474

Journal of Occupational and Organizational Psychology (2016), 89, 474–492

© 2015 The British Psychological Society
www.wileyonlinelibrary.com

Coping with work-related stressors and building

resilience in mental health workers: A comparative
focus group study using interpretative
phenomenological analysis
Danielle Lamb1* and Nicola Cogan2
1
University of Glasgow, UK
2
Psychological Therapies Team, Lanarkshire, UK

Experiencing excessive stress in the workplace can lead to mental ill health, which has
costs both personally for individuals and for the wider economy in terms of lost working
days. This study used two in-depth focus groups, one with NHS mental health workers
(n = 9) and one with Samaritans’ volunteers (n = 8), to investigate how they cope with
work-based stressors, and build and maintain resilience. The qualitative data derived from
the focus groups were compared and analysed using interpretative phenomenological
analysis to gain an in-depth understanding of the lived experiences of those working in
both statutory and voluntary adult mental health settings. Four superordinate themes
emerged: (1) Perceived lack of control as a stressor; (2) Ways of building resilience; (3)
The dual impact of values; and (4) The effect of environment. The implications of these
findings are discussed in the context of recommendations for training to help foster
resilience within mental health care systems, along with possible areas of future
investigation.

Practitioner points
 Resilience has been shown to be an important element in allowing those working and volunteering in
mental health settings to cope with the stressors inherent in their chosen field.
 Allowing staff reasonable control over their work, and providing an adequate environment in which to
carry out their work, is conducive to building and maintaining resilience.
 Consideration should be given to the dual nature of some elements of working in a mental health
context, in terms of both the positive and negative impact they can have (e.g., values and environment).
 Training programmes using aspects of developments such as mindfulness and acceptance and
commitment training may also be able to contribute to building and maintaining resilience in mental
health workers.

Excessive stress can lead to mental health problems (Bakker, Holenderski, Kocielnik,
Pechenizkiy, & Sidorova, 2012), which in turn can cause long-term absence from work.
This can have personal and financial costs for individuals (Black & Frost, 2011) and social
and economic costs for society (Mental Health and Work, 2008). Although some stress in
the workplace (and outside it) can contribute to positive outcomes such as personal

*Correspondence should be addressed to Danielle Lamb, Division of Psychiatry, University College London, 6th Floor Maple
House, 149 Tottenham Court Road, London W1T 7NF, UK (email: d.lamb@ucl.ac.uk).

DOI:10.1111/joop.12136
 Building resilience in mental health workers 475

transformation or growth (Tedeschi, Park, & Calhoun, 1998), it can also lead to ill health,
absenteeism, reduced efficiency and performance, and lowered morale in workers (Bhui,
Dinos, Stansfeld, & White, 2012; Cooper & Dewe, 2008; HSE, 2009; Jordan, Gurr, &
Tinline, 2003; Sutherland & Cooper, 1990). Such outcomes can also have an impact on
work engagement amongst staff, with reduced levels of energy, involvement, and efficacy
(Schaufeli, 2012). The contribution of those in paid and voluntary mental health services
who provide support for people struggling with such challenges is significant (Samaritans,
2012a).
As the number of people identified as experiencing mental health problems increases,
so too does the pressure on those working in mental health (R€ ossler, 2012). Excessive
workloads placed on such workers can lead to them experiencing increased levels of
stress and associated mental health difficulties themselves (Cushway & Tyler, 1994;
R€ossler, 2012), which can cause professional impairment (Barnett, Baker, Elman, &
Schoener, 2007). Finding ways to effectively combat and prevent negative aspects of
stress in mental health workers is, consequently, an important area of investigation.
Initiatives such as Healthy Working Lives (HWL, 2012) in Scotland and Health Work and
Wellbeing in England (HWW, 2013) indicate an appreciation of this at a policymaking
level.
The focus of research in this area has shifted in recent years from stress reduction
towards the concept of resilience: Adaptation to, and even thriving in the face of, adversity
(Everly & Lating, 2013; Fullagar & Kelloway, 2010; Pipe et al., 2012; Wagnild & Young,
1993). Definitions vary, but most are captured by the following: ‘a dynamic process
encompassing positive adaptation within the context of significant adversity’ (Luthar,
Cicchetti, & Becker, 2000). As will be discussed below, resilience amongst those working
in mental health has not been sufficiently addressed in previous research, and so the
definition of resilience commonly used may not be appropriate within this context. It is
suggested by the authors that in a work context, ‘resilience’ might be best understood as
positive coping with persistent occupational stress.
Previous research has identified that those individuals classed as ‘resilient’ have some
shared characteristics, for example being female, socially responsible, good communi-
cators, capable of self-reflection, flexible and determined, and having supportive social
and family relationships (Joseph & Linley, 2006; Luthar & Cicchetti, 2000; Werner &
Smith, 1992). The majority of resilience research to date has focused on maltreated
children and trauma victims (Herrman et al., 2011), and the question of whether such
findings can be extrapolated to adult populations working in mental health settings has
yet to be studied in detail. There is some general evidence that volunteering in mental
health is associated with increased positive affect (Greenfield & Marks, 2004). There is
also evidence indicating some key factors that contribute to the well-functioning of
professional mental health workers, including peer support, stable personal relationships,
supervision, a balanced life, and personal psychotherapy (Coster & Schwebel, 1997).
Moderators of stress for those working in mental health have been identified, such as
exercising, talking to a partner, relaxation, and the use of cognitive behavioural skills
(Cushway & Tyler, 1994; Richardson & Rothstein, 2008). There is also evidence that
engagement in mindfulness-based stress reduction interventions can improve the self-
care of mental health workers (Goodman & Schorling, 2012; Irving, Dobkin, & Park, 2009;
Shapiro, Brown, & Biegel, 2007). Studies have tended to use mainly quantitative research
paradigms, with little research attempting to gain an in-depth understanding using
qualitative approaches of the lived experiences of those working within an adult mental
health context (Ungar, 2003).
476 Danielle Lamb and Nicola Cogan

The aim of this study was to use interpretative phenomenological analysis (IPA) to
compare the experiences of statutory NHS professionals (NPs) and Samaritans’ volunteers
(SVs) in terms of how they cope with work-related stressors. The aim of using IPA was to
allow an exploration of the lived experiences of those working in mental health settings,
the meanings of such experiences, and how these are made sense of. Given the increased
impetus towards joint working between statutory and voluntary agencies within mental
health care systems (DoH, 2013), the comparative component of this study aimed to
highlight both shared experiences and discrepancies within their perspectives as to how
staff cope with the specific stressors that such working contexts bring. The two groups
work with similar service users, but in different contexts: Samaritans’ work is voluntary
and for short periods of time and has a relatively flat organizational structure, while the
NHS is a statutory body, where workers spend longer periods of time, and has a
hierarchical organizational structure. In coming to better understand the experiences of
those working in these contexts, it is hoped that conceptual insights may be gained
regarding how the complex relationships between individuals, groups, and environmen-
tal factors interact to both potentially cause stress and protect against it. Such insights may
assist in the development of a more refined definition of the concept of ‘resilience’
relevant to those working in mental health contexts, as well as identify potential areas for
training. It is anticipated that service development and training that supports and enables
staff to better fulfil their roles will lead to improved outcomes for service users, with
associated social and economic benefits.

