Mental health and intellectual disability professionals use of emotion regulation and coping strategies, and their relationship to burnout: a systematic review; and, The indirect effect of attitudes towards aggression on forensic mental health professionals’ wellbeing, and the role of psychological flexibility
Introduction: Poor employee wellbeing has been linked to higher levels of staff sickness and poorer quality of care in mental health and intellectual disability services. Despite the implications, research into factors associated with poor wellbeing in these populations is limited, with research into the wellbeing of forensic mental health professionals being particularly scarce. Forensic mental health professionals face unique demands in their roles, including increased exposure to violence and aggression, which have been linked to reduced wellbeing. Several resources including tolerant attitudes towards aggression and psychological flexibility have been associated with improved wellbeing in this population. Little is known about the interactive effects of job demands and resources on the wellbeing of forensic mental health professionals, and research into this is required to increase our understanding of potential mechanisms for change. To address these issues, a systematic review was conducted to examine the relationship between various coping and emotion regulation strategies, and burnout, in mental health and intellectual disability professionals. Following this, an empirical study which aimed to investigate the indirect effect of attitudes towards aggression on wellbeing, via exposure to violence and beliefs about safety, was conducted. The role of psychological flexibility in these relationships was also explored. Method: A systematic search was conducted across four databases (Medline, EMBASE, Psychinfo and CINAHL) and 11 studies that met the inclusion criteria were identified. The methodological quality of the included studies was assessed. For the empirical study, data from a previous study conducted by Cooper, Ferreira and Slessor (2016), where forensic mental health professionals working in a high security setting completed self-report questionnaires assessing attitudes towards aggression, perceived exposure to aggression, beliefs about safety, psychological flexibility and wellbeing, were re-analysed using serial mediation and moderated serial mediation analyses. Results: The results of the systematic review showed that increased mindfulness and acceptance were associated with decreased burnout, whereas escape-avoidance and maladaptive coping were associated with increased burnout. Higher levels of mindfulness and emotion-focused coping significantly predicted decreased burnout, whereas increased maladaptive coping significantly predicted increased burnout. Problems with methodological quality were common. The results of the empirical paper indicated that less tolerant attitudes to aggression are indirectly associated with reduced wellbeing via increased perceived exposure to aggression and increased concerns related to personal safety. The negative impact of increased concerns about safety on psychological distress was strongest in individuals with lower levels of psychological flexibility. Conclusions: The review concluded that further research exploring the relationships between coping and emotion regulation strategies and burnout in mental health and intellectual disability professionals is required, with a focus on increasing methodological quality. It was suggested that interventions aimed at increasing mindfulness and acceptance may have some utility in reducing burnout in this population. The empirical study concluded that staff who hold less tolerant views of aggressive behaviours may perceive themselves as being exposed to aggression more frequently, leaving them more vulnerable to increased fears for their safety, leading to reduced wellbeing. The association between increased fears about safety and increased psychological distress was even stronger when coupled with low levels of psychological flexibility. It was suggested that interventions which focus on changing the way staff relate to difficult thoughts and feelings may be effective in improving wellbeing in this population.