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Running head: IMPACT OF WORKPLACE ENVIRONMENT
Impact of Workplace Environment on Peer and Non-Peer Mental Health Providers
Thomas L. Fisher
Shippensburg University of Pennsylvania
Thesis Committee:
Kim Weikel, Committee Chair
Kathryn Potoczak, Committee Member
Steven Haase, Committee Member
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Abstract
Job-related burnout, a three-dimensional experience involving emotional exhaustion,
depersonalization, and reduced personal accomplishment is found to be common among those in
the mental health field due to the nature and gravity of their work. With a growing focus on
recovery-oriented care, many mental health agencies are increasing their employment of peerproviders. Peer providers are mental health workers with diagnosed mental illness who actively
and intentionally use their personal experience with mental illness to help their clients. These
workers may be prone to the experience of microaggressions and stigma related to mental illness
in the workplace. The Maslach Burnout Inventory (MBI) and Areas of Worklife Survey (AWS)
were completed by mental health workers serving four counties in Pennsylvania. Among peerworkers, there were significant associations between levels of burnout and both sense of
community and sense of control as measured by the community and control subscales of the
AWS. These associations were not found among non-peer providers.
Keywords: burnout, peer-providers, workplace environment, community
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Impact of Workplace Environment on Peer and Non-Peer Mental Health Providers
For a great deal of time, the importance of physical and mental health of workers has
been underestimated and overlooked by employers. As job demands continue to grow, there is an
enhanced opportunity for the experience of stress to occur. With this additional stress comes a
greater likelihood of negative impacts on the general well-being of employees. While this
phenomenon can likely be observed in any sector of the workforce, it is especially apparent in
fields where there is frequent contact with consumers (Maslach & Leiter, 2016). The mental
health field is one where this is especially true as workers often have frequent and direct contact
with those seeking services. Sustained exposure to and a maladaptive response to workplace
stress can lead to a psychological condition referred to as burnout.
Definitions and Measurement of Burnout
As evidence of the importance of employee well-being continues to grow, there has been
an increased focus on identifying and responding to burnout among mental health workers.
Because of this, much research has been conducted to define the experience of burnout precisely.
Freudenberger (1974) was the first individual to utilize the term burnout. He defined burnout as a
two-dimensional experience that was characterized by a sense of failure by the employee and a
general worn out feeling. Pines and Aronson (1981) highlighted a sense of exhaustion as being a
defining characteristic of burnout. According to their research, the exhaustion was
multidimensional and was experienced in the physical, mental and emotional realms. Sarros and
Densten (1989) focused on the experience of stress in their definition of burnout as well as the
concept that the experience of burnout can be brought on by work that provides too little rigor or
brings little recognition to the employee.
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Due to the numerous variations in definitions of the experiences that constitute burnout
described above, it is not surprising that there are several measures that have been used in recent
research to identify burnout in employees. In general, measures can be divided into two
categories: Measures that conceptualize burnout in a multidimensional fashion and measures that
solely focus on the idea of exhaustion as being the key factor of burnout (Maslach & Leiter,
2016). The Bergen Burnout Inventory (BBI) is one such of example of a measure utilized to
assess burnout. This inventory takes a multidimensional approach and incorporates the concepts
of exhaustion at work, a negative outlook on the purpose of work and a feeling of insufficiency
in the workplace (Feldt, Rantanen, Hyvonen et al., 2014). In contrast, the Shirom-Melamed
Burnout Measure (SMBM) and the Copenhagen Burnout Inventory (CBI) measure the
experience of burnout only in terms of the feeling of exhaustion, with some distinctions made
between physical and emotional exhaustion (Shirom & Melamed, 2006; Kristensen, T.S. et al.,
2005).
While all of the above measures have proven useful in identifying the experience of
burnout, the most common measure for assessing burnout is the Maslach Burnout Inventory
(MBI) (Maslach & Leiter, 2016). With the MBI being the standard measure used for conducting
burnout research, it follows that the conceptualization of burnout established by this model is the
most widely accepted (Maslach & Leiter, 2016). The MBI established job-related burnout as a
three-dimensional experience involving emotional exhaustion, depersonalization, and reduced
personal accomplishment (Maslach, Jackson, & Leiter, 2016). The MBI and the accompanying
definition of burnout which were originally developed in English have since been translated to
several other languages while still maintaining validity (Maslach & Leiter, 2016).
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The first dimension of burnout in the MBI is emotional exhaustion. Emotional exhaustion
is often considered the most detrimental dimension of burnout in terms of employee well-being
and job performance. Maslach and Jackson (1981) characterized this facet of burnout as an
experience where workers, specifically mental health workers, no longer feel they have the
psychological resources regularly utilized to offer services to their clients. Due to the close
psychological connection that mental health providers often form with their clients, it is clear
why the experience of emotional exhaustion can be particularly troubling, both in terms of the
well-being of the mental health providers and those seeking mental health services.
Depersonalization is the second defining characteristic of the experience of burnout.
Maslach and Jackson’s (1981) research suggests that the experience of depersonalization may be
connected to emotional exhaustion. Generally, depersonalization can be described as involving
attitudes towards clients that do not align with the goals of the mental health field, a heightened
and unmanaged sense of irritability, and a general disengagement from the services being
provided to clients (Maslach & Leiter, 2016). Additionally, providers experiencing
depersonalization may come to have an outlook that supports the concept that clients are
deserving of the troubles that have caused them to seek mental health services (Maslach &
Jackson, 1981). This construct has been broadened in the subsequent general form of the MBI
and is referred to as cynicism in order to address burnout in occupations that fall outside of the
social services field.
The final construct of the MBI centers around the feeling of personal accomplishment an
employee reports. If an employee is experiencing burnout, they are more likely to evaluate their
workplace performance as being unsatisfactory (Maslach & Jackson, 1981). This is often
accompanied by a new sense of an inability to perform tasks associated with providing mental
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health services to clients (Maslach & Leiter, 2016). Low morale and an inability to cope are also
measured under the personal accomplishment construct.
Emotional exhaustion, depersonalization and reduced sense of personal accomplishment
are the commonly accepted aspects of burnout as measured by the MBI. Given this definition, it
becomes clear that evaluations of self and others are the primary context in which burnout is
conceptualized and there is ongoing research investigating the predictors of workers’ selfevaluation of burnout (Maslach & Leiter, 2016). Removed from the context of the environment,
the ways in which one evaluates themselves most likely varies from person to person. This can
be a result of lived experiences, general outlook or various other factors. One of these differences
in self-evaluation and assessment may result from employees that have specific lived experience
relating to mental illness.
Burnout Among Mental Health Workers
In general, burnout has been researched in the context of professions that are people
oriented. This would include examining burnout among teachers, health care workers, human
services providers and other occupations that are similar to these in regards to the amount of
consumer contact involved (Maslach & Leiter, 2016). Research findings suggest burnout rates
tend to be greater among mental health and healthcare professionals than in the general
workforce (Maslach & Leiter, 2016). With burnout comes lowered productivity and a decrease in
the general quality of services provided, which is particularly troubling given the importance of
the work being done by these professionals (Maslach & Leiter, 2016). In addition, these
professionals often suffer from a reduction in overall wellbeing (Maslach & Leiter, 2016).
