Occupational health practitioners are at the frontline of supporting individuals in the workplace cope with physical and psychological issues. But what about their own mental and emotional burnout? Through a literature review, Alan Dovey, Michael Swift and Paul Anthony argue that the mental wellbeing of OH professionals is being put at risk by a lack of effective clinical supervision within the specialty.
This article is a literature review exploring the role of clinical supervision in occupational health (OH) paradigms.
Its aim is to determine the relative outcomes of undertaking clinical supervision, particularly noting the consequences of working with psychopathology and general psychological disorder. It will establish the levels of support available, and outline some necessary steps moving forward to implement clinical supervision within occupational health.
About the authors
Alan Dovey is director of Working Minds UK and a consultant cognitive behavioural psychotherapist and honorary clinical lecturer at the University of Birmingham; Michael Swift is a senior research associate and psychological therapist at Working Minds UK; and Paul Anthony is a cognitive behavioural therapist and senior lecturer in CBT at Staffordshire University
What is clinical supervision?
Clinical supervision is a procedure of specialised support and education that aims to enhance the continued professional development of an individual’s character (Milne, 2007). The most typical supervision model is comprised of an employee sitting down with a mental health professional at bi-weekly intervals to discuss thoughts, feelings and experiences of certain clients or scenarios (Hawkins & Shohet, 2012).
Clinical supervision serves to address an individual’s progressive needs and aims to provide insight into a range of challenges within an occupational setting; serving to increase an individual’s competence and self-efficacy through exchanges with skilled professionals in a conducive environment (Milne et al, 2008).
The notion of clinical supervision has been a part of health and social care professions for a long time, however the concept has become particularly synonymous with psychologists and nurses. Within occupations such as midwifery and psychotherapy, evidence-based supervision systems exist to monitor, enhance and develop practice. Recently however the role of clinical supervision has been applied to occupations regarding any individual who may be exposed to psychopathology (Wahesh, 2016).
Clinical supervision is now firmly established as a key element of professional practice and is recommended or required for registration with a range of regularity for organisations operating within the context of health and social care (BACP, 2019; BABCP, 2019; NMC, 2019; RCOT, 2015; HCPC, 2019). The important role of clinical supervision in improving care and as a means to value and support professional practice has also been a feature of UK health policy (DoH 1998;1999). Furthermore, the absence of a culture that supports clinical supervision has been cited as a factor contributing to recent catastrophic failings in healthcare provision (Tomlinson, 2015; Francis, 2013; Berwick, 2013).
The occupational health advisor role
The occupational health advisor is trained in the use of assessment and intervention to progress, recover or maintain the meaningful activities, or occupations, of individuals, groups, or communities (Wilberforce et al, 2016). Occupational health advisors (OHA) are a crucial aspect of any organisation as they directly improve the physical and psychological wellbeing of employees, whilst also aiding in reducing sickness absence.
OHAs by their nature require practitioners to work with a range of individuals suffering from a range of physiological and psychological illnesses. Although there is no definite scope of issues an OHA works with, research suggests that they work as a part of a system including the employee, managers and HR and are at the front line of support for psychopathology (Wilberforce 2016).
Sociological studies have estimated that the majority of the population will spend over 90,000 hours working throughout our lives. Given that this is almost a third of our entire lives, the impact of OHAs and the support they provide to individuals is vastly important. OHAs are typically the first line of contact that employees will reach out to, particularly in high-stress job roles and healthcare settings (Nugent, Hancock and Honey, 2017). This, combined with the cumulative evidence that suggests one-in-four people will experience a mental health problem each year, identifies a clear necessity for OHAs in supporting employees.
Psychopathology and emotional burnout
OHAs are at the frontline of supporting individuals in the workplace cope with physical and psychological issues. An increasingly concerning issue within healthcare settings, and particularly for healthcare professionals, however, is “emotional burnout”.
Burnout is defined as an emotional response to work-related events that manifest in psychological disorder (Moss et al, 2016). Burnout often develops gradually and is categorized into three categories: emotional exhaustion, depersonalisation and reduced personal accomplishment.
Several research studies have identified the detrimental effect that working with psychopathology can have on increasing the risk of burnout; given the increased exposure to such symptoms in the occupational health arena, this has dramatic implications for such practitioners (Fernandez-Sanchez et al, 2018; Parola et al, 2017). It is also important to note that burnout has been recognised as a disease by the World Health Organization.
The American Medical Association conducted a study in 2018 which identified that 46% of health professionals reported being burned out. Although this was an improvement on the 54% reported in 2014, the research further identified that those working with psychopathology often developed burnout and depression in tandem (AMA, 2018). Although burnout appears a symptom, healthcare professionals working with individuals suffering with psychological issues are more likely to withdraw from social activities, isolate themselves and have significant difficulty concentrating (Ahola et al, 2014).
