Morale in the English mental health workforce: questionnaire survey.

BACKGROUND: High-quality evidence on morale in the mental health workforce is lacking. AIMS: To describe staff well-being and satisfaction in a multicentre UK National Health Service (NHS) sample and explore associated factors. METHOD: A questionnaire-based survey (n = 2258) was conducted in 100 wards and 36 community teams in England. Measures included a set of frequently used indicators of staff morale, and measures of perceived job characteristics based on Karasek's demand-control-support model. RESULTS: Staff well-being and job satisfaction were fairly good on most indicators, but emotional exhaustion was high among acute general ward and community mental health team (CMHT) staff and among social workers. Most morale indicators were moderately but significantly intercorrelated. Principal components analysis yielded two components, one appearing to reflect emotional strain, the other positive engagement with work. In multilevel regression analyses factors associated with greater emotional strain included working in a CMHT or psychiatric intensive care unit (PICU), high job demands, low autonomy, limited support from managers and colleagues, age under 45 years and junior grade. Greater positive engagement was associated with high job demands, autonomy and support from managers and colleagues, Black or Asian ethnic group, being a psychiatrist or service manager and shorter length of service. CONCLUSIONS: Potential foci for interventions to increase morale include CMHTs, PICUs and general acute wards. The explanatory value of the demand-support-control model was confirmed, but job characteristics did not fully explain differences in morale indicators across service types and professions.

Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation.

BACKGROUND: Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. METHOD: We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England. RESULTS: Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. CONCLUSIONS: Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.

Demands, control, supportive relationships and well-being amongst British mental health workers.

PURPOSE: Staff well-being is considered to be a potential problem within mental health occupations, and its variability is in need of investigation. Our starting point is to assess the role of demands, control and supportive relationships that are at the core of Karasek's model. The study aims to assess the relationship amongst mental health workers of job demands, control and support (from peers and superiors) with multiple measures of well-being. METHOD: Data were obtained through a self-completion questionnaire from mental health staff in 100 inpatient wards, 18 crisis resolution/home treatment teams and 18 community mental health teams. The data was analysed using multilevel regression analysis. RESULTS: Job demands (negatively), control (positively) and supportive relationships (positively) are each uniquely associated with the five measures of well-being included in the study: namely intrinsic satisfaction, anxiety, depression, emotional exhaustion and personal accomplishment. Non-linear and interaction effects involving these demands, control and supportive relationships are found, but vary in type and strength across well-being measures. CONCLUSIONS: The combination of low levels of demands and high levels of control and supportive relationships is good for the well-being of mental health staff. Our results suggest that management initiatives in mental health services should be targeted at creating this combination within the working environment, and particularly at increasing levels of job control.

Evaluating the built environment in inpatient psychiatric wards.

OBJECTIVE: Research on inpatient psychiatric care has paid little attention to the built environment of psychiatric wards. This study described the built environment in a sample of inpatient psychiatric wards in England and investigated relationships between staff satisfaction with the built environment of the ward and objective design features of the environment. METHODS: Trained researchers completed a checklist of built-environment characteristics of 98 inpatient wards in England in 2007-2009. Interrater reliability was assessed and confirmed. Staff on these wards completed a three-item measure assessing the ward for overall design, fitness for purpose, and role in ensuring safety. Multilevel modeling was used to test relationships between built-environment features and staff satisfaction. RESULTS: A total of 1,540 staff responded. The wards encompassed a wide variety of service types and built-environment features. Staff satisfaction with the built environment was associated with noncorridor design and with the provision of personal bathrooms for patients. No association with observability of patients, exterior views, or other facilities was found. There was no difference between nurses and other groups in satisfaction with overall design, but nurses rated ward environment lower on ensuring safety (p=.036) and on fitness for purpose (p=.012). CONCLUSIONS: Objective measurement of the built environment in inpatient psychiatric settings is feasible and can be used to identify features that increase user satisfaction.