Burnout and Leadership Style in Behavioral Health Care: a Literature Review
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Introduction Behavioral health care disorders, including mental, emotional, and substance use disorders, affect almost 20% of adolescents and adults in the United States (U.S.) and are increasing in prevalence.1 These disorders tend to be high-cost conditions with over $90 billion being spent annually on the diagnosis, treatment, and maintenance of these conditions.2 Due in part to the growing prevalence of behavioral health disorders, their chronic nature, and the type of care needed for patients with these conditions, maintaining a qualified workforce is an ongoing challenge in behavioral health care services. For instance, studies estimate that nearly 50% of behavioral health care providers feel overburdened due to the emotionally taxing nature of the job, high stress levels, perceived lack of career advancement opportunities, and low salaries coupled with high caseloads.3–7 The cumulative result of such prolonged work-related stress is employee burnout. Address correspondence to Reena Joseph Kelly, MHA, Department of Health Services Administration, University of Alabama at Birmingham, 1716 9th Ave. S., SHPB 547, Birmingham, AL 35233, USA. . Larry R. Hearld, PhD, Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, USA.
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Journal of Behavioral Health Services & Research, 2019. 1–19. c 2019 National Council for Behavioral Health. DOI 10.1007/s11414-019-09679-z
Burnout and Leadership Style in Behavioral Health Care
KELLY & HEARLD
Burnout has been broadly defined as a complex, psychological syndrome which manifests in response to prolonged exposure to chronic interpersonal stressors.8, 9 Although commonly seen among those in helping professions such as health care, teaching, law enforcement, and social services, a high incidence of burnout can exist in multiple settings and across different professions such as engineering, accounting, and sales.10–13 Employee burnout among behavioral health care workers is associated with a wide range of physical, emotional, and behavioral symptoms at the individual level such as aggressive behavior, physical illness, acts of violence, conflicts at home and the workplace, depression, and higher likelihood of alcohol and substance abuse.14–17 At the organizational level, behavioral health care employee burnout is associated with a deterioration in the quality of care leading to negative clinical outcomes such as low patient satisfaction, poor communication with patients and staff, poor patient engagement, and more errors.18, 19 Outside of clinical care outcomes, burnout has also been linked to negative employee outcomes such as low employee morale, absenteeism, lower organizational commitment, and job turnover,8, 20, 21 all of which ultimately result in higher costs to the individual and the organization. Several studies and reports examining the behavioral health care workforce in the U.S. indicate that there exists a severe shortage of nearly all types of behavioral health care providers (e.g., psychiatrists, clinical and school psycholog
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