Among mental health professionals, consequences of burnout include increased rates of
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substance use, lower quality of work, low quality ratings by consumers, and an increase in
unplanned absences (Park, Chang, Mueller, Resnick & Eisen, 2016; Johnson et al., 2018).
Peer-Providers in the Mental Health Field
Mental health agencies are more commonly orienting themselves towards the concept of
recovery which involves focusing on collaboration, the development of a hopeful and optimistic
outlook, the promotion of autonomy in the decision-making process, and the deliberate emphasis
on the particular strengths an individual brings to the community (Chinman et al., 2017). Mental
health services that are recovery oriented highlight the importance of peer relationships between
those with mental illness. In order to fully embody recovery orientation, mental health
organizations are beginning to employ peer providers. Peer providers are mental health workers
with diagnosed mental illness who actively and intentionally use their personal experience with
mental illness to help their peers (Chinman et al. 2017; Mowbray et al. 1996). It is believed that
through the use of their lived experiences relating to mental illness, peer providers are able to
connect on a deeper level with their clients (Moran, Russinova, Gidugu, & Gagne, 2012).
The value of peer providers goes much further beyond simply assisting in establishing a
deeper bond with clients. Peer providers, because of their lived experience, have the ability to
show a greater sense of empathy with their clients (Mowbray et al., 1996; Salzer, 2010). Insight
into the workings of mental health services from the client perspective is also brought to the
provider-client relationship by peer workers (Paulson et al., 1999). Finally, peer providers can
bring valuable opportunities for professional development to organizations. By helping their nonpeer provider counterparts understand on a more personal level the client perspective, peer
workers can help to reduce the stigma that exists around mental illness, even in mental health
organizations (Dixon et al., 1997; Solomon, 2004). While the lived experience of peer providers
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brings a wealth of value to the mental health field, the emotional strain that can accompany
serious mental illness has caused some in the field to question whether the peer provider position
is a viable position. Specifically, some have raised concerns that peer workers may be more
likely to experience burnout as a result of their peer status.
Workers experiencing burnout are prone to negative impacts in work and personal life,
providing cause to investigate factors contributing to burnout (Morse, Salyers, Rollins, MonroeDevita, & Pfahler, 2011). Park, Chang, Mueller, Resnick, and Eisen (2016) began the
investigatory work of determining whether there are differences in burnout rates among peer and
non-peer providers. Their study utilized peer support specialists working at health care systems
within the Veterans Health Administration. Park et al. (2016) found no differences in the rates of
burnout among peer providers and other providers of mental health services. Their findings
suggest that concerns raised about peer providers may not actually play out in the field.
The Veterans Health Administration system offers a vast array of services with resources
that are often greater in number compared to smaller organizations that offer mental health
services. Because of this, it is necessary to compare rates of burnout among peer and non-peer
workers within smaller organizations to determine whether the results of the Park et al. (2016)
study will generalize to smaller community mental health settings. Scheetz, McQuaid, Bennett,
& Weikel (2017) worked to investigate this comparison and sampled peer and non-peer mental
health providers in a rural county in Pennsylvania. The findings of Scheetz et al. (2017), like the
study by Park et al. (2016), suggest there is no need for concern that peer providers will
experience greater levels of burnout than their non-peer counterparts. Scheetz et al. (2017)
actually found that the peer providers in their study experienced lower rates of emotional
exhaustion and depersonalization when compared to their non-peer counterparts. However, it is
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important to note that this study had a small sample size and needs to be replicated (Scheetz et
al., 2017). Although findings to date suggest that peer providers are not more likely than other
providers to experience burnout, it is possible that there may be differences in the predictors of
burnout between the two types of providers.
Worklife Predictors of Burnout
Leiter and Maslach (2000) argue that work atmosphere is an important predictor of
burnout, and they developed the Areas of Work Life Scale (AWS) to measure congruency
between employees’ work lives and their personal expectations regarding their work experience
(Leiter & Maslach, 2000). The AWS works to establish the notion that burnout is more than
simply workplace stress. It accomplishes this by utilizing a model that assesses the ongoing and
evolving relationship between a person and their workplace (Leiter & Maslach, 2011). There are
six domains under the AWS that were developed based upon previous common correlational
comparisons between work environment and burnout. These six areas are: Workload, control,
reward, community, fairness, and values (Leiter & Maslach, 1999).
Some of the domains established by the Areas of Worklife Survey are more heavily
studied than others. The most discussed is the domain of workload (Leiter & Maslach, 2011).
This domain is reflective of the current trend in the amount of work employees are required to
complete with less time and fewer resources. Leiter and Maslach (2011) suggest that it is not
simply the occurrence of this trend that leads to the experience of burnout. Rather it is the
prolonged exposure to increased job demands without a period of recovery to allow the
employee to rest and reset. This experience would result in low scores on the domain of
workload on the AWS, representing a poor match between an employee and the work
environment they are in. In contrast, a manageable workload that allows for the development of
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skills and personal growth within one’s occupation would result in higher scores on the domain
of workload (Leiter & Maslach, 2011).
Control represents the second domain of the Areas of Worklife Survey. Control
encapsulates the degree to which an employee feels they have the ability to influence decisions
that have an impact on the work that they are engaging in (Leiter & Maslach, 2011). There are
several possible sources of a reduced sense of control in the workplace. One of these sources is
role conflict. Role conflict results when there are conflicting expectations within the same
position and can represent an authority issue within an organization (Leiter & Maslach, 2011).
This conflict has the ability to prevent progress in the workplace, and thus, adds to the
experience of burnout. Role ambiguity can be a second contributing factor to a lack of sense of
control in the workplace. When employees are unsure exactly what the expectations are within
their position, they are unable to establish what they should strive to accomplish (Leiter &
Maslach, 2011).
The third domain of the AWS examines the congruency between an employee’s
expectations of the rewards they will receive at work and the actual rewards they are able to earn.
Employees often have the expectation that when they complete work in a satisfactory way, they
will be recognized for their efforts (Leiter & Maslach, 2011). The source of the recognition and
reward can come from colleagues, management, or those outside of the organization that have a
vested interest in the work being completed. When this recognition and reward is absent, there is
a greater opportunity for a feeling of disconnect from the work being completed (Leiter &
Maslach, 2011).
The fourth dimension of the AWS centers around the organizational decision making
process. Specifically, how an employee perceives the basis for decisions made within the
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workplace can be a predictor of the experience of burnout (Leiter & Maslach, 2011). The
evaluation of the decision-making process is categorized under the domain of fairness.
Employees are less likely to experience burnout if there is the perception that decisions within
the workplace are fair and represent a sense of equality where it is deserved.
The final two domains of the Areas of Worklife Survey are the most central to the
proposed study. These are the domains of community and values. The community domain
considers the interpersonal relationships that exist in the workplace (Leiter & Maslach, 2011).
This includes an examination of how conflict is mediated, the sense of teamwork that exists, the
existence of supporting relationships, and how close employees feel to one another (Leiter &
Maslach, 2011). Employees are less likely to experience burnout if there is a strong sense of
community among members of an organization. Without a sense of community, employees often
feel isolated in their work.
Values is the second domain of the AWS that will be emphasized for this study. The
values domain examines the match between the ideals of an employee and their workplace
(Leiter & Maslach, 2011). A strong match between the values of an employee and the
organization in which they work provides the opportunity to advance both personal and
organizational goals that align with one another at the same time. When there is poor congruency
between an employee’s values and the values of their workplace, the employee may find
themselves in situations that require them to violate their personal values in order to meet the
expectations of their position. This leads to a strong desire to become disengaged from the work
being completed and can contribute to the experience of burnout (Leiter & Maslach, 2011).
Worklife Experience of Peer Providers
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Unfortunately, due to the prior poor treatment of those with mental illness, it is
undeniable that stigma regarding mental illness exists within the United States. This stigma often
can take one of two forms. The first form being overt stigma that consists of the obvious and
outward display of degrading attitudes towards those with mental illness (Firmin, Mao, Bellamy,
& Davidson, 2018). The second form that is possibly more difficult to address, is the use of
microaggressions. Microaggressions can be defined as, “brief, everyday exchanges that send
denigrating messages to certain individuals because of their group membership” (Sue, 2010, p.
xvi). For peer providers, it is their group membership relating to their lived experience of mental
illness and treatment that can leave them vulnerable within the workplace to the experience of
stigma and microaggressions.
Firmin, Mao, Bellamy, and Davidson (2018) found that among a sample of 65 peer
support specialists, 78 percent had experienced microaggressions within the workplace at least
once related to their peer support status, and 38 percent reported experiencing microaggressions
at least once a day. In addition, to these experiences of microaggressions, peer workers reported
experiencing overt forms of prejudice relating to their peer status. Peers reported, “Hearing
clinicians joke about recovery oriented language and people making jokes about [them] being a
‘patient’” (Firmin et al., 2018, p. 1543). Similarly, interviews with peer providers have found
them to report poor treatment in the workplace (Mancini & Lawson, 2009), with more than half
reporting experiences of direct and indirect expressions of prejudice relating to their peer
provider status (Moran et al., 2013).
Based upon the evidence presented in the studies above, it is clear that peer workers are
vulnerable to a form of prejudice and discrimination that their non-peer counterparts are not.
That experience of prejudice could contribute to burnout among peer workers. It is hypothesized
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that scores on the AWS subscale measuring sense of Community will be the strongest predictor
of emotional exhaustion among peer mental health workers. In addition, given that burnout rates
are lower among mental health workers in settings that are recovery-oriented (Kraus & Stein,
2013), but that some peers find themselves in settings that seem to lack a recovery-oriented
philosophy (Moran, Russinova, Gidugu, & Gagne, 2013), it is also hypothesized that the
association between burnout and person-work values discrepancies (AWS Values subscale) will
be stronger among peer providers than among non-peer workers.
Hypotheses
1) There will be no difference in emotional exhaustion between peer and non-peer mental health
workers.
2) The association between the Community subscale of the AWS and emotional exhaustion, as
measured by the MBI, will be stronger among peer workers than non-peer mental health
providers. This association among peer providers will also be the most significant association of
the six subscales of the AWS for this group.
3) The association between the Values subscale of the AWS and emotional exhaustion will be
stronger among peer providers than non-peer workers.
4) The Workload subscale of the AWS will be the subscale most strongly associated with
emotional exhaustion in non-peer mental health providers.
Method
Participants
Eighty-two percent of the workers were female and 90% were White. The number of
years of experience working in the mental health field ranged from 1 to 35 years for the peer
providers and less than six months to 45 years for the non-peer providers.
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Measures
Burnout
Burnout rates among peer and non-peer providers was measured using the Maslach
Burnout Inventory (MBI). The MBI measures burnout in terms of three dimensions: Emotional
exhaustion, depersonalization, and sense of personal accomplishment. The MBI is considered the
gold standard measure for assessing burnout. The MBI is useful because it provides national
average burnout rates that can be used to make comparisons between the sample of providers in
this study and national norms. The reliability estimates for the emotional exhaustion subscale of
the MBI average in the high 0.80s. The depersonalization and the personal accomplishment
subscales both have reliability estimates that average in the mid 0.70s (Maslach, Jackson &
Leiter, 2017).
Person-Job Congruency
Person-Job congruency was measured utilizing the Areas of Worklife Survey (AWS).
The AWS contains six subscales: Workload, control, reward, community, fairness, and values.
There are a total of 28 items on the full AWS (see appendix). Test-retest correlations were
conducted to establish the reliability of the AWS. The correlations ranged from 0.51 to 0.62. The
correlation values for workload, control, reward, community, fairness, and values were 0.62,
0.54, 0.51, 0.53, 0.59, and 0.56 respectively (Leiter & Maslach, 2011). Correlations between
each AWS subscale and subscale-related complaints from over 1000 hospital employees
indicates subscale validity (Leiter & Maslach, 2011).
Procedure
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The current study is a part of a larger project to assess mental health workplace wellbeing in four rural counties in Pennsylvania. As a part of the larger project, surveys containing
the MBI and AWS were sent to participating mental health agencies online utilizing Survey
Monkey. Following data collection, bivariate correlations were assessed between the three
subscales of the MBI and the six AWS subscales. Separate bivariate correlations were calculated
for the peer and non-peer providers. Specific attention was given to the Community and Values
subscales of the AWS to test the hypotheses that have been made. Fisher’s r to Z transformations
were completed in order to test for the significance between the differences in correlations.
Results
Consistent with the first hypothesis, there was no statistically significant difference in
emotional exhaustion between the peer (M=19.13, SD=11.98) and non-peer workers (M=20.74,
SD=11.40), t(64)= -.543, p=.589 (see Table 1). Similarly, the AWS includes six subscales
measuring different types of person-job congruence (Workload, Control, Reward, Community,
Fairness, and Values). Independent samples t-tests indicated no significant differences between
the peer and non-peer workers on any of those subscales, p >.10 (see Table 2).
With regard to the second hypothesis, the association between sense of community and
emotional exhaustion/burnout, r(21) = -.598, p < .01, was significant and moderately strong
among the peer providers. In contrast, the association between community and burnout among
the non-peer providers was lower and not statistically significant, r(38) = -.260, p = .115.
However, using a Fisher’s r to Z transformation, the difference between the two correlations was
not significant, Z = -1.462, p = 0.072. The association between workplace values and burnout
was the same for the peer, r(21) = -.261, p = .253, and non-peer, r(39) = -.261, p = .109,
providers, which did not support our hypothesis regarding differences in those associations.
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Interesting, but not predicted, was a difference between the two types of workers in the
importance of workplace control. The association between workplace control and burnout was
moderately strong and statistically significant among the peer providers, r(20) = -.622, p = .003,
but weak and not statistically significant, r(39) = -.154, p = .350 among the other providers. The
difference between these two correlations was significant Z = -2.179, p = 0.01 (see Table 3 & 4).
With regard to the forth hypothesis, workload was the most strongly associated subscale
with emotional exhaustion among non-peer providers as predicted. This association was
moderately strong and was statistically significant r(39) = -.439, p = .005. Workload was also
most strongly associated with emotional exhaustion among peer providers. The association was
strong and statistically significant, r(21)= -.736, p = .000.
Discussion
A peer worker’s continued recovery is important not only for their own well-being but
also for their work with peers. Consistent with previous work by Park et al. (2016) in the VHA
system, the peer workers in this study do not appear to be more susceptible to job-related burnout
than other mental health workers. This provides further support for the peer worker career option
for those in recovery from serious mental illness, as such a career does not appear to put them at
increased risk for psychological harm as previously feared. The continuation of the incorporation
of peer providers in mental health agencies can further support recovery orientation in these
agencies and the services that they are providing to their clients.
This study was the first of our knowledge to investigate the possible influence of peer
worker status on the associations between the workplace environment and burnout. The current
findings suggest that the workplace factors predicting burnout among mental health employees
may differ between peer and non-peer workers. Specifically, the relationships peer providers
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have with their co-workers may have crucial impacts on their personal and professional wellbeing, as the association between low sense of workplace community and burnout was
noticeably strong among the peer employees in this study. This strong association between
disappointing workplace community and burnout may be linked to the increased experience of
microaggressions in the workplace. As Firmin et al. (2018) notes, these microaggressions can be
as a result of disclosing a personal experience with mental illness and often are reflective of the
quality of the relationships that exist between colleagues in the agency. The findings in this study
provide support for the need for intentional strategies to lessen the frequency of
microaggressions experienced both to support psychological health in general and as a means to
protect peer providers from experiencing emotional exhaustion related to burnout.
Similarly, the significant association between control and burnout among peer workers
may again be attributed to the professional relationships peers have with their non-peer coworkers, as a reduced sense of control in peer-providers may be a result of a tendency for nonpeer workers to not trust the judgment of peer-provider, an example of indirect
microaggressions. The work of Firmin et al. (2018) suggests that many peer-providers find
themselves in positions that inherently provide them with less control and voice in an
organization, which may cause them to experience a reduced sense of control in their workplace
which in turn could contribute to burnout among these workers. Attempted replication of the
strong association between reduced sense of control and burnout among peer providers will be
important, as that association is possibly very meaningful but was not hypothesized as part of the
present study. Furthermore, because microaggressions provide a plausible explanation for the
strong associations between burnout and both lack of community and control in the workplace,
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future studies should also seek to investigate whether or not peer workers experience burnout in
their daily work and the role of microaggressions in those experiences.
While we did not find support for our hypothesis that values may be strongly associated
with emotional exhaustion of peer-providers, the present researcher believes that hypothesized
association should still be investigated in future research. A possible explanation for the lack of
association in the present study may be that peer-providers tend to find themselves in agencies
that match their values simply because the agency sought out peer-workers for the position. This
may inherently mean that the agency is recovery oriented, drastically reducing the ability for
expectation mismatch in terms of values. Such a possibility suggests that peer providers may be
at a reduced risk of burnout in agencies that are peer run, the types of mental health agencies that
are most likely to be recovery-oriented and most likely to match the values of peer workers. The
current participant pool did not allow for sufficient comparisons between peer-providers at peer
run agencies and those that are agencies managed by non-peer providers. Future research should
aim to investigate the possibility of this difference, and the role of values discrepancies in any
such difference.
The current finding of the significant association between workload and burnout among
peer and non-peer workers is consistent with previous work by Leiter and Maslach (2011). This
suggests that mental health workers, regardless of peer status, are more susceptible to emotional
exhaustion when they are overworked and feel like they are not capable of completing all the
tasks assigned to them in a timely manner. Leiter and Maslach (2011) further suggest that too
large of a workload, and the emotional exhaustion that comes with it, may lead to a deterioration
of relationships and community within the workplace. This, coupled with the findings of this
study that suggest community in the workplace is strongly associated with emotional exhaustion
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among peer workers, gives cause for concern that an increased workload can create a positive
feedback loop for emotional exhaustion among these workers.
It is important to note some limitations of the present study. The sample size was not
particularly large for the present study, in part because many rural mental health agencies
reported issues relating to technology and internet connectivity that prevented them from
efficiently completing the web delivered survey. Paper and pencil administration of the survey
may yield a more significant sample size allowing for the completion of regression analyses that
would allow for an examination of what subscales of the AWS may best predict burnout for peer
and non-peer workers. Additionally, the participants in this study were predominantly white and
while this is reflective of the four counties in which they work, may make generalization to the
larger population of providers more difficult.
Conclusion
Peer providers are a valuable resource to mental health agencies and the positon provides
the opportunity for those in recovery from a serious mental illness to find gainful employment
that allows them to give back to the system that assisted them. While there is growing research to
support that these providers are not at a greater risk for burnout than their non-peer counterparts,
burnout rates are still high among mental health workers in general. This study provides
evidence to support the need for increased efforts to build community among mental health
providers in the workplace and ensure that workers feel an adequate sense of control in
performing their role in order to reduce emotional exhaustion among these professionals,
particularly those that identify as peers. Future work is needed to further establish which aspects
of the work environment may contribute differently to burnout for peer and non-peer providers.
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Freudenberger, H.J. (1974). Staff burnout. Journal of Social Issues, 30, 159-65.
Kristensen, T.S., Borritz, M., Villadsen, E., et al. (2005). The Copenhagen Burnout Inventory: A
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Leiter, M.P., & Maslach, C. (2011). Areas of worklife survey manual and sampler set (fifth
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Mancini, M., & Lawson, H. (2009). Facilitating positive emotional labor in peer providers of
mental health services. Administration in Social Work, 33, 3-22. Doi:
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Maslach, C. & Jackson, S.E. (1981). The measurement of experienced burnout. Journal of
Occupational Behavior, 2, 99-113.
Maslach, C. & Leiter, M.P. (2016). Understanding the burnout experience: Recent research and
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Maslach, C., Jackson, S.E., & Leiter, M.P. (2016). Maslach burnout inventory: Manual. Mind
Garden.
Moran, G.S., Russinova, Z., Gidugu, V., & Gagne, C. (2013). Challenges experienced by paid
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Morse, G., Salyers, M. P., Rollins, A. L., Monroe-Devita, M., & Pfahler, C. (2011). Burnout in
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Park, S. G., Chang, B., Mueller, L., Resnick, S. G., & Eisen, S. V. (2016). Predictors of
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Scheetz, D., Bennett, T., McQuaid, E., & Weikel, K. (2017) Burnout rates among peer specialists
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Hoboken, NJ: John Wiley and Sons.
IMPACT OF WORKPLACE ENVIRONMENT
Appendix
Table 1
Group Statistics
Fisher 23
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Table 2
Equality of means for peer and non-peer providers
Fisher 24
IMPACT OF WORKPLACE ENVIRONMENT
Table 3
Associations between burnout and AWS for peer-providers
Fisher 25
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Table 4
Associations between burnout and AWS for non-peer providers
Maslach Burnout Inventory Sample Items
How often (0-6, 0 being never and 6 being every day):
1. “I feel emotionally drained from my work.”
2. “In my opinion, I am good at my job.”
3. “I doubt the significance of my work.”
Areas of Worklife Survey Sample Items
(1-5, 1 being strongly disagree and 5 being strongly agree):
Workload: “I do not have time to do the work that must be done.”
Control: “I have control over how I do my work.”
Reward: “I receive recognition from others for my work.”
Community: “Members of my work group communicate openly.”
Fairness: “Resources are allocated fairly here.”
Values: “My values and the Organization’s values are alike.”
Fisher 26
Impact of Workplace Environment on Peer and Non-Peer Mental Health Providers
Thomas L. Fisher
Shippensburg University of Pennsylvania
Thesis Committee:
Kim Weikel, Committee Chair
Kathryn Potoczak, Committee Member
Steven Haase, Committee Member
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Fisher 2
Abstract
Job-related burnout, a three-dimensional experience involving emotional exhaustion,
depersonalization, and reduced personal accomplishment is found to be common among those in
the mental health field due to the nature and gravity of their work. With a growing focus on
recovery-oriented care, many mental health agencies are increasing their employment of peerproviders. Peer providers are mental health workers with diagnosed mental illness who actively
and intentionally use their personal experience with mental illness to help their clients. These
workers may be prone to the experience of microaggressions and stigma related to mental illness
in the workplace. The Maslach Burnout Inventory (MBI) and Areas of Worklife Survey (AWS)
were completed by mental health workers serving four counties in Pennsylvania. Among peerworkers, there were significant associations between levels of burnout and both sense of
community and sense of control as measured by the community and control subscales of the
AWS. These associations were not found among non-peer providers.
Keywords: burnout, peer-providers, workplace environment, community
IMPACT OF WORKPLACE ENVIRONMENT
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Impact of Workplace Environment on Peer and Non-Peer Mental Health Providers
For a great deal of time, the importance of physical and mental health of workers has
been underestimated and overlooked by employers. As job demands continue to grow, there is an
enhanced opportunity for the experience of stress to occur. With this additional stress comes a
greater likelihood of negative impacts on the general well-being of employees. While this
phenomenon can likely be observed in any sector of the workforce, it is especially apparent in
fields where there is frequent contact with consumers (Maslach & Leiter, 2016). The mental
health field is one where this is especially true as workers often have frequent and direct contact
with those seeking services. Sustained exposure to and a maladaptive response to workplace
stress can lead to a psychological condition referred to as burnout.
Definitions and Measurement of Burnout
As evidence of the importance of employee well-being continues to grow, there has been
an increased focus on identifying and responding to burnout among mental health workers.
Because of this, much research has been conducted to define the experience of burnout precisely.
Freudenberger (1974) was the first individual to utilize the term burnout. He defined burnout as a
two-dimensional experience that was characterized by a sense of failure by the employee and a
general worn out feeling. Pines and Aronson (1981) highlighted a sense of exhaustion as being a
defining characteristic of burnout. According to their research, the exhaustion was
multidimensional and was experienced in the physical, mental and emotional realms. Sarros and
Densten (1989) focused on the experience of stress in their definition of burnout as well as the
concept that the experience of burnout can be brought on by work that provides too little rigor or
brings little recognition to the employee.
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Due to the numerous variations in definitions of the experiences that constitute burnout
described above, it is not surprising that there are several measures that have been used in recent
research to identify burnout in employees. In general, measures can be divided into two
categories: Measures that conceptualize burnout in a multidimensional fashion and measures that
solely focus on the idea of exhaustion as being the key factor of burnout (Maslach & Leiter,
2016). The Bergen Burnout Inventory (BBI) is one such of example of a measure utilized to
assess burnout. This inventory takes a multidimensional approach and incorporates the concepts
of exhaustion at work, a negative outlook on the purpose of work and a feeling of insufficiency
in the workplace (Feldt, Rantanen, Hyvonen et al., 2014). In contrast, the Shirom-Melamed
Burnout Measure (SMBM) and the Copenhagen Burnout Inventory (CBI) measure the
experience of burnout only in terms of the feeling of exhaustion, with some distinctions made
between physical and emotional exhaustion (Shirom & Melamed, 2006; Kristensen, T.S. et al.,
2005).
While all of the above measures have proven useful in identifying the experience of
burnout, the most common measure for assessing burnout is the Maslach Burnout Inventory
(MBI) (Maslach & Leiter, 2016). With the MBI being the standard measure used for conducting
burnout research, it follows that the conceptualization of burnout established by this model is the
most widely accepted (Maslach & Leiter, 2016). The MBI established job-related burnout as a
three-dimensional experience involving emotional exhaustion, depersonalization, and reduced
personal accomplishment (Maslach, Jackson, & Leiter, 2016). The MBI and the accompanying
definition of burnout which were originally developed in English have since been translated to
several other languages while still maintaining validity (Maslach & Leiter, 2016).
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 5
The first dimension of burnout in the MBI is emotional exhaustion. Emotional exhaustion
is often considered the most detrimental dimension of burnout in terms of employee well-being
and job performance. Maslach and Jackson (1981) characterized this facet of burnout as an
experience where workers, specifically mental health workers, no longer feel they have the
psychological resources regularly utilized to offer services to their clients. Due to the close
psychological connection that mental health providers often form with their clients, it is clear
why the experience of emotional exhaustion can be particularly troubling, both in terms of the
well-being of the mental health providers and those seeking mental health services.
Depersonalization is the second defining characteristic of the experience of burnout.
Maslach and Jackson’s (1981) research suggests that the experience of depersonalization may be
connected to emotional exhaustion. Generally, depersonalization can be described as involving
attitudes towards clients that do not align with the goals of the mental health field, a heightened
and unmanaged sense of irritability, and a general disengagement from the services being
provided to clients (Maslach & Leiter, 2016). Additionally, providers experiencing
depersonalization may come to have an outlook that supports the concept that clients are
deserving of the troubles that have caused them to seek mental health services (Maslach &
Jackson, 1981). This construct has been broadened in the subsequent general form of the MBI
and is referred to as cynicism in order to address burnout in occupations that fall outside of the
social services field.
The final construct of the MBI centers around the feeling of personal accomplishment an
employee reports. If an employee is experiencing burnout, they are more likely to evaluate their
workplace performance as being unsatisfactory (Maslach & Jackson, 1981). This is often
accompanied by a new sense of an inability to perform tasks associated with providing mental
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 6
health services to clients (Maslach & Leiter, 2016). Low morale and an inability to cope are also
measured under the personal accomplishment construct.
Emotional exhaustion, depersonalization and reduced sense of personal accomplishment
are the commonly accepted aspects of burnout as measured by the MBI. Given this definition, it
becomes clear that evaluations of self and others are the primary context in which burnout is
conceptualized and there is ongoing research investigating the predictors of workers’ selfevaluation of burnout (Maslach & Leiter, 2016). Removed from the context of the environment,
the ways in which one evaluates themselves most likely varies from person to person. This can
be a result of lived experiences, general outlook or various other factors. One of these differences
in self-evaluation and assessment may result from employees that have specific lived experience
relating to mental illness.
Burnout Among Mental Health Workers
In general, burnout has been researched in the context of professions that are people
oriented. This would include examining burnout among teachers, health care workers, human
services providers and other occupations that are similar to these in regards to the amount of
consumer contact involved (Maslach & Leiter, 2016). Research findings suggest burnout rates
tend to be greater among mental health and healthcare professionals than in the general
workforce (Maslach & Leiter, 2016). With burnout comes lowered productivity and a decrease in
the general quality of services provided, which is particularly troubling given the importance of
the work being done by these professionals (Maslach & Leiter, 2016). In addition, these
professionals often suffer from a reduction in overall wellbeing (Maslach & Leiter, 2016).
Among mental health professionals, consequences of burnout include increased rates of
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Fisher 7
substance use, lower quality of work, low quality ratings by consumers, and an increase in
unplanned absences (Park, Chang, Mueller, Resnick & Eisen, 2016; Johnson et al., 2018).
Peer-Providers in the Mental Health Field
Mental health agencies are more commonly orienting themselves towards the concept of
recovery which involves focusing on collaboration, the development of a hopeful and optimistic
outlook, the promotion of autonomy in the decision-making process, and the deliberate emphasis
on the particular strengths an individual brings to the community (Chinman et al., 2017). Mental
health services that are recovery oriented highlight the importance of peer relationships between
those with mental illness. In order to fully embody recovery orientation, mental health
organizations are beginning to employ peer providers. Peer providers are mental health workers
with diagnosed mental illness who actively and intentionally use their personal experience with
mental illness to help their peers (Chinman et al. 2017; Mowbray et al. 1996). It is believed that
through the use of their lived experiences relating to mental illness, peer providers are able to
connect on a deeper level with their clients (Moran, Russinova, Gidugu, & Gagne, 2012).
The value of peer providers goes much further beyond simply assisting in establishing a
deeper bond with clients. Peer providers, because of their lived experience, have the ability to
show a greater sense of empathy with their clients (Mowbray et al., 1996; Salzer, 2010). Insight
into the workings of mental health services from the client perspective is also brought to the
provider-client relationship by peer workers (Paulson et al., 1999). Finally, peer providers can
bring valuable opportunities for professional development to organizations. By helping their nonpeer provider counterparts understand on a more personal level the client perspective, peer
workers can help to reduce the stigma that exists around mental illness, even in mental health
organizations (Dixon et al., 1997; Solomon, 2004). While the lived experience of peer providers
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Fisher 8
brings a wealth of value to the mental health field, the emotional strain that can accompany
serious mental illness has caused some in the field to question whether the peer provider position
is a viable position. Specifically, some have raised concerns that peer workers may be more
likely to experience burnout as a result of their peer status.
Workers experiencing burnout are prone to negative impacts in work and personal life,
providing cause to investigate factors contributing to burnout (Morse, Salyers, Rollins, MonroeDevita, & Pfahler, 2011). Park, Chang, Mueller, Resnick, and Eisen (2016) began the
investigatory work of determining whether there are differences in burnout rates among peer and
non-peer providers. Their study utilized peer support specialists working at health care systems
within the Veterans Health Administration. Park et al. (2016) found no differences in the rates of
burnout among peer providers and other providers of mental health services. Their findings
suggest that concerns raised about peer providers may not actually play out in the field.
The Veterans Health Administration system offers a vast array of services with resources
that are often greater in number compared to smaller organizations that offer mental health
services. Because of this, it is necessary to compare rates of burnout among peer and non-peer
workers within smaller organizations to determine whether the results of the Park et al. (2016)
study will generalize to smaller community mental health settings. Scheetz, McQuaid, Bennett,
& Weikel (2017) worked to investigate this comparison and sampled peer and non-peer mental
health providers in a rural county in Pennsylvania. The findings of Scheetz et al. (2017), like the
study by Park et al. (2016), suggest there is no need for concern that peer providers will
experience greater levels of burnout than their non-peer counterparts. Scheetz et al. (2017)
actually found that the peer providers in their study experienced lower rates of emotional
exhaustion and depersonalization when compared to their non-peer counterparts. However, it is
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 9
important to note that this study had a small sample size and needs to be replicated (Scheetz et
al., 2017). Although findings to date suggest that peer providers are not more likely than other
providers to experience burnout, it is possible that there may be differences in the predictors of
burnout between the two types of providers.
Worklife Predictors of Burnout
Leiter and Maslach (2000) argue that work atmosphere is an important predictor of
burnout, and they developed the Areas of Work Life Scale (AWS) to measure congruency
between employees’ work lives and their personal expectations regarding their work experience
(Leiter & Maslach, 2000). The AWS works to establish the notion that burnout is more than
simply workplace stress. It accomplishes this by utilizing a model that assesses the ongoing and
evolving relationship between a person and their workplace (Leiter & Maslach, 2011). There are
six domains under the AWS that were developed based upon previous common correlational
comparisons between work environment and burnout. These six areas are: Workload, control,
reward, community, fairness, and values (Leiter & Maslach, 1999).
Some of the domains established by the Areas of Worklife Survey are more heavily
studied than others. The most discussed is the domain of workload (Leiter & Maslach, 2011).
This domain is reflective of the current trend in the amount of work employees are required to
complete with less time and fewer resources. Leiter and Maslach (2011) suggest that it is not
simply the occurrence of this trend that leads to the experience of burnout. Rather it is the
prolonged exposure to increased job demands without a period of recovery to allow the
employee to rest and reset. This experience would result in low scores on the domain of
workload on the AWS, representing a poor match between an employee and the work
environment they are in. In contrast, a manageable workload that allows for the development of
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 10
skills and personal growth within one’s occupation would result in higher scores on the domain
of workload (Leiter & Maslach, 2011).
Control represents the second domain of the Areas of Worklife Survey. Control
encapsulates the degree to which an employee feels they have the ability to influence decisions
that have an impact on the work that they are engaging in (Leiter & Maslach, 2011). There are
several possible sources of a reduced sense of control in the workplace. One of these sources is
role conflict. Role conflict results when there are conflicting expectations within the same
position and can represent an authority issue within an organization (Leiter & Maslach, 2011).
This conflict has the ability to prevent progress in the workplace, and thus, adds to the
experience of burnout. Role ambiguity can be a second contributing factor to a lack of sense of
control in the workplace. When employees are unsure exactly what the expectations are within
their position, they are unable to establish what they should strive to accomplish (Leiter &
Maslach, 2011).
The third domain of the AWS examines the congruency between an employee’s
expectations of the rewards they will receive at work and the actual rewards they are able to earn.
Employees often have the expectation that when they complete work in a satisfactory way, they
will be recognized for their efforts (Leiter & Maslach, 2011). The source of the recognition and
reward can come from colleagues, management, or those outside of the organization that have a
vested interest in the work being completed. When this recognition and reward is absent, there is
a greater opportunity for a feeling of disconnect from the work being completed (Leiter &
Maslach, 2011).
