‘People need a period of stability, otherwise they may actively resist beneficial change’

From compassion fatigue and burnout to resilience – Gail Kinman takes Lance Workman through her work as an occupational health psychologist.

You’re currently Professor of Occupational Health Psychology at the University of Bedfordshire. Did you set out to become an academic psychologist?
I didn’t do my degree until I was 34. I had been working as an administrator in various organisations and had always wanted to be a social worker. I eventually went to my local university to enrol and found out that the social work course was full, but the admissions tutor asked me if I had thought about doing psychology. I thought, ‘That sounds interesting, why not?’

So I didn’t set out to be a psychologist at all. In the end, I got a first and then went on to get a PhD from the University of Hertfordshire. During my undergraduate degree, I became interested in the work-related wellbeing of academics. Both my first and second husbands were academics and so were most of our friends. This meant I had some insight into the heavy demands and role pressures they experience and the deep involvement they typically have in their work. For my undergraduate dissertation research, I was lucky enough to be sponsored by the (then) National Association for Teachers in Higher Education to do a national survey of wellbeing in the sector. I won a British Psychological Society prize for my dissertation research, which involved presenting it at the Division of Occupational Psychology [DOP] conference. This was very scary, but I found the conference very friendly and thoroughly enjoyed the experience. Then I got asked to do more and more research in that area and ended up looking at mental health and work–life balance in academics for my PhD.

Later, I started to broaden the focus of the occupational groups I was working with – but I have always been interested in jobs which were in some way vocational and emotionally demanding.

Why did you choose occupational health psychology?
It wasn’t called occupational health psychology when I started out – the type of research I did came under the heading of ‘workplace stress’. Occupational health psychology broadened out the field considerably. It concerns the application of psychology to improving the quality of work life and to protecting and promoting the safety, health and wellbeing of workers. I am on the Executive Committee of the European Academy of Occupational Health Psychology. This was established in 1997 to support research, education and professional practice across Europe. We have started to work closely with the DOP as we have common interests and goals. 

Many psychologists have key figures that influenced the direction they took academically. Is this true for you?
I have been very lucky to meet a lot of people who are my heroes, and I have even interviewed some of them in my role as Associate Editor for Interviews for this magazine. Tom Cox is a pioneer in occupational health psychology – he wrote the first book on stress I ever bought. Richard Lazarus and Susan Folkman are internationally recognised for their contributions to the field of stress and coping. Susan is now doing some ground-breaking work on caregiving, end-of-life care and bereavement in people with HIV/AIDS. Christina Maslach is a major hero – I recently interviewed her for this magazine about how she developed the burnout construct, her struggles to get it recognised by the academic community, and her recent intervention work. She is a real inspiration.

Over the years, you have published several surveys that have revealed high levels of work-related stress in academia.
My first national survey in the sector was conducted in 1996, and I have done three further waves of data collection. We have used the work-related wellbeing framework developed by the UK Health and Safety Executive (HSE) to track sector-level changes over time across a large sample of academics. We found that demands are increasing steadily over time. Interestingly, even though academics perceive more control than the minimum standards recommended by the HSE, it is eroding due to a growing culture of managerialism and disempowerment in higher education. This is a problem because academics expect a great deal of autonomy over their work – job control can offset the negative impact of demands on wellbeing, so it has serious implications.

The number of roles academics are expected to fulfil has also increased dramatically. It is no longer just about research and teaching, academics need to ‘sell’ their services externally as well as demonstrate the impact and reach of their work. There are also more pressures regarding pastoral care – students are experiencing more mental health problems and need reassurance and guidance, which can be emotionally demanding. At the same time academics are required to keep up to date with their own fast-moving disciplines. We have also found that support has changed over time. Perceptions of support from managers has decreased but support from colleagues has remained stable – which is a considerable source of satisfaction and wellbeing.

One of the most powerful findings in our most recent study, conducted with Siobhan Wray of York St John University, is the high level of ‘change fatigue’.

This is a general sense of apathy or passive resignation towards organisational change. It is a growing problem, not only in academia but also in other public sector work, particularly within the NHS. Change fatigue can be highly stressful and reduce job satisfaction and motivation, stifle creativity and organisational citizenship behaviours, and encourage absenteeism and turnover. People need a period of stability, otherwise they may actively resist beneficial change.

We have also found that work–life conflict has increased dramatically. Academics are spending more and more hours working, taking time and energy away from their personal life. We have found a particularly high level of strain-based conflict, where people worry about work even when they aren’t actually doing it. This can threaten their health, their personal relationships and, over time, their job performance. In terms of mental health, over half of our participants scored at ‘caseness’ levels where some intervention is recommended. A similar pattern has been found in national studies of Australian academics, suggesting that wellbeing in the sector is a general problem.

