Lived Experience as a Protective Factor for Mental Health Workers
Abstract
Objective:
When clients do not seem to be improving, mental health workers have more negative job attitudes, experience higher levels of client-related burnout, and are more interested in leaving the field. Nonetheless, it is unclear whether all mental health workers are equally susceptible to burnout caused by feelings that their clients are not improving. Specifically, people with lived experience of mental illness are intimately familiar with their own recovery challenges and thus may be less susceptible to this source of burnout.
Methods:
To test this possibility, mental health providers (N=179) from a nongovernmental community mental health organization in Australia completed a survey assessing their perceptions of client improvement from treatment, their feelings of client-related burnout, and a range of organizational outcomes (job satisfaction, job engagement, workplace well-being, and intentions to resign).
Results:
Moderated mediation analyses revealed that although mental health providers who felt that their clients were not improving experienced client-related burnout, lived experience served as a buffer. Staff with lived experience were less susceptible to burnout associated with perceptions that their clients were not improving from treatment. Mental health providers with lived experience also reported more positive job attitudes compared with providers without lived experience.
Conclusions:
Given the high rates of burnout in the mental health profession, future research should examine why lived experience appears to buffer staff from burnout when they believe that their clients are not improving. This knowledge could aid in the development of interventions to boost resilience, engagement, and longevity in the field.
HIGHLIGHTS
•
Mental health workers’ efforts to assist clients, coupled with feelings that only limited progress is being made, were associated with client-related burnout.
•
This relationship was weaker among workers who identified as having lived experience of mental illness, demonstrating a previously undocumented benefit of lived experience.
•
Client-related burnout was generally associated with more negative workplace attitudes.
Working in the field of mental health can be emotionally taxing, particularly in community mental health service settings, which are often underresourced, with high demands and few support services to assist staff and clients (1). People working in mental health are susceptible to client-related burnout (i.e., physical and psychological exhaustion when working with clients) (2). Although numerous factors are associated with client-related burnout, such as inadequate supervision (3) and severity of clients’ mental illness (4), recent evidence demonstrates that perceptions that clients are not improving also contribute to client-related burnout (5). Given the emotional labor involved in the provision of mental health services, particularly in an underresourced environment, it is no surprise that mental health workers can experience burnout if they perceive that their counseling is not improving their clients’ lives.
Client-related burnout is associated with negative job attitudes, lower job engagement, poorer workplace well-being, and increased intentions to resign (6, 7). Burnout among health care workers may also result in poorer outcomes for clients, including decreased satisfaction with treatment and lower reported quality of care (8, 9), and may be more common in settings where client progress is slow and uneven (10). Because the recovery trajectories for clients dealing with mental health issues is variable and can depend on the severity of their mental health issue and the support available to them (6), it is important to consider factors that might buffer mental health staff from client-related burnout associated with perceptions of limited client progress.
Lived experience with mental illness, which refers to people who have personal experience of mental health challenges and who have used mental health services themselves (11), may play a role in this process. Research has increasingly recognized the importance of peer workers in mental health and drug and alcohol treatment settings (12–14), but few studies have focused specifically on the benefits of lived experience among health care staff in relation to workplace outcomes. Although the literature does not always make clear distinctions, individuals who identify as peer support workers are generally employed in a role that specifically incorporates their work as peers, whereas staff with lived experience are employed first and foremost as health care providers, who may or may not choose to share their history of mental health issues or use it to inform their work with clients (15). This unofficial, yet valuable, source of expertise among those with lived experience is not always acknowledged in clinical services or research (16). Yet staff with lived experience of mental health issues have first-hand experience with their own recovery challenges, as well as with the difficulties in navigating the mental health care environment as consumers. As a consequence, staff with lived experience may be less susceptible to client-related burnout caused by feelings that their help has resulted in little client progress, because they understand that recovery can be slow and uneven.
