Morale and job perception of community mental health professionals in Berlin and London

  • Stefan PriebeEmail author
  • Walid K. H. Fakhoury
  • Karin Hoffmann
  • Richard A. Powell



Morale and job perception of staff in community mental health care may influence feasibility and quality of care, and some research has suggested particularly high burnout of staff in the community. The aims of this study were to: a) assess morale, i. e. team identity, job satisfaction and burnout, in psychiatrists, community psychiatric nurses and social workers in community mental health care in Berlin and London; b) compare findings between the groups and test whether personal characteristics, place of working and professional group predict morale; and c) explore what tasks, obstacles, skills, enjoyable and stressful aspects interviewees perceived as important in their jobs.


In all, 189 mental health professionals (a minimum of 30 in each of the six groups) responded to a postal survey and reported activities per week using pre-formed categories. Perception of professional role was assessed on the Team Identity Scale, job satisfaction on the Minnesota Job Satisfaction Scale, and burnout on the Maslach Burnout Inventory. Seven simple open questions were used to elicit the main tasks, skills that staff did and did not feel competent in, aspects that they did and did not enjoy in their job, and obstacles and factors that caused pressure. Answers were subjected to content analysis using a posteriori formed categories.


Weekly activities and morale varied between sites and professional groups. Some mean scores for groups in London exceeded the threshold for a burnout syndrome, and are particularly less favourable for social workers. Working in London predicted higher burnout, lower job satisfaction and lower team identity. Being a psychiatrist predicted higher team identity, whilst being a social worker was associated with higher burnout and lower job satisfaction. Male gender predicted lower burnout and higher team identity. However, professional group and site interacted in predicting burnout and job satisfaction. Psychiatrists in London had much more favourable scores than the other two groups, whilst this did not hold true in Berlin. Answers to open questions revealed universal aspects, such as enjoying direct patient contact and disliking bureaucracy, but also various views that were specific to a site or professional group or both.


Burnout remains a problem for some, but not all, professional groups in community mental health care, and social workers in London appear to be a group with particularly low morale. Differences between professional groups depend on the location, and it remains unclear to what extent job-related and general factors impact on the morale of mental health professionals. Answers to open questions reveal general as well as specific aspects of the job perception of the professional groups, some of which may be relevant for service development, training and supervision. More conceptual and methodological work and more extensive studies are required to develop a better understanding of how community mental health professionals perceive their job and how morale may be improved.