Method
Approach
This was a comparative study using an interpretative phenomenological approach (Smith,
1996). Two focus groups were conducted and the resulting recordings transcribed in full
verbatim and analysed using IPA. In IPA, the analysis is phenomenological in that it is
concerned with the perceptions and experiences of individuals, and interpretative in that
it acknowledges the significant role the analyst plays in making sense of these individuals’
experiences. As Smith points out (2004), this type of research involves a double
hermeneutic; the individual tries to make sense of their experiences, and the researcher
tries to make sense of the individual trying to make sense of their experiences. While the
researcher attempts to understand what it is like for the individual to have a particular
experience, they cannot access such experiences directly, and so their own perceptions
will inevitably complicate the process (Smith, 1996). This interpretative element of
understanding another’s experience is key to IPA.
In practical terms, IPA begins with an interpretative initial reading, noting the analyst’s
responses to the text in one margin of the transcribed text, followed by a second reading
while noting in the other margin themes that emerge from these initial responses. The
emergent themes are interrogated to make relevant connections, and a table of the
resulting superordinate themes is created (Smith & Osborn, 2003).
The use of IPA with focus group data is still a relatively novel approach: The majority of
IPA studies use individual interviews to gather data (Borkoles, Nicholls, Bell, Butterly, &
Polman, 2008; Chapman, Parameshwar, Jenkins, Large, & Tsui, 2007; De Visser & Smith,
2006; Smith & Osborn, 2007). However, several IPA studies have used focus group data
(de Visser & Smith, 2007; Dunne & Quayle, 2002; Flowers, Duncan, & Frankis, 2000), and
others have argued that when handled appropriately focus group data can be suitable for
 Building resilience in mental health workers 477

IPA (Palmer, Larkin, de Visser, & Fadden, 2010; Tomkins & Eatough, 2010). Smith,
Flowers, and Larkin (2009) give cautious support for the use of focus groups, clarifying
that as long as the researcher is satisfied that the presence of others does not inhibit
individuals’ discussion of personal experiences, the data obtained is suitable for IPA.
The conceptual foundations of IPA, the phenomenology and hermeneutics of
philosophers such as Heidegger (1927), provide further support for the use of focus group
data. Heidegger (1927) sees individuals as acting in and interpreting the pre-existing world
of people, objects, relationships, language, and culture, and so takes the context in which
people operate as central to understanding how they make sense of the world (Smith
et al., 2009). In investigating the experience of individuals working or volunteering in
teams as components of larger organizations, the context they operate in is key to a
phenomenological understanding. The direct observation of group discussion can
arguably provide a richer source of contextual data than one-to-one interviews, with
interaction between multiple participants offering the opportunity for individuals to
become aware of their own thoughts and feelings in ways that are less likely in a one-to-
one interview (Tomkins & Eatough, 2010; Wilkinson, 2004). As Smith et al. (2009) point
out, the process of sense-making is not experienced in isolation, but within a given
context.
This study drew on the traditional iterative IPA methodology (Smith et al., 2009) of
reading through the transcripts multiple times, noting themes, and grouping and refining
them into superordinate themes and subthemes. Further iterative loops were added to
consider, in particular, positionality, roles and relationships, organizations and systems,
how the multiple cases could be integrated (Palmer et al., 2010), and part-whole
relationships (Tomkins & Eatough, 2010). Themes were refined, adapted, and compared
using extensive theme tables for each focus group, which were then used in parallel to
inform the writing up of the findings. Reflective notes were made during the analytic
process and were also contained in the theme tables. Even with such modification it looks
possible to retain the core of what makes the IPA methodology distinct: The
phenomenological approach and focus on interpretation.
The comparison of themes arising from different groups is also unusual in IPA studies.
Previous research using IPA has tended to use interviews from homogenous groups to
draw out similarities in the experiences of multiple individuals (Borkoles et al., 2008;
Smith & Osborn, 2007). However, assuming conditions are met for the data collected to be
analysed using IPA, comparing the themes emerging from different groups when they
work in similar areas does not seem to be at odds with the analytic methodology.
Returning again to the phenomenological and hermeneutic underpinnings of IPA, it is
through consideration of our experiences in relation to those of others that we make sense
of the world, and in this sense, adding a comparative component to a methodology using
IPA provides an additional dimension to the interpretative framework.

Participants
Focus group 1 was composed of SVs (n = 8) with an age range of 24–69 (mean age = 44),
a work-related experience range of 6 months to 25 years (mean = 8.88), and a gender
split of seven females and one male. Focus group 2 was composed of NPs (n = 9), four
clinical psychologists, two trainee clinical psychologists, one counsellor, and two clinical
associates in applied psychology. The age range of focus group 2 was 24–54 (mean
age = 38.91) with a work-related experience range of 3–17 years (mean = 7.11), and the
gender split was eight females and one male. The inclusion criteria for focus group 1 were
478 Danielle Lamb and Nicola Cogan

that participants had received full Samaritans training and been qualified for at least
6 months. The inclusion criteria for focus group 2 were that participants were currently
working in the NHS as mental health professionals with at least 1 year of experience. The
difference in minimum length of experience required reflects the nature and length of
training undertaken by the different groups, and the nature of their work. Differences
between the groups include shorter, voluntary, training, and working hours for SVs
compared to NPs, who were full-time NHS employees (NHS, 2012; Samaritans, 2012b) and
a focus for SVs solely on listening to service users and encouraging them to explore the
feelings they are experiencing; for NPs, the focus is on assessment of psychological
difficulties that service users experience, and treatment of these via therapy, counselling,
and/or advice (BPS, 2012). To ensure participant anonymity, but in keeping with the
idiographic approach of IPA, the participants’ names have not been used and instead each
participant has been given a pseudonym.

Data collection
Information was sent to potential participants inviting them to take part in the study. In
accordance with Wilkinson’s recommendation (2004), once approximately eight
participants meeting the inclusion criteria were identified, arrangements were made to
hold the focus groups. Focus group 1 was held in a meeting room within a branch of the
Samaritans organization, and focus group 2 was held in a meeting room in an NHS health
centre, both in 2012 in Scotland. To minimize the impact of having strangers present
during discussion of potentially sensitive issues, each focus group was conducted by just
one researcher.
Participants were provided with further information about the study prior to
conducting the focus groups and signed a consent form. Each focus group was recorded
using an audio recorder, and participants stated their name at the start of the session to
enable accurate transcription. During the focus groups, six prompt questions were asked
by the researcher to facilitate discussion: (1) Do you experience stress in your role? (2)
What causes you stress in your role? (3) What helps you cope? (4) Have you had any
training in how to cope? (5) What day-to-day support do you feel you have? and (6) Is there
any further training or support you would like to have? To give participants as much scope
as possible to share their own experiences, and to avoid trying to (even subconsciously)
guide discussion, the researcher asked only the prompt questions and did not follow up
with any more specific questions or observations. Each of the focus groups was
approximately 1 hr in duration. Reflective notes were made by the researcher concerning
group interactions.

