Burnout in Mental Health Services: A Review of the Problem and Its Remediation

  • Gary MorseEmail author
  • Michelle P. Salyers
  • Angela L. Rollins
  • Maria Monroe-DeVita
  • Corey Pfahler
Original Paper


Staff burnout is increasingly viewed as a concern in the mental health field. In this article we first examine the extent to which burnout is a problem for mental health services in terms of two critical issues: its prevalence and its association with a range of undesirable outcomes for staff, organizations, and consumers. We subsequently provide a comprehensive review of the limited research attempting to remediate burnout among mental health staff. We conclude with recommendations for the development and rigorous testing of intervention approaches to address this critical area.


Burnout Burnout prevention Mental health staff 



This study was funded in part by an IP-RISP grant from the National Institute of Mental Health (R24 MH074670; Recovery Oriented Assertive Community Treatment). We also appreciate the assistance of Candice Hudson, L. Kay Webb, Bonnie Barbareck, and Dawn Hope Shimp in the preparation of this manuscript.


  1. Acker, G. (2010). The challenges in providing services to clients with mental illness: Managed care, burnout and somatic symptoms among social workers. Community Mental Health Journal, 46(6), 591–600.PubMedCrossRefGoogle Scholar
  2. Ahola, K., Honkonen, T., Isometsä, E., Kalimo, R., Nykyri, E., Aromaa, A., et al. (2005). The relationship between job-related burnout and depressive disorders—results from the Finnish Health 2000 Study. Journal of Affective Disorders, 88(1), 55–62.PubMedCrossRefGoogle Scholar
  3. Awa, W. L., Plaumann, M., & Walter, U. (2010). Burnout prevention: A review of intervention programs. Patient Education and Counselling, 78(2), 184–190.CrossRefGoogle Scholar
  4. Bittman, B., Bruhn, K. T., Stevens, C., Westengard, J., & Umbach, P. O. (2003). Recreational music-making: A cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers. Advances in Mind-Body Medicine, 19(3–4), 4–15.PubMedGoogle Scholar
  5. Boyer, S. L., & Bond, G. R. (1999). Does assertive community treatment reduce burnout? A comparison with traditional case management. Mental Health Services Research, 1(1), 31–45.CrossRefGoogle Scholar
  6. Burke, R. J., & Richardsen, A. M. (1993). Psychological burnout in organizations. In R. T. Golembiewski (Ed.), Handbook of organizational behavior. New York: Marcel Dekker.Google Scholar
  7. Canfield, J. (2005). Secondary traumatization, burnout, and vicarious traumatization: A review of the literature as it relates to therapists who treat trauma. Smith College Studies in Social Work, 75(2), 81–101.CrossRefGoogle Scholar
  8. Carney, J., Donovan, R., Yurdin, M., & Starr, R. (1993). Incidence of burnout among New York City intensive case managers: Summary of findings. Psychosocial Rehabilitation Journal, 16(4), 25–38.Google Scholar
  9. Carson, J., Cavagin, J., Bunclark, J., Maal, S., Gournay, K., Kuipers, E., et al. (1999). Effective communication in mental health nurses: Did social support save the psychiatric nurse? Nursing Times Research, 4(1), 31–42.Google Scholar
  10. Chemiss, C. (1980). Staff burnout: Job stress in the human services. Beverly Hills, CA: Sage.Google Scholar
  11. Corrigan, P. W. (1990). Consumer satisfaction with institutional and community care. Community Mental Health Journal, 26(2), 151–165.PubMedCrossRefGoogle Scholar
  12. Corrigan, P. W., McCracken, S. G., Edwards, M., Kommana, S., & Simpatico, T. (1997). Staff training to improve implementation and impact of behavioral rehabilitation programs. Psychiatric Services, 48(10), 1336–1338.PubMedGoogle Scholar
  13. Deegan, P. E., Rapp, C., Holter, M., & Riefer, M. (2008). Best practices: A program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatric Services, 59(6), 603–605.PubMedCrossRefGoogle Scholar
  14. Ducharme, L. J., Knudsen, H. K., & Roman, P. M. (2008). Emotional exhaustion and turnover intention in human service occupations: The protective role of coworker support. Sociological Spectrum, 28(1), 81–104.CrossRefGoogle Scholar
  15. Dunkley, J., & Whelan, T. A. (2006). Vicarious traumatisation: Current status and future directions. British Journal of Guidance & Counselling, 34(1), 107–116.CrossRefGoogle Scholar
