Stress and community mental health nurses

A particular aim of mine in starting this blog was to bring research I have been involved in to a wider audience. So with this in mind, here is a post introducing readers to a series of studies I worked on, with Cardiff colleagues, from the late 1990s to around 2006.

The All Wales Community Mental Health Nursing Stress Study was our first project, led by Professor Philip Burnard. Included in the team were Deborah Edwards, Dave Coyle, Anne Fothergill and myself. Our funding was from the GNC for England and Wales Trust, and we aimed to find out about the causes, moderators and outcomes of stress in community mental health nurses (CMHNs) working in Wales. Our data were generated using a demographic questionnaire and these previously created measures:

  • Maslach Burnout Inventory
  • General Health Questionnaire (GHQ-12)
  • Rosenberg Self-Attitude Questionnaire
  • Community Psychiatric Nursing Stress Questionnaire (Revised)
  • Psychnurse Methods of Coping Questionnaire

Our first published paper was this literature review, which Scopus tells me has thus far been cited in 66 subsequent publications. We went on to publish a series of data-based articles from the study, in some of the journals whose names I have added to the word cloud above. The references for these papers are listed here, along with a brief summary of our headline findings.

The team’s next study was a systematic review of stress management in the mental health professions. This was funded by the Wales Office of R&D for Health and Social Care, which was the predecessor body to NISCHR. We found far more papers describing how stressed people are than we found papers suggesting solutions to this problem. Follow this link for a reference list and project summary.

Finally in this series of projects was a study ‘to identify the factors that may influence the effectiveness of clinical supervision and to establish the degree to which clinical supervision might influence levels of reported burnout in community mental health nurses in Wales, UK‘. An expanded team this time included Linda Cooper, John Adams and Tara Jugessur. This study involved the distribution of two questionnaires, again to community mental health nurses in Wales:

  • Maslach Burnout Inventory (MBI)
  • Manchester Clinical Supervision Scale

This project, too, has a webpage giving details of our main findings and of our published papers.

In the years since this last project concluded I have had conversations with people on what the next line of inquiry might be. The questions we first asked some 15 years ago seem to me to be as relevant today as they were then. I imagine there remain large numbers of very stressed and burned-out mental health practitioners out there. I also suspect there is still work to do to protect the well-being of staff, and to promote their resilience.


10 thoughts on “Stress and community mental health nurses

    1. Natasha, also check out papers by Ted White in Australia: who is interested in clinical supervision and service user outcomes, amongst other things.

  1. Hi, I am a third year Mental health nursing student currently completing my dissertation on burnout in CMHNs in the UK. I am focusing primarily on strategies to prevent or alleviate it. I have found your research extremely illuminating and would like to thank you for all your work within this field.
    I wonder if there are any studies that you are aware of that may answer my question, I have completed a search on various databases and have accumulated a few papers alongside yours, however I would be really interested to know if you would recommend any further research or articles.

    Thank you in advance – I feel this topic as stated in your blog is as relevant today as it was in the 1990’s, so finding effective strategy’s to prevent it is as ever an important need. I look forward to hearing from you.

    1. Hi Charis, good luck with your dissertation.

      I agree this is still an important area, though not one I’ve been working in lately. Following the All Wales CMHN stress study we completed a systematic review of interventions, because (like you) we thought the question of what to do about stress and burnout is a good one. We found some, but not much, literature: though we haven’t updated any of this for years. We then investigated the relationships between burnout and clinical supervision.
      Here are some references, in case you haven’t already come across them:

      Coyle, al. 2005. A systematic review of stress among mental health social workers. International Social Work 48(2), pp. 201-211.

      Edwards, D. al. 2005. Factors influencing the effectiveness of clinical supervision. Journal of Psychiatric and Mental Health Nursing 12(4), pp. 405-414.

      Edwards, D. al. 2006. Clinical supervision and burnout: the influence of clinical supervision for community mental health nurses. Journal of Clinical Nursing. 15(8), pp. 1007-1015.

      Edwards, D. J. and Burnard, P. 2003. A systematic review of stress and stress management interventions for mental health nurses. Journal of Advanced Nursing 42(2), pp. 169-200.

      Edwards, D. J. and Burnard, P. 2003. Stress and coping for occupational therapists working within mental health: a systematic review. British Journal of Occupational Therapy 66(8), pp. 345-355.

      Edwards, D. al. 2002. Stress management for mental health professionals: a review of effective techniques. Stress and Health 18(5), pp. 203-215.

      Fothergill, A., Edwards, D. J. and Burnard, P. 2004. Stress, burnout, coping and stress management in psychiatrists: Findings from a systematic review. International Journal of Social Psychiatry 50(1), pp. 54-65.

      Hannigan, B., Edwards, D. J. and Burnard, P. 2004. Stress and stress management in clinical psychology: findings from a systematic review. Journal of Mental Health 13(3), pp. 235-245.

      Also: John Galvin, who used to work in Cardiff but is now in Birmingham, is interested in this area and has researched this more recently. Here’s a link:

      1. Thank you so much for your reply and those articles – its really appreciated!

        I wonder if you could answer one more question in regards to your research; in a few papers I have looked at (Burnard et al 2000) (Edwards et al, 2001), a planned qualitative research paper has been discussed, looking into the relationship with the line manager as part of the ‘second phase’ of the research. I have seen the paper on supervision and FCMHNs, however I have been unable to locate the ‘in-depth qualitative study’ that has been discussed.
        I wonder if you are aware of the paper that I am referring to?
        If so, would it be possible to know the name and date of the paper as I would be interested in its findings and its relevance to my dissertation.

        I really appreciate your help, thank you in advance.

      2. Hi Charis
        That’s well-spotted on your part. I see the lines you refer to, but that ‘second phase’ never happened. I can’t recall why, either! But at least in your dissertation you can say that you contacted one of the team, who confirmed that you’re not missing anything.
        All the best

  2. Hi Ben,
    Okay – that’s great to know, thank you for confirming that for me! Really appreciate all your help:)

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