The fourth dimension of the AWS centers around the organizational decision making
process. Specifically, how an employee perceives the basis for decisions made within the
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Fisher 11
workplace can be a predictor of the experience of burnout (Leiter & Maslach, 2011). The
evaluation of the decision-making process is categorized under the domain of fairness.
Employees are less likely to experience burnout if there is the perception that decisions within
the workplace are fair and represent a sense of equality where it is deserved.
The final two domains of the Areas of Worklife Survey are the most central to the
proposed study. These are the domains of community and values. The community domain
considers the interpersonal relationships that exist in the workplace (Leiter & Maslach, 2011).
This includes an examination of how conflict is mediated, the sense of teamwork that exists, the
existence of supporting relationships, and how close employees feel to one another (Leiter &
Maslach, 2011). Employees are less likely to experience burnout if there is a strong sense of
community among members of an organization. Without a sense of community, employees often
feel isolated in their work.
Values is the second domain of the AWS that will be emphasized for this study. The
values domain examines the match between the ideals of an employee and their workplace
(Leiter & Maslach, 2011). A strong match between the values of an employee and the
organization in which they work provides the opportunity to advance both personal and
organizational goals that align with one another at the same time. When there is poor congruency
between an employee’s values and the values of their workplace, the employee may find
themselves in situations that require them to violate their personal values in order to meet the
expectations of their position. This leads to a strong desire to become disengaged from the work
being completed and can contribute to the experience of burnout (Leiter & Maslach, 2011).
Worklife Experience of Peer Providers
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Unfortunately, due to the prior poor treatment of those with mental illness, it is
undeniable that stigma regarding mental illness exists within the United States. This stigma often
can take one of two forms. The first form being overt stigma that consists of the obvious and
outward display of degrading attitudes towards those with mental illness (Firmin, Mao, Bellamy,
& Davidson, 2018). The second form that is possibly more difficult to address, is the use of
microaggressions. Microaggressions can be defined as, “brief, everyday exchanges that send
denigrating messages to certain individuals because of their group membership” (Sue, 2010, p.
xvi). For peer providers, it is their group membership relating to their lived experience of mental
illness and treatment that can leave them vulnerable within the workplace to the experience of
stigma and microaggressions.
Firmin, Mao, Bellamy, and Davidson (2018) found that among a sample of 65 peer
support specialists, 78 percent had experienced microaggressions within the workplace at least
once related to their peer support status, and 38 percent reported experiencing microaggressions
at least once a day. In addition, to these experiences of microaggressions, peer workers reported
experiencing overt forms of prejudice relating to their peer status. Peers reported, “Hearing
clinicians joke about recovery oriented language and people making jokes about [them] being a
‘patient’” (Firmin et al., 2018, p. 1543). Similarly, interviews with peer providers have found
them to report poor treatment in the workplace (Mancini & Lawson, 2009), with more than half
reporting experiences of direct and indirect expressions of prejudice relating to their peer
provider status (Moran et al., 2013).
Based upon the evidence presented in the studies above, it is clear that peer workers are
vulnerable to a form of prejudice and discrimination that their non-peer counterparts are not.
That experience of prejudice could contribute to burnout among peer workers. It is hypothesized
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 13
that scores on the AWS subscale measuring sense of Community will be the strongest predictor
of emotional exhaustion among peer mental health workers. In addition, given that burnout rates
are lower among mental health workers in settings that are recovery-oriented (Kraus & Stein,
2013), but that some peers find themselves in settings that seem to lack a recovery-oriented
philosophy (Moran, Russinova, Gidugu, & Gagne, 2013), it is also hypothesized that the
association between burnout and person-work values discrepancies (AWS Values subscale) will
be stronger among peer providers than among non-peer workers.
Hypotheses
1) There will be no difference in emotional exhaustion between peer and non-peer mental health
workers.
2) The association between the Community subscale of the AWS and emotional exhaustion, as
measured by the MBI, will be stronger among peer workers than non-peer mental health
providers. This association among peer providers will also be the most significant association of
the six subscales of the AWS for this group.
3) The association between the Values subscale of the AWS and emotional exhaustion will be
stronger among peer providers than non-peer workers.
4) The Workload subscale of the AWS will be the subscale most strongly associated with
emotional exhaustion in non-peer mental health providers.
Method
Participants
Eighty-two percent of the workers were female and 90% were White. The number of
years of experience working in the mental health field ranged from 1 to 35 years for the peer
providers and less than six months to 45 years for the non-peer providers.
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 14
Measures
Burnout
Burnout rates among peer and non-peer providers was measured using the Maslach
Burnout Inventory (MBI). The MBI measures burnout in terms of three dimensions: Emotional
exhaustion, depersonalization, and sense of personal accomplishment. The MBI is considered the
gold standard measure for assessing burnout. The MBI is useful because it provides national
average burnout rates that can be used to make comparisons between the sample of providers in
this study and national norms. The reliability estimates for the emotional exhaustion subscale of
the MBI average in the high 0.80s. The depersonalization and the personal accomplishment
subscales both have reliability estimates that average in the mid 0.70s (Maslach, Jackson &
Leiter, 2017).
Person-Job Congruency
Person-Job congruency was measured utilizing the Areas of Worklife Survey (AWS).
The AWS contains six subscales: Workload, control, reward, community, fairness, and values.
There are a total of 28 items on the full AWS (see appendix). Test-retest correlations were
conducted to establish the reliability of the AWS. The correlations ranged from 0.51 to 0.62. The
correlation values for workload, control, reward, community, fairness, and values were 0.62,
0.54, 0.51, 0.53, 0.59, and 0.56 respectively (Leiter & Maslach, 2011). Correlations between
each AWS subscale and subscale-related complaints from over 1000 hospital employees
indicates subscale validity (Leiter & Maslach, 2011).
Procedure
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 15
The current study is a part of a larger project to assess mental health workplace wellbeing in four rural counties in Pennsylvania. As a part of the larger project, surveys containing
the MBI and AWS were sent to participating mental health agencies online utilizing Survey
Monkey. Following data collection, bivariate correlations were assessed between the three
subscales of the MBI and the six AWS subscales. Separate bivariate correlations were calculated
for the peer and non-peer providers. Specific attention was given to the Community and Values
subscales of the AWS to test the hypotheses that have been made. Fisher’s r to Z transformations
were completed in order to test for the significance between the differences in correlations.
Results
Consistent with the first hypothesis, there was no statistically significant difference in
emotional exhaustion between the peer (M=19.13, SD=11.98) and non-peer workers (M=20.74,
SD=11.40), t(64)= -.543, p=.589 (see Table 1). Similarly, the AWS includes six subscales
measuring different types of person-job congruence (Workload, Control, Reward, Community,
Fairness, and Values). Independent samples t-tests indicated no significant differences between
the peer and non-peer workers on any of those subscales, p >.10 (see Table 2).
