Deteriorated Wellbeing Among Mental Health Professionals Working In UK Higher Education

For my recent Master’s dissertation I investigated levels of wellness among mental health professionals (MHPs) working in UK higher education. The study sought to both investigate job stress, burnout and negative perceptions of the work environment among MHPs and to compare how specific work-related factors may predict burnout levels and perceived level of work environment support among this population. The findings indicated that there are high levels of stress and burnout among this population. Specifically, high levels of exhaustion and emotional exhaustion, depersonalisation, feelings of incompetence, perceptions of a negative work environment and deterioration in personal life are being experienced by these individuals. MHPs who had larger caseloads than they would prefer were more likely to report feelings of depersonalisation, exhaustion, and a marked deterioration in their personal lives.  Degree of burnout was found to differ based on case type. For example, when counselling students for trauma, MHPs were likely to experience a reduction in quality of personal life while counselling students for relationship difficulties had a medium positive effect on MHPs’ feelings of personal accomplishment.

Why are UK MHPs working in higher education experiencing deteriorated wellbeing?

There may be several reasons for the reported high levels of stress and burnout among this population:

MHP Job role

There are several aspects specific to working in student mental health in UK higher education that place counsellors, psychologists and mental health advisers at risk for the experience of stress and burnout. It has been proposed that the very act of providing mental health and counselling services to clients can result in the erosion of the wellbeing of the mental health practitioner. MHPs are at particular risk for the development of stress and burnout on account of their spending extensive periods of time in intense sessions with clients. The intensity of these environments can result in emotional drainage, chronic stress and burnout (Maslach & Jackson, 1981).  Burned out mental health professionals can become emotionally exhausted, develop negative perceptions and feelings about their clients, and experience crises in their professional competence (Schaufeli, Leiter, & Maslach, 2009).

MHPs working in higher education are typically at the forefront of assessing, advising and counselling students’ on their psychological issues. In addition to providing psychological services, these individuals may be expected to provide consultation services, outreach and education services, engage in research and program evaluation (Kadambi, Audet & Knish, 2010), along with conducting basic administrative duties and actively sustaining membership on committees (Hewitt & Wheeler, 2004), further adding to their workload. Burnout in the mental health professional can be considered a job stress arising from the social interaction between the MHP and the client (Everall & Paulson, 2004). Counsellors, psychologists and others working in the ‘helping’ professions may therefore be at risk for the development of stress and burnout due to tendencies such as placing others’ needs before their own, suppressing their emotions when faced with clients’ issues, and a heightened sensitivity to others and the environment (Bearse, McMinn, Seegobin & Free, 2013).  In addition to being subjected to the same organisational stressors as most workers, MHPs face the emotional strain of dealing with troubled persons, often over extended time periods (Moore & Cooper, 1996).  For example, MHPs are at risk for the development of vicarious traumatisation, compassion fatigue and countertransference. Vicarious traumatisation refers to the MHP becoming traumatised upon listening to their clients’ accounts of their graphic or traumatic experiences, while compassion fatigue refers to the compromising of the MHP’s empathetic ability to recognise pain in clients and their motivation to respond to it (Bearse, McMinn, Seegobin & Free, 2013). Countertransference can negatively impact the cognitive, affective, and behavioural responses of the MHP to the particular needs of their clients.

The British government’s recent widening of access to higher education

Historically, access to UK higher education was very much limited to the upper social classes. Students attending British universities tended to be part of the academic elite, from economically privileged backgrounds, with secured family support (Macaskill, 2013).  The British government’s policy to increase access to UK higher education aimed to open it up to those groups traditionally denied access such as individuals from poorer economic backgrounds, those individuals who had attended state schools (Hoare & Johnston, 2011) and minority ethnic groups (Walker, 2010).  Since 2003, UK higher education institutions have been allowed to raise tuition fees up to a prescribed maximum but must enter into access agreements with the British government and must gain approval from the Office for Fair Access showing how the institution intends to use the additional fee income to finance student widening-participation (Hoare & Johnston, 2011).

The rising number of UK university students experiencing mental health issues

Research indicates that the number of UK university students experiencing mental health issues is on the rise (Quinn, Wilson, MacIntyre, & Tinklin, 2009) and that the mental health of higher education students is worse than that of the general population (Connell, Barkham, & Mellor-Clark, 2007). For example, in their study investigating the psychological well-being of undergraduate students from pre-registration period to year three at a large UK university, Bewick, Koutsopoulou, Miles, Slaa, & Barkham (2010) found that students were more strained and stressed once they started university compared to their pre-university levels. Borrilla, Fox, Flynn, & Roger (2009), in their study of self-harm incidents (scratching, cutting, poisoning, overdose etc.) among UK university students, found that a total of 27% reported at least one incident of self-harm, with almost 10% having harmed themselves continually whilst in higher education.  In their survey of students from six UK universities, Ibrahim, Kelly, & Glazebrook (2013) found that while many students experience some symptoms of depression during their time in higher education, those from less advantaged backgrounds are more at risk for the development of depression. Macaskill’s (2013) study assessed the levels of mental illness among undergraduate students enrolled in an English university and found that while the rates of student mental illness equalled those of the general population, second year students reported the most significant increases in psychiatric symptoms. Russell & Shaw (2009) investigated the prevalence of social anxiety among students enrolled at a large UK university and found that approximately 10% reported marked to severe social anxiety. Tinklin, Riddell & Wilson (2005), reporting on the case studies of five UK higher education students dealing with mental health issues, confirmed that certain aspects of the higher education environment had intensified their mental health difficulties. The findings of these few research studies paint a picture of an increasingly ill student population.

