Burnout continues to be a concern for behavioral health providers. The shear nature of the work – which involves helping individuals manage mental health issues, substance use issues, trauma, behavioral health crises, can be emotionally taxing. Just this year, the U.S. Surgeon General identified addressing burnout as a top priority. Historically, burnout is addressed through the promotion of individual level strategies such as encouraging stress management techniques, self-care, and professional development trainings. Individual strategies alone are not sufficient as they don’t address all the factors that may be impacting the person.
The social-ecological model is a prevention framework that considers the complex interplay between individuals, interpersonal, institutional/organizational, community, and public policy. This framework is useful when considering strategies to prevent and address burnout, as a multi-pronged approach is necessary. SAMHSA released a new report that outlines organizational interventions to prevent and reduce burnout among behavioral health providers. The recommendations are summarized below.
Burnout is a state of physical and emotional exhaustion resulting from chronic workplace stress. Burnout can be worsened by mental health disorders (e.g., anxiety and depression), general life stress, job dissatisfaction, moral injury, secondary and vicarious trauma, and compassion fatigue.
Burnout is characterized by three dimensions:
Exhaustion—feeling depleted, overextended, and fatigued
Depersonalization—being detached from oneself and emotionally distant from one’s clients and work
Feelings of inefficacy—having a reduced sense of professional accomplishment
You can measure burnout using Maslach Burnout Inventory, which is the leading measure of burnout.
☑ A sense of failure
☑ Procrastination
☑ Physical illness
☑ Feelings of helplessness
☑ Loss of motivation
☑ Withdrawal from relationships and responsibilities
Burnout has individual, interpersonal and organizational implications.
Individual: Chronic stress impacts physical health and is a risk factor for chronic fatigue, gastrointestinal problems, insomnia, headaches, hypertension, depression, anxiety, and suicidal ideations. In addition, burnout can result in feelings of hopelessness, despair, boredom, cynicism, withdrawal, irritability, loss of morale, and isolation. Ultimately, a person may develop a negative self-concept, withdraw socially, and struggle with regulating emotions.
Interpersonal: Burnout may impact a person’s relationships with family, friends, and clients. They may emotionally distance themselves from others, lose empathy, and their communication with others may weaken.
Organizational: Burnout impacts turnover, attrition, productivity, quality of work, absenteeism, commitment to the organization, and morale.
The organizational level conditions that contribute to burnout include:
Workload: Chronic excessive workload without sufficient time for rest and recovery can contribute to burn out. This may include working overtime, excessive work hours, time pressures, extra administrative tasks, unnecessary training, and understaffing.
Control: Lack of self-efficacy at work relates to burnout. If a practitioner doesn’t feel that they have control over their workload or their work environment, professional autonomy, access to needed resources then they may experience disengagement and burnout.
Reward: Insufficient and inconsistent recognition and reward can result in a clinician feeling like their work is undervalued and unimportant. Low salaries, limited career advancement opportunities, low reimbursement rates from insurance companies, or insurance companies denying coverage to certain types of providers all impact burnout rates.
Community: Lack of support and trust among coworkers can lead to exhaustion and depersonalization. Organizational environments that are founded on equity, respect, effective communication, conflict resolution and team building can foster a sense of community.
Fairness: Non-transparent and inequitable decisions can contribute to feelings of unfairness, cynicism, and feelings of disrespect.
Values: A values conflict between an employee’s and organization’s values can contribute to employee’s feeling dissatisfied with their job, which may result in lack of motivation.
Organizational strategies are necessary in order to address the root cause of burnout. Strategies include practice delivery improvements, workflow modifications, institutional policy changes (i.e., time off and leave policies), culture change, and expanding resources for staff (i.e., childcare and family support programs). 5 evidence-based interventions are outlined below.
Availability, Responsiveness, and Continuity (ARC) Intervention: This team-based, manual-guided approach helps to improve organizational and social contexts of clinician burnout. This intervention takes 18 months and has been shown to increase morale, job satisfaction, organizational commitment, and personalization. In addition, it has been shown to decrease role conflict and organizational rigidity.
Participatory Workplace Intervention: Focuses on identifying adverse psychosocial work factors, implementing environmental interventions (i.e. ergonomics), addressing communication, training, staffing processes, and team building. This intervention takes between 12 – 36 months and has been shown to increase supervisor support for up to 3 years, and decrease psychosocial demands, effort-reward imbalance, and work-related burnout for up to 3 years.
Workplace Interventions: Aim at improving communication between staff members, redesigning workflows, and implementing quality improvement projects that address clinician concerns. This intervention takes between 12 – 18 months to implement and has been shown to decrease burnout and increase job satisfaction.
Multi-component Intervention: Consists of leadership prioritizing the well-being of employee’s at the same level of quality of care and financial outcomes. This intervention can take up-to 5 years, and has been shown to significantly decrease both emotional and work-related exhaustion.
Organizational pilot program: Aims to improve well-being by utilizing an assessment, cultural transformation practices through leadership, team development, and addressing workflow design. This intervention takes 12 months and has been shown to decrease emotional exhaustion and increase the likelihood an employee would recommend the workplace to a friend or relative.
In each of these strategies a needs assessment was conducted, and input was solicited from every type of staff position (and there was leadership buy-in). After completing the needs assessment, a multi-disciplinary team was established to review data and develop an intervention. Strategies were prioritized based on the needs of the organization. After implementation, there was continual monitoring of progress and revising of plans as needed.
Ultimately, burnout is reduced, when organizational interventions are implemented. In addition, work-related attitudes are improved, and better cultures are created. For more detailed information, review SAMHSA’s Addressing Burnout in the Behavioral Health Workforce Through Organizational Strategies report.
References
Substance Abuse and Mental Health Services Administration (SAMHSA): Addressing Burnout in the Behavioral Health Workforce Through Organizational Strategies. SAMHSA Publication No. PEP22-06-02-005. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2022.
