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Liz Hey, Principal Psychologist at Hogrefe UK
This week is Mental Health Awareness Week. Many factors go into determining the state of our mental health – from environmental and economic factors, to genetics, to our relationships with friends and family – there is no one way to focus on it, and there is no one answer to how to achieve it. We chose to focus on one of the factors that unfortunately affects many of us at some point: burnout.
During the pandemic it became apparent that our healthcare services were under extreme pressure. The situation was adding tremendous pressure to an already-overburdened NHS and our increasing dependency on healthcare workers. The global advice to healthcare managers and team leaders at the time included keeping staff protected from chronic stress and poor mental health. This was to be achieved through good quality communication, staff rotation, regular breaks, flexible schedules and social support[i]. This, it was thought, would lead to staff having greater capacity to fulfil their roles.
According to a 2022 NHS staff survey, one in three UK healthcare workers now suffers from burnout[ii]. Staff sickness absence rates have not fallen below pre-pandemic levels and the main reason given is work-related stress. In 2022, NHS England recorded 6 million staff sickness days, related to mental health and wellbeing[iii]. Some reports estimate the cost to the NHS to be over £2bn per year. Other costs and implications of that level of absence which passed on to patients and the wider community may be immeasurable.
One of the objectives of last year’s NHS Long Term Workforce Plan[iv] is to reduce the absence rate. An NHS Employers article from earlier this year highlights that burnout is something which particularly affects people in certain occupations, such as frontline workers in clinical services[v].
More widely, since the pandemic we have seen an exponential rise in the number of workers across industries in the UK experiencing chronic, long-term health problems including mental health challenges. A recent Mental Health UK report suggests 90% of UK adults experienced high or extreme stress in the past year, and almost a quarter of UK adults felt unable to manage stress and pressure in their lives[vi]. The CIPD reports the average absence per employee last year was the highest level in a decade[vii]. Burnout is frequently cited in research and industry reports as one of the main reasons people leave their jobs.
As workplace wellbeing and stress management have become a serious concern over recent years, more organisations are now attempting to tackle this through programmes and interventions, employee benefits and, more generally, stress awareness and resilience training.
But is this really addressing what is at the core of many workplace issues which result in employee stress – and what exactly is burnout?
The term “burnout” was first coined by the psychologist Herbert Freudenberger in the 1970s. He used it to describe the consequences of severe stress and high ideals in ‘helping’ professions. Christina Maslach and Susan Jackson further refined the concept of burnout, referring to “the prolonged response to chronic interpersonal stressors at work” and the presence of emotional exhaustion, depersonalisation and lack of personal fulfilment[viii].
Burnout is commonly characterised by exhaustion, cynicism, apathy, detachment and ineffectiveness. It can be the cause of, or the result of, stress, anxiety, and/or depression. The effects of burnout are a reduced ability to look after ourselves and others, diminished performance at work, and a lack of enjoyment in life. In some it can lead to self-abuse and harm to others. Other problems may arise such as chronic insomnia, along with psychosomatic disorders including headaches, hypertension, cardiopulmonary diseases, musculoskeletal problems, gastritis, stomach ulcers, and dizziness[ix].
State: Engagement. Burnout often affects the most engaged workers, which makes sense – those who care most are most likely to be affected. The link between a lack of engagement and burnout is well-known [x]. Reduce the chance of burnout and you promote engagement, and vice versa.
Trait: Personality. Research has shown that personality traits are linked to burnout. If we refer to a Five Factor Model of personality such as the NEO Personality Inventory (Costa and McRae, 1999), we can see this clearly. For example, if an individual has high Emotional Reactivity they are likely to be more prone to stress and less resilient. High Conscientiousness is linked to more self-belief and personal organisation. High Agreeableness means someone enjoys working with others and is likely to seek their support in times of stress or pressure.
The something else? Emotional intelligence (EI). Having a greater self-awareness regarding what has the potential to trigger anxiety and stress at work can be used to identify the problem. This can be used as a preventative measure by both individuals and organisations. If an individual is aware of how their personality and EI or emotional processing are affected by work or stress, then the chances of burnout are reduced. This will no doubt be of help when navigating and managing pressure and complexities at work.
