriesResrlrsweeklv m*" concePlual and metbodoloSi!al work
".i*l,i"r'-a t"."t" *ried belieen sitesand profes' ".iri.i... "","ntiu"ttua;e'arerequired todevelop.abet-
for grouPsin London !ni to."
rionuilio"pt so-" -"an scores ierunderstandingofhow communlty mental healthpro-
iessionah perceiv:e theirjobandhowmorale mdyberm
Prots.Priebe(A) w K H.Falhoury
Unirfor SocialandCommuity Psvchiat'y Keywords burnout conrentandlysis corrmunny
Nshan Ce re for MentalHealth
London!13 8SgU(
-"nilf ft"l,r' care job salislactionmentalhealth
'lel.:+ 44-7017540
4214 professionals- staffmorale
! Mail s.p.iebe@qmd.acul(
Berlinlnstitute of SocialPsychiat.v
Therei. increa.ingevidence burnout
", ii*in*n, pto-U.".,o bo!h and
emPloyee5 emplq
sainsburyCentrefor MentaLHeaLth UK
"r.,.'i,t' otouna270.000 for
emPloyee5 examPle'
taking time off work yearly becauseof work-related of different careap-
specificstrengthsand weaknesses
stress(McKee 1996).Mental health professionals, like
other health care workers, arc subject to stress and The latter two aspectsrequjrecomParisonsbetween
burnout, and sincethe 1990s,there havebeen callsfor professionalgroups and differenl h€alth care syslems.
more systematicresearchon the moraleandwell-bein8 This study,therefore,assessed moral€ and iob percep
ofhealth carestaffin generaland mentalhealthProfes' rion ol p\ychialtirl'. commLnily Prychia'r, aur'e'
| sor ker. (\WJ. all working in . om-
sionalsworking in the community in Particular (e.g (rPN\ dnd roci"l
Reesand Cooper 1992;Wall etal. 1997;Departmentof munity nenral health care. The studywas conductedin
Health 1998).studiesinvestigatingthe moraieof mental r\ao capital.of large' Europedn counllie\, i c. in Berln
health professionalshave shown that the burnout and andLondon.I he twocaprtaJs 'harevariouschrra, err(
poor mental well'being of thes€professionals were at tics includingthe usualinner-cityProblems,butmental
hrgher1evel. compared wilh olhel o((uPdl iondl grouPs healthcaresyslemsaredifferentlyorganised it line with
I Lar!onel al. lo95atOnyell el al.l9qr;Pro5.€r el al.I oq6; distinct traditions and tunding arrangements- This ap'
Wvkes €tal. 1997). These professionals face additional pliesin particular to communitymentalhealthcare.In
st;ain bv the very natureoi the mentalhealthwork and London,communitymentalhealthcareteamsarea cen
as a result maybe more at risk than their colleagues in tral componentof secondarycare,whichis organisedin
other areasof healthcare(Mooreand CooperI996).In a co ordinatedfashionwithin a NationalHealthService
creasedworkloads,workintensity,understaffing,job in fhe redmsprovidelhP \landard.are tor Pdlienlswrth
security and continuous,rapid organisationalchange seuere mentaliUne<cp\ and are supPorted by olher In-
within the professionhaveall been identified as major and oufpalient services. Berlin has a mor€ fragmented
sourcesof stressamong mental health workers (Ed_ healrhcarelyrremwrrhseteralProv;der.runninSser-
wardset?1.2000). viceswithin the samearea.Multi-disciplinaryteamsin
studies have shown high levels of dissatisfaction, the communityare rare and linl(edto differenttypesof
stressand burnout among psychiatrists(Benbowand provider organisations.They fullil rather sPecificter
Tollev1998iGuthrie etal.1999;Rathodeta1.2000),and lidry lunclion"for peoplewith severe and(hronicmen
communitv Dsvchiatricnurses (Drake and Brumble tal iilnesses,and their methods ofworking vary Whitst
comb 19se;Snilgrove199s).Particularlyhigh lev€lsof working hours for staff in London and Beriin are slmr-
emotionalexhaustionhavebeenfound amongcommu- lar, palvades between the cities.The pay also varies
nity mentalhealthstaff (Prosseretal.1996iCarsonet al. withrn eachprofessionalSroup at eachsite depending
1995b).Inde€d, thele js eviden€essggestingthat work- on seniorityind, for example,ageand family statusin
ing in the community may be more stressfr for tnental Berlin.In London,the estimatedaveragePre-taxsalary
healthprofessiomlsthanworking in in-Patieniservlces in euroofpsychiatristsis 105,000,CPNS 41,000,andSws
(Prosseret al.l999).Thehigh levelofstressand,in turn, 48,000,wh a in Berlin that of psychiat sts is 57,000,
burnout and demoralizationcanimpact on the feasibil CPNS32,000and SWs38,000
ity and quaiity of mentalhealthservicesin the commu- The curent exPloratorycross-sectionalstudy had
nit* and concernshave been raised that burnoui in three aims: (l) to assessmorale,i.e. t€am identity,job
community staff may makecommunity-basedse ices satisfactior and burnout, in Psychiatrists,CPNSand
for mentally ill people difficult to sustain (Wykes etal SWsworking in communitymentalhealthcarein Berlin
1997).Burnout of community care staff has recently and Londonj (2) to compare findings between the
been investigatedin London (Billings etal. 2004) and qroupsandte.twhetherand,if wharwavPersonal
was found to b€ associatedwith poorer patient out_ charicrerislics of Lhernlerviewees theplaceof workrnS
comesin assertiv€outreachservicesprovidingintensive and the professional identity predict morale;and (3) to
communitytr€atment(Priebeetal.2004) explorewhat lasks.obslscles. skills enioyableand
Thereare at leastfour differentreasonswhy further rtrersfulaspecr.inLerviewees PerLeived asimPortantin
researchon the morale and job percePtionof commu_ theirjob.
nity m€ntalhealthstaff maybe imPortant,andwhy reg- Thestudy,tlerefore,employed quantitativeand qual
ular assessm€nts of staff morale may becomepart of irative methods,using establishedquestionnairesand
routinequalirymanagemenL in (ommunitycarern lhe slmpleopen questions,the answersto which were sub_
future.Fir't.aoosirrvimorale is essentialto recrurland ject;d to-cont;ntanalysis.
retain talentedand oualified staff Secondlv,staff with
hiqher mordieare likely lo deliter better care Thildly.
colmmunitvmentalheahhcarerequirescollaboralionol subjedsandnethods
differentprofessional groups,and a preciseunderstand
ing ofthe morale and job perceptionofthe profession-
als involved should facilitate team working and oPtimal T \ e . a m p , c . o n s .r e do l p y c n r o t r n r'. P N ! a n dr r { ' D r o \r d i 8 ( a t e