Therefore, we hypothesized that perceptions that clients are not improving should lead to client-related burnout but that this relationship should be weaker or nonexistent among mental health workers with lived experience. Consistent with previous research (5), client-related burnout should play a mediating role between mental health workers’ perceptions that their clients are not improving and their subsequent job satisfaction, engagement, workplace well-being, and intentions to resign. This mediated relationship, in turn, should be moderated by lived experience (Figure 1).
FIGURE 1. Hypothesized model of the relationship between mental health workers’ perceptions that their clients are not improving and negative workplace outcomesa
aThe relationship between perceptions that clients are not improving and negative workplace outcomes should be mediated by burnout (paths a×b), such that lack of client improvement leads to increased burnout (path a), which in turn leads to negative workplace outcomes (path b). This mediated relationship should vary as a function of lived experience. Specifically, lived experience should buffer staff from burnout when they perceive clients are not improving from treatment (path d). Path c′ shows the direct effect of perceptions of client improvement on each workplace outcome. This figure depicts moderated mediation; client-related burnout should play a mediating role between perceptions of client improvement and workplace outcomes, and this mediated relationship should be moderated by lived experience.
Methods
Participants and Procedure
Participants were employees of a community mental health service organization in Australia who provide direct support to the people accessing their services. Although a diagnosis is not necessary to access support from this organization, its stated mission is to provide services to people who are experiencing severe and persistent mental illness. The participating community mental health organization sent its employees an e-mail containing a weblink to the survey. Employees who clicked on the link were provided information about the study before deciding to continue. Employees were eligible for participation if they indicated that they were over age 18 and provided direct support to the people who access their services. The survey was launched on October 28, 2020, and was open for 3 weeks.
The scales in the survey were presented in a randomized order, with the exception of the demographic questions, which were always at the end of the survey. At the completion of the survey, participants could provide their e-mail address to be included in a prize draw. E-mail addresses were collected in a separate spreadsheet file so that they could not be linked to survey responses. Six respondents were randomly selected to receive a $50AUD gift voucher. The study was approved by the University of New South Wales Ethics Committee (HC200473) and conformed to the ethical standards set out in the 1964 Declaration of Helsinki.
Measures
Client-related burnout was assessed with the six-item subscale from the Copenhagen Burnout Inventory (Cronbach’s α=0.82) (2). The items are designed to tap feelings of physical and psychological exhaustion from working with clients. A sample item is “Does it drain your energy to work with the people who access your services?” Responses are provided on a 5-point scale ranging from never to always, with higher numbers indicating greater client-related burnout.
Job satisfaction was assessed with Brayfield and Rothe’s (17) job satisfaction scale (Cronbach’s α=0.82). A sample item is “Most days I am enthusiastic about my work.” Responses are provided on a 5-point scale (1, strongly disagree, to 5, strongly agree), with higher numbers indicating greater job satisfaction.
Job engagement was assessed with nine items from Rich and colleagues’ (18) Job Engagement Scale (Cronbach’s α=0.90). Sample items include the following: “I devote a lot of energy to my job”; “At work, I am absorbed by my job.” Responses are provided on a 5-point scale ranging from strongly disagree to strongly agree, with higher numbers indicating greater job engagement.
Intentions to resign from the organization and from the profession were assessed with Boroff and Lewin’s (19) two-item scale. Samples from each scale are “I am seriously considering quitting this job for an alternative employer,” and “I am seriously considering quitting the mental health profession.” Both scales showed good reliability (for intentions to quit the organization, r=0.89; for intentions to quit the profession, r=0.80). Responses are provided on a 5-point scale ranging from strongly disagree to strongly agree, with higher numbers indicating greater intentions to resign.
Workplace well-being was assessed with Warr’s (20) 12-item scale (Cronbach’s α=0.93). Participants read, “Thinking of the past two weeks, how much of the time has your job made you feel each of the following,” which is followed by adjectives such as tense, depressed, optimistic, and enthusiastic. Responses are provided on a 6-point scale ranging from 1, never, to 6, all of the time. Items are reverse-coded as necessary, such that higher numbers indicate better workplace well-being.