Findings
Themes
While four superordinate themes emerged from the analytical process, differences were
identified between the two groups in emphasis and how the themes were experienced.
The superordinate themes and subthemes are set out in Table 1.
In the findings below, each quotation is followed by parentheses containing
information about focus group transcript and participant, and the page and line numbers
of the quotation; for example, SV4 1:20 refers to focus group 1 transcript (SV), participant
4 (Elizabeth), page 1, line 20.
 Building resilience in mental health workers 479

Table 1. Superordinate themes and subthemes for focus groups 1 and 2

Superordinate themes SV subthemes NP subthemes

1. Perceived lack of (i) Content (i) Content

control as a stressor
2. Ways of building resilience
3. The dual impact of values
4. The effect of environment
(ii) Managing calls (ii) Managing risk
(iii) Other Samaritans (iii) Reality of the situation
(iv) Balancing multiple demands (iv) Quantity of work
(i) Practical coping mechanisms (i) Practical coping mechanisms
(ii) General support (ii) Communication
(iii) Training (iii) Using clinical skills
(iv) Acceptance (iv) Acceptance
(v) Space
(i) Attitude (i) Attitude
(ii) Ownership (ii) Self-improvement
(iii) Samaritan values (iii) Balance
(iv) Identity (iv) Quality of care
(i) Physical environment (i) Physical environment
(ii) Structures (ii) Structures
(iii) Processes (iii) Bureaucracy
(iv) Location

Note. NP = NHS professional; SV = Samaritans’ volunteer.

Perceived lack of control as a stressor. Several elements of working in mental health

emerge as potential stressors, and participants tended to perceive that they have little
control over these elements. Both SVs and NPs felt a lack of control over the content of
information shared by service users, as Elizabeth says, ‘you know you might be awaiting a
call that’s potentially quite difficult to listen to’ (SV4 1:20), and Rebecca points out, ‘clients
may bring in issues that I’m going through myself’ (NP4 2:7–8). However, the content of
contacts was, perhaps surprisingly, not seen as a major stressor by either group, with both
making comments such as Lisa’s, ‘I get far more stressed by the [practical elements of the]
job than by the clients’ (NP2 1:17), and evidence of this feeling can be seen in many of the
quotes below.
Of more concern was the lack of control over how length of contact with service users
is managed, for the SVs, and how risk is managed for the NPs. For example, Rachel finds
that ‘thinking about how you’re going to end the call. . .that’s more stressful to me than a
very distressed caller’ (SV5 2:18–19). This is echoed in the idea of managing risk and the
perceived lack of control NPs feel they have over this, in particular when patients reach
crisis points, as emphasized by Helen, ‘one of the hardest things I find in this job is just
working towards an ending, and a crisis happens’ (NP3 13:18–9). One of the things that
seems to increase stress around this is that the risk NPs are trying to manage is affected by
many factors outside their control. For example, John points out that ‘A lot of problems
people come and see us with, it’s like wider social problems’ (NP5 12:35–36), and
considers this to be ‘the reality of the situation’ (NP5 12:20) that he has no power to
change. Similarly, the reality of working in a large organization means that there is a lack of
control over the responses other Samaritans give to service users, and this is also seen as
stressful. This is emphasized in a discussion of email responses from other branches to
service users by Laura, Lindsey, and May:
480 Danielle Lamb and Nicola Cogan

Laura: Emails is the only area of Sams that I find other Sams stressful [laughter] it’s the only one
where I get frustrated at other people from other branches [agreement] y’know

...

May: I mean you’re right, it’s other Samaritans that cause stress (SV 4:23–5:6).

Lindsey points out that balancing multiple demands due to additional roles taken on
can be more stressful than call content: ‘roles maybe that you’re trying to fulfil. . .can fairly
often be more stressful than actually taking calls’ (SV2 1:11). Roles such as being shift
leader, branch secretary, and branch chair must be taken on by some SVs in order for the
branch to continue running, and there appears to a feeling that there is a lack of control
over whether enough individuals will volunteer to take on such roles. NPs also face
difficulties in balancing multiple demands, and this exchange between Lisa and Anna
illustrates the stress caused by the lack of control over the quantity of work:

Lisa: . . .I have to run around the country for a start [agreement] cos I’ve only got one room at
[the health clinic] . . . There’s like you said, a zillion things that you’re trying to keep on top of
and to remember to do and to read and zillions of emails and really interesting attachments as
well that you want to read and you look at it and go ‘well I can’t just now’ [agreement] and do
you ever go back to it? Sometimes.
Anna: We were talking about that the other day, there’s all this helpful stuff that’s shared among
the team and you just never get a chance to read it – that stresses me out. (NP 1:17–28).

For NPs in particular, lack of control over the quantity of work appears to be a major
stressor, in contrast to SVs, whose working model of voluntary shifts enables them to take
on as much or as little work as they feel able to.

Ways of building resilience. The ways in which NPs and SVs cope with work-based
stressors and build resilience are varied. The use of coping mechanisms such as humour
seems to be common to both groups, as mentioned by May, ‘sometimes there’s a bit of
black humour’ (SV6 7:10–11) and Helen, ‘humour as well. . .black humour’ (NP3 8:28–
29). Helen also talks about the importance of spending time with ‘your family and your
friends’ (NP3 7:1). Maintaining a balance between work and everyday life seems
important in building resilience, as emphasized by Sophie, ‘Part of I think coping with the
stress is knowing that you go away and you leave it here’ (SV3 7:18–19). This seems to be
linked to the idea of needing time off to gain some space suggested by Hannah, ‘sometimes
you just need to have a day off’ (NP8 8:24–25), indicating for both groups a link between
attaining a sense of perspective and fostering resilience.
For SVs, these kinds of coping mechanisms are underpinned by the general support
available, as outlined by Alison, ‘there’s so many different levels of it. . .initial training. . .a
mentor with you. . .another training session. . .leaders. . .’ (SV8 11:5). The support of
colleagues in talking about concerns seems to be key, as explained by May, ‘it’s just lovely
to have support, someone that’s going to listen and be there to speak to about it’ (SV6 6:5–
7). Similarly, Hannah suggests communication with peers as helpful in managing stress,
‘you could speak to someone, bounce ideas off people’ (NP8 13:37–38). For NPs, the
support experienced appears to be slightly more specific and linked to discussion of
professional practice, rather than the more generalized nature of the SVs supportive
 Building resilience in mental health workers 481

environment. However, for both groups this indicates the need for peer support in
building resilience.
A significant difference between the groups is that NPs already possess knowledge of
stress management techniques because quite often these are skills they impart to service
users, and they have spent years training in these areas. The idea that using such skills can
be helpful in building resilience is emphasized by Helen:

I do probably intuitively try and use ideas, cognitive behavioural skills or sometimes just being
able to tolerate the stress and be ok to feel these emotions and the kind of mindfulness in
particular I’ve found a really useful personal strategy to manage some of the stresses of the
job.(NP3 6:28–31)

For SVs, as Heather explains, the training available is much less focused and intensive,
although it can enable self-awareness and identification of personal and organizational
values: ‘it makes you stop and think about how you do things and why you do them and
why we’re all here’ (SV1 9:3–5).
The concept of acceptance appears to be key in building resilience for both groups.
For SVs, as Sophie points out, ‘once the call is ended you can’t do any more and you quickly
learn to accept that’ (SV3 7:21), and this is echoed by May, ‘you have to realise you can’t
always help’ (SV6 3:24). Similarly for NPs, as Helen points out, ‘recognising what things
here are beyond my control’ (NP3 6:31) is helpful, and ‘there’s certain things we have to
accept’ (NP3 11:19). This aspect of working in mental health is clearly linked to theme 1,
in the sense that although the elements of care that workers have no control over are
experienced as stressors, the ability to accept this feeling of lack of control seems to help
them to cope with this stress.
One area where there was a clear difference between the groups was around the idea
of space. For NPs, with their much more time-pressured environment, having enough
space during the day, for example for lunch and between contacts, seemed very
important to cope with the other stressors inherent in their work. For example, Hannah
and Anna both mentioned the necessity of a break at lunch: ‘. . .You get that space,
y’know, it should be absolutely fundamental that you get half an hour break for lunch’
(NP8 16:30–31); ‘I do value that half an hour’ (NP1 14:21–22). Time to reflect in-between
contacts was also seen as vital by Lisa: ‘But even head space, to finish working with one
person, have some sort of pause, and then to start getting ready to work with the next
person’ (NP2 17:14–15). For SVs, who work much shorter and less frequent shifts, this
did not emerge as an issue.