use of personalresources. And fourthly,staff'sperceP- i n o r m u n r l . r t r n g . l o r p e o p k w 1 n m e r r d l h e a l l hP ' o b l e m 'i n
tion oftheir roles,tasksand problemsmay caPtureim- Be,lin.c.d;tdd L o a d o , U l i r e dK r 8 d o r ' w " a m e d d l a _ i n '
Dortanrfealures ol the philosophyofaserviceandin n u m . a r p l " n ? eo l t o p a r r . ( r P " f i f o - e . ( h m e " r d h " d l L ho r o f e '
q sionals.o!p ai eachsite This wasbaed on thecert.aLLimit Theo_
combrnarionith;sments. helproidentily
nensGunscor€sranginSftm 0 to5a)Thc
,e..h h J A e e { ' l n . l u r l \ \ " m ! P ' r ' i 0 o m o r e r r e d e r d S e d n d so!rcet coisktsolnnE (nes has hve
h p - m p ; s , l l L , e r o ' . r o I o ' c I n r l P P o o deDenonalisat,on donain ive artirudeto Parienls)
;,"r'.tu,tun o i : , o A , n a"on
d 1 d n e r d ' / 0 0 - \ ' n r h i it;s (sun scots between o and io) Findllv, the PcrsoDal
J l r . t u . r h d I h eh r P l e i ' r " l t " r r' r o n D d n . e ) a o m " i r " e B dr e A d . n i o ' o l o n P ' e l t ) r 1 u d " ' ! t h l
" r o r o - r o ' r . r , a y . i * " * , r e , e ' e d r ' u o { . - ' r d e k r "' iL/ " ' v r \ ' l o...hmen
' r e m r r r . o r e ' r r g r-nhge t*;oo, r. O l o 4 3 A r ' " l b r n o u " ' t r ' 4b_
'"ilpr* "i ,u "!* ."..-"d " o P r o P a d cd . r h o - 8 h' oto\io"d
- u m / e d ' ' l e ' " u n e a o v a o a i n e i p r o ' n " r i o n ' . r h d u
r u " 1 , , ' n r . , . .p o " . ' ' o a " ' m d " - d m P d - d n d o m l v " u o n . " a o e , i . _ , t o . . " . p . h r q i ' . o ' i r , bJ r r " n r ' n t h i " u b _
ln Inrdoi rhe vl'ple 'l pt n4rrr rn_ t0 s4\ d' rhot' In ihr
p . v ' r r ' " r " n " d - f _ e d a l hP'I ro o' In (he :,me dFr'o
,l'rhnrron d l.{ oj dll.;n -rr.;r d i o n 5 b ' a l "
T \ P ' r { I o r e m o r o d l . \ J r a u ' l . o n , d d e l - { t u l ,
-dewnL.d.ntrel dte.r$Pon'ibi rr'rorl' nEfor
1 r e , i r ) M e n r . l H ; d h h - r r ' L a r l u n o o " 5 J u l l_ w e r Sevo oDen{ndedquesijonsvereusedlo asses$e resPonoenn
dor ano rlr rL-eP
o b o q ( e D r i o n . , hqP; c l i o n ' ^ r e d r c ' P od P r l ' r o I :
l-onoo,nu* ""o'ee t'*r'rouh wenlondo'rdno\our\l'n . . t h r e e i " ' o D . ^1.'rhe)P,'r-r"rPdrn
rJ')oLhLondo-r ""dmPk'otCP\' r , i r a . . o r . h o " r . r , ,
a", " a.'"v*o'"y
an=3(]lardSWs{n=30)wererandonlvdrawnfrodadatabasecom ihcnjob: (3) three;ain skillsihev feh cmPelent ini(4)!hr* nain
o ' i . j ' , r h , y d . d f o r r " l o n P " r , . r I n' d r e e ' ' r n . P e ' ( r h e \ e r _
ri.,dbvrhe\a,n.b'yLPl to'v"nrJHP"Inor'ondonb"ed r r d r robi o b (r(b, bo Jrtmrec ; m. i.rnsd
thi r' reccman'
m PPee."6r lur<lr"h' eo vdq'
d Lu d!u' ' rn looLl !!Iinn rrhhoer: t
noo Lqr!r
- . , nu,+. lv.a ? f d"dnP P i o t , oDi r therr
ioved asP(s
, , l " o r r . q , , n d .o T m u nr ) P i . h E
' n e o r r u p e ,n p n r d . h e a , 'p , o r e o - J S r o L P P o _ r J ! u r J i o n d r r e jo6jand (7) three nan fadds $at.aused Presurein then job
i o t r o " " a i v r " . e m r n a " '* e r e . e n r r o 4 0 P < v c h i a r ' r " 4 ? ' w ' " n d
: . C p N . r e . u h r n g r n T s n . b e o o . , - drapo. 0 po o n ,re. , . r e p a r v e l ) .
n B . , . . r l e r r ; . e r p . . n i D 8| } " ' r u o ) " - d a / i n E ' u l l o P r t r i '
p a t p E e r e ' " n r I o h e d r r e . l o \ o r d l 1 , 2 7 \ o i D i r r' r r d c h t d o L 'P r P n l
i " " - a . " ' a , r ' ' , . t r o r * " r p a . e t r ' I n n i r L ' " m L ' l d n / e n r ' " l l r r . h e \ r d r . n n J P a . / d ba p l o r > o l d- . ' e r \ P \ q w r r . o h . \ t r i o - l
('SPDJ) which at anached tolo_ . " , - " a . r n " 1 * ' " 1 . ", I ora-.nlirri'edrG d''r'Prre {rn'
;ociarpsycliat.ic dNtricr setices
r r o , r e o ' e * n r e or ' ' h r r e q : e n c ya n d D a . F r ' E o J r b r ' o - ' l o t
c a a u r - t r o n r r'ei r"p r o v i o + ' o r - o m P l e m e l t d r"\r' vo'/er J' s ' x P - o r d ' ers
. i r e ! o d . d l d " r "" l d r P " 1 ' r n o ' " n d . r d d 6 E n o " 5 D ) l o t r o n l
" i " . " r - a n , ^ 1 " e . . ' . p t " e " ; le r ' ' " , n o dr'one' bl
p o r r e n h k r l n r h r o n rm<e n r aJl l n e _ e ' " n d l ' L P P " ( l k r r ' n ! r n P r N a ' e u o u : o . r r l - t h P" n d l / i . o r t h e . i v r t r P a w e e k h r n u m b e ro l
o r t - e b a r d D i d ( r n et , L h ! n P n p h ! $ o n l o idl ps) \iarr" d " i . , , . ' " p " , ' . . p . ' w e e \ " n e a \ d c n \ i r yb v F a ' \ r $ N l d r n r
-?u nkrPrai' ., onedi r 'r.rePR'en "r_ t-i'"" . - o . p " * n , g P o D r o r h P r o r d l n r m b P r n f h o u 'te
f.odalply, \;ui5. \" s. ot - e i d r r e . P o n d P l A m e d r lorer'h ai rrrlwa!
b v ' o l ' 1 e ! e ' D o - r e db J P e r ( e l l r E e
r , r o i r " U p r o n o e r .w * e p . t " o l J | } a P P r o d c h e d
were senl out wrth forea.h ErouPof Profe$ionah
searchers{(. H.). A total of i2o questionnaires
" r e m i n d . ir o l w h i " n ! o $ ' ' r ' e l u t n e a on. w'} .rJv.i. o \"_"n.e raNovA\r\.'elte lPr wa u''o Io
o n\ ) h a r l n "
- r q . t h l e e h d d b e e ' f i I e d i n r e { r h e r , i , " r i ' a l ' . 8 n i f , a n ( e o f d r r r e r e n , " ' b e r k " eD
, q 9o " " , o n " q , . { . o n , " . i" odP
n u ' * ' ' n d ' o , a l / o R { r n 8 e r'-andLon
( t ! ' f o n {'rd' and i o m . . n i r y p ' i r r " r i n
o , ' " r o o r - " - p r o r es ' o n , l E r o u D r h r e " D v
P t \ t e s ' r h n o d i r e . r t p ' P o n ' b ' r r \ o r P a r F n r don. Tle ie;r;onl Cli-squarelest wd usedto asse$statGtjcalsis
t h r e eb v - r d l t a b l e (1 1 L n '
3l CPNS,and 38 SWs{ere in nlf(d eror eroupditffle.c" beseer'r'8ori'J\!r
Thus,rhe resultsof 30 psychiatrisrs, p ' * * ' r r o n o r r h er e , u l ' o n l vd c k v ' o f r l e
ru"',." " 'itp.
' . r r , , r n J . . B n i f , . , n ( i " d e D o l e d l o iJ l . o m D d ' o n " T h t o u S h o L l
Becausethe stu dy used Postal gu.stioD n aires to collecl inlorma
ofstaffwho did nol r!. analvsis._a sisnificance-ilerion equ.i to or smaiLerthan 0 0s was
!ion,no data{ere gaGered;D&e clara.teristics stalistical significance.
used ro;e
returD lhe questionnaire
To resrwherherdifferencesin burnout'job sadsfadion,andiean
identiw wereduero site of practi.e (Berlin,London)'lvPeof!rcres_
. i o n d L e r o u D r D ( v , h i c ! . 5P ' ' .N, " w s l o r P e h o n a" ' a ' . . ' e r r " ( ' o '
ii" i.';,,;.*s ' , c " . B e n d * I e n sh o r e x P ' r ' e n . e n e c e a e r J l i n
a qru,'Lred e a rM o d e r
l c L M I fr'\d .rP *r {d! urd lh' k'r P-o' de rc8ttu
T t s en l d ' - r d e r " b L r h e o \ a l e s " n o o o e n q l e { r o n '
("8e , : " , , " , r * - a " " . t r " , r ' d n d n . el o ' o . e o e t P n d " n{ r i 4 o l e b v
o ! " . n o n n a i e . o r ' e r e o$ e s o . r o d P m o s % D h i ' n d ( t ' i \ l i ' r
m p d m o r el a ( l o - .d n d / o r\ a r r a be ' a n o P r o v r d eP f e ' r o f i i r e r a ' '
i e n d e r a n dt o b d e r a J .' e g . d ' e l o . d " l e n 8 f o l e r P * r e n c P ' o r e '
tions betweenveiables ln olr cat, thte modelstere conPutd'
; j o r i l , e ' p o l q b l i r F ! . n d . . ! j r i r e (o e r x e e k ) o lP t o l e ' n o r a r s
habL'heo rJtderr. t r e , eu . e d r o & ' e * i o b P e r e P L r o n a n d with buraout, iob satisfaction, ard teafr id€ntitv as dePetdent va!_
D r c f e s ' i o ntaol l e( t h . f e d ml d e n ' r t s c J e ( R / z o e lJ I e 0 \ ' i o b ' a ' able, 5rLd/ rie dnd r}?e o' Prore_ o_dl8rolP weteerrP cd r: 5red
: r a . t i o n ( r h e V , n n e . o r "J o b \ a t i " f a . r r o n
s . a l e W e t s s p J l e 6 - r r . r c , . . r e o r h e rr a i i o r . r n d rw e t ea l , o e n r e r e rdn r h eG I M
(Maslachandlackson . e e . e e r o * , a d y " a - o r pra.r(e in renrJ I alh nder"bl"Pte
andbunour (Th€MaslachBudoutlnventot ( o t ' r i b u t e dr o t h e
l 9 3 l ; M r s l a . he l a l . 1 9 9 6 ) " i n r j ' n e , h e , "' , I : , o _t y ' , ' . o l e \ ! i a r , i 8 n f i c ' r )
lb ilen" trhj.I de rated on d . . J a " " " " pr".rea *rl' te'r p"'rE rr.'quarcd ri" Pro-Poa'on
The ler'm lden'tv r.ale.onra.n)
.r w I "n.e ; the deDe,dpfr varidbterha,n erplri ncdbv drtrerer . e\
h'e-Doint likert-tvpe scalewi|n ansvss rangingfron (ll stongrl
disairee to (5) sto;gly aSreeThe sd scorehas a minimun oI 16 anon s Eroup'i. . hi: -ode trassed becaur n lcn rdPnrrfvin era'.
'r.. "?!."'".**' pl"a"., \arrdbre' P E beseen Proresrondl
anda mdimun 0180.
stud/ was tne e r o u Dr d . i r P I.n o r d ; r r o . $ e $ r h ee n e n ro t r n " P ' e d ' r i v Pv d l u eo l
The Mimesola Job Satislaction Scaleused in tbis . a m ea e p e n d e ndrn dr r d e P e n d e n \ crr i r b l e 'w e r e
r h "
20 iten shortversion,Fo!eachilen.ratitgsrangedfrom(l)veryds_ ia.\'oredi,.or,
" fesre-ion "nal)5e'. wrlh d'ra o he
scores rdging from 20 to 100 ,,u;"ii"a . ,"p.;" .-l'.p
satisfi€<lio (5) very sarisfied,wirh suD
il" -"*"i i..,ti" i'"-."nt {w*s eraL1e67) sussest thalrhe ,i"la. a""a ,.!**ion . "ir r( k;' .nd vr'"n(e bv e"''
i r . n . o f t h e S e r e t r r . c d e . c nb e g r o u p e di n o r ' l i ' r ' r ' i n s i _ _
' ' o n a n d 1 , 2 , ' e l r r i n ' .$(r n t u . r . o n l r r ' r n t , ' a u t n r o n r e f l el ' h P ror the ,n.*er: to tle soen oPe- .Ltnion\' themn( conrenr
extet! to which Droiesionals feel their job fits ihen skills and leeds ualvli. M'condlcred Jnng.Ponei oarotmed''rgories n{o re
It consistsof 12iems wilh sun scores.angingfron 12lo 60 The re_ ,ed"he,5 De' :.rp \BsliD/l ondon \ePda e ) derived areSor'e'lo'
' h e a n . r e j ' r o z " ] r q u o r ' o no L ' o l I h eP r c r r d e d -areriJ Ther'd
m d n , n se i p h rt r e m ! .d p t r r ee { r r n s . c , J r r r a c r i oLn\ a r" ' e * $ s a r n
; n o - ' r . r i r r w o L m s i o n d i r ' o n "a r d f e w l d ' - s u r " o r $ h n s i n s .""ri"" "*. 't'* -,i p""a "ndd8rced uPo_b\ Iheso etr'her'
R ? i " , , . h " " . ' ' " " , * " ' ' " ' d . v e l o p e du s t o w n' " r e g o r i er' o r e n e l
fton s io 40).A total;ob salisfaction scorevas obtained bI adding nP
tne s.oresf;r intrinsicandextrinsicsatisfadionfor eac! iesPoldenr' Io(a,pb(ti'e .on'ePl.dnorerm.noloA E t) l s L h P d n a) { ( w " \ ' o m
were n . p , € 4 . h e . " r-e* e o r d
i . e
. n r i f i e d . B e r ln w e r e" a n \ a r e dI n r oL n S r r s r '
The MasLac!Burnolt lnvenlory has 22 items ResPondenrs reg-i".
ro' ,n.der, or p,oie'.io0ar' c.rin .nd
ieu.t oln"
askedro lrovide a .atits for each item' rangins fron 10) nevd to (6)
eve.vdr(vith Dossibl;sum scoresol burnoui ranSingiiom 0 to London were, therefole, differeni Tne Per.entaS€ or lesPonoems
L32):Th'escareiaselfis didded dree donainsr (l ) emotionalex' whoseanswersfelt i o eachcateSorv{asrhen calcdated lti6tobe
hution, (2) depe6onausation, and (3) PersonalaaonPljslment n6tedthalthe catesolies{e!emuluallveelusivedd'hence'the Per
The edotional etlaustion donain (reducrion in emoiional re_ centagesdo nol add uP to IOO
T.blez A.rivity proteis
forea.h (per.enta9eottimeipent
Ptdia$iss Connunily Sodl
A q e , g ( n d e r a n d . o m e l o h c h d r a L l e l j s l j L \o i l h e r i \ tFyrhiatic wortsj
e r " r p , o t m e n r a h e a l l h p l o l e s ' r o n d l sa r e s u m m a r i ' e d It{€an+so Mean
I tD MeanlsD
in riute t. rnere are some significantdifferencesbe'
tween professionalgroupsand sites,with psychiatrists
in Londonbeingmore often male,havinga higher case
1t.2r10.8 8.417.0 12.118.2
l o a d ,l , k r n g . e 5 os r t e n, r e y w o r k i n gr o l ea n dh a v i n g Btrlin
19.6112.5 17!+12.6
more lrequenrlyon-.dll duriP\ rhrn 'he orher lvP
Table2 showswhat a.tivities mental health profes- Ee ln 5.3J4.r 5.7!4.6 63!52
sionalsreportedsPendingtheirtime on during a normal 6.9!6.5 7,5!9) 9.9110.7
norking week.Between19.5Eoand 34.7% of the work-
ins tim; is spenton administrationand travel.ln Lon Befin r5-t1t6.3 t3.5110.4 l5.8Jll.6
do."n.ea,h grirupaddnrondlly sPend\morethao)0 oool n.arlb 16.918.5 12,5+11.73
rheir tjme in meering\. whil\l thrsi\ JiShrl) lower in
vary betweengrouPsandfor Benin 1 9 . 8 1 1 6 , 8 1 0 . 1 1 1 1 , 3 r1 0 , 8 1 8 . 0 r
Berlin. Other activitiesalso 9.7j:6.7 ll4r8.0 79!5I
each qroup between in
sites, Particularhow much time
is speinton seeingpatientsin the hospital,in patients' 4.4!4.6 7,918.9 4.1+7.8
homesand elsewhere 4.5):4.6 4.9:t9.3 27!40
Table3 showsdata on blrmout' job satisfactionand

8!r in 1.417.t 7.2+10.8 3.4!1.2

8.9167 6.115.6 8.6114,2
Tablel Differencei in BerinandLondon

Uean!sD- IrieanasD U..nisD

(0196) (or%)

Eein contadin palienlshome5

209d 70.5+22.a1

_ Blrlln 5 , 6 ! 1 1 . 1 5215+201' 11.61t2.8"

with otheraqen(e5
119.8a150.0 28.9!68.9j Be in 2.3r2.1 7.5t2,7
295.2a108.2 13.019,8 17.7
!8.7 2.5+25

Berlln Se in t,6l6J
63% 82% 8 9 ,

0 3.5+5.1 2.5r8,1

B! in 1.8+D.l
Betlin 5l% 299i 32%
91yo 3696'
rTheschefe ten(onPaiinq emeproiesJionagrcup 'e (London
iThekheffelen(or(hlsqGreincde of %)(ompdir'g sameproresona9r0up
orBerin)Bdatinka lYii9niikant
by5ireoIpGd@(London orBe in)Lfttkli(allyignllicnt rThekhefferen(omparnq at'no&rnrne
,The9(heffe n @seof %)(' Fydialist5and.ommunilvp3y.h
1enlorchi 5quare ofpn.ri@ isnalistkallyrigniii(anl
f(anl 3ame sire
munry psy(hhtri(nuresinthesame s te olptadkeLstatistiGllysign I Theschefie
ten.ompdinq psydialr5s andso(alworkerintheemotte ol
3The9cheltetert(orchi'squaGin.a5eof%)conpadn9 psychiatrnts
pradke lysigniii.anl
worker nrhe$mes1eotpfadkeE natsti.alysigniii(anr ithe Sctrefie <o..unnypsychiattunuresandso.iaLwo*etsin
lThe kheffeten (o,Ch rq@rein Gs of%)(onpding@mnunlypsy(hiati. tesrcomparlnq
$eemesleofpGdi.ei5statisti., Is qnin(anl

on all scalesother than personalac€omPlishment, and

te6midentity for the six groupsof$ental healthprofes scotes
favourable of all
and they haveconsistently the least
siondl'.Psf'hi"lri.l' rePorlmoredepel5ondhsdlron
jdenlily in iondon CPN' \how lhe "amedii six qroups.
plu' higheremolional e)dau'liondnd burnoul i"blei showsthe resultsofthe GeneralLinearModel
tn London.SW\ rn Londonhrve le\5lrvoulablP5Lore\ Univariate predictive analysis with tolal scores of

Table3s2isfa.tion, andteamdenlrtv Prd[atdrE ommlftY sodal FolloYA) " ,
aDdLoMon gsvdiank rcrl€l'

i{€an19 i'l€.n+50 ll€rn150

Berlin 44.9!7,5 453:15,5 3J96.178) 0.006

< o.o0o1
24.4X).9 27.5!6.2 21.5t5.7

Serlin 69.0r8.8 4.r(5.178) 0.001

10,9!7.A 12.6
66.8i 61.7117.43

< 0.0001

B€nii 1t.24(5.179)< 0.0001

11.115.9 15.015.2

17.1!4.9 i6.!!7.7 31.516.6 i.90\5.177) 0.001


Bedin 35.lill.1 lo.5i1l.7r 9.58(5.174)< 0.0001

< o.oool
59.018.1j 14.08(5.r81)

itt . s.t'"tt.t",r.otp lns,at. proiesional orBerlln) sgnif_
j'ills.n,fi",.n..p.l"s p,
and psv'htlic
ommunitv nure5ln siieolpnctrei'na

Table4 Begre$ron anddalvr5 ofEdan.esinq df

c . n e ' a l L n e a r M o d e l Uant el vr e s t l o r D u r n o u l , o D
5atirfadion andteamidenltvas dependeni van_
abler,,!formentalhealthprcle$ioiahinBe inand
T)Teofprcfe$iooa 12,53882 6,269.41 20.72 < 0,0001 011
factor5ite 767767 1,138.84 4A3 0.014 0,05

429.!4 429,14 1 1.99 0.043 0.02

1,M9.62 924.81 2 8,59 < 0,m01 0.10
987.65 49r.12 2 4.56 0.012 0.05

4,117.92 2058.96 27.99 < 0.0001 0.26

nltvD5ychiatic qende(malefenale]
!Yo*er), varat

IiTiTl"",y,.'ltrl'ii:::n,",ho5erharhad reverlorrhe
asiqnrcn.e 05
burnoul,iob \dlj'ld'lion .1nd eam identityas depen- Dis(ussion
dcnt tdrirble..Whenlhe influence ol pertonal'hara'
lerislrc5. \lud) sile dnd p'ofes'ronal idenrilydrFconsrd
hasdescribedthe exteniofburnout in
.."a in " oredi. t iue eqr,alion, lhe prolessiondr Sroupi< Previousresearch
l N a i s b e r S f e n nei nl .Sl l 9 9 r l D e a r ve l " l _
idenrifie<1'as a 'ignifi.inl Predicloroi e"chor the three D 5 y L h r d t r s l r
eral.l00l r.nur\e(I e 8 l-a8ineldllos6l
n.oectsot moraie.Ho.eve" for burnouldndJob'ali\ iq6otAmsrutz
(Siefert etal 1991;Mar ott etal'
,n.11on.1641p i' 3 srgnifi(anlinleraclioneffe'rhPrween "nd social workers
"ite und p.ofessiottaiidentjty,indicalingthat the differ ior,tl in differ"nt of mental health care Prcfes'
sionalsworking in community settingsaPpearto be
encesbeiweenprofessionalgrouPsdependon the loca-
morevulnerabli to developburnout than staffworking
tion. Psychiatrists in London have mrr'h more
favourablescoresthan the other two grouPs,whilstthis in hospital settings(Thointon 1992;FaSinetal 1995:
differen.edoesnothold true - or at leastnottn a shrls Carsorietal. tgss;prosseretal. 1996).Yet,piofessionals
tically srqnificantway in Bedin in community carehave also reportedhigher levelsoI
(Waileel dl l995:carsonrtal'lqq))The
torwird *eprlise muhiple regrer'jon dnaly'es iob'ati\lacliot 'l' lhr€e
ol Ihe sludy5irebeingd 5W hndinesolthis studl irdicaleL\almoralewilh jden
showedthat,indipendenr burnouland Ieam
i. d signrfi.antpredi.rorol hiSherburnoul{P' r0 22' ,"rn".i.."u ,ob sorislacrion.
titv: variesbetween professionalgrcups and contextsol
t-- ,:is. o-0.00:, r'-s.7) and loweriob saljsfa'tion crite-ria published
r B - 0 . 1 9l:- r . b 8 , p - 0 0 0 8 r - 1 q r . $ h i l s lb e i n ga h"ltth.ut. ty"t".t. i..ording to the
bv Ma5lach el al.I lqqo).lh< medn scores Ior emotronal
psyLhrarri.r r' a 'ignificanrPredi.lorof hiSherreim
r - ! 7 1 ) w o r k exlau'rion exceeded the $resholdfol a bulnoul 5yn-
l a i n t i . v 1 p =0 . 2 o i - - 4 0 6 . p 0 0 0 0 1 ( dnd 5!vs rn London,and lhe d€Person
dromein PNs
i"n in't-ondon is a signifiiantPrediclorof higher <(ores'or dllgroups in London5coresolemo
b u ' r n o u r ( 0 - - 0 . J 1 , Ir-4 . 7 2 . p 0 0 0 0 l r r - 1 0 . 0 ) . l o w e r anJ depiaonalisation for the-other
iionul ""j,au.rion
; . b s a t i s d . t r o(nl l - - 0 . 1 e . - 2 . 6 0P - 0 0 0 e 1 - J 2 ) ' personal accompli.hmenl scores lor all
- o z l P ' 0 0 0 0 1 ' erouos ano
a n dl o w e 'l e a mi d e nirl y I B - - 0 4 0 .| - satisfac-
i( d lioulls u'.re" rf'e UurnoLrtthre'hold lob
r . 15.4,.Berns - t ao w e r menralhealthprotessional
male l'ondon and
D r e d i c ( oo .l burnoul {p. . 0 . 1 7 .r - 2 . 5 0 . iion icoreswereparticularlylow for Sws in
rp - +0 18' team ialentitysc;resvaried with lower scores for Sws
i = o.or:.r = z s r' ana ltgher teamidentiry rnd london levels ol personal dc'omPlish
t = + ) . 7 3 , P = 00 0 7 , t 1 2 = . 7)
exlauslionin both BerlindndLon_
ofthe 'n'wer! lo mentandemorional
Tablecidnd o .how the caleSories in Berlin,werecom-
don,andlevels ofdepersonalisation
the sevenopeD questions Someaspectswere cons$- levelaidenlified in o$er Lommunitycare
rn Darable lo dre
tentlv reDoriedaarossall groups Most Professionals srudie' t Wykes e1al l997).makingouj
reearded.iinical (areasI mainIaskanden_ !taff s bur:.out
each'ero'up to $e other'ludies,desPire the facr
inu"d"coniacL-with patienLs. Also. I tubstanlialnumber al"*rlt. varied be'
'oirespondents tut"s in the current sludy
in eich grouPmentionedasa main task tf'"t ttte .!"oo"se
twe€n40%;nd 75%.
aa-ini'ttrtiu. r".pontiU;l;tl"'and a mana8erialrole
(less in cPNsan; 5Ws in I ondon r,LomPl"ired about The differencesbetlveenprofessionalgrouPsarenot
acrosssites Whilst in l-ondon-Psychiatrists
i..t of resourc"tttest'o in Berlin)dndldckof lime,lelt consistent
rnow a much highermorale..ore$an thr othertuo
competenl in theirclinicalworkI lesssoin London)and lo$ one -
resPon'ibilitjes and bu- professronal eroJp. andSw' a Pdrlicularly
did irot enjoyadministrarive situalion ol
Althoughbureaucrac) $ar menl'^neoasnoI i.rch differenie. do nor exisl in Berlin lhe
reau.racy. on lt has been
.' ."'oulUt. in B;rlin a. in London,profe'sronalsin aws in the UK is worth commenting
noted that local authoritieshavea seriousproblem re-
e.tli; l'.ssoft.n rePorledit a\ an obsta'le to Petform rnd relainingtheseProfe!rionals ln 3n arLrcle
Lheiriob and did nol menlionil as causrnS Ptessure .ruitinq The CDdrdian in 2000 il \ad\
wds nol menlionedas causjng in the n'ational newspaper
Al\o.lackol resources thal nearly two-lhirds of local Sovernmenl
communiLalion wilh oointed out
pressure in Berlin.whilsl Problems
all grouPs. are short of Sws - with Lotdon and the
other stafffeaturedln
Therewerefurther diffirencesbetwe€nthe sites For Sou$ Laslfacingvacancylevel(a' high as )0% be
.ru'. of poo' pri. t;gt' ttle's le'els iallingjobsatisfa(-
exampie,patisrcein dealingwith patientswasreport€d
rion,a blimecrit ure anda hoslileworkjn8environmenl
"" unl-oirnunt .titt onty iriBerlin, pre-occupation with
wasmentionedascausinSpressureonly (httpr//societyguardjan.couk/
ri sk asseisment andreraininS health
"oi;IJcar.rt.6iin.ulti.s recruiring
in Lonalon,andmanagerialwork overloadfeaturedmore staff, SWs,remam today
'for in Lond-on.Thereare alsospecificaspects -and social Particularv
ofthefindings,various method
protessionolSrouPs For inllance' in in on inrerptelorion
Psy'hialrisl' of thjs exPloralor) 5ludy have10
and lrarnrngasa olosi,al shorlcomings
Lonion trequenrllrePor!supervjsion ea'h group at
ilen intoaccountThesamplesizefor
main raskoi tbeii job'enjoyihedjv€rsityandchallenge be 30, increastng
- eachsitewasequalor sliShtlylargerthan
ol the work as wejl as lrrining and leaching dnd re_
they do rheprobabililyol I ype ll eltor IhatocLut\whena real
search andmentiontheir low payassomething i' ob* uredb) thesmal'
nol enjoyin lheir job.Also.theyareIheonlv groupnot
Jirr,i."*. u"ti'*' ii"" grouPs
(Lawrie etal.2002).The small sampleslze-
mentioningleamwork dsaneniovable d'peclol therrJoD samplesize

lable5 lask andprcbemi


Apon3ibilihes 7 7
Acadernk 21
rctpon5lbilities 17 28
Admlninrative 82
100 9l
ins€wked4elopment 21 t0
lnvolvement 21
Supefl rohs
ision^raining 5l
obrtacles to
ll 24
Gmmunicaion 17
17 50
wo't ovedoad 17 ,: 19
50 l
61 75
l8 6l
t0 21
Training 20
Skillrnotompetentinio pedordlhe$srj 17 25
f,sertivenes*ilh(wi$patienb^taff) 1l
41 17 71
Managemenvadmininrative skills
50 50
spehlisenskills/knowledge 7
Thiigs inth€ifjob
Div€rity/challenq€ 6! ll ,i
60 61 79
.spec( 3
Tninss notenjovii {reirjob
2l 54
AdmlnindivercsPmsibilitid tl
bYvioleftPatents 14
30 62 12
kck ofrc5ou(6nind5
tl 38 J2
in(cordinating@re 2A 29
Thing,Espo.densfel dle prsu.e inlh€irjob
17 l5 t7
21 27 l9
Cmmuni(anon Prcbkn!wih olhBniff 50
50 62
b(k ofr6ourct{lnd5 38 ,:
withisk asse$ment tl J
urgedreturnls 7

- be' London.and ta-kingd job in suchleams-irdr obviour

and the problem of multiple testinS was accePted andSw' ln Berlin' nurses
rather substan- .i.l."i"t.ttv
."*. tJ *"t" int.t".t.a in identifying j".il.* ar€ an excePrion so rhat'trl'f
'ur- i"i".""i 'ii"'J
lial effe(t'andarmedlo combinetheque(tionnarre attitudesand
qudtitalivemelhods f l:rnilalions
urlher ti"."""nt " ."L.ti"" t"sed on inte;ests,
\evwith simple what impactthis selection on morale
differenr orialification.
uil t}''. t".ilonrt rpproachrheinevitablv unclear'also.workingin an unusual seltln8
process, and the varying response rate remains
selection .uom- rmshlhelplo establish leam idenlityreduce burnoul
munity m;ntal heaithteamsaremainstreamservrces
T.bte6 I6k andproblems bylsy.hra
nuresandroft I wor(
fi nj .orimunity

la 30 19
100 58 76
lnse i@develoPment
60 19
tl 5
l9 24
Obstaclesencounlercdtopedomthe t1
Buca!aacy t3
withothsnafi t0
communkation 17 37
t7 tl
6l l6 t7
oveoad 10 1l 13
ManaqemenvadmininGtivewo 23
Skilh thejob
77 71 76
20 42 16
t3 tl l
ll t9 14
Paten(e withpatienl3
7 5
wlh parenls
esforre 5
l 5

Skilh theta5k5
onshipwlthpatent5 8
Asedjvene$AeniiqboundarAforrea 16 24
5kilk 2J
Manaqemenvadtllninrative 32 40
skilLs/knowhdge 13
spedalBed 3
17 t0 8
Palience wilhparients
Thn9srespondents intheirjob
47 29
37 37
2A 32
Diveritykhallenge 58
l 3 t8
l l l
Trainrnghea.hinqa5Pect tl
onand&lnowledgemenl orhetrwoix l3 26
leedbad ft
wili Panenir
ftingr respondentsdonotenjovinthei job 42
rcsponsibilities 16
Administrative 74
1l t0
NelpinqpatenB ofdailvlivn9
17 7
inco{rdrnannq 20 73
mt witho$s profes,ionab
Probh 5
l t6 5
Thinqs 45
withothsnatr 20
C;munkaiionProblems l
measuEuedwili' Paneiti
comPuhory 29
l3 tl
Gensal condition5
working 17
PrcbLems benavour 3 l9

3 ll
PrcblemswithhledrCoY l3 5


oloqvi. requiredSuchmelhod'5houldbe con'islenlly

anclraiseiob satisfactionMoreover,the imPactof these
,'" ditferenrplacesano heahhcare'ystems
factorsmight differ in the threeprofessionalgroups ln dndjnrerprered Thi'
that statements on morale si'tharfindine"canbe compdred
any case,tiefindingssuSSest pre'enti,n attemPl lo do thal. 'j nd ri linled ro sur-
ofitaffin communitymentalhealthcarecannotbe gen' studv
vevsin lralvtCale,zrr el dl l004 | and Auslrra lswobodd
eralisedand shouldbe speciileddependingon profes-
et;1.a, b, in prino usinga similar aPproach'
sionalidentity and context Furtherstudiesarerequrred that a combination
io identifv wirat aspectsof the contextare relevantfor Th; findingsofthis a$dy suSSest
of established"scales and simple open queslionsmay be
sraff morite. The significantdifferencebetweenBerlin
.nit London mav b-eassociatedwith featuresof the u r"utonutt"*ry fott"u.d to developvalid mtthods that
herhh cdresyslemspecrfi.job de. riprion'or qualifi c,n be u\ed in roulineprdlliceand resedrthOnLe
propr,"'" t"rf'oa. nrui beene5lablished rongirudinil
.nlions (e.e.beller iesources. higher clinicalcomPe overrime
iesspressure through bureaucracyrePorted in"Jrr."* '.q,ired ro a\\P\' cndn-ge\
tence,and and.negarrvery
in Berlin in oPen que'lrons, bur miShral'o be and idenrifyldrrol' lhar' po\ilively
imDact on ;taff morale-One may conclud€thai more
iifluencedby moregeneralfd!lo^ 'uch d\diffprentt'd
dition5ol work ellios .elf-e'reemol helPingProfe' corlceptualand methodologicaiwork is neededto de
'ratt in 'onrm'nity
u"loo',U"u"t rna"t.,ondingof how
sions.analthe reputalion of community mentalhealth perceivJrherr job' and how morale
carein the medii and public Suchgeneralfactorsmay"f f,*f'f, care
varv betweenandwithin cou ries. maybe improved
i'he findinss ofthis study allow only speculations as u
_ A.lnowledoeFenlt The ar|ior. *oJrd ile to rl'nl h' 'on
to what the re-asons for differences in morale notiust ' r- aok-'
,."i;.;:;r,';i'," (ommu r\ Dr' hi'n. nu'*' 1o -h"Lrol
letween sites,butalsobetweenProfessional groupsand *i"i"'0"-a"c " 't. .'""' i;ooi Ber dd 61do
r"/ l'' on
betlveen male and female staff - ale. Reportson weeKy * . ' r J , i ' . r i r " o , " " 1 o ' t ' t , ' r v u l P n" n d D t R ' \ ' t d
are rilelt lo have been ina(curale and biared' fibutne to the ea.Lysta8$ of the stndv
bDIstrll5uggesl lhattherearesubslanridl drfferencesbe_
rweentheiitivities of rhe assessed profe<sionaJ group'
which mieht influencemoralealongwith variousotner
i..i"r" ."?r, ", ,t"tt,, ""tonomy, i;wards' suPportand l.
' 1100 B-r'oL
A m . u r i V r \ e u e n ' . h w . _ d e rM \ l o d e ' r r n c * d r i e
b e rp . l . h i a < l d 8 e ni ? 1 n P ' _ n d A t l e
The answersto the open questlonsrevealnow Pro "-,i."'.1'"n u t * . i ' " g c ' v ' h r r P r d i b l b ( r6-
job Some z. leribow s, fotlev o ( rsqet Prychiatrisbundd stres
fessionalgroupsin the two caPitalsview their --all
u;".. ,pi".r'un;u.""t. dnd nol surprisingly B u I l 2 2l 2 D r ' e b e SM u n e '
d;5lik -I s ' r " * r . f . h n r c . : , S . l U i n g o n P u r e d \ e rA
eioup, iJpon.njoying direcr.linicalwork dnd
'ine rl'irti'"i wii,.I wli'" t iriEnr c 'roo' A$-
drr"uu.tu.y.'!ttt"Oer'in Praclice. ir is possibleto i * r u ' n r - o o . , . r " r e x p ' l e ; t ' ' a n dP e r e P t r ^\ ' P c nL o n
i"iuc" brr"orcir.v in fuvourof moreclinicilworkand a.n e*.tl"" outt*.tt sda7?arr2 Brl Psfhialrv18lir 39 147
coniactwith patierits,and whether such chang€ will in- , s.i; M"di."lA"-.*ti.n (19e2)stre$ andthenedicarPro_
f€ssion. BMA,!.ndof
deed improvi morale remainsto be tested Tfaining in , i i i ' " ' , . r " " " L F r r e ,' r a d t " \ r t e ) 'c n dr o P n Si n M " r r a l
,i-" *inue"..nt and leam communicdtionskills HealthNu6insChapranaid tlall rondon
miehr beneit all professionalgrouPsVarinul other a\- "- - * " " I i - ; , ' H o M a l e vP d ew i l d €A B r o w _D r l o a r b )
peJt.,ho-ever.are more sPeciliLto onesrle or one pro_ s t " , . . n a . o p i " g : n m e r r d lh e ' l L h' u h e < P ' v c h i rd' < d e
i.,sion"i eroup und *uy nled 10be consideredin train- t. l-.f q p ,q . i . , I r r o o : '5 " r F t ' " u r r h o l rM ' L h ' ' o rP \ v cot l
ine,supervision andjobPlanning. These asPecrs cannol
oavr;adon lducarton|jmiGd England 'e(L'uB a quar
.tt'ue iiscu'sea heri. t he positive PercePtronof a'd "a. i'?". '.;"i"' i.,r'' ' ,*s rwort.i"s oE?dr-er:
raises the questron i"'".'li"i "r"' ' ' I he\rario;dri otfi'P I o-don
demicwork of Londor Psychiatrists q . i i , ; " M ,i . " ; ; r . i , ' * I r r c o a r s r R t ' ' n' o n r r n i r y r e l r
^.lo wlettrer ttre ottrei professionalgroups and their rt.arLr..r*e, co.pnite rom" MPl healLhI\'tr' 'a dlrr ela
moralemiehtalsobenedifroma stronger a'ademicrole '\ 'n
' n- o " " , " e " l i ' R M \ . d [ r A " a a o P e h o n d r ri n r vd
witt tustsin t.uctringu"d research. Morein-dePlhslud . ^ d r - , o ' . v . t t " ' , r . t n r ' ' o P ' v " h r a r - l 4 2 ' 4 \ : lrI 2r l
iei are probablyneededto explainsomeofthe findings' ,r. la".a"bls"-"'cc."vPD.rcr'e'8JI A Hrnr8an.8/2000r
it may be dif- 5 r r e . "sr d b l r n o u lI n . o r m J n r ' \ m r ' a l n " ' x' rf unr 5- b- :m Ea R_
ror insiance,withoutfurtheiexPlontion, t r e r o r . e p , v c l " dM r ' e nH r eJrh 7l !
" ' " i " r r n e ;
ficult to und€rstandwhy London psychiatists are the i.i ""o"; 1.'.r t DeviLlier,\ Barr'efl H o MallevP
only grouPwitn frequenr(omPlaints.aboul low Pay r- i""," \^;,r M, M(lrarrr( i 8'otrn P r.aqo) re$ 'oPnE "nd