Employees responded to two items designed to tap the degree to which they perceive their clients to be improving from treatment (“The support I provide enables the people who access our services to live better lives,” and “The support I provide improves the lives of the people who access our services”; r=0.91). Participants responded by using a 5-point scale (1, strongly disagree, to 5, strongly agree), with higher numbers indicating greater perceived improvement among their clients.
At the completion of the survey, participants indicated their age, gender, tenure working in the mental health sector and in the organization, and their role in the workplace. Finally, participants were asked, “Do you identify as someone who has lived experience with mental health issues?” (yes or no). Participants who responded yes received a follow-up question asking, “Over the course of your life, how much has your personal experience of mental health issues affected your life?” Respondents answered on a scale ranging from 0, not at all, to 10, greatly affected.
Analysis Plan
Moderated mediated regression analyses were conducted using SPSS, version 26, and model 7 of the PROCESS macro (21). The basic goal of moderated mediation is to test the influence of a moderator variable (i.e., lived experience) on a proposed mediated relationship (i.e., beliefs that clients are not improving leads to burnout, and greater burnout leads to more negative workplace outcomes). This causal chain (lack of client improvement to burnout to workplace outcomes) was predicted to differ between staff with and without lived experience: moderated mediation. Our moderated mediation analyses tested whether lived experience buffers staff from the burnout experienced when they perceive that their clients are not improving from treatment and also tested whether client-related burnout plays a mediating role between mental health workers’ perceptions that their clients are not improving and their subsequent job satisfaction, engagement, workplace well-being, and intentions to resign (Figure 1).
Results
Preliminary Analyses
The sample comprised 179 employees (45 men, 131 women, one nonbinary individual, and two who preferred not to say) who completed the online survey, a response rate of approximately 23%. With regard to age, 39 participants were under age 30, 50 were ages 30 to 39, 33 were ages 40 to 49, 45 were ages 50 to 59, and 12 were age 60 or older. The mean±SD number of years that respondents had worked in the mental health field was 5.92±5.99 (range 1 month to 37 years). Respondents’ average tenure working for their current employer was 3.65±3.51 years (range 1 month to 18 years).
Among the 179 respondents, 112 identified as having lived experience with mental health issues, and 67 did not. Lived experience did not differ as a function of education level. On average, participants with lived experience indicated that their mental health issues had affected their lives in meaningful ways (mean±SD score=7.13±1.99, on a scale ranging from 0, not at all, to 10, greatly affected).
On average, respondents felt that their clients were improving from treatment (Table 1), although there was considerable variability in this belief, with responses ranging across the full scale. Perceptions of client improvement were unrelated to the demographic variables. Specifically, no differences were noted in ratings of client improvement between staff with and without lived experience (mean±SD=4.40±0.77 versus 4.32±0.70). The relationship between tenure and perceptions of client improvement was not significant, suggesting that beliefs about client improvement were not affected by how long someone had worked at the organization (r=0.09, p=0.234) or in the mental health field (r=0.071, p=0.344). Degree of burnout also did not vary as a function of lived experience (r=–0.11, p=0.153). Table 1 presents the means, standard deviations, and intercorrelations between the study variables. To the degree that staff perceived their clients were not improving from treatment, they reported lower job satisfaction, poorer workplace well-being, greater intentions to quit the organization and profession, and higher client-related burnout.
| Score | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Variable | 1 | 2 | 3 | 4 | 5 | 6 | 7 | M | SD |
| 1. Perception that clients are not improvinga | — | 4.37 | .74 | ||||||
| 2. Client-related burnoutb | .37*** | — | 3.80 | .64 | |||||
| 3. Job satisfactionc | .30*** | .48*** | — | 3.96 | .67 | ||||
| 4. Job engagementd | .48*** | .40*** | .53*** | — | 4.13 | .60 | |||
| 5. Workplace well-beinge | .26*** | .40*** | .74*** | .36*** | — | 4.26 | .91 | ||
| 6. Intentions to resign (organization)f | –.15* | –.26** | –.60*** | –.29*** | –.60*** | — | 2.39 | 1.17 | |
| 7. Intentions to resign (profession)f | –.23** | –.40*** | –.60*** | –.34*** | –.48*** | .63*** | — | 1.91 | .96 |
| 8. Lived experience (yes or no)g | –.05 | –.11 | –.17* | –.18* | –.21** | .15† | .18* | ||
a
Measured on a 5-point scale (1, strongly disagree, to 5, strongly agree), with higher scores indicating greater perceived improvement.