The dual impact of values. For both groups, there seems to be a strong sense of shared
values between colleagues. For SVs, as Heather says, ‘it’s about people wanting to give
something’ (SV1 10:6–7), and this is echoed by Lindsey, ‘I think we all like people
basically. . .we’re all quite interested in each other’ (SV2 7:29–30). The NPs seemed to
share this sense of appreciation of the position they occupy in having patients open up to
them and discuss personal issues, ‘It’s quite a privileged position to be in, and it really is a
really enjoyable aspect of the role as well’ (NP3 4:24–25). Similarly, Alison neatly sums up
the sense that being an SV is a privilege, ‘you’re having people open up and tell you their
hopes and fears and it really is a privilege to be able to do that’ (SV8 10:34–35). The attitude
both groups have to their work seems to mean that their shared values have a positive
impact on workers.
482 Danielle Lamb and Nicola Cogan

The idea of having the ‘proper Samaritans attitude’ (SV7 2:32) was emphasized by
Tom, and these values are reflected by Elizabeth’s statement that ‘our role is that we are
here to support people’ (SV4 2:9–10). Another impact that shared Samaritans values seem
to have is in creating a sense of identity. The idea that being a Samaritan enables SVs to
assert their own identity is captured by Lindsey, ‘here I’ve found I’m just called upon to be
myself’ (SV2 10:28–29).
The differences between the two groups become evident in terms of how far they are
able to work to their values. For SVs, sharing values appears to help build a sense of
ownership and responsibility, as Lindsey and Elizabeth point out:

Lindsey: . . .We all feel that sense of responsibility for keeping it going
Elizabeth: Because if we don’t all pull our weight it’s going to just come to pieces
Lindsey: Exactly, yes [agreement] (SV4 19:21–25).

For NPs however, the excessive workload mentioned in theme 1 means that key values
for them such as providing high-quality care, and self-improvement to facilitate this, may
sometimes be compromised. For example, improving practice via self-reflection is seen as
very important by Lisa, ‘in my training self-reflection and self-awareness is massive, it’s
core’ (NP2 10:7), and also points out that ‘I want my job to always be trying to achieve
quality work’ (NP2 1:36). However, Anna feels that ‘it [excessive workload] will impact on
the quality of what we’re doing’ (NP1 18:16), and it seems that attempts to try and balance
the quantity of work with providing quality care can turn positive values such as self-
improvement into a cause of stress:

Balancing the clinical demands with all the admin and other stuff and trying to keep up to date
with developments and clinical practice and trying to feel. . .that you’re practising ethically in
a way that’s relevant to the latest evidence as well I suppose, it just never seems like there’s
enough hours in the day.(NP1 1:9–13)

While SVs find support in their shared values, NPs, working in the much larger and
more rigid organization of the NHS, find that valuing self-improvement and maintaining
the quality of care can impact negatively by contributing to stress. This demonstrates the
dual impact that shared values can have, with both positive and negative outcomes
depending on the work context.

The effect of environment. The organizational and physical environments appear to

affect how participants in both groups cope with stress, although, similar to the previous
theme, this is manifested in different ways, both positive and negative. Sophie explains
how supportive the Samaritans organizational structures are, ‘you can talk to your shift
partner and the leader and any Sam [co-worker]’ (SV3 8:24), and May adds to this, ‘extra
support comes from Samaritan’s care [co-workers]’ (SV6 12:12). Although Sophie points
out that there are processes to follow, ‘certain procedures and certain standards that
people need to adhere to’ (SV3 4:6–7) the fact that ‘it’s not a sort of call centre
environment’ (SV7 6:17) is appreciated by Tom.
The way the Samaritans organization is structured helps foster a sense of equality in
SVs, which is compared by Alison to the experience of working in a paid environment:
We’re in for a shift for 3 hr, we’re equal and we’re doing the same thing and we’ve got the
same sort of role and responsibility and it makes it easier to empathise with the other person
 Building resilience in mental health workers 483

[agreement] and if you’re in a workplace somebody’s stressed out and you’re like ‘Pft well he
gets paid more than I do’ (SV8 10:16–20).

In contrast, there seems to be a perception amongst NPs that NHS managerial

structures and environment can be a cause of stress, as explained by John:

[There] needs to be like a structural acknowledgement of what we’re doing y’know. . .I think
the training shouldn’t necessarily be for us, it should be for the people who decide what we’re
supposed to be doing, they need to know what it is we do (NP5 18:17–20).

This perceived lack of understanding by management is also demonstrated by Lisa’s

reply to the idea of making time for self-care to build resilience: ‘What, with all the
pressure of “Come on we’ve got to get the waiting lists down”?’ (NP2 10:29). This is
echoed in Helen’s statement that ‘I’ve always felt it’s been lip service. . .you’ve been in
training sometimes and it’ll be like, “Ooh, and remember self-care” like an afterthought’
(NP3 9:12–13). Ultimately, as Anna points out, this seems to come back to, ‘recognising
the bureaucracy and the admin demands’ (NP1 10:24).
The contrasts between SVs and NPs continue when the physical environment is
considered. There is a strong emphasis on the SVs’ physical environment as being set up to
foster resilience, with the operations room in the Samaritans centre being described as a
‘wee cocoon’ (SV8 7:5) by Alison, and Elizabeth agreeing, ‘sometimes when I come into
that room I actually feel calmer’ (SV4 1:19). The sense of safety and security is also
emphasized by Alison, ‘it’s like you can feel quite safe when you walk in the door’ (SV8
7:8). For NPs, however, the physical environment emerged as a significant potential
stressor. Helen points out that the facilities available are less than ideal, ‘the clinics are
often very medically oriented, which doesn’t necessarily bode well for creating a nice
therapeutic environment’ (NP3 5:6–7). Additional stress appears to be generated by
having to use facilities that are, as Anna says, ‘not really fit for purpose at all, falling down’
(SV1 5:17). Location of clinics and isolation from other services and teams also seem to
contribute to stress, as Helen points out:

We’re kind of geographically quite isolated from for example the community mental
health teams or the crisis team, which means that you can’t just have that direct face to
face contact with some of the colleagues that would help us joint work with risk.(NP3
2:34–36)

The experience of feeling isolated appears to act as a stressor for NPs, in contrast to
SVs, whose single-site (within a widely distributed network of branches) and paired
working model means that their environment seems to build resilience.