Key words

burnout content analysis community mental health care job satisfaction mental health professionals staff morale 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Amstutz MC, Neuenschwander M, Modestin J (2001) Burnout bei psychiatrisch tätigen Ärztinnen und Ärzten. Resultate einer empirischen Untersuchung. Psychiatr Praxis 8:163–167Google Scholar
  2. 2.
    Benbow S, Jolley D (1998) Psychiatrists under stress. Psychiatr Bull 22:1–2Google Scholar
  3. 3.
    Billings J, Johnson S, Bebbington P, Greaves A, Priebe S, Muijen M, Ryrie I, Watts J, White I, Wright C (2003) Assertive outreach teams in London: staff experiences and perceptions. Pan-London Assertive Outreach Study Part 2. Br J Psychiatry 183:139–147CrossRefPubMedGoogle Scholar
  4. 4.
    British Medical Association (1992) Stress and the medical profession. BMA, LondonGoogle Scholar
  5. 5.
    Carson J, Fagin L, Ritter S (1995a) Stress and Coping in Mental Health Nursing. Chapman and Hall, LondonGoogle Scholar
  6. 6.
    Carson J, Barlett H, O’Malley P, de Wilde A, Brown D (1995b) Stress and coping in mental health nurses. Psychiatric care 3(6):235–239Google Scholar
  7. 7.
    Dancey CP, Reidy J (2002) Statistics without Maths for Psychology. Pearson Education Limited, EnglandGoogle Scholar
  8. 8.
    Department of Health (1998) Working together: securing a quality workforce for the NHS. The Stationary Office, LondonGoogle Scholar
  9. 9.
    Drake M, Brumblecombe N (1999) Stress in community mental health nursing: comparing teams. Ment Health Nurs 19:14–19Google Scholar
  10. 10.
    Deary IJ, Agius RM, Sadler A (1996) Personality and stress in consultant psychiatrists. Int J Soc Psychiatry 42(4):112–123Google Scholar
  11. 11.
    Edwards D, Burnard P, Coyle D, Fothergill A, Hannigan B (2000) Stress and burnout in community mental health nursing: a review of the literature. J Psychiatr Ment Health Nurs 7:7–14CrossRefPubMedGoogle Scholar
  12. 12.
    Fagin F, Carson J, Leary J, De Villiers N, Bartlett H, O’Malley P, West M, Mcelfatrick S, Brown P (1996) Stress, coping and burnout in mental health nurses: findings from three research studies. Int J Soc Psychiatry 42(2):102–111Google Scholar
  13. 13.
    Fagin L, Brown D, Bartlett H, Leary J, Carson J (1995) The Claybury CPN under stress study. Is it more stressful to work in hospital or in the community? J Adv Nursing 22:1–12Google Scholar
  14. 14.
    Galeazzi GM, Delmonte S, Fakhoury WK, Priebe S (2004) Morale of mental health professionals in Community Mental Health Services of a Northern Italian Province. Epidemiologia e Psichiatria Sociale 13(3):191–197Google Scholar
  15. 15.
    Guthrie E, Black D (1997) Psychiatric disorder, stress and burnout. Adv Psychiatr Treatment 3:275–281Google Scholar
  16. 16.
    Lawrie S, McIntosh A, Rao S (2002) Critical Appraisal for Psychiatry. Elsevier Science Limited, PhiladelphiaGoogle Scholar
  17. 17.
    Marriott A, Sexton L, Staley D (1994) Components of job satisfaction in psychiatric social workers. Health and Social Work 19(3):199–205Google Scholar
  18. 18.
    Maslach C, Jackson S (1981) Maslach Burnout Inventory Manual (Human Services Survey). Consulting Psychologists Press, CaliforniaGoogle Scholar
  19. 19.
    Maslach C, Jackson S, Leiter MP (1996) Maslach Burnout Inventory Manual, 3rd edition. Consulting Psychologists Press, CaliforniaGoogle Scholar
  20. 20.
    McKee V (1996) Working to a Frenzy. The Guardian, London, Tuesday, 1 October, p 14Google Scholar
  21. 21.
    Moore KA, Cooper CL (1996) Stress in mental health professionals: a theoretical overview. Int J Soc Psychiatry 42:82–89Google Scholar
  22. 22.
    Naisberg-Fennig S, Keinin G, Elizur A (1991) Personality characteristics and proneness to burnout. A study among psychiatrists. Stress Medicine 7:201–205Google Scholar
  23. 23.
    Onyett S, Heppleston T, Bushnell D (1994) A national survey of community mental health teams. J Ment Health 3:175–194Google Scholar
  24. 24.
    Priebe S, Fakhoury W, White I, Watts J, Bebbington P, Billings J, Burns T, Johnson S, Muijen M, Ryrie I, Wright C for the Pan-London Assertive Outreach Study Group (2004) Characteristics of teams, staff and patients: associations with outcomes of patients in assertive outreach. Br J Psychiatry 185:306–311Google Scholar
  25. 25.
    Prosser D, Johnson S, Kuipers E, Szmukler G, Bebbington P, Thornicroft G (1996) Mental Health, ‘burnout’ and job satisfaction among hospital and community based mental health staff. Br J Psychiatry 170:134–338Google Scholar
  26. 26.
    Prosser D, Johnson S, Kuipers E, Szmukler G, Bebbington P, Thornicroft G (1997) Perceived sources of work stress and satisfaction among hospital and community mental health staff, and their relation to mental health, burnout and job satisfaction. J Psychosom Res 43(1):51–59Google Scholar
  27. 27.
    Prosser D, Johnson S, Kuipers E, Dunn G, Szmukler G, Reid Y, Bebbington P, Thornicroft G (1999) Mental health, burnout and job satisfaction in a longitudinal study of mental health staff. Soc Psychiatry Psychiatr Epidemiol 34:295–300CrossRefPubMedGoogle Scholar
  28. 28.
    Rathod S, Roy L, Ramsay M, et al. (2000) A survey of stress in psychiatrists working in the Wessex region. Psychiatr Bull 24:133–136Google Scholar
  29. 29.
    Rees D, Cooper C (1992) Occupational stress in health service workers in the UK. Stress and Medicine 8:79–90Google Scholar
  30. 30.
    Reid Y, Johnson S, Morant N, Kuipers E, Szmukler G, Thornicroft G, Bebbington P, Prosser D (1999) Explanations for stress and satisfaction in mental health professionals: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 34(6):301–308CrossRefPubMedGoogle Scholar
  31. 31.
    Rizzo J, House R, Lirtzman S (1970). Role conflict and ambiguity in complex organisations. Administrative Science Quarterly 15:150–163Google Scholar
  32. 32.
    Seifert K, Jayaratne S, Chess WA (1991) Job satisfaction, burnout, and turnover in health care social workers. Health and Social Work 16(1):193–202Google Scholar
  33. 33.
    Snelgrove SR (1998) Occupational stress and job satisfaction: a comparative study of health visitors, district nurses and community psychiatric nurses. J Nurs Management 6:97–104Google Scholar
  34. 34.
    Swoboda H, Sibitz I, Fruhwald S, Klug G, Bauer B, Priebe S (in print) Job satisfaction and burnout among community-based mental health staff. Psychiatrische PraxisGoogle Scholar
  35. 35.
    Swoboda H, Sibitz I, Fruhwald S, Klug G, Bauer B, Priebe S (in print) How do community-based mental health staff in Austria perceive their job? A qualitative study. Psychiatrische PraxisGoogle Scholar
  36. 36.
    Thornton PI (1992) The relation of coping, appraisal, and burnout in mental health workers. J Psychol 126(3):261–271Google Scholar
  37. 37.
    Waite A, Oliver N, Carson J, Fagin L (1995) Job satisfaction in mental health nursing: is community or ward based work more satisfying. Psychiatr Care 2(5):167–170Google Scholar
  38. 38.
    Wall T, Bolden R, Borrill C, Carter A, Golya D, Hardy G, Haynes C, Rick J, Shapiro D, West M (1997) Minor psychiatric disorder in NHS trust staff: occupational and gender differences. Br J Psychiatry 171:519–523PubMedGoogle Scholar
  39. 39.
    Weiss DJ, Davis RV, England GW, Loftquist LH (1967) Manual for the Minnesota Satisfaction Questionnaire. University of Minnesota, MinneapolisGoogle Scholar
  40. 40.
    Wykes T, Stevens W, Everitt B (1997) Stress in community care teams: will it affect the sustainability of community care? Soc Psychiatry Psychiatr Epidemiol 32:398–407Google Scholar

Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • Stefan Priebe
    • 1
    Email author
  • Walid K. H. Fakhoury
    • 1
  • Karin Hoffmann
    • 2
  • Richard A. Powell
    • 3
  1. 1.Unit for Social and Community PsychiatryNewham Centre for Mental HealthLondon E13 8SPUK
  2. 2.Berlin Institute of Social PsychiatryBerlinGermany
  3. 3.Sainsbury Centre for Mental HealthLondonUK

Personalised recommendations