b
Measured with the six-item subscale from the Copenhagen Burnout Inventory (2). Possible scores range from 1, never, to 5, always, with higher scores indicating greater client-related burnout.
c
Measured with Brayfield and Rothe’s (17) job satisfaction scale. Possible scores range from 1, strongly disagree, to 5, strongly agree, with higher scores indicating greater job satisfaction.
d
Measured with Rich and colleagues’ (18) Job Engagement Scale. Possible scores range from 1, strongly disagree, to 5, strongly agree, with higher scores indicating greater job engagement.
e
Measured with Warr’s (20) 12-item scale. Possible scores range from 1, never, to 6, all of the time, with higher scores indicating better workplace well-being.
f
Measured with Boroff and Lewin’s (19) two-item scale. Possible scores range from 1, strongly disagree, to 5, strongly agree, with higher scores indicating greater intentions to resign.
g
Point-biserial correlation was used for all analyses with lived experience (1, yes; 2, no).
*
p<.05, **p<.01, ***p<.001.
†
p=.05.
Moderated Mediation Analyses
Model 7 of the PROCESS macro (21) with 5,000 bootstrapped resamples was used to test the model presented in Figure 1. The results of this model are presented in Table 2. Perceptions that clients were not improving were associated with more burnout (Table 2, column a). Importantly, as can be seen in column d, the relationship between client improvement and burnout (Figure 1, path a) was moderated by lived experience (Figure 1, path d). This interaction was decomposed by examining the relationship between client improvement and burnout separately for staff with and without lived experience. These follow-up analyses revealed that the relationship between client improvement and client-related burnout was significantly weaker among staff with lived experience (b=0.175, p=0.017), suggesting that they were less susceptible to the burnout caused by perceptions that clients were not improving, compared with those without lived experience (b=0.591, p<0.001). In summary, when staff believed that their clients were not improving, staff with lived experience reported lower burnout, compared with staff without lived experience.
| a | b | c′ | a×b | d | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Perceptions of lack of client improvement to burnout | Burnout to outcome | Perceptions of lack of client improvement | Indirect effect (test of mediation) | Index of moderated mediation | ||||||
| Variable | Coeff. | 95% CI | Coeff. | 95% CI | Coeff. | 95% CI | Coeff. | 95% CI | Coeff. | 95% CI |
| Lived experience | ||||||||||
| Job satisfaction | .18* | .03, .32 | .45* | .25, .65 | .10 | –.05, .25 | .08* | .02, .17 | .19* | .05, .31 |
| Job engagement | .18* | .03, .32 | .19* | .02, .37 | .23* | .09, .37 | .03* | .01, .08 | .10* | .03, .19 |
| Workplace well-being | .18* | .03, .32 | .63* | .38, .89 | .20 | –.00, .40 | .11* | .03, .22 | .21* | .06, .36 |
| Intentions to resign (organization) | .18* | .03, .32 | –.57* | –.93, .22 | –.03 | –.31, .25 | –.10* | –.22, –.02 | –.18* | –.37, –.03 |
| Intentions to resign (profession) | .18* | .03, .32 | –.67* | –.95, –.39 | –.04 | –.26, .17 | –.12* | –.25, –.04 | –.23* | –.41, –.06 |
| No lived experience | ||||||||||
| Job satisfaction | .59* | .39, .79 | .41* | .18, .64 | .18 | –.05, .41 | .24* | .09, .44 | .19* | .05, .31 |
| Job engagement | .59* | .39, .79 | .19* | .00, .37 | .51* | .33, .70 | .11* | .01, .23 | .10* | .03, .19 |
| Workplace well-being | .59* | .39, .79 | .31 | –.07, .69 | .11 | –.27, .49 | .18 | –.09, .45 | .21* | .06, .36 |
| Intentions to resign (organization) | .59* | .39, .79 | –.08 | –.59, .43 | –.36 | –.87, .15 | –.05 | –.49, .28 | –.18* | –.37, –.03 |
| Intentions to resign (profession) | .59* | .39, .79 | –.26 | –.64, .12 | –.36 | –.75, .02 | –.15 | –.40, .08 | –.23* | –.41, –.06 |
a
Column labels a, b, c′, and d correspond to path labels in Figure 1. Path a shows the effect of perceptions that clients were not improving on burnout. Path b shows the effect of burnout on each of the workplace outcome variables. Path c′ shows the direct effect of perceptions of client improvement on each workplace outcome. Column a×b shows the indirect effect of perceptions of client improvement on workplace outcomes via burnout. Column d indicates whether the mediated relationship varies as a function of lived experience (moderator variable). Coeff., unstandardized coefficients; 95% CI based on 5,000 bootstrap samples. Separate models were run for each outcome variable.
*
Significant effect.
We also examined whether beliefs that clients are not improving influenced workplace outcomes directly (path c′) and indirectly through burnout (column a*b). That is, does client-related burnout mediate the relationship between perceived lack of client improvement and workplace outcomes, and, importantly, does this mediated relationship differ as a function of lived experience? Results indicated that the mediated relationship between client improvement and the outcome variables via client-related burnout differed significantly as a function of lived experience for all the outcome variables (Table 2, column d). Nonetheless, the pattern of these moderated mediated relationships was not uniform across the outcome variables. Among staff with lived experience, burnout was associated with poorer workplace well-being and increased intentions to quit the job and profession. As can be seen in Table 2, burnout was not associated with these workplace outcomes among staff without lived experience. In contrast, burnout was associated with lower job satisfaction and job engagement for both groups of staff.
Finally, we compared the hypothesized model depicted in Figure 1 to all other viable competing models to assess whether the causal direction we propose better fits the data than do alternative causal models. For example, we examined whether more negative organizational outcomes (i.e., job satisfaction, job engagement, workplace well-being, and intentions to quit) might lead employees to experience client-related burnout, which in turn affects perceptions of client improvement. Across the 12 alternative models, only job engagement showed significant moderated mediation (further details are provided in an online supplement to this article). Thus these additional analyses suggest that none of the alternative models fit the data as well as did the hypothesized model.
Discussion
Given the emotional demands of working in community mental health, staff being susceptible to client-related burnout is not surprising. Building on previous research demonstrating that perceptions that clients are not improving are associated with client-related burnout (5), we found that lived experience of mental health issues buffered health care workers against client-related burnout. Health care workers with lived experience also reported more positive job attitudes, compared with those without lived experience.
In light of the buffering role that lived experience appeared to play in reducing burnout associated with perceptions that clients were not improving, future research should uncover why lived experience is beneficial. For example, do staff with lived experience differ in their recovery beliefs, compared with staff without lived experience? Lived experience provides staff with first-hand knowledge about the path to recovery, and thus they may be more likely to recognize the nonlinear path that recovery can take (22). If differences in recovery beliefs help explain the buffering role of lived experience, interventions outlining the nonlinearity of recovery may help reduce burnout that is caused by feeling unable to help clients. Alternatively (or additionally), having dealt with the challenges of recovery personally, staff with lived experience may be more empathic toward their clients, and this increased empathy may make them less susceptible to client-related burnout when they perceive that their clients are not improving. Uncovering the mechanisms by which lived experience buffers staff from client-related burnout can aid the development of interventions to boost resilience and ultimately workplace longevity among mental health employees.
