Compassion fatigue in mental health professionals in the United Kingdom: an occupational perspective, a qualitative exploration, and a psychometric evaluation

With the rising prevalence of mental health ailments, a shortage of qualified mental health professionals, and the emotionally taxing nature of mental healthcare, mental health professionals are vulnerable to experiencing the psychological cost of caring, also known in the research literature as “compassion fatigue”. Previous research reports moderate to high levels of compassion fatigue in mental health professionals, yet the focus on potentially alterable work-related covariates has been less prominent in comparison with relatively stable individual-level factors. Moreover, minimal research has been conducted to examine the psychometric properties of Professional Quality of Life Scale Version 5 (Stamm, 2010), an instrument widely used to assess compassion fatigue in health and social care professionals. Therefore, the aims of this research were twofold: to explore the concept of compassion fatigue from the perspective of occupational health psychology; and to examine the construct validity of ProQOL 5 scale, in a sample of mental health professionals based in the United Kingdom (UK). 
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\nThis thesis is a confluence of three research studies. The first study was a systematic review of 44 empirical studies examining the association between occupational risk and preventive factors and compassion fatigue in mental health professionals. The findings were in alignment with the Job Demands-Resources (JD-R) model wherein job demands (such as, quantitative and qualitative workload, burden of empathising with clients, and engagement with survivors of trauma) were positively associated with compassion fatigue. Job resources (such as, supervisor’s support, co-workers’ support, manager’s support, organisational support, use of evidence-based practices, and empathic alliance with clients) were found to attenuate the impact of job demands and promote a sense of compassion satisfaction. The study provides a framework for developing capacity-building programmes to develop mental health professionals’ personal resources and highlights methodological limitations in existing research. Also, from a theoretical point of view, it highlights the role of occupational factors in making professionals vulnerable to compassion fatigue. Existing theoretical models of compassion fatigue have not paid adequate attention to occupational or work-related factors and have instead focused more on individual-level factors or core requirements of mental healthcare such as, empathising with clients. Thus, by suggesting that occupational factors could also play a potent role, the findings of this study have the potential to expand current theoretical models. 
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\nThe second study is a phenomenological study on occupational experiences of 19 mental health professionals in context of the COVID-19 pandemic. Three superordinate themes, which emerged from the analysis included: transition from face-to-face therapy to online therapy, novel changes and wellbeing, and uncertain professional support in uncertain times. The study elaborates the interaction among these themes in influencing participants’ professional experiences and wellbeing and highlights the need for providing training in online or telephonic therapy. Experiences related to compassion fatigue were also observed and have been detailed in the relevant chapter. The study contributes to the limited body of research on the impact of the pandemic on mental health professionals based in the UK. 
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\nThe third study is a psychometric evaluation of the Professional Quality of Life Scale Version 5 (ProQOL 5; Stamm, 2010), an instrument popularly used to assess compassion fatigue and compassion satisfaction. The study conducted confirmatory factor analysis to examine the factorial structure of the scale on a sample of 366 clinical psychologists, counsellors, and psychotherapists practicing in organisational and independent settings in the UK. In alignment with previous studies, the factorial structure of the scale demonstrated poor fit to data. Thus, a novel technique called exploratory graph analysis was used to explore the structure. The study found support for a revised 21-item scale and provides directions for future research to further investigate this structure. 
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\nOverall, this thesis makes three pertinent contributions to the extant literature. First, it suggests that occupational or work-related factors share a significant association with compassion fatigue therefore, it is vital that their role is taken into cognisance by empirical and theoretical research. Second, it provides a rich, detailed qualitative evidence that highlights complex interactions among psychosocial hazards at work and their association with compassion fatigue in mental health professionals, which could be used to make structural changes in the system to improve professionals’ occupational experiences. Third, it provides preliminary evidence in favour of a revised 21-item three factor-structure of ