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Journal of Mental Health (2002) 11, 3, 255–265

Social work, stress and burnout: A review

CHRIS LLOYD1, ROBERT KING2 & LESLEY CHENOWETH3

1
IMHS, Gold Coast Hospital, Department of Occupational Therapy, Southport ,
2
Department of Psychiatry & 3School of Social Work and Social Policy, University of
Queensland, Brisbane, Queensland, Australia

Abstract
Stress and burnout for health care professionals have received increasing attention in the literature.
Significant administrative, societal and political changes have impacted on the role of workers and the
responsibilities they are expected to assume. Most writers suggest that social work is a highly stressful
occupation, with stress deriving in particular from role conflict between client advocacy and meeting
agency needs. This article reviewed the social work literature with two questions in mind: Are social
workers subject to greater stress than other health professionals? What factors contribute to stress and
burnout among social workers? We found that most of the literature was either anecdotal or compared
social worker stress with general population norms rather than with stress levels of workers in
comparable professions. Such empirical research as is available suggests that social workers may
experience higher levels of stress and resulting burnout than comparable occupational groups. Factors
identified as contributing to stress and burnout included the nature of social work practice, especially
tension between philosophy and work demands and the organization of the work environment. There
was some evidence that supervision and team support are protective factors.

Introduction and political change (Jones & Novak, 1993;


Kurland & Salmon, 1992). A number of
Social workers have previously been iden- writers have commented that much of what is
tified as being at risk of experiencing stress known about stress and burnout among social
and burnout (Acker, 1999; Egan, 1993; Gilbar, workers is anecdotal and there is a lack of
1998; Sze & Ivker, 1986; Um & Harrison, systematic research findings on this subject
1998). Social work is strongly client-based, (Collings & Murray, 1996; Gibson et al.,
with workers being involved in complex so- 1989; Soderfeldt et al., 1995; Taylor-Brown
cial situations. As such they can experience et al., 1981; Thompson et al., 1996 ).
many of the conflicts that are evident in Cournoyer (1988) suggested that human serv-
human service work (Cournoyer, 1988; Pines ice professionals tend to underestimate the
& Kafry, 1978; Soderfeldt et al., 1995). In extent of distress experienced by social work-
addition, the last decade has seen a transfor- ers. A recent survey of the literature found
mation in the nature and practice of social only a few systematic studies of burnout in
work, as a result of administrative, societal, social workers; this is in contrast to what is
Address for Correspondence: Chris Lloyd, IMHS, Gold Coast Hospital, 108 Nerang Street, Southport Q 4215,
Australia. Tel : 07 55718506; Fax: 07 55718948; E-mail: Chris_Lloyd@health.qld.gov.au

ISSN 0963-8237print/ISSN 1360-0567online/2002/030255-11 © Shadowfax Publishing and Taylor & Francis Ltd
DOI: 10.1080/09638230020023642
256 Chris Lloyd et al.

known about burnout in other human service ity to clients’ problems make them vulner-
fields (Soderfeldt et al., 1995). able to work stress. Rushton (1987) queried
This article will examine sources of stress whether people who are vulnerable to depres-
and stress outcomes (especially burnout) that sion choose social work rather than another
are experienced by social workers. occupation because, unconsciously, they wish
to work through personal problems by help-
Definition of stress and burnout ing others. It has been suggested that, for
most social workers, the need to be helpful is
Stress can be defined as the emotional and a primary motive in their choice of profession
physiological reactions to stressors (Maslach and this need can easily lead to over involve-
et al., 1996; Zastrow, 1984). A stressor is a ment with patients thereby contributing to
demand, situation or circumstance that dis- stress (Acker, 1999; Borland, 1981; Egan,
rupts a person’s equilibrium and initiates the 1993).
stress response of increased autonomic The very core of social work lies in rela-
arousal. Prolonged stress is associated with tionships with clients. Even when social
chronic anxiety, psychosomatic illness and a workers are engaged with clients who have
variety of other emotional problems clearly unrealistic or inappropriate demands
(Caughey, 1996; Taylor-Brown et al., 1982; or expectations, there is potential for internal
Zastrow, 1984). Burnout is a particularly conflict. Much emphasis is placed during
serious feature of chronic stress and one that training on the relationship between client
can impair the human service worker’s effec- and social worker (Rushton, 1987). Rushton
tiveness (Collings & Murray, 1996). Burn- (1987) suggested that because social workers
out is a syndrome with dimensions of emo- are taught to be non-judgemental in their
tional exhaustion, depersonalisation, and re- relationships with clients, they might find it
duced feelings of personal accomplishment hard to admit that the personalities and atti-
(Maslach et al., 1996). A key dimension of tudes of clients make effective service re-
the burnout syndrome is increased feelings of sponse difficult or impossible. As a result
emotional exhaustion where workers feel they they may persevere and assume personal
are no longer able to give of themselves at a responsibility or agency responsibility for
psychological level. A second dimension is failure.
depersonalisation, meaning that workers re- There is a commonly held belief that social
spond to persistent stress by developing nega- work is a highly stressful occupation as a
tive, cynical attitudes and feelings about their result of conflicting roles, status, functions
clients. The third dimension is reduced per- and contexts (Dillon, 1990; Gilbar, 1998;
sonal accomplishment, meaning the worker Rushton, 1987). In the health system there
views their work negatively and feels dissat- has been increasing emphasis on instrumen-
isfied with their work accomplishments tal outcomes and throughput and decreasing
(Maslach et al., 1996). emphasis on the worth of the individual. This
has the potential for conflict for social work-
Does social work philosophy and values ers as they continue to maintain supportive
make it inherently stressful? relationships based on social work values
Writers such as Pines & Kafry (1978) pos- (Borland, 1981). Kurland & Salmon (1992)
tulated that social workers are a rather homo- considered that social workers face ever in-
geneous group, emotionally, whose sensitiv- creasing pressures as the problems they deal
Social work, stress and burnout 257

with reflect the societal changes and the in- just being nice or doing the common sense
creasing stress of everyday life. things that anyone can do. It has been sug-
There may be conflict between social work gested that there is confusion about roles and
ideals (for example, advocacy, social justice, tasks within social work itself and with how
client self-determination, and empowerment) to demonstrate effectiveness (Rushton, 1987).
and expected role performance (Balloch et A number of writers have mentioned that
al., 1998; Borland, 1981; Dillon, 1990; Jones how others (including work colleagues and
& Novack, 1993; Rushton, 1987). Reid et al. the public) view social work is a source of
(1999) noted that these kinds of conflicts stress for social workers (Collings & Murray,
were experienced by social workers under- 1996; Gibson et al., 1989; Jones et al., 1991;
taking Mental Health Act assessments. So- Smith & Nursten, 1998). Jones & Novak
cial workers experienced conflict between (1993) considered that this has resulted in
acting as patients’ advocates and represent- challenges to the legitimacy and identity of
ing their interests, and the responsibility to social work.
ensure patients and others are safe. A qualitative study conducted by Reid et al.
Competing values between administrators (1999) found that social workers in mental
and social workers have been identified as a health reported that they felt frustrated be-
source of stress (Borland, 1981; McLean & cause their role was misunderstood by others
Andrew, 2000). This is particularly evident and that their range of skills was neither
in health care settings, where it may be seen adequately understood nor adequately val-
that social work values are not always cost ued by other health service staff. Likewise,
effective. Social workers have little power or Kadushin & Kulys (1995) found that social
control in a physician-dominated authority workers experienced conflicting role expec-
structure, for example, discharge planning tations, that other members of the team did
offers a classic example of responsibilit y not understand the social work role and did
without decision-making power (Borland, not appreciate what they accomplished.
1981; Kadushin & Kulys, 1995) where expe- McLean & Andrew (2000) found that stress
diencies of hospital management frequently resulted from role conflict, disagreement
require patients to be discharged before they about good practice, and lack of recognition.
feel ready to leave. The work carried out by Role conflict intensifies the amount of burn-
social workers is problem centred and often out and job dissatisfaction experienced by
involves choosing between unsatisfactory social workers (Um & Harrison, 1998).
alternatives (Rushton, 1987). Social workers are susceptible to changes
in social policy and legislation that have
Status and autonomy as sources of social characterised much of the western world.
work stress Rushton (1987) suggests that changes in the
Dillon (1990) suggested that social work- UK including the new emphasis on financial
ers often have little control over whom they management as opposed to professional ex-
see, the nature and length of contacts with pertise have adversely affected social work-
clients, the range of expert functions they will ers. Balloch (1998) identified the devalua-
be requested to carry out, and the value placed tion of practice skills, cutbacks in support and
by others on their work. According to Dillon supervision, and the lack of career opportuni-
(1990), others misinterpret social work as ties for those who remained in social work
258 Chris Lloyd et al.

rather than making the move into manage- the expectations of other members of the role
ment as being consequences of changes in set regarding that role influence how the
public administration. It has been suggested occupant perceives and performs the role
that social workers lack the resources and the (Egan & Kadushin, 1995). Jones (1993) in
staffing to do the work required of them and his study of child welfare administrators found
that new legislation is giving them further that they experienced professional role con-
responsibilities with limited control or au- flict, as well as organizational goal conflict.
tonomy (Jones & Novak, 1993; Michalski et The participants reported significant instances
al., 1999; Rushton, 1987). Social workers of role conflict to the extent that others had
face a conflict between the demands made on conflicting role expectations of them. Sze &
them as employees and their expectations of Ivker (1986) commented that it is not known
some professional autonomy (Banks, 1998; why social workers in a given setting or role
Rachman, 1995; Rushton, 1987). perceive that they are under more stress or are
more subject to strain than workers in other
Organisational structure and climate settings or roles.
Bradley & Sutherland (1995) conducted an
Since the introduction of health care re-
investigation of occupational stress among
forms, the organisational context of social
professional and support staff within a social
work is attracting increasing attention as a
services department in north-west England.
possible cause of job stress (Kadushin &
The participants consisted of 63 social work-
Kulys, 1995; McLean & Andrew, 2000;
ers (85% response rate) and 74 home helps
Rachman, 1995). Stress resulting from or- (response rate 79%). The findings from this
ganisational factors is a concern to many study about the main sources of stress for
employers owing to the substantial human social workers were similar to that reported
and economic costs it incurs (Bradley & by Collings & Murray (1996). The social
Sutherland, 1995). Cushman et al. (1995) workers reported higher levels of stress as a
found that respondents identified a number of result of organisational structure and climate,
stressors related to the organisation of work. particularly relating to the problems of work-
These included lack of funding, personnel ing in a climate of low morale (Bradley &
shortages, high worker turnover rates, lack of Sutherland, 1995).
linkages to other work units, attitudes of As organisations change and previously
other health professionals, and working in a well-established work practices are replaced
bureaucratic environment. Additional or- by more complex and overlapping roles, all
ganizational constraints include the pressure workers are susceptible to stress associated
to discharge patients more quickly, no time to with role ambiguity. Role ambiguity was
provide counselling or emotional support, found to be an important source of dissatis-
and lack of co-operation from hospital staff faction for social workers in research carried
(Kadushin & Kulys, 1995). Collings & out by Balloch et al. (1998). They found that
Murray (1996) found that the most powerful the most frequently mentioned sources of
predictor of overall stress related to the pres- subjective stress included being exposed to
sure involved in planning and reaching work conflicting demands, being expected to do
targets. things which were not part of the job, being
Individuals are normally assigned and fol- unable to do things which should be part of
low certain roles in their work setting. The the job, and being unclear about what was
expectations of the occupant of the role and expected. Role ambiguity occurs when there
Social work, stress and burnout 259

is uncertainty about the scope of the job and Bennett et al. (1993) studied three groups
about the expectations of others. Stress aris- of social workers, including those working in
ing from unclear goals or objectives can the areas of child health, adult mental health
ultimately lead to job dissatisfaction, lack of and adult physical dysfunction, to examine
self-confidence, a lowered sense of self-es- sources of stress, coping strategies, and stress
teem, low motivation to work, and intention outcomes. They found that the measure of
to leave the job (Sutherland & Cooper, 1990). mental distress was substantially higher than
Rabin & Zelner (1992) found that lack of job the norms for any other occupational group.
clarity predicts high turnover and burnout, The study produced evidence of relatively
regardless of the type of setting. They sug- high levels of both work-related anxiety and
gested that job clarity could be a preventive trait depression amongst all social workers
factor in burnout. when compared to normative population s
and workers in other professions. Similarly,
Bradley & Sutherland (1995) found higher
Stress outcomes – morbidity, job
levels of ill health for social workers and
satisfaction, burnout and staff home help workers in comparison with the
turnover normative group. The social work symptoms
of distress included physical exhaustion (51%)
Thompson et al. (1996) found high levels and emotional exhaustion (38%). Thus the
of emotional distress in their study of field measure of mental health found that both
social work staff in the UK. Seventy-four per home help workers and social workers re-
cent of the respondents showed borderline or ported poorer mental well-being than other
pathological levels of anxiety. In looking at occupational groups.
occupational stress amongst Northern Ire- Balloch et al. (1998) conducted a survey in
land social workers, Gibson et al. (1989) five different local authorities in England to
found that 37% of respondents were identi- explore the relationship between levels of
fied as ‘cases’, that is, they described symp- satisfaction, dissatisfaction and stress among
toms that could be classified as mild psychi- social services staff. Interviews were carried
atric morbidity. A later study by Caughey out with 1276 people (response rate 87%).
(1996) of 36 participants who worked in one The mean GHQ score for the sample was
social services district office, found that 72% higher compared to previous research, with
of the respondents displayed signs of psychi- managers scoring higher than staff. Staff
atric morbidity as measured by the GHQ28. who experienced role ambiguity had signifi-
In a study looking at the psychological strains cantly higher GHQ scores than those who felt
experienced by social workers in Hertford- confident about what their jobs entailed.
shire, Jones et al. (1991) found that 55% of Recently, it has also been found that a signifi-
the sample experienced anxiety and that lev- cant proportion of social work lecturers were
els of anxiety increased as perceived de- suffering from borderline levels of anxiety
mands increased. In a study of the effects of and depression (Collins & Parry-Jones, 2000).
burnout and work stress on family relations, Job satisfaction is of particular importance
social workers who experienced more in- since an individual tends to apply for or stay
tense burnout were more likely to demon- in a satisfying job, and avoid or leave a
strate depression, anxiety, and irritableness, dissatisfying job. The importance of job
and lower marital satisfaction (Jayarante et satisfaction is evidenced by its consistent
al., 1986). correlation with absenteeism and turnover
260 Chris Lloyd et al.

(Hagen, 1989; Himle et al., 1986; Martin & considered that feelings of lack of accom-
Schinke, 1998). Jayaratne & Chess (1984) plishment of professional objectives might
investigated stress and burnout among 144 well be more likely in a profession, which
community mental health workers, 60 child attracts those with idealism, which is not
welfare and 84 family services workers. They subsequently realised in practice. Findings
found that reported levels of emotional ex- such as these illustrate considerable disen-
haustion and depersonalisation did not differ chantment with day-to-day social work prac-
significantly between child welfare workers tice.
and community mental health workers. The Himle et al. (1986) conducted a cross-
family services workers recorded significantly cultural comparison of the perceptions of job
lower levels of depersonalisation. Forty per satisfaction, burnout and turnover between a
cent of the sample thought that they would be national sample of social workers in Norway
likely to change jobs. and a national sample of social workers in the
Previous research by Maslach et al. (1996) USA. The Norwegian social workers re-
predicted that burnout would be related to the ported higher levels of burnout, job dissatis-
desire to leave one’s job. Gibson et al. (1989) faction and intent to leave their jobs than
found that 73% of respondents had thought of American workers. Among the work-related
leaving social work at some point, with half stressors, Norwegian workers reported higher
of the respondents having considered leaving levels of stress related to role ambiguity, role
in the past year. A number of other studies conflict, job challenge, value conflict, and
have also found a high percentage of social financial rewards, and less stress related to
workers intending either to leave the profes- promotion and workload than American
sion entirely or leave their current position workers. Himle et al. (1986) concluded that
(Hagen, 1989; Himle et al., 1986; Samantrai, the strongest predictor of all dimensions of
1992). burnout is the challenge of the job.
Gibson et al. (1989) conducted a study of Martin & Schinke (1998) conducted a study
occupational stress in Northern Ireland of to determine levels of job satisfaction and
176 field social workers using the Maslach burnout in mental health workers. Two hun-
Burnout Inventory (MBI Maslach et al., dred family/children and psychiatric workers
1996). Results from this study revealed that of seven social service organisations in the
47% of social workers were in the moderate New York metropolitan area were surveyed
intensity burnout category in terms of fre- using the Minnesota Satisfaction Question-
quency and intensity of the emotional ex- naire, the MBI, and the Staff Burnout Scale
haustion subscale and 42% were high inten- for Health Professionals. Fifty-seven per
sity on the depersonalisation subscale. On cent of psychiatric and 71% of family/chil-
the subscale that measures burnout due to dren workers identified themselves as being
feelings of lack of personal accomplishment, moderately or severely burnt out. It was
social workers exhibit high levels. All of the concluded that the absence of certain integral
respondents fell into the high burnout cat- job facets, for example, promotional oppor-
egory for frequency (100%) and almost all tunities and remuneration are associated with
for intensity (98%). It is evident then that the staff burnout.
main manifestation of burnout among the In England, Prosser et al. (1999) conducted
social work sample was in feelings of per- a longitudinal study examining mental health,
sonal accomplishment. Gibson et al. (1989) burnout and job satisfaction of mental health
Social work, stress and burnout 261