The number of university students seeking psychological support and the severity of their emotional and behavioural problems is increasing

With the UK government’s changes in policy regarding the widening of access to higher education and the reported increased vulnerability of university students, it may come as no surprise that counselling services are reporting that the number of students seeking psychological support, and the severity of emotional and behavioural problems among students, is increasing (Connell, Barkham, & Mellor-Clark, 2007).  Greater demands are therefore being placed on student psychological support services with little or no corresponding increase in resources (Quinn, Wilson, MacIntyre, & Tinklin, 2009).  With burnout having been positively correlated with MHPs’ heavy workload (Di Benedetto & Swadling, 2014) and the increasing effects of managing a caseload having been linked to fatigue, exhaustion and burnout (Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler, 2011), it seems that the risk for UK higher education mental health professionals to experience stress and burnout is at an all-time high.

Why does this matter?

As already described, stress and burnout can seriously negatively impact the wellbeing and personal lives of MHPs. Mental health professionals, the individuals charged with facilitating the mental health and wellbeing of university students, may be doing so at the expense of their own health. While this is a tragedy in and of itself, a stressed and burned out MHP continuing to work and counsel students can potentially pose harm to students, to colleagues, to the university at large and to society in general.

Reduced quality of care for students

Poor mental health can vastly decrease an MHPs’ ability to provide effective services to students (Sang Min, Seong Ho, Kissinger, & Ogle, 2010), and therefore it is possible that many students enrolled in UK higher education are not getting their psychological needs adequately met by their stressed and burned out university counsellors. Higher education counsellors often work in environments characterised by high levels of exposure to the negative emotions of students. Because higher education counsellors and psychologists are the primary tool in the provision of student counselling and psychological intervention, they influence treatment outcome to a huge degree and therefore providing quality services to students requires that these professionals maintain themselves physically, mentally and spiritually (Yii-Nii, 2012).  Job-related stress and burnout among mental health professionals therefore not only negatively affects the practitioner but it can greatly impact the client-therapist relationship (Malinowski, 2013).  Burnout among MHPs disrupts the continuity of care, undermines the quality of services provided, and impairs job performance, all of which can potentially lead to the reduction of the ability to be attentive, empathic and collaborative (Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler, 2011) with clients.

Cost to the university and society at large

According to Dewe & Cooper (2012), the potential impacts of employee stress include high staff turnover, employee absenteeism, employee presenteeism (lost productivity due to an ‘ill’ employee coming to work and performing below par), and employee sickness absence.  An absent workforce can also pose negative impacts to society at large with employee absenteeism poses high financial costs to the UK economy (Dewe & Cooper, 2012) and can potentially cost businesses millions of pounds per year (Keane, 2008).  Excessive employee absenteeism due to stress and burnout can result in the crumbling of a company’s business foundation, as the mounting workload and increasing pressure take their toll on remaining staff members (Keane, 2008) and picking up the slack for absent colleagues can result in stress and burnout.

What can be done?

Until the British government addresses and makes attempts to rectify the disconnect between the increasing demands being placed upon student psychological support services and the little or no corresponding increase in resources, MHPs will continue to suffer from job-related stress and burnout. In the meantime, stressed and burned out MHPs can incorporate some coping strategies and behaviours into their daily routine to improve their wellbeing so as to gain more energy to cope with the daily demands associated with counselling students. Verywell.com suggests the following strategies for stressed and burned out individuals charged with caring for others:

Reduce workload

Where possible, the MHP experiencing work-related stress and burnout should attempt to minimize his or her workload. The MHP can only effectively take care of others when they also take care of themselves. If the MHP can get help from coworkers and support staff in reducing their workload, it may increase their stamina to care for clients.

Meditation

Meditation can help the MHP to become less reactive to job-related stress.

Exercise

Regular exercise can facilitate a break from stress, an outlet for frustrations, a meditative state, and metabolize stress hormones, thereby minimizing the effects of chronic stress.

Social support

Talking to friends and family or getting help from support groups or a counsellor are all ways of getting social support. Social support has been linked to stress-relief, good health, greater longevity, and increased life satisfaction.

 

A contribution by Emer Cogan, University of Liverpool online student.