Discussion
The four themes that emerged from the transcripts focused on control, building resilience,
values, and environment. There were a number of similarities between the two groups,
particularly with regard to the first two themes, but also several differences, especially in
the last two themes. In general, differences between the groups appear to be due to the
differing contexts the participants work within, and this overarching issue will be
discussed in more detail below.
484 Danielle Lamb and Nicola Cogan

Discussion of findings
While the distressing content of contacts with service users was mentioned by both
groups, neither seemed to consider this a major source of stress. In fact, several
participants in both groups explicitly stated other aspects of their roles as more stressful
than contact with service users. Similar issues emerged from both groups regarding
perceived lack of control contributing to feelings of stress, and this has also been
demonstrated in previous research. Karasek (1979) and Landsbergis (1988) have shown
that a combination of low decision latitude (i.e., how much control workers have over
their roles and environments) and heavy workload demands is associated with burnout
and job dissatisfaction. The lack of perceived control that NPs have over, for example
increasing waiting list pressures, adversely impacts on their sense of being able to cope
with work-related stressors far more than the content of service user sessions. This is
supported by Onyett (2011), who found that concerns about lack of resources and
workload pressures contribute to high levels of emotional exhaustion in community
mental health teams.
The relationship between stress and the content of sessions is complex, however, as it
appears lack of control over the ‘realities of life’ that bring service users into contact with
services can greatly increase stress. Whereas the role of SVs, as part of a listening service,
could be described as more passive, NPs find they are expected to ‘fix’ the problems that
service users arrive with, and this can cause more stress. In addition, lack of control over
the sheer quantity of work and sense that there is always more to be done (with individual
service users already being seen, and those on waiting lists) together with the limited
session length (1 hr is standard) is experienced as stressful by NPs. In contrast, SVs are
able to spend as long as necessary with callers, knowing that any additional callers
phoning the service will be picked up by volunteers in other branches. It seems likely that
the countrywide nature of the Samaritans service reduces stress by distributing
responsibility. It is possible that the 24/7 nature of the Samaritans service also decreases
the pressure felt in terms of the quantity of work to be done, in that SVs know that when
they end their shift, others take over and ensure continual coverage. The fact that crisis
teams (24/7 NHS mental health teams) report lower emotional strain and higher levels of
control over their work than psychiatric inpatient or CMHT staff (Johnson et al., 2012)
lends further support to this idea. These findings point to the very complex nature of
control, with the context workers operate in seeming to be key to how much stress is
experienced.
The second theme, ways of building resilience, demonstrated that there are many
different ways people cope with excessive stress. Participants in both groups appeared to
share several of the characteristics found by previous research to indicate resilience, for
example the ability to use humour (Simeon et al., 2007; Stevanovic & Rupert, 2004),
being female (Rutter, 1985; Werner & Smith, 1992), good communication (Cushway &
Tyler, 1994; Werner & Smith, 1992), supportive relationships (Joseph & Linley, 2006;
Luthar & Cicchetti, 2000), self-reflection (Joseph & Linley, 2006; Trowell, Davids, Miles,
Shmueli, & Paton, 2008), and the personal use of clinical and therapeutic skills (Shapiro
et al., 2007). This last point is of most relevance to NPs, who have the clinical skills
mentioned. Mindfulness in particular was one area that several participants commented
on, and there is growing evidence that mindfulness-based training can be beneficial in a
workplace context (Flaxman & Bond, 2010; Morgan, Simpson, & Smith, 2014).
Another element that seemed key for both groups in building resilience was attaining a
sense of acceptance of those things beyond their control. This has obvious links to the first
theme, and it appears that while lack of control can be a significant stressor, the ability to
 Building resilience in mental health workers 485

accept situations that are out of one’s control can act as a protective factor. This seemed to
be an issue for both groups and did not appear to be dependent on the context, possibly
because the cause of stress (the lack of control over elements of service user’s lives that
distress them) is similar for both SVs and NPs. Peer support and communication were
important to both groups, although the former more to SVs and the latter to NPs, which
reflects the differing foci of their roles, with SVs operating in a more informal environment
focusing on general support, and the NPs in a more formal setting where regular
communication between teams and agencies is the norm. The perceived pressures from
the quantity of work discussed in theme 1 could also contribute to the fact that the NPs
appear to have less time to devote to informal peer support.
The third theme, values, emerged from both groups, but in different ways. SVs
reported a common sense of identity in their shared values. Conversely, while the NPs also
had shared values, resource pressures in the NHS meant that NPs felt they were not able to
consistently work to those values. The pressure to reduce waiting lists in accordance with
government targets (NHS, 2013) meant that there was perceived to be a lack of time, and
this became a source of stress. The reasons for the differences between the two groups
appear to be contextual, with NPs spending a much greater proportion of their time
dealing with these issues. The nature of the NPs’ work, in particular the intense time
pressures, means that there is greater potential for positive values (such as wanting to
maintain a high quality of therapeutic intervention) to contribute to stress if NPs feel that
they are unable to provide a quality service. The voluntary nature of SVs’ work and the
context of being a charitable rather than statutory service mean that there is less pressure,
for example, to reduce waiting lists, and so they have more opportunities to work to their
values. As mentioned above, the distributed network of Samaritans centres and 24/7
nature of the organization also help SVs maintain resilience to stress, in ways that appear
much more difficult in contexts such as the NHS.
There appears to have been little previous research of the dual impact of values, or how
the conceptual issues of values and control are linked and interact, but there is an
indication from some studies that shared values and acceptance can contribute to
fostering resilience (Bond & Bunce, 2000). In the previous theme, we saw that personal
use of clinical skills and attaining a sense of acceptance can both build resilience.
Considering the importance of values in addition to these themes points to an intervention
called acceptance and commitment therapy (ACT), a mindfulness-based intervention that
aims to develop psychological flexibility (Flaxman & Bond, 2010; Hayes, Strosahl, &
Wilson, 1999; Morgan et al., 2014). Psychological flexibility is defined as the ability to
contact the present moment as a conscious human being, and persist with or change
behaviour in the service of valued ends (Hayes & Strosahl, 2004). In settings such as the
NHS, where there may be wider organizational problems over which individuals have
little or no control, or the Samaritans where there is no control over the social issues that
cause callers so much distress, the use of interventions such as ACT as a training tool might
prove beneficial in building and maintaining resilience (Jeffcoat & Hayes, 2012).
One of the reasons NPs perceived that they were unable to consistently work to their
values was due to the environment they operate in, which emerged as an issue in the
fourth theme. The physical environment was a stressor for the NPs, with facilities seen as
not fit for purpose, for example very medically oriented rooms, and some buildings that
needed extensive repair work to fix leaking ceilings. The idea that physical environment
can affect workers is not a new one, and Klitzman and Stellman (1989) found that adverse
environmental conditions can negatively impact on worker satisfaction and mental
health. In contrast, the importance of a calm, safe physical environment was emphasized
486 Danielle Lamb and Nicola Cogan