staff. They found that being based in the ers that perceived the team as being support-
community was associated with higher GHQ- ive had higher scores on the measure of
12 scores when compared to in-patient staff. personal accomplishment, indicating less risk
Being a social worker was associated with of burnout. In looking at perceived supervi-
higher stress, lower job satisfaction, and higher sor support, Coady et al. (1990), found that
levels of emotional exhaustion as measured there was no correlation between perceived
by the MBI. Acker (1999) found a significant supervisory support and social workers scores
relationship between involvement and emo- on the subscales of emotional exhaustion or
tional exhaustion. He concluded that social personal accomplishment. There was, how-
workers are negatively affected by working ever, a significant difference in scores on the
with clients with severe mental illness. depersonalisation subscale. The findings
suggest that social workers who perceive
Protective factors: Supervision and team their supervisor as supportive have less po-
support tential for burnout. As an extension of these
Various forms of social support protect findings, Collings & Murray (1996) found
against burnout (Maslach et al., 1996) and a that one aspect of supervision that was pre-
number of social work researchers have ex- dictive of high levels of stress perceived that
amined the effects of emotional support on one’s supervision was primarily geared to
moderating the impact of job stress (Coady et protecting supervisors.
al., 1990; Himle et al., 1986, 1989; Koeske & Koeske & Koeske (1989) found that work-
Koeske, 1989; Um & Harrison, 1998). Um & load had no direct effect on burnout but quite
Harrison (1998) found that social support a substantial effect when the moderating im-
acted as an intervening and moderating factor pact of support was considered. Heavy work-
between burnout and job dissatisfaction . load produced more burnout, but only when
Supervision is a major form of social worker social support was low. The element of work
support and social workers often turn to their load most relevant to burnout (under low
supervisors for assistance with cases and for support) were the number of clients seen in a
help with the further development of skills typical day, the average hours per day spent
(Collings & Murray, 1996; Mizrahi & in direct client contact and the percentage of
Abramson, 1985; Rushton, 1987). Himle et crisis interventions .
al. (1989) examined the ability of emotional
support to buffer the impact of job stress. Discussion
They reported that emotional support by both
supervisors and co-workers is associated with There is a strong perception in the profes-
lower levels of burnout, work stress and sion that stress is a problem and that it is
mental health problems. Fahs Beck (1981) particularly associated with role ambiguity,
identified lack of support on the job, particu- discrepancies between ideals and work out-
larly executive support, was a correlate of comes and personal vulnerability character-
burnout. istics of people who enter the profession. The
Coady et al. (1990) found that there was no quantity and quality of the empirical research
significant relationship between scores on is weak but there is some evidence that social
the emotional exhaustion and depersonalisa- workers experience high levels of stress and
tion subscale and the social workers percep- consequent burnout, especially as measured
tion of team support. However, social work- by the MBI personal accomplishment dimen-
262 Chris Lloyd et al.