  16. Edwards, D., Burnard, P., Coyle, D., Fothergill, A., & Hannigan, B. (2000). Stress and burnout in community mental health nursing: A review of the literature. Journal of Psychiatric and Mental Health Nursing, 7, 7–14.PubMedCrossRefGoogle Scholar
  17. Emmons, R. A., & Shelton, C. M. (2001). Gratitude and the science of positive psychology. In C. Snyder & S. Lopez (Eds.), Handbook of positive psychology (pp. 459–471). New York: Oxford University Press.Google Scholar
  18. Ewers, P., Bradshaw, T., McGovern, J., & Ewers, B. (2002). Does training in psychosocial interventions reduce burnout rates in forensic nurses? Journal of Advanced Nursing, 37(5), 470–476.PubMedCrossRefGoogle Scholar
  19. Fallot, R. D., & Harris, M. (2008). Trauma informed approaches to systems of care. Trauma Psychology Newsletter, 3(1), 6–7.Google Scholar
  20. Feingold, A. (2005). Sustaining stamina at the interface of HIV and mental health practice. Mental Health AIDS, 6(2), 6–9.Google Scholar
  21. Feingold, A. (2008). Kicking it upstairs. Mental Health AIDS, 9(2), 8–9.Google Scholar
  22. Figley, C. R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1–20). Philadelphia, PA, USA: Brunner/Mazel.Google Scholar
  23. Garman, A. N., Corrigan, P. W., & Morris, S. (2002). Staff burnout and patient satisfaction: Evidence of relationships at the care unit level. Journal of Occupational Health Psychology, 7(3), 235–241.PubMedCrossRefGoogle Scholar
  24. Geller, G., Bernhardt, B. A., Carrese, J., Rushton, C. H., & Kolodner, K. (2008). What do clinicians derive from partnering with their patients? A reliable and valid measure of “personal meaning in patient care”. Patient Education and Counseling, 72(2), 293–300.PubMedCrossRefGoogle Scholar
  25. Gilbody, S., Cahill, J., Barkham, M., Richards, D., Bee, P., & Glanville, J. (2006). Can we improve the morale of staff working in psychiatric units? A systematic review. Journal of Mental Health, 15(1), 7–17.CrossRefGoogle Scholar
  26. Glisson, C., Dukes, D., & Green, P. (2006). The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children’s service systems. Child Abuse and Neglect, 30(8), 855–880. discussion 849–854.PubMedCrossRefGoogle Scholar
  27. Goldmacher, S. (2009, November 19, 2009). California’s budget woes will continue for years, report says, The Los Angeles Times. Retrieved from,0,433593.story.
  28. Gowdy, E. A., Carlson, L. S., & Rapp, C. A. (2003). Practices differentiating high-performing from low-performing supported employment programs. Psychiatric Rehabilitation Journal, 26, 232–239.PubMedCrossRefGoogle Scholar
  29. Halberg, I. R. (1994). Systematic clinical supervision in a child psychiatric ward: Satisfaction with nursing care, tedium, burnout, and the nurses’ own report on the effects of it. Archives of Psychiatric Nursing, 8(1), 44–52.CrossRefGoogle Scholar
  30. Halbesleben, J. R. B., & Buckley, M. R. (2004). Burnout in organizational life. Journal of Management, 30(6), 859–879.Google Scholar
  31. Halbesleben, J. R. B., Osburn, H. K., & Mumford, M. D. (2006). Action research as a burnout intervention: Reducing burnout in the federal fire service. Journal of Applied Behavioral Science, 42(2), 244–266.CrossRefGoogle Scholar
  32. Halbesleben, J. R., & Rathert, C. (2008). Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients. Health Care Management Review, 33(1), 29–39.PubMedCrossRefGoogle Scholar
  33. Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., et al. (2004a). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35(4), 821–835.CrossRefGoogle Scholar
  34. Hayes, S. C., Follette, V. M., & Linehan, M. M. (2004b). Mindfulness and acceptance: Expanding the cognitive-behavioral tradition. New York: Guilford Publications, Guilford Press.Google Scholar
  35. Hoge, M. A., Morris, J. A., Daniels, A. S., Stuart, G. W., Huey, L. Y., & Adams, N. (2007). An action plan for behavioral health workforce development: A framework for discussion. Rockville, MD.Google Scholar
  36. Holmqvist, R., & Jeanneau, M. (2006). Burnout and psychiatric staff’s feelings towards patients. Psychiatry Research, 145(2–3), 207–213.PubMedCrossRefGoogle Scholar
  37. Kerns, C. D. (2006). Gratitude at work: Counting your blessings will benefit yourself and your organization. Graziado Business Review, 9(4). Retrieved from