by SVs, and this appeared to foster resilience. Operating in a physical environment that felt
safe and supportive seemed to help SVs cope with the emotional pressures of their roles.
Another contrast was between the supportive organizational structures articulated by
SVs, and the stress caused by organizational pressures expressed by NPs. This is evident in
previous research, with lack of support from supervisors being linked with increased
stress levels (Balshem, 1988; Kirmeyer & Dougherty, 1988) and symptoms of depression
(Repetti, 1993). It has also been shown that stress can result from organizational structure
and management style (Cooper & Cartwright, 1994) and organizational pressures for
change (Rush, Schoel, & Barnard, 1995). These elements are all present in the NPs’
working lives, and it seems that they do negatively impact on how well they feel they are
able to cope with stress at work.
It seems clear from the discussion above that the context workers operate in is
significant in how much stress they experience, and the extent to which they are able to
cope with this. The findings indicate that being able to spend adequate amounts of time
with service users (as well as time for preparation and staff development activities), in a
supportive, therapeutic environment, and having a joined-up organization with a
relatively flat hierarchy and superiors who understand the nature of the job are all
important factors in helping workers cope with stress. Being able to work to one’s values,
and being accepting of those aspects of the job that are outside of one’s control also appear
to influence stress levels. In seeking ways to address these issues, it is possible that stress
management interventions could be helpful. Unlike generic stress management
interventions that take no account of differing work contexts, ACT, with its focus on
values and psychological flexibility, can be tailored to specific environments. ACT has the
added benefit of a large, coherent, body of research: The construct of psychological
flexibility has been tested and validated in both clinical and non-clinical groups (Bond
et al., 2011).
The conceptual coherence and validated measurement tools of constructs such as
psychological flexibility are arguably something the concept of resilience currently lacks.
There are currently no ‘gold standard’ resilience measures (Windle, Bennett, & Noyes,
2011), and this is perhaps an area for future research. The authors suggested above that a
refined definition of ‘resilience’ might be called for, one with more relevance to the
context of those working in mental health (rather than those who have experienced
specific traumatic events). There certainly seems to be a need for widely understood and
accepted ways of talking about the stresses inherent in working in mental health settings,
and ways of coping with them. The authors suggest the following definition of resilience
could be used in mental health working contexts: ‘The ability to cope, and even thrive
through actively engaging in professional skills development, in the face of persistently
high levels of work-based stress’.

Limitations of the study

In working with focus groups, the presence of the researcher may alter existing group
dynamics. Lack of honest self-disclosure and self-representation may be an issue where the
researcher is unknown to the participants, and where the researcher is known to
participants, overfamiliarity may skew the content of discussion. It should be noted that
the researcher was known to all SVs, and to two NPs, and it is possible that knowing some
participants could have affected the group dynamics. The researcher attempted to
minimize any such effect by not demonstrating overfamiliarity with any individual
participants. In this study, it seems that several of the themes that emerged were
 Building resilience in mental health workers 487

consistent with the kinds of issues raised in previous research (Cushway & Tyler, 1994;
Joseph & Linley, 2006; Luthar & Cicchetti, 2000; Shapiro et al., 2007; Trowell et al., 2008;
Werner & Smith, 1992), which may have been due to the researcher’s familiarity with this
work-limiting analysis. However, the analysis highlighted additional themes that warrant
further exploration, and so it is not felt that previous research overly influenced the
outcomes of the study. The ways in which prior understandings were bracketed to allow
new ideas to emerge are discussed below in the reflexive account.

Reflexive account
The use of regular supervision was helpful in noting and challenging any potential
assumptions of the researcher. Issues discussed included the researcher’s own very
positive feelings about working as an SV, and the supportive nature of the Samaritans as
an organization. Also discussed was the fact that there is, and has been for some time,
substantial media coverage of the pressures on the NHS. Identifying these concerns and
how they might affect the researcher’s perception of the findings was helpful, and
provided an awareness of these issues during the analysis. Notes were kept during
supervision sessions and compiled to form a reflexive log. During the analysis and
writing up of findings, regular reference was made to the reflexive log detailing these
issues, in order to attempt to bracket them and allow space for new ideas to emerge. This
enabled the researcher to acknowledge her own theoretical leanings, and provided a
useful baseline understanding from which to develop new ways of interpreting the data.
Another issue covered in these sessions was whether the use of the concept of
‘resilience’ was appropriate. Through discussion of the concept, its definition, and the
content of the focus group sessions, it was felt that this term was useful in reflecting the
experiences of the participants. The language used by participants and the way that they
made sense of their experiences was consistent with the concept of resilience as defined
in the current literature. However, it was discussed that a more nuanced definition, as
suggested above, may even better capture the experiences of those working in mental
health.
It was noted that the comparative nature of this study meant that the ‘adaptation of
themes’ and ‘integration of multiple cases’ stages of analysis had more in common with
the processes used in IPA of one-to-one interviews than the kind of focus group studies
that have been conducted previously (Palmer et al., 2010). The use of focus groups
(rather than individual interviews) worked well in terms of accessing how teams
interact, and brought out issues through discussion that individuals might not have
mentioned. It was noted that interactions between individuals in both groups were
respectful and good natured, with some laughter, joking and agreement throughout
each session. In both groups, less experienced participants tended to speak less, with a
couple of participants in each group contributing very little. It is possible that these
participants felt uncomfortable discussing their thoughts in front of more experienced
colleagues, and this is one potential disadvantage of using focus groups. Alternatively, it
is possible that participants who spoke less simply had fewer opinions on the topic
under discussion or that others had already made points similar to any they would have
raised.
To date, focus group studies using IPA have tended to use multiple groups but from
homogenous populations (e.g., Dunne & Quayle, 2002), whereas this study was slightly
unusual in using groups from different populations and comparing the similarities and
differences between emergent themes. Using heterogeneous groups (but who work in
488 Danielle Lamb and Nicola Cogan

similar areas) provided the opportunity to compare the way in which context can affect
outcomes (WHO, 2005), and indicated conceptual insights that might not have become
apparent had more traditional methods been used, for example the dual nature of values
and environment as being both potential causes of, and protectors against, stress, and the
link both have to issues around control. The positive impact that working to one’s values
can have appears to be facilitated by increased levels of control, and control over one’s
environment also has positive effects. The interrelated nature of these concepts is
something that has not been addressed in previous work, and was possible because of the
qualitative, comparative nature of this research.

Conclusion
In conclusion, it appears that for those working in mental health services, the distressing
content of the work is not necessarily a primary stressor, although it can become so when
combined with other stressors such as excessive workloads and/or lack of supervision.
Differences between the two groups studied demonstrate that the quantity and nature of
the work, and the environment in which it is carried out, are key to understanding how
those working in mental health cope with work-based stressors and build resilience.
Having adequate time to prepare for contact with service users, to complete adminis-
trative tasks, and to keep up to date with developments in the field is of vital importance to
NPs in maintaining the high-quality services they seek to offer. The supportive
management and organizational structures, and calm and safe environment experienced
by SVs contribute to their ability to cope with stressors. This points to the significance of
taking into account the context of work, in particular when developing interventions to
help workers cope more effectively with stress.
There needs to be recognition at management, political, and legislative levels that
stress can have a negative impact on workers, and efforts made to alter the conditions
that cause negative stress. However, in the light of scarce resources, there could also be a
move towards training enabling mindful awareness and acceptance of those things that
cannot be changed, and a focus on values that can be realistically pursued. The dual
impact that values can have should be noted, as while shared values can help to build
resilience, the NPs demonstrated that being unable to work to strongly held values can
have negative consequences. Future research could consider further the interrelated
nature of several of the concepts explored here, for example how perceived control
interacts with values and the environment, and how important context is when
identifying training interventions to mitigate negative outcomes. In particular, there are
indications that interventions such as mindfulness and ACT could contribute to fostering
resilience by increasing psychological flexibility, and future research might explore the
relationship between these two constructs. The sense in which teams of workers
collectively cope is another area that warrants much deeper investigation, and it is
suggested that further research using focus groups with teams of workers could be
useful in drawing out insights in this area. There remain questions of causality, that is do
those with resilient characteristics seek out the kinds of roles that require this ability, or
does being in situations requiring resilience cause these characteristics to be developed?
This is another possible area for future research, and one that could be beneficial in
developing methods of fostering resilience in mental health workers, and so enable them
to better assist service users in regaining and maintaining their own mental health and
well-being.
 Building resilience in mental health workers 489