*t'Jnin r^r *.v hau" - by far - the hrghesr'alar) o( all bunoJr h melrJ neJLhnurr" lndin8' lrom $ree rerdr
six groupsinvestigatedin this study. n u d i e s . l nSrol c P s y c h L a t r y1 40 221( 1 u1 ) ,..
rourinely ,
' , i , " , , i . i l * . o , d . ' r " ' H . t ' a r y I .c d ^ o - | , I o o 5Tr h e . l a y
5"latt;oraleandjobperceptjon\ shouldbe
" , i " t p r , . a * " " - . ' d v l ' i r ; o r e ' r r e * r d roworl.rnho
asses.ed in communitymenlalhealth(aredndusedfor p . r aol r : r t h e c o m m u n tIr vA)d \\ r F i n 8 - ' z : l l '
cualily management and servicedeveloPmen! Al5o' ''. " L l i " - , , . r q D e l m o n r er ja l ' r o u l v \ ^ KP r i P b e \ r z 0 0vio r r e
rirevshouldbi investigaled wirhin menral herllh ser ;i;;;;.;.".,, ptole* orar(tr ' ormun I ven arH'athse'
" t i , " * " q n c e l - pd e t r ; o l o s i d e P ' j " h i d r r i "
uii' r" os non speci6<contertudlia'torr influ "i."'J,r'-L|.i'
13(3)l9t 197
andoutcome-of;nlertenrions lor Sociale
encrnBlhe fedsibrliry
oorhiulpo"er' a rran'pdrenl. briet dnd sound method-
R d t n o d: , R o l | , F a m \ " yV e l " l r l O C r A O' u r v e v o i ' l r e s i l P v
1 5 , Gulhrie !, llack D (1997) Psychiat.n disorder, stress and .h..ri.r, w;rt,ns . .h. $ps"r re8,or P.v,hur! BL-l2'
burlouiAdv Psvchialrliealmenl3:275281
t3l 136
1 6 . Lawries,l,lclnt;sb A,Rao s (2002)crirical APPraisalfor PsI.]i *v'e
ar.v EhevierScien.eLinited, PhiladelPhia 29. R e " . D , ( n o p e r ' L l o a z 'O . ( u P d r i o n 4t r y " I n 1 P r ' l l h
r o r k e E i n t h eU K . S i r e sa n dM e d i ' i n e8 7 4
Ma;riorr A, SextonL, Stal€yD (1e94)conPonen$ ofjob saris
fadion i! psychiatricsocialwo.kes Heallh and SocialWork 30. R pd t j o h r ' o n \ J v o i d n \l K r p { " l - s / n u l ' I I C'ot T\urnn-oll
i BebbiDgronP,rr(, D ' lo'ror LxDlald.o. , iP" dnd
l9(3):199-205 qud)
k t , 5 l A r , o ; I n n e n , a l h e a t l hp r o e * i o n r k : . q u a l n a t i v e
1 8 . M^iach c.lackson s (l9st )MaslachBurnoutInvenroryMa'ual Psycnstt EPrdemiol l4(!):l0l r03
Pre$, Cali SocPsy.hkrry
{Human seryicessurvey) Consultin8Psvchologists o o nole(o r r r.nd dnbiCui)
n i z z or .u o u . i n . i r r z r a n ' '
in omp{ o'8a. vrion' AdTrni,rr.'rve 5 r r n ' PO - ' r ' e l r ' ' 5
l9 MasldcbC,iackot S,r€ner MP (1996)Mdlach Burnournven_
Ptes, {Llifor 150l6l
io.y uanuui,:' "dirior' co""ulring Psychologisrs qq ' ob!Jinr('ior brrloul
32. s e i f r r tI \ , J d y a r a l n) ,PL h P \ t a A I (o'ia
" n d t l r n ; v e r i n h t u l , i ' r ' , e' o . i a r " o r t P r ' H ' a l r hd n d
20. i{c(ee v (1996)working to a lrelzy The Gua.dia', London'
TuesdatI October,P 14
2 1 . Moo."tA,coop& a! (1996)stras in nental heaiihProfssior' 3 3 . SnelsroveaR (1998)OcuPationalsra$ and job etisfa'tion: a
als a theoreticai ovav'ew ln1 ) Soc Psvchiatrv 42:82 89 ;on;amtive study of heaith visitos, dist.icr nu6* a'd 'om'
muriitv Dsvcliatricnurses.lNurs Managemenr 6:9' 104
22. N d i b o e F " n n r a S , X e s rCn , E l i T - rA r l r o l P e - ' o n i l r v ( h a r a ! (in
r r s ' . - " r d p r o _ n e mrqo l - r n o . l { ' r u o ) a r o n 8 P { ' l a _ { s 34. swob;d'ail, sibitz I, r.ulwald s nug G, BauerB, Priebes
prinO lob satisfactionand burnout anong .onnunrrv_Daseo
Stles Medicine7:201-205
;.ntal he.lth sra{. Psvchiatische Praxn
23, Onvett S,Eeppleslon T, BushnelLD ( 1994)A nationar survel ol \'tn
."; -"nitv;;ntal healthteans l Menl Heaith1:17s 194 s w ; l o d a h s i o i r / l . h u t w a d s i ? l u gu B d u e rB P t r e b P
q o,t'r n o " a o . o _ . u n u ' b r . e d m e j r d h t a L h r ' r ( ' n A ur r i o
24. Priebes, F;khoDiy W i{hite l, watts l, Bebbingror ljlings l, ? q' 1u Lr hea, er r"er ,' ound r ' P r . h r a n F f e P P ' r
BunsT,lohnson S,Muij€nM, RvrieI, Wright C for the P2nr'on_ 'pr ?i .r.e" ,n""" d rpe i r ) o bA
.r""r or 'oPinS .PPidisJ and
don A$ddve Ouireac! Studl GrouP (2004) Chdactetistics ol al heal$ workfl l P\vchol rl6ri) 261 77-
wiih ourconesof Paiienls b!-noul 1 men
tems,siaff dd pstients:associations n' 1
3 7 , w d r l eA O l j v P ' \ . C r r ) o n l . l a g l / l o o ' ) I o b ' d t " i
LnasenrveoulreachBr J Psychratryl35:J06 rll
m e ,r , l n € l , h n u ^ r g : 6 c o i m u n . r ) o t w " ! d b A e d w n ' l ' n o t e
P r o n e r D . l o h n . o n \K u . p e r i t . r n u l l e r 6 B ? b b i n S r o n P T h o l
'ati"i8'tio1 iaxsfvine.PsvchiakCale u(5) 167-170
n,crofr L ' aoor Venla Hea.ln. burnour ana iob
wdtT B;toe1F Bo-ril L.ra.p A colaD.'ld,dv6 Ha)nes
m o n g h o . p , r Jd , d . o d m u n i r , b a ' e dm e _ r Jh e ; d J d f i B ' I
I , R . . I J . . h r p ' - oD \ ^ e ) rM . l a o - ' M r n o rP ' t ( b d r i . d n o r d e r r n
r n s ' u . . r i r . o - . - p a t r u t a r d B e r d edr ! , e r P ne ( B r ' P v '
26. P - ; $ e j D , l o h n $ n 5 ( L P e , . L ' h u r e r c E e b b i n g r oPr T h o -
n.(ror u trca-r Pfl!.veo {u($ ol do'l srre* dnd vrF'dc
-tr robTv"n'rl rol
cw.I orrqrhr
rion monE lo.PtrJ .nd (orrLnirv nental hrJrh r'fl 'r d Un've'rrr'o'V n
, r e , , r e l a . i ; nr o n e n , a l h e r l r L b u r n o - ra n d i o b : a r ' J a ' r i o I
P s v c h o s oRme i 4 3 ( l ) : 5 1 - 5 9
Wyk6 T, St€v;s W Everitt B (1997) Stre$ in conmlnity cat
2 7 , prc*er o,lohnson s KL.Per. r. Dun_ l,.s/nul<i. G Rejd Y car' Soc
te;;s, wil it affdt the $stainabnnv of connuiq
B e b b , n q r ;P ; T } o r n i . ' o f r ' c ' - e c a rM . i r J h e a r h b u r D o l ra _ d
'irriso' Pslchiatly Prychiar. EPidemiol 32:398 407
i o br , i : r d ( n o l i n a l o n s n u d , n d l e L d e omt e n r a l h e J L ' r
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