Although not directly relevant to our findings, future research might also examine whether (and when) staff with lived experience disclose this information to their clients and if so, whether this disclosure is beneficial. Research suggests that lived experience can inform how mental health workers engage with and understand clients and can increase credibility and rapport with them (23, 24). Having successfully navigated the challenges of their own mental health, employees with lived experience may be examples to clients that successful recovery can be achieved over time. Additionally, workers with lived experience may have a more deep-seated optimism in their clients’ long-term prognosis, which may ultimately enhance their clients’ recovery. Future research should explore whether client outcomes vary as a function of whether their mental health providers have lived experience.
As with any research, limitations should be considered when interpreting the findings. First, because of the cross-sectional design, causality is unclear. For example, health care workers who had more negative job attitudes may simply have been less likely to recognize improvement in their clients. This possibility seems unlikely, however, because mental health staff with lived experience had more positive job attitudes, yet their perceptions of client improvement did not differ from those of staff without lived experience. Nonetheless, reverse causal models were run to determine whether any models fit the data better than the proposed model. The results demonstrated that alternative models were statistically less plausible, but experimental or longitudinal research is necessary to address concerns about causality.
Second, because of our exclusive reliance on self-report measures, the results are susceptible to problems of common method variance, which can inflate interrelationships between variables. To address this concern, we followed recommendations to create methodological separation (25). For example, predictor, moderator, and mediator variables were all assessed on different response scales. We also presented the different types of measures on separate survey pages. Finally, the amount of identifiable information collected was minimized to reduce common method variance that can arise from social desirability concerns (25). Despite these proactive steps, future research should use a multimethod approach where possible. For example, a longitudinal design incorporating more objective measures of client improvement would eliminate concerns about the causal direction of the proposed model and common method variance.
Third, the number of health workers in this sample who reported a history of lived experience of mental health issues was almost double the number who reported no lived experience. This discrepancy may be a by-product of self-selection into the survey (particularly in the context of a 23% response rate), but a history of mental health issues appears to draw people to work in the mental health sector (26). Thus, although it is unclear how representative these samples of individuals with and without lived experience are of the field of community mental health, the pattern of relationships appears to be robust. Finally, although not a limitation per se, the finding that client-related burnout was not consistently associated with more negative workplace outcomes among employees without lived experience was unexpected. We have no explanation for this uneven pattern of results, but we suggest that it is worth reexamining in future research.
Conclusions
This study provided evidence that long-term efforts to assist clients, coupled with feelings that only limited progress is being made, were associated with client-related burnout. Nonetheless, this relationship was weaker among staff who identified as having lived experience, demonstrating a previously undocumented benefit of lived experience. Given the high rates of burnout in the mental health profession, future research should explore why lived experience protects staff from client-related burnout. This information can aid in the development of interventions to boost worker resilience, engagement, and longevity in the field.
Acknowledgments
The authors are grateful to the community mental health organization for its participation in this research. They also thank members of the Community Research Advisory Committee for their advice on the project.
Supplementary Material
File (appi.ps.202100468.ds001.pdf)
- View/Download
- 124.48 KB
References
1.
Green AE, Albanese BJ, Shapiro NM, et al: The roles of individual and organizational factors in burnout among community-based mental health service providers. Psychol Serv 2014; 11:41–49
2.
Kristensen TS, Borritz M, Villadsen E, et al: The Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work Stress 2005; 19:192–207
3.
Livni D, Crowe TP, Gonsalvez CJ: Effects of supervision modality and intensity on alliance and outcomes for the supervisee. Rehabil Psychol 2012; 57:178–186
4.
Ballenger-Browning KK, Schmitz KJ, Rothacker JA, et al: Predictors of burnout among military mental health providers. Mil Med 2011; 176:253–260
5.
von Hippel C, Brener L, Rose G, et al: Perceived inability to help is associated with client-related burnout and negative work outcomes among community mental health workers. Health Soc Care Community 2019; 27:1507–1514
6.
Green AE, Miller EA, Aarons GA: Transformational leadership moderates the relationship between emotional exhaustion and turnover intention among community mental health providers. Community Ment Health J 2013; 49:373–379
7.