References
Bakker, J., Holenderski, L., Kocielnik, R., Pechenizkiy, M., & Sidorova, N. (2012). Stress@ Work: from
measuring stress to its understanding, prediction and handling with personalized coaching.
Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium, 673–678.
doi:10.1080/02678370802393649
Balshem, M. (1988). The clerical workers’ boss: An agent of job stress. Human Organization, 47,
361–367. doi:10.1177/108602669200600205
Barnett, J. E., Baker, E. K., Elman, N. S., & Schoener, G. R. (2007). In pursuit of wellness: The self-care
imperative. Professional Psychology: Research and Practice, 38, 603–612. doi:10.1037/0735-
7028.38.6.603
Bhui, K. S., Dinos, S., Stansfeld, S. A., & White, P. D. (2012). A synthesis of the evidence for managing
stress at work: A review of the reviews reporting on anxiety, depression, and absenteeism.
Journal of Environmental and Public Health, 2012, 21. doi:10.1155/2012/515874
Black, C., & Frost, D. (2011). Health at work – an independent review of sickness absence. London,
UK: Department of Work and Pensions.
Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused
worksite stress management interventions. Journal of Occupational Health Psychology, 5,
156–163. doi:10.1037/1076-8Q98 1.1.156
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., . . . Zettle, R. D.
(2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A
revised measure of psychological flexibility and experiential avoidance. Behavior Therapy, 42,
676–688. doi:10.1016/j.beth.2011.03.007
Borkoles, E., Nicholls, A. R., Bell, K., Butterly, R., & Polman, R. C. J. (2008). The lived experiences of
people diagnosed with multiple sclerosis in relation to exercise. Psychology & Health, 14, 27–
35. doi:10.1080/14768320701205309
BPS (2012). Retrieved from http://careers.bps.org.uk/area/clinical
Chapman, E., Parameshwar, J., Jenkins, D., Large, S., & Tsui, S. (2007). Psychosocial issues for
patients with ventricular assist devices: A qualitative pilot study. American Journal of Critical
Care, 16, 72–81. Retrieved from http://ajcc.aacnjournals.org/content/16/1/72.full
Cooper, C. L., & Cartwright, S. (1994). Healthy mind; healthy organizations – a proactive approach to
occupational stress. Human Relations, 47, 455–471. doi:10.1177/001872679404700405
Cooper, C., & Dewe, P. (2008). Well-being – absenteeism, presenteeism, costs and challenges.
Occupational Medicine, 58, 522–524. doi:10.1093/occmed/kqn124
Coster, J. S., & Schwebel, M. (1997). Well-functioning in professional psychologist. Professional
Psychology: Research and Practice, 28, 5–13. doi:10.1037/0735-7028.28.1.5
Cushway, D., & Tyler, P. A. (1994). Stress and coping in clinical psychologists. Stress Medicine, 10,
35–42.
de Visser, R., & Smith, J. A. (2006). Mister in between: A case study of masculine identity and health-
related behaviour. Journal of Health Psychology, 11, 685–695. doi:10.1177/13591053
06066624
de Visser, R. O., & Smith, J. A. (2007). Alcohol consumption and masculine identity among young
men. Psychology & Health, 22(5), 595–614.
DoH (2013). Retrieved from https://www.gov.uk/government/publications/2010-to-2015-
government-policy-mental-health-service-reform
Dunne, E. A., & Quayle, E. (2002). The impact of iatrogenically acquired hepatitis C infection on the
well-being and relationships of a group of Irish women. Journal of Health Psychology, 6, 679–
692. doi:10.1177/1359105302007005676
Everly, G. S., & Lating, J. M. (2013). Resilience: The final frontier. In G. S. Everly & J. M. Lating (Eds.), A
clinical guide to the treatment of the human stress response (pp. 143–154). New York, NY:
Springer.
490 Danielle Lamb and Nicola Cogan

Flaxman, P. E., & Bond, F. W. (2010). A randomised worksite comparison of acceptance and
commitment therapy and stress inoculation training. Behaviour Research and Therapy, 48,
816–820. doi:10.1016/j.brat.2010.05.004
Flowers, P., Duncan, B., & Frankis, J. (2000). Community, responsibility and culpability: HIV risk
management amongst Scottish gay men. Journal of Community and Applied Social
Psychology, 10, 285–300. doi:10.1002/1099-1298(200007/08)10:4<285
Fullagar, C., & Kelloway, E. K. (2010). New directions in positive psychology: Implications for the
workplace. In J. Houdmont & S. Leka (Eds.), Contemporary Occupational Health Psychology:
Global perspectives on research and practice (pp. 146–161). Chichester, UK: Wiley-Blackwell.
Goodman, M. J., & Schorling, J. B. (2012). A mindfulness course decreases burnout and improves
well-being among healthcare providers. International Journal of Psychiatry in Medicine, 43,
119–128. doi:10.2190/PM.43.2.b
Greenfield, E. A., & Marks, N. F. (2004). Formal volunteering as a protective factor for older adults’
psychological well-being. The Journals of Gerontology, Series B, Psychological Sciences and
Social Sciences, 59B, S258–S264. doi:10.1093/geronb/59.5.S258
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An
experiential approach to behavior change. New York, NY: Guilford Press.
Hayes, S. C., & Strosahl, K. D. (2004). A practical guide to acceptance and commitment therapy.
New York, NY: Springer, US.
Health and Safety Executive (2009). Stress-related and psychological disorders. Author. Retrieved
from http://www.hse.gov.uk/statistics/causdis/stress/
Heidegger, M. (1927). Being and time. Translated by John Macquarrie and Edward Robinson.
London, UK: SCM Press, 1962.
Herrman, H., Stewart, D. E., Diaz-Granados, E., Berger, E. L., Jackson, B., & Yuen, T. (2011). What is
resilience? Canadian Journal of Psychiatry, 56, 258–265.
HWL (2012). Retrieved from http://www.healthyworkinglives.com/
HWW (2013). Retrieved from https://www.gov.uk/government/policies/helping-people-to-find-
and-stay-in-work/supporting-pages/co-ordinating-the-health-work-and-wellbeing-initiative
Irving, J. A., Dobkin, P. L., & Park, J. (2009). Cultivating mindfulness in health care professionals: A
review of empirical studies of mindfulness-based stress reduction (MBSR). Complementary
Therapies in Clinical Practice, 15, 61–66. doi:10.1016/j.ctcp.2009.01.002
Jeffcoat, T., & Hayes, S. C. (2012). A randomized trial of ACT bibliotherapy on the mental health of K-
12 teachers and staff. Behaviour Research and Therapy, 50, 571–579. doi:10.1016/
j.brat.2012.05.008
Johnson, S., Osborn, D. P. J., Araya, R., Wearn, E., Paul, M., Stafford, M., . . . Wood, S. J. (2012). Morale
in the English mental health workforce: Questionnaire survey. The British Journal of
Psychiatry, 201, 239–246. doi:10.1192/bjp.bp.111.098970
Jordan, J., Gurr, E., & Tinline, G. (2003). Beacons of excellence in stress prevention: Research report
133. London, UK: Health & Safety Executive Books.
Joseph, S., & Linley, P. A. (2006). Positive therapy: A meta-theory for positive psychological
practice. New York, NY: Routledge.
Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job
redesign. Administrative Science Quarterly, 24, 285–308.
Kirmeyer, S. L., & Dougherty, T. W. (1988). Work load, tension and coping: Moderating effects of
supervisor support. Personnel Psychology, 41, 125–139.
Klitzman, S., & Stellman, J. M. (1989). The impact of the physical environment on the psychological
well-being of office workers. Social Science and Medicine, 6, 733–742.
Landsbergis, P. A. (1988). Occupational stress among health care workers: A test of the job demands
control model. Journal of Organizational Behavior, 9, 217–239.
Luthar, S., & Cicchetti, D. (2000). The construct of resilience: Implications for interventions and
social policies. Development and Psychopathology, 12, 857–885.
Luthar, S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and
guidelines for future work. Child Development, 71, 543–562. doi:10.1111/1467-8624.00164
 Building resilience in mental health workers 491