sion. This may have to do with the discrep- social work and their expected role perform-
ancy between the ideals of social work and ance.
what social workers actually do in practice. Organisational factors that have been iden-
Of the various sources of stress as being tified as contributing to the burnout process
identified as being characteristic of social for social workers include role ambiguity,
work, only two could be said to be inherent. role conflict, challenge of the job, and job
These are the appeal of the profession to autonomy. From the literature it appears
vulnerable or unstable people and the idealis- evident that social workers experience a high
tic and reforming philosophy of the profes- degree of role ambiguity and role conflict.
sion. All the other stressors are contextual With changes to organisational structures, it
and relate to organisational and role deploy- would seem that social workers are unable to
ment issues. use the skills they have learnt as others have
The literature suggesting that the profes- conflicting role expectations of them. Their
sion appeals to vulnerable or unstable people professional concepts have been undermined
is either taken from a personal account or an and they have been confronted with ethical
expressed belief. There is little evidence to dilemmas about how to best meet client need
support this, although a number of studies within a framework of reform and regulation.
have found high levels of psychiatric morbid- Social workers have been expected to deal
ity as measured by the GHQ (Balloch et al., with the plight of clients with reduced au-
1998; Caughey, 1996; Collins & Parry-Jones, tonomy and reduced resources. It is not
2000; Gibson et al., 1989; Thompson et al., surprising then to find a high degree of burn-
1996). Social workers have also been found out on the dimension that measures feelings
to have high levels of general anxiety and of personal accomplishment.
depression (Bennett et al., 1993) and poorer From the earlier literature, there is some
mental well-being (Bradley & Sutherland, evidence that social workers in mental health
1995) as compared to the normative popula- experienced lower levels of burnout than
tion. It is difficult to determine whether this hospital or welfare social workers. However,
psychiatric symptomatology was already this is not a consistent picture with only a few
present or, whether, the perceived stresses comparative studies and one study showing
experienced by the social workers resulted in social workers in family work having less
them developing such high levels of emo- depersonalisation than mental health social
tional distress. workers. In hospital settings, a medical model
Social work is a profession that aims to is followed, which has implications for social
improve social functioning by the provision workers in terms of status differences and the
of practical and psychological help to people demands placed on social workers by the
in need. The accepted view held by social medical profession that are frequently at odds
workers is that many of their clients’ difficul- with social work values. The social services
ties are linked in diverse ways to their social, have been identified as stressful for social
economic, and political status in society (Jones workers as they find themselves with fewer
& Novak, 1993). Marked changes in societal resources to meet the needs of clients with
expectations and service delivery have cre- multiple social issues. It must be noted,
ated difficulties for social workers to work however, that there is a great diversity of
within this frame of reference. This then social work roles and hence the potential for
results in a discrepancy between the ideals of high variability in stress.
Social work, stress and burnout 263

Health and social care have changed mark- stress and burnout. Demographic variables
edly in relation to the organisation and deliv- do not appear to be significantly related to
ery of services. In order to respond to these stress and burnout. Most of the factors re-
changes, it is necessary for the individual lated to the individual social worker were not
professions to develop effectiveness in their associated with stress and burnout. Organi-
own areas of practice to further develop their sational factors such as work pressure, work
own professional identity. The fact that so- load, role ambiguity, and relationship with
cial worker’s knowledge base has been largely supervisor have been identified as primary
taken from that of allied fields means that predictors of these feelings. Only a few
their unique contribution to the team is not client-related factors were mentioned in the
always clearly understood or valued (Dillon, studies. Risk factors associated with burnout
1990; Rabin & Zelner, 1992; Reid et al., appeared to include the lack of challenge on
1999). The degree to which social workers the job, low work autonomy, role ambiguity,
are able to define their own job domain will difficulties in providing services to clients,
depend on their ability to actively negotiate and low professional self-esteem. Moderat-
their desired aims and methods, as well as to ing influences were mainly found to be su-
resist attempts by other professions to define pervisory support. Further research is war-
social work areas of expertise (Rabin & ranted to examine a wider range of potential
Zelner, 1992). Job clarity can be defined as stressors and the development of strategies
the degree to which the worker is aware of for alleviating stress, for example, increased
his/her own authority to decide treatment opportunities for supervision and better mana-
methods; of areas considered to be his/her gerial and team support. Research effort can
domain of expertise; and of the expectations then result in the development of more effec-
held by clients, supervisors and colleagues tive strategies designed to lessen and prevent
(Rabin & Zelner, 1992). work-related stress. Increased knowledge in
this area could greatly influence the job ef-
Conclusion fectiveness and satisfaction of social work-
ers.
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