Prosser D, Johnson S, Kuipers E, et al: Perceived sources of work stress and satisfaction among hospital and community mental health staff, and their relation to mental health, burnout and job satisfaction. J Psychosom Res 1997; 43:51–59
8.
Garman AN, Corrigan PW, Morris S: Staff burnout and patient satisfaction: evidence of relationships at the care unit level. J Occup Health Psychol 2002; 7:235–241
9.
Salyers MP, Fukui S, Rollins AL, et al: Burnout and self-reported quality of care in community mental health. Adm Policy Ment Health Ment Health Serv Res 2015; 42:61–69
10.
Salyers MP, Brennan M, Kean J: Provider Expectations for Recovery Scale: refining a measure of provider attitudes. Psychiatr Rehabil J 2013; 36:153–159
11.
Jones N, Niu G, Thomas M, et al: Peer specialists in community mental health: ongoing challenges of inclusion. Psychiatr Serv 2019; 70:1172–1175
12.
Mancini MA: An exploration of factors that affect the implementation of peer support services in community mental health settings. Community Ment Health J 2018; 54:127–137
13.
Shalaby RAH, Agyapong VIO: Peer support in mental health: literature review. JMIR Ment Health 2020; 7:e15572
14.
Storm M, Fortuna KL, Brooks JM, et al: Peer support in coordination of physical health and mental health services for people with lived experience of a serious mental illness. Front Psychiatry 2020; 11:365
15.
Chapman J, Roche AM, Kostadinov V, et al: Lived experience: characteristics of workers in alcohol and other drug nongovernment organizations. Contemp Drug Probl 2019; 47:63–77
16.
Goldberg M, Hadas-Lidor N, Karnieli-Miller O: From patient to therapatient: social work students coping with mental illness. Qual Health Res 2015; 25:887–898
17.
Brayfield AH, Rothe HF: An index of job satisfaction. J Appl Psychol 1951; 35:307–311
18.
Rich B, LePine J, Crawford E: Job engagement: antecedents and effects on job performance. Acad Manage J 2010; 53:617–635
19.
Boroff KE, Lewin D: Loyalty, voice, and intent to exit a union firm: a conceptual and empirical analysis. Ind Labor Relat Rev 1997; 51:50–63
20.
Warr P: The measurement of well-being and other aspects of mental health. J Occup Psychol 1990; 63:193–210
21.
Hayes A: Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, Guilford, 2018
22.
Bedregal LE, O’Connell M, Davidson L: The Recovery Knowledge Inventory: assessment of mental health staff knowledge and attitudes about recovery. Psychiatr Rehabil J 2006; 30:96–103
23.
Sells D, Davidson L, Jewell C, et al: The treatment relationship in peer-based and regular case management for clients with severe mental illness. Psychiatr Serv 2006; 57:1179–1184
24.
Reingle Gonzalez JM, Rana RE, Jetelina KK, et al: The value of lived experience with the criminal justice system: a qualitative study of peer re-entry specialists. Int J Offender Ther Comp Criminol 2019; 63:1861–1875
25.
Podsakoff PM, MacKenzie SB, Lee J-Y, et al: Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol 2003; 88:879–903
26.
Farooq K, Lydall GJ, Malik A, et al: Why medical students choose psychiatry—a 20 country cross-sectional survey. BMC Med Educ 2014; 14:12
Information & Authors
Information
Published In
History
Received: 6 August 2021
Revision received: 13 October 2021
Accepted: 6 December 2021
Published online: 16 March 2022
Published in print: September 01, 2022
Keywords
Authors
Funding Information
This research was funded by linkage grant LP120200417 from the Australian Research Council.The authors report no financial relationships with commercial interests.
Metrics & Citations
Metrics
Citations
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
View Options
View options
PDF/EPUB
View PDF/EPUBLogin options
Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.
Personal login Institutional Login Open Athens loginNot a subscriber?
PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.
Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).