Mental Health and Work (2008). Retrieved from http://www.dwp.gov.uk/docs/hwwb-mental-

health-and-work.pdf
Morgan, P., Simpson, J., & Smith, A. (2014). Health care workers’ experiences of mindfulness
training: A qualitative review. Mindfulness, 6(4), 744–758. doi:10.1007/s12671-014-0313-3
NHS (2012). Retrieved from http://www.jobs.nhs.uk/about_nhs.html
NHS (2013). Retrieved from http://www.scotland.gov.uk/About/Performance/scotPerforms/
partnerstories/ NHSScotlandperformance
Onyett, S. (2011). Revisiting job satisfaction and burnout in community mental health teams.
Journal of Mental Health, 20, 198–209. doi:10.3109/09638237.2011.556170
Palmer, M., Larkin, M., de Visser, R., & Fadden, G. (2010). Developing an interpretative
phenomenological approach to focus group data. Qualitative Research in Psychology, 7, 99–
121. doi:10.1080/14780880802513194
Pipe, T. B., Buchda, V. L., Launder, S., Hudak, B., Hulvey, L., Karns, K. E., & Pendergast, D. (2012).
Building personal and professional resources of resilience and agility in the healthcare
workplace. Stress and Health, 28, 11–22. doi:10.1002/smi.1396
Repetti, R. L. (1993). The effects of workload and the social environment at work on health. In L.
Goldberger & S. Breznitz (Eds.), Hand book of stress: Theoretical and clinical aspects (pp. 368–
385). New York, NY: Free Press.
Richardson, K. M., & Rothstein, H. R. (2008). Effects of occupational stress management
intervention programs: A meta-analysis. Journal of Occupational Health Psychology, 13(1),
69–93. doi:10.1037/1076-8998.13.1.69
R€ossler, W. (2012). Stress, burnout, and job dissatisfaction in mental health workers. European
Archives of Psychiatry & Clinical Neuroscience, 262, 65–69. doi:10.1007/s00406-012-0353-4
Rush, M. C., Schoel, W. A., & Barnard, S. M. (1995). Psychological resiliency in the public sector:
“hardiness” and pressure for change. Journal of Vocational Behavior, 46(1), 17–39.
Rutter, M. (1985). Resilience in the face of adversity: Protective factors and resistance to psychiatric
disorder. British Journal of Psychiatry, 147, 598–611. doi:10.1192/bjp.147.6.598
Samaritans (2012a). Retrieved from http://www.samaritans.org/about_samaritans/facts_and_
figures.aspx
Samaritans (2012b). Retrieved from http://www.samaritans.org/volunteer-us
Schaufeli, W. B. (2012). Work engagement. What do we know and where do we go? Romanian
Journal of Applied Psychology, 14(1), 3–10.
Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers: Effects of
mindfulness-based stress reduction on the mental health of therapists in training. Training and
Education in Professional Psychology, 1, 105–115. doi:10.1037/1931-3918.1.2.105
Simeon, D., Yehuda, R., Cunill, R., Knutelska, M., Putnam, F. W., & Smith, L. M. (2007). Factors
associated with resilience in healthy adults. Psychoneuroendocrinology, 32, 1149–1152.
doi:10.1016/j.psyneuen.2007.08.005
Smith, J. A. (1996). Beyond the divide between cognition and discourse: Using interpretative
phenomenological analysis in health psychology. Psychology & Health, 11, 261–271.
doi:10.1080/08870449608400256
Smith, J. A. (2004). Reflecting on the development of interpretative phenomenological analysis and
its contribution to qualitative research in psychology. Qualitative Research in Psychology, 1(1),
39–54. doi:10.1191/1478088704qp004oa
Smith, J. A. (2007). Hermeneutics, human sciences and health: Linking theory and practice.
International Journal of Qualitative Studies on Health and Well-Being, 2, 3–11. doi:10.1080/
17482620601016120
Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory,
method and research. London, UK: Sage.
Smith, J. A., & Osborn, M. (2003). Interpretative phenomenological analysis. In J. A. Smith (Ed.),
Qualitative psychology: A practical guide to research methods (pp. 51–80). London, UK: Sage.
Smith, J. A., & Osborn, M. (2007). Pain as an assault on the self: An interpretative phenomenological
analysis. Psychology and Health, 22, 517–534. doi:10.1080/14768320600941756
492 Danielle Lamb and Nicola Cogan

Stevanovic, P., & Rupert, P. A. (2004). Career-sustaining behaviors, satisfactions, and stresses of
professional psychologists. Psychotherapy: Theory, Research, Practice, Training, 41, 301–309.
doi:10.1037/0033-3204.41.3.301
Sutherland, V. J., & Cooper, C. L. (1990). Understanding stress: A psychological perspective for
health professionals. London, UK: Chapman and Hall.
Tedeschi, R. G., Park, C. L., & Calhoun, L. G. (1998). Posttraumatic growth: Positive changes in the
aftermath of crisis. Hillsdale, NJ: Lawrence Erlbaum.
Tomkins, L., & Eatough, V. (2010). Reflecting on the use of IPA with focus groups: Pitfalls and
potentials. Qualitative Research in Psychology, 7, 244–262. doi:10.1080/14780880903121491
Trowell, J., Davids, Z., Miles, G., Shmueli, A., & Paton, A. (2008). Developing healthy mental health
professionals: What can we learn from trainees? Infant Observation, 11, 333–343. doi:10.1080/
13698030802553583
Ungar, M. (2003). Qualitative contributions to resilience research. Qualitative Social Work, 2(1),
85–102. doi:10.1177/1473325003002001123
Wagnild, G., & Young, H. (1993). Development and psychometric evaluation of the resilience scale.
Journal of Nursing Measurement, 1, 165–178.
Werner, E., & Smith, R. (1992). Overcoming the odds: High risk children from birth to adulthood.
Ithaca, NY: Cornell University Press.
Wilkinson, S. (2004). Focus groups. In J. A. Smith (Ed.), Qualitative psychology – A practical guide
to research methods (pp. 184–204). London, UK: Sage.
Windle, G., Bennett, K. M., & Noyes, J. (2011). A methodological review of resilience measurement
scales. Health and Quality of Life Outcomes, 9, 8. doi:10.1186/1477-7525-
World Health Organisation (WHO) (2005). Mental health policies and programmes in the
workplace. Geneva, Switzerland: Author.

Received 14 November 2013; revised version received 10 August 2015

Copyright of Journal of Occupational & Organizational Psychology is the property of Wiley-
Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's express written permission. However, users may print,
download, or email articles for individual use.