With regards specifically to health professionals, early research into burnout has suggested these individuals have greater prevalence of emotional exhaustion and cynicism towards clients (Delos Reyes, 2018). Although the impact of working with psychopathology is an endorsing cause for OHA burnout, Gupta et al (2012) suggests that burnout is heightened by overbearing workloads and unrealistic demands from managers and clients; subsequently leading to feelings of inadequacy within their job role.
The research suggests that occupational health advisors are required to provide compassionate care with every interaction; utilising evidence-based practice and resilience to adequately facilitate wellbeing (Shapiro & Carlson, 2009). It further suggests that the process of supervision serves to improve resources, such as wellness, resilience, patience and development.
Therefore, supervision can act as a buffer to the negative impact of working with psychopathology. Effective clinical supervision can lead to an improved sense of emotional wellbeing and reduction in overall staff turnover and sickness absence, all of which is of course essential for maintaining the integrity and operations of an organisation (Schwerman and Stellmacher, 2012).
What if supervision is not available?
A review of the clinical supervision protocol for occupational health advisors may succinctly identify the distinct issue of burnout among the profession.
This issue in part appears to be due to the unavailability of clinical supervision to all OHAs, despite members of the profession having similar levels, if not more, of exposure to psychopathology at a daily level.
Although the benefits of supervision have been laid out over several well-conducted studies, many organisations do not employ a sufficient protocol for such individuals. In part this may be due to the somewhat unclear guidelines at a systemic level.
The Royal College of Occupational Therapists (RCOT) provides the following suggestion (2015) in the context of occupational therapy, but which we suggest could also have relevance/value to the situation of occupational health advisors.
“It may be possible to negotiate periodic access to a more senior or experienced occupational therapist from outside the immediate department or organisation. If there is no one available in neighbouring statutory services, an independent practitioner could be approached…”
It adds: “It may be possible to make best and most efficient use of an external supervisor through the use of group supervision, phone contact or an internet-based system. If an occupational therapist is working alone, with no support, there may be increased risk of poor or unsafe practice, particularly if they are less experienced.”
One reason for citing the RCOT in this context is that, within the literature at least, there appears to be a lack of documentation regarding the specific demographic of OHAs who undergo formal clinical supervision.
The most sufficient protocol to ensure OHAs are receiving sufficient support may be to branch out to external organisations, given the scarcity of internal support. This view is supported by the model suggested by Hunter and Blair (1999) in producing a conducive supervision protocol for therapists.
Suggestions for future research
The literature as it stands suggests a clear relationship between exposure to psychopathology and levels of emotional burnout in healthcare professionals. As the current research suggests, the adherence to consistent clinical supervision within occupational health settings does not reflect the necessary level for support.
Given the currently high prevalence of mental health disorders and psychopathology in the workplace, it appears clinicians may not be obtaining the necessary professional support to clarify their emotions and improve their professional development.
In part, there appears to be a lack of transparency between the theoretical guidelines of supervision and in-practice clinical supervision implementation.
Although clinical supervision may be available to some OHAs, it appears it is not being utilised as effectively as possible. This may in part be due to a lack of understanding, consistent practice and genuine utilisation of supervision within organisations at an employee/managerial level.
It is strikingly apparent that occupational health advisors should have more access to clinical supervisory services. It is understood that, within many organisations, the funding and time allowed towards internal supervision is not providing efficacious results.
Subsequently, it could be suggested that organisations should in part put more resources in place for their employees and, as stated by the CQC (2008), “lean on” third party services to obtain care.
Although research into clinical supervision is well-documented within a vast amount of healthcare paradigms, research is required into the specific demography of occupational health advisors who have access to clinical supervision.
It would also be valuable to establish the subjective experiences of such practitioners to obtain the experiences, thoughts and outcomes of clinical supervision. The hope would be that this insight could then be incorporated into practice within organisations.
Given the nature of psychopathology and burnout, the most striking outcome appears to be the absolute necessity to provide supervision for those occupational health advisors who would not only like – but require – support.
Finally, given the increase in awareness and severity of mental health problems in the workplace this should be looked upon as a priority.
Two of the authors of this paper are mental health professionals who have worked in the occupational health setting for nearly 20 years. They especially have noted a significant increase in psychopathology of the clients being referred.
What has been your experience of burnout?
This article provides a literature review and the perspective of three clinical practitioners in regards to possible burnout and emotional and mental ill health among OH advisors. But does it chime with the experience of OH practitioners? Occupational Health & Wellbeing would like to find out!
Does your experience within the profession, anecdotal or otherwise, reflect the findings of this review? Do you feel there is a link between clinical supervision (or lack of) and burnout?
Do you feel, in turn, that there is a need for better supervision (clinical or otherwise) within OH and, if so, what shape or model should this take? All feedback will be anonymised upon request.
Please feel free to get in touch with the editor Nic Paton on [email protected]
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SOM and the Charlie Waller Trust have produced a guide on looking after your wellbeing for OH professionals – see https://www.som.org.uk/sites/som.org.uk/files/A_guide_for_Occupational_Health_Clinicians-compressed.pdf