With regard to the second hypothesis, the association between sense of community and
emotional exhaustion/burnout, r(21) = -.598, p < .01, was significant and moderately strong
among the peer providers. In contrast, the association between community and burnout among
the non-peer providers was lower and not statistically significant, r(38) = -.260, p = .115.
However, using a Fisher’s r to Z transformation, the difference between the two correlations was
not significant, Z = -1.462, p = 0.072. The association between workplace values and burnout
was the same for the peer, r(21) = -.261, p = .253, and non-peer, r(39) = -.261, p = .109,
providers, which did not support our hypothesis regarding differences in those associations.
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 16
Interesting, but not predicted, was a difference between the two types of workers in the
importance of workplace control. The association between workplace control and burnout was
moderately strong and statistically significant among the peer providers, r(20) = -.622, p = .003,
but weak and not statistically significant, r(39) = -.154, p = .350 among the other providers. The
difference between these two correlations was significant Z = -2.179, p = 0.01 (see Table 3 & 4).
With regard to the forth hypothesis, workload was the most strongly associated subscale
with emotional exhaustion among non-peer providers as predicted. This association was
moderately strong and was statistically significant r(39) = -.439, p = .005. Workload was also
most strongly associated with emotional exhaustion among peer providers. The association was
strong and statistically significant, r(21)= -.736, p = .000.
Discussion
A peer worker’s continued recovery is important not only for their own well-being but
also for their work with peers. Consistent with previous work by Park et al. (2016) in the VHA
system, the peer workers in this study do not appear to be more susceptible to job-related burnout
than other mental health workers. This provides further support for the peer worker career option
for those in recovery from serious mental illness, as such a career does not appear to put them at
increased risk for psychological harm as previously feared. The continuation of the incorporation
of peer providers in mental health agencies can further support recovery orientation in these
agencies and the services that they are providing to their clients.
This study was the first of our knowledge to investigate the possible influence of peer
worker status on the associations between the workplace environment and burnout. The current
findings suggest that the workplace factors predicting burnout among mental health employees
may differ between peer and non-peer workers. Specifically, the relationships peer providers
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 17
have with their co-workers may have crucial impacts on their personal and professional wellbeing, as the association between low sense of workplace community and burnout was
noticeably strong among the peer employees in this study. This strong association between
disappointing workplace community and burnout may be linked to the increased experience of
microaggressions in the workplace. As Firmin et al. (2018) notes, these microaggressions can be
as a result of disclosing a personal experience with mental illness and often are reflective of the
quality of the relationships that exist between colleagues in the agency. The findings in this study
provide support for the need for intentional strategies to lessen the frequency of
microaggressions experienced both to support psychological health in general and as a means to
protect peer providers from experiencing emotional exhaustion related to burnout.
Similarly, the significant association between control and burnout among peer workers
may again be attributed to the professional relationships peers have with their non-peer coworkers, as a reduced sense of control in peer-providers may be a result of a tendency for nonpeer workers to not trust the judgment of peer-provider, an example of indirect
microaggressions. The work of Firmin et al. (2018) suggests that many peer-providers find
themselves in positions that inherently provide them with less control and voice in an
organization, which may cause them to experience a reduced sense of control in their workplace
which in turn could contribute to burnout among these workers. Attempted replication of the
strong association between reduced sense of control and burnout among peer providers will be
important, as that association is possibly very meaningful but was not hypothesized as part of the
present study. Furthermore, because microaggressions provide a plausible explanation for the
strong associations between burnout and both lack of community and control in the workplace,
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 18
future studies should also seek to investigate whether or not peer workers experience burnout in
their daily work and the role of microaggressions in those experiences.
While we did not find support for our hypothesis that values may be strongly associated
with emotional exhaustion of peer-providers, the present researcher believes that hypothesized
association should still be investigated in future research. A possible explanation for the lack of
association in the present study may be that peer-providers tend to find themselves in agencies
that match their values simply because the agency sought out peer-workers for the position. This
may inherently mean that the agency is recovery oriented, drastically reducing the ability for
expectation mismatch in terms of values. Such a possibility suggests that peer providers may be
at a reduced risk of burnout in agencies that are peer run, the types of mental health agencies that
are most likely to be recovery-oriented and most likely to match the values of peer workers. The
current participant pool did not allow for sufficient comparisons between peer-providers at peer
run agencies and those that are agencies managed by non-peer providers. Future research should
aim to investigate the possibility of this difference, and the role of values discrepancies in any
such difference.
The current finding of the significant association between workload and burnout among
peer and non-peer workers is consistent with previous work by Leiter and Maslach (2011). This
suggests that mental health workers, regardless of peer status, are more susceptible to emotional
exhaustion when they are overworked and feel like they are not capable of completing all the
tasks assigned to them in a timely manner. Leiter and Maslach (2011) further suggest that too
large of a workload, and the emotional exhaustion that comes with it, may lead to a deterioration
of relationships and community within the workplace. This, coupled with the findings of this
study that suggest community in the workplace is strongly associated with emotional exhaustion
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 19
among peer workers, gives cause for concern that an increased workload can create a positive
feedback loop for emotional exhaustion among these workers.
It is important to note some limitations of the present study. The sample size was not
particularly large for the present study, in part because many rural mental health agencies
reported issues relating to technology and internet connectivity that prevented them from
efficiently completing the web delivered survey. Paper and pencil administration of the survey
may yield a more significant sample size allowing for the completion of regression analyses that
would allow for an examination of what subscales of the AWS may best predict burnout for peer
and non-peer workers. Additionally, the participants in this study were predominantly white and
while this is reflective of the four counties in which they work, may make generalization to the
larger population of providers more difficult.
Conclusion
Peer providers are a valuable resource to mental health agencies and the positon provides
the opportunity for those in recovery from a serious mental illness to find gainful employment
that allows them to give back to the system that assisted them. While there is growing research to
support that these providers are not at a greater risk for burnout than their non-peer counterparts,
burnout rates are still high among mental health workers in general. This study provides
evidence to support the need for increased efforts to build community among mental health
providers in the workplace and ensure that workers feel an adequate sense of control in
performing their role in order to reduce emotional exhaustion among these professionals,
particularly those that identify as peers. Future work is needed to further establish which aspects
of the work environment may contribute differently to burnout for peer and non-peer providers.
IMPACT OF WORKPLACE ENVIRONMENT
Fisher 20
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Appendix
Table 1
Group Statistics
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Table 2
Equality of means for peer and non-peer providers
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Table 3
Associations between burnout and AWS for peer-providers
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Table 4
Associations between burnout and AWS for non-peer providers
Maslach Burnout Inventory Sample Items
How often (0-6, 0 being never and 6 being every day):
1. “I feel emotionally drained from my work.”
2. “In my opinion, I am good at my job.”
3. “I doubt the significance of my work.”
Areas of Worklife Survey Sample Items
(1-5, 1 being strongly disagree and 5 being strongly agree):
Workload: “I do not have time to do the work that must be done.”
Control: “I have control over how I do my work.”
Reward: “I receive recognition from others for my work.”
Community: “Members of my work group communicate openly.”
Fairness: “Resources are allocated fairly here.”
Values: “My values and the Organization’s values are alike.”
Fisher 26