References

Elizabeth Scott. (2015, March 27). How to Deal With Caregiver Burnout. Retrieved from https://www.verywell.com/how-to-deal-with-caregiver-burnout-3144561

Bearse, J. L., McMinn, M. R., Seegobin, W., & Free, K. (2013). Barriers to psychologists seeking mental health care. Professional Psychology: Research And Practice, 44(3), 150-157. doi:10.1037/a0031182.

Bewick, B., Koutsopoulou, G., Miles, J., Slaa, E., & Barkham, M. (2010). Changes in undergraduate students’ psychological well-being as they progress through university. Studies In Higher Education, 35(6), 633-645. doi:10.1080/03075070903216643.

Borrilla, J., Fox P., Flynn, M., & Roger, D. (2009). Students who self-harm: Coping style, Rumination and Alexithymia. Counselling Psychology Quarterly, 22(4), 361–372.

Connell, J., Barkham, M., & Mellor-Clark, J. (2007). CORE-OM mental health norms of students attending university counselling services benchmarked against an age-matched primary care sample. British Journal Of Guidance & Counselling, 35(1), 41-57. doi:10.1080/03069880601106781

Dewe, P., & Cooper, C. L. (2012). Well-being and work. [electronic book] : towards a balanced agenda. Basingstoke, Palgrave Macmillan, 2012.

Di Benedetto, M., & Swadling, M. (2014). Burnout in Australian psychologists: Correlations with work-setting, mindfulness and self-care behaviours. Psychology, Health & Medicine, 19(6), 705-715 11p. doi:10.1080/13548506.2013.861602.

Everall, R. D., & Paulson, B. L. (2004). Burnout and Secondary Traumatic Stress: Impact on Ethical Behaviour. Canadian Journal Of Counselling, 38(1), 25-35.

Hewitt, E., & Wheeler, S. (2004). Counselling in higher education: the experience of lone counsellors. British Journal Of Guidance & Counselling, 32(4), 533-545. dos 10.1080/03069880412331303312

Hoare, A., & Johnston, R. (2011). Widening Participation through Admissions Policy–A British Case Study of School and University Performance. Studies In Higher Education, 36(1), 21-41.

Ibrahim, A., Kelly, S., & Glazebrook, C. (2013). Socioeconomic status and the risk of depression among UK higher education students. Social Psychiatry & Psychiatric Epidemiology, 48(9), 1491-1501. doi:10.1007/s00127-013-0663-5

Kadambi, M., Audet, C. T., & Knish, S. (2010). Counseling Higher Education Students: Counselors’ Positive Experiences. Journal Of College Student Psychotherapy, 24(3), 213-232. doi:10.1080/87568225.2010.48629

Keane, S. (2008). The absence bug. Irish Veterinary Journal, 61(10), 688.

Macaskill, A. (2013). The mental health of university students in the United Kingdom. British Journal Of Guidance & Counselling, 41(4), 426-441. doi:10.1080/03069885.2012.743110.

Malinowski, A. J. (2013). Characteristics of Job Burnout and Humor among Psychotherapists. Humor: International Journal Of Humor Research, 26(1), 117-133. doi:10.1515/humor-2013-0007

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Morse, G., Salyers, M., Rollins, A., Monroe-DeVita, M., & Pfahler, C. (2011). Burnout in Mental Health Services: A Review of the Problem and Its Remediation. Administration And Policy In Mental Health And Mental Health Services Research, 39(5), 341-352.).

Quinn, N., Wilson, A., MacIntyre, G., & Tinklin, T. (2009). ‘People look at you differently’: students’ experience of mental health support within Higher Education. British Journal Of Guidance & Counselling, 37(4), 405-418. doi:10.1080/03069880903161385

Russell, G., & Shaw, S. (2009). A study to investigate the prevalence of social anxiety in a sample of higher education students in the United Kingdom. Journal Of Mental Health, 18(3), 198-206.

Sang Min, L., Seong Ho, C., Kissinger, D., & Ogle, N. T. (2010). A Typology of Burnout in Professional Counselors. Journal Of Counseling & Development, 88(2), 131-138.

Schaufeli, W.B., Leiter, M.P. & Maslach, C. (2009). Burnout: 35 years of research and practice. Career Development International, Vol. 14 Iss 3 pp. 204 – 220

Tinklin, T., Riddell, S., & Wilson, A. (2005). Support for students with mental health difficulties in higher education: the students’ perspective. British Journal Of Guidance & Counselling, 33(4), 495-512.

Walker, P. (2010). The Commodification of British Higher Education: Trials and Triumphs of Massification in the Metropolitan University. At The Interface / Probing The Boundaries, 60195-210.

Yii-Nii, L. (2012). Experiences of Burnout, Self-Care, and Recovery of Female University Counsellors in Taiwan. Canadian Journal Of Counselling & Psychotherapy / Revue Canadienne De Counseling Et De       Psychothérapie, 46(3), 221-238.

 

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