When the onus is placed on the individual to ‘manage’ their own mental health and stress levels, this perhaps steers us away from the responsibility organisations have to protect and help their staff. Nonetheless, interventions and programmes can be provided which assist employees to increase their awareness and help to build resilience.
The key to preventing burnout is not only to look at what the individual is feeling and the resulting negative impact of stress and pressure on them, but also at the circumstances which precipitate the problem, and the environment in which they are working. Indeed, the latest International Disease Classification (ICD-11), which added burnout in 2019 as an ‘occupational phenomenon’, classifies it as a mismatch between workload and the physical and mental resources the individual has to be able to cope[xi].
The symptoms may or may not be obvious and burnout can result in staff absence, either short or long-term. Burnout also occurs alongside presenteeism, wherein workers are at work but are not able, or willing, to perform, which can also have a widespread organisational impact. The cost is therefore significant, and it should be incumbent on organisations to try and manage.
Burnout can be identified through staff surveys, conversations with managers, staff groups and through HR. It may not always be possible, however, to assess what an individual is responding to and the extent to which they are experiencing stress and other factors. This is where established measures come into play. They can be of significant benefit to both individuals and organisations in identifying specific aspects of the problem and in focussing attention on helping to alleviate it.
Measures specific to burnout are available, and it can also be helpful to look specifically as measures of personality (such as the NEO-PI-3 UK or the BIP) and at measures related to emotional intelligence and emotional processing – see below for more on those.
When burnout is discovered, organisations need to provide staff with information about how they can access mental health and wellbeing services. They must also facilitate access to such services and ensure staff know how to access emotional and practical support; critical factors in tackling workplace burnout. We are seeing a higher prevalence of mental health first aid workers in larger organisations, as well as Employee Assistance Programmes (EAP)s, both of which can act as triage for helping people who are struggling to cope. However, the CIPD report that only 25% of companies offer all employees health plans that provide access to independent health services (which can avoid long NHS delays and waiting lists). And, worryingly, they also report that senior leaders’ interest in wellbeing strategies appears to be waning post-pandemic[xii]. So, longer-term, the impact of workplace stress may not be sufficiently well-managed.
Once burnout has been identified there needs to be real and robust support offered to help employees manage the stress and pressure they are experiencing and that is, no doubt, the more challenging problem. Interventions to reduce burnout would include improving workflow conditions, creating healthier workplaces and good leadership. Going back to the beginning of this article, and the advice for the managers of healthcare workers in the days of the pandemic, there was an emphasis on providing psychological, emotional and social support, but also about making necessary adjustments to working conditions – staff rotation, regular breaks, flexible schedules – which would allow people to do their jobs better.
Safer for them, and safer for us all.
[i] World Health Organization (WHO, 2020) Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence.
[ii] https://www.nhsstaffsurveys.com/results/national-results/
[iii] https://www.nuffieldtrust.org.uk/resource/all-is-not-well-sickness-absence-in-the-nhs-in-england
[iv] https://www.longtermplan.nhs.uk/
[v] https://www.nhsemployers.org/articles/beating-burnout-nhs
[vi] https://mentalhealth-uk.org/
[vii] CIPD (2023) Health and wellbeing at work. London: Chartered Institute of Personnel and Development.
[viii] Maslach, C. and Jackson, S.E. (1981, pp.99) The Measurement of Experienced Burnout. Journal of Organizational Behavior, 2, 99–113. http://dx.doi.org/10.1002/job.4030020205
[ix] Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52, 397–422. https://doi.org/10.1146/annurev.psych.52.1.397
[x] Maslach, C., & Leiter, M. P. (2008). Early predictors of job burnout and engagement. Journal of Applied Psychology,93(3), 498–512. https://doi.org/10.1037/0021-9010.93.3.498
[xii] CIPD (2023) Health and wellbeing at work. London: Chartered Institute of Personnel and Development.
