This month there are two articles selected as the RCPsych Article of the Month for October. One of the two articles selected is ‘Burnout in mental health services in Ireland during the COVID-19 pandemic‘ and the blog is written by author Anne Doherty and the article is published in BJPsych Open.

One of the few welcome developments associated with COVID-19 was a renewed interest in the mental health of healthcare workers. All over the world there were initiatives where mental health professionals stepped forward to support their colleagues in novel ways. This placed an additional expectation on mental health professionals that in addition to providing care to their patients with the additional challenges of a pandemic, they were also looking after a wider group: their colleagues. In Ireland, mental health services have been chronically underfunded, receiving less than 6% of the healthcare budget compared with 10-13% in comparable western countries, and as a result the pandemic placed additional stress on a strained system.  

Our study sought to examine the specific stress placed on those mental health professionals and used the Copenhagen Burnout Inventory (CBI) as the primary outcome measure. In this study we found that 2 in 5 mental healthcare staff had moderate/high rates of burnout The majority of participants had moderate/high rates of work-related burnout (81.9%) and personal burnout (83.1%), while patient-related burnout was lower, with 21.5% having moderate/high levels on the CBI. This study included non-clinical staff (from services and administrative backgrounds) and there were no significant differences between clinical and non-clinical staff.

Consistent with previous research, female gender was associated with personal and work-related burnout on multivariate analysis. Personal burnout was also associated with younger age and work characteristics (service locality), spending a lot of time outside of main responsibilities, higher overcommitment, low reward with more effort and intention to change job. Work-related burnout was associated with overcommitment, high effort with less reward, location of services, spending a lot of time outside of main responsibilities and intention to change job. Patient-related burnout was associated with external issues such as location of services and personal factors such as overcommitment and personal health status.

Few variables directly relating to the COVID-19 pandemic were identified as risk factors for burnout. This may be related to the timing of this study, as it was conducted later in the pandemic. It does, however, suggests pre-pandemic burnout which was exacerbated by the additional strain placed on organisations and individuals by the COVID-19 pandemic. The findings highlight the importance of recognising organisational factors that contribute to employee burnout.

This study suggests that organisational factors may contribute more to burnout than internal factors of the workers, that those factors pre-dated the COVID-19 pandemic and perhaps will continue to exist. This is important in addressing the factors which impact on healthcare workers lives from an organisational perspective, rather than adopting a purely resilience-based approach. 

This article addresses a critical issue in healthcare not only in Ireland, but throughout international health services.  The authors conducted a cross-sectional survey of three mental health services across Ireland utilizing a study-specific questionnaire, the Copenhagen Burnout Inventory and the Effort-Reward Imbalance Scale.  The authors noted high rates of personal (64.1%) and work-related (58.5%) burnout but low rates of patient-related burnout (21.5%) among mental health workers.  Further there was a weak association with COVID-19-related factors suggesting burnout predated COVID-19.  Though this study has specific limitations (cross-sectional design, low response rate, and focus on three services with lack of randomization to all Irish mental health services), the findings are consistent with the literature – burnout is key problem that requires policy changes with emphasis on specific factors.  We welcome this article and similar submissions on this important topic. 

Kenneth R. Kaufman

Editor-in-Chief, BJPsych Open