  38. Knudsen, H. K., Ducharme, L. J., & Roman, P. M. (2008). Clinical supervision, emotional exhaustion, and turnover intention: A study of substance abuse treatment counselors in the Clinical Trials Network of the National Institute on Drug Abuse. [Research Support, N.I.H., Extramural]. Journal of Substance Abuse Treatment, 35(4), 387–395.Google Scholar
  39. Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., et al. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA: Journal of the American Medical Association, 302(12), 1284–1293.PubMedCrossRefGoogle Scholar
  40. Leiter, M. P., & Harvie, P. L. (1996). Burnout among mental health workers: A review and research agenda. International Journal of Social Psychology, 42, 90–101.CrossRefGoogle Scholar
  41. Leiter, M. P., Harvie, P., & Frizzell, C. (1998). The correspondence of patient satisfaction and nurse burnout. Social Science and Medicine, 47(10), 1611–1617.PubMedCrossRefGoogle Scholar
  42. Leiter, M. P., Laschinger, H. K. S., Day, A., & Oore, D. G. (in press). The impact of civility interventions on employee social behavior, distress, and attitudes. Journal of Applied Psychology.Google Scholar
  43. Leiter, M. P., & Schaufeli, W. B. (1996). Consistency of the burnout construct across occupations. Anxiety, Stress & Coping: An International Journal, 9(3), 229–243.CrossRefGoogle Scholar
  44. Mancini, A. D., Moser, L. L., Whitley, R., McHugo, G. J., Bond, G. R., Finnerty, M. T., et al. (2009). Assertive community treatment: Facilitators and barriers to implementation in routine mental health settings. Psychiatric Services, 60(2), 189–195.PubMedCrossRefGoogle Scholar
  45. Maslach, C. (1993). Burnout: A multidimensional perspective. In W. B. Schaufeli, C. Maslach, & T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 19–32). Washington, DC: Taylor & Francis.Google Scholar
  46. Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach burnout inventory manual (3rd ed.). Palo Alto, California: Consulting Psychologists Press.Google Scholar
  47. Maslach, C., & Pines, A. (1979). Burnout, the loss of human caring. In A. Pines & C. Maslach (Eds.), Experiencing social psychology. New York: Random House.Google Scholar
  48. Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52, 397–422.PubMedCrossRefGoogle Scholar
  49. Melchior, M. E., Philipsen, H., Abu-Saad, H. H., Halfens, R. J., van de Berg, A. A., & Gassman, P. (1996). The effectiveness of primary nursing on burnout among psychiatric nurses in long-stay settings. Journal of Advanced Nursing, 24(4), 694–702.PubMedCrossRefGoogle Scholar
  50. Murphy, L. R. (1996). Stress management in work settings: A critical review of the health effects. American Journal of Health Promotion: AJHP, 11(2), 112–135.PubMedCrossRefGoogle Scholar
  51. Oddie, S., & Ousley, L. (2007). Assessing burn-out and occupational stressors in a medium secure service. The British Journal of Forensic Practice, 9(2), 32–48.CrossRefGoogle Scholar
  52. Onyett, S., Pillinger, T., & Muijen, M. (1997). Job satisfaction and burnout among members of community mental health teams. Journal of Mental Health, 6(1), 55–66.CrossRefGoogle Scholar
  53. Paris, M., Jr., & Hoge, M. A. (2010). Burnout in the mental health workforce: A review. Journal of Behavioral Health Services & Research, 37(4), 519–528.CrossRefGoogle Scholar
  54. Peterson, U., Demerouti, E., Bergström, G., Samuelsson, M., Åsberg, M., & Nygren, Å. (2008). Burnout and physical and mental health among Swedish healthcare workers. Journal of Advanced Nursing, 62(1), 84–95.PubMedCrossRefGoogle Scholar
  55. Pines, A., & Aronson, E. (1988). Career burnout: Causes and cures. New York, NY, USA: Free Press.Google Scholar
  56. Pines, A., & Maslach, C. (1978). Characteristics of staff burnout in mental health settings. Hospital & Community Psychiatry, 29(4), 233–237.Google Scholar
  57. Priebe, S., Fakhoury, W. K. H., Hoffmann, K., & Powell, R. A. (2005). Morale and job perception of community mental health professionals in Berlin and London. Social Psychiatry and Psychiatric Epidemiology, 40(3), 223.PubMedCrossRefGoogle Scholar
  58. 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. Journal of Psychosomatic Research, 43(1), 51–59.PubMedCrossRefGoogle Scholar
  59. Robey, K., Ramsland, S. E., & Castelbaum, K. (1991). Alignment of agency and personal missions: An evaluation. Administration and Policy In Mental Health, 19(1), 39–45.CrossRefGoogle Scholar
  60. Rohland, B. M. (2000). A survey of burnout among mental health center directors in a rural state. Administration and Policy In Mental Health, 27(4), 221–237.PubMedCrossRefGoogle Scholar
  61. Rollins, A., Salyers, M., Tsai, J., & Lydick, J. (2010). Staff turnover in statewide implementation of ACT: Relationship with ACT fidelity and other team characteristics. Administration and Policy in Mental Health and Mental Health Services Research, 37(5), 417–426.PubMedCrossRefGoogle Scholar
  62. Rupert, P. A., & Kent, J. S. (2007). Gender and work setting differences in career-sustaining behaviors and burnout among professional psychologists. Professional Psychology: Research and Practice, 38(1), 88–96.CrossRefGoogle Scholar
  63. Salyers, M. P., Hudson, C., Morse, G., Rollins, A. L., Monroe-DeVita, M., Wilson, C., et al. (2011). BREATHE: A pilot study of a one-day retreat to reduce burnout among mental health professionals. Psychiatric Services, 62(2), 214–217.PubMedCrossRefGoogle Scholar
  64. Scarnera, P., Bosco, A., Soleti, E., & Lancioni, G. E. (2009). Preventing burnout in mental health workers at interpersonal level: An Italian pilot study. Community Mental Health Journal, 45(3), 222–227.PubMedCrossRefGoogle Scholar
  65. Schulz, R., Greenley, J. R., & Brown, R. (1995). Organization, management, and client effects on staff burnout. Journal of Health and Social Behavior, 36(4), 333–345.PubMedCrossRefGoogle Scholar
  66. Schwab, R. L., Jackson, S. E., & Schuler, R. S. (1986). Educator burnout: Sources and consequences. Educational Research Quarterly, 10, 15–30.Google Scholar
  67. Siebert, D. C. (2005). Personal and occupational factors in burnout among practicing social workers: Implications for research, practitioners, and managers. Journal of Social Service Research, 32(2), 25–44.CrossRefGoogle Scholar
  68. Smoot, S. L., & Gonzolas, J. L. (1995). Cost-effective communication skills training for state hospital employees. Psychiatric Services, 46, 819–822.PubMedGoogle Scholar
  69. Stalker, C., & Harvey, C. (2002). Professional burnout: A review of theory research, and prevention Partnerships for Children and Families Project. Waterloo: Wilfrid Laurier University.Google Scholar
  70. Taris, T. W. (2006). Is there a relationship between burnout and objective performance? A critical review of 16 studies. Work & Stress, 20(4), 316–334.CrossRefGoogle Scholar
  71. Toppinen-Tanner, S., Ojajärvi, A., Väänänen, A., Kalimo, R., & Jäppinen, P. (2005). Burnout as a predictor of medically certified sick-leave absences and their diagnosed causes. Behavioral Medicine, 31(1), 18–27.PubMedCrossRefGoogle Scholar
  72. van Dierendonck, D., Garssen, B., & Visser, A. (2005). Burnout prevention through personal growth. International Journal of Stress Management, 12(1), 62–77.CrossRefGoogle Scholar
  73. van Dierendonck, D., Schaufeli, W. B., & Buunk, B. P. (1998). The evaluation of an individual burnout intervention program: The role of inequity and social support. Journal of Applied Psychology, 83(3), 392–407.CrossRefGoogle Scholar
  74. van Dierendonck, D., Schaufeli, W. B., & Buunk, B. P. (2001). Burnout and inequity among human service professionals: A longitudinal study. Journal of Occupational Health Psychology, 6(1), 43–52.PubMedCrossRefGoogle Scholar
  75. Webster, L., & Hackett, R. K. (1999). Burnout and leadership in community mental health systems. Administration and Policy In Mental Health, 26(6), 387–399.PubMedCrossRefGoogle Scholar
  76. World Health Organization. (1992). The ICD-10 classification of mental and behavioral disorders. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Gary Morse
    • 1
    Email author
  • Michelle P. Salyers
    • 2
    • 3
    • 4
  • Angela L. Rollins
    • 2
    • 3
    • 4
  • Maria Monroe-DeVita
    • 5
  • Corey Pfahler
    • 6
  1. 1.Places for People: Community Alternatives for Hope, Health and RecoverySt. LouisUSA
  2. 2.Department of Veterans Affairs, Center of Excellence on Implementing Evidence-Based PracticeVeterans Health Administration, Health Services Research and Development Service (VA HSR&D)IndianapolisUSA
  3. 3.Department of PsychologyIUPUIIndianapolisUSA
  4. 4.ACT Center of IndianaIndianapolisUSA
  5. 5.Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA
  6. 6.Social WorkIUPUIIndianapolisUSA

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