It seems to me that these problems could be resolved with better management interventions. Line managers didn’t come out very well in your surveys – is that something particular to academia, or do you think we all complain about our line managers?
Poor management is clearly an issue, but line managers often get little training and support. In academia, people are often promoted to a management role because they excel at research and/or teaching. Then, when they are promoted, they have to stop doing the things they are good at and start doing things that they haven’t really been trained to do. There is a great deal of bureaucracy to wade through. Academics are also notoriously difficult to manage – somebody once said it is like herding cats, as they try to be as independent as possible. So there are problems on both sides, which can encourage conflict… management styles in academia probably need some re-thinking.

On a more positive note, you are also interested in resilience. I’ve noticed that resilience has been a pretty big topic since psychologists looked at the aftermath of 9/11. What can people do to improve levels of resilience?
Resilience is an important resource as it helps us overcome stress and adversity. My research with social workers, nurses, the clergy and prison officers has shown that it is crucial for people who do emotionally demanding jobs. People in such jobs need to be caring and compassionate, but they also have to manage their emotions effectively to avoid becoming over-involved with service users or overwhelmed by their needs. Our early work aimed to identify the psychosocial factors that underpinned resilience in social workers. We found that emotional intelligence, reflective ability and coping flexibility, as well as social support, were key features of resilient people. A lack of resilience is a risk factor for the wellbeing of employees and the people they look after.

Based on this research, we developed a series of interventions for organisations and individuals to support resilience. A ‘tool-box’ type of approach seems most effective, as people are introduced to different strategies that they can choose from depending on the situation or their personal preference. Mindfulness, for example, can be very useful in building the capacity for resilience and protecting wellbeing, but we have found that it may be more attractive to people who have more highly developed reflective abilities.
Peer coaching is another good way to build resilience. It’s a kind of formalised support system that is goal-orientated and solution-focused. Emotional disclosure, where people write about their feelings, can also be very effective. These strategies have some value in building resilience and protecting health at the individual level, but organisations have a duty of care to protect the wellbeing of their staff. Even the most resilient social worker or nurse would struggle to survive in working conditions that are pathogenic. 

Another area you have examined is compassion and empathy in nurses and social workers. Is it true that displaying high levels of empathy to patients can lead to compassion fatigue? And, if so, don’t we have a bit of a conundrum in that we want nurses who are compassionate and empathic – but this might make them ill?
Yes, absolutely. Compassionate ‘person-centred’ care has wide-ranging benefits for service users. Staff who are more compassionate and empathic also tend to find their work more satisfying – this ‘compassion satisfaction’ can protect against burnout. Nonetheless, there is growing evidence that compassion fatigue, characterised by emotional exhaustion, cynicism and feelings of disillusionment, are commonplace, and it is a key risk factor for employee health and retention as well as job performance. We have found that self-compassion, where people are as caring and understanding towards themselves as they are to others, helps build resilience and protects against compassion fatigue. It is vital to build a culture of compassion, but policy makers should appreciate the risk factors and provide workers with the skills and organisational support required to manage the emotional demands of the work effectively.

You mentioned prison officers earlier – tell me about your work with them and the problems they face.
A few years ago, I was approached by the Prison Officers Association. They were aware of the work I had done with academics and commissioned me to do a national study of wellbeing in the prison sector. Many feel that the prison service is in crisis – the job in itself is physically and mentally challenging, but the increasing demands, reducing resources and the fast pace of change have increased the risk of stress-related illness, absenteeism and retention problems. Although I had previously worked with various occupational groups, I really had no idea about what being a prison officer was like. We quickly realised that the job is often very dangerous and emotionally demanding – officers are frequently exposed to harassment and violence and they have to be very vigilant. Peer support is of great importance – for many, relationships with peers is the most positive part of the job. Many officers find the work rewarding and genuinely care about rehabilitating prisoners.

Nonetheless, we found the extent of mental health problems in the sector worrying – nearly three quarters of our participants scored at levels where intervention is recommended. Incidentally, recent research conducted by a colleague found that 92 per cent of officers in a single prison in England were experiencing anxiety and depression. Officers had problems winding down from the work, and sleeping problems and relationship breakdown were common. Interventions are clearly needed, but we found the provision of support to be very poor. Where it was available, uptake was low as staff were reluctant to disclose that they were not coping well and were concerned about confidentiality. I am really proud of this research, because officers clearly felt that nobody cared about the problems they face. They were really pleased that their working conditions had been brought into the public eye and invited me to their annual conference. We were invited to present the findings of our research at the House of Commons, and it has subsequently been taken to a select committee. So hopefully this might lead to some changes.

Let’s hope it does! So far you’ve been involved in work on empathy, wellbeing, compassion fatigue and work–life balance, what’s next?
I’d love to do more research on interventions, as well as identify ways to increase the uptake of support in work in jobs where disclosing a ‘failure to cope’ can be highly stigmatised. Sadly, many people working in health and social care seem to feel this way. By 2022 there will be an almost 50 per cent rise in the number of people needing some level of care. The increase in the pension age means that people will need to work for longer. Although the work can be very satisfying, people are burning out. We must get a lot better at supporting people who work in these jobs. A multi-level approach is needed where individual resilience is supported by resilient organisations that, in turn, are underpinned by effective public policies. Changing policies and organisational practices is much more challenging than working at the individual level, but this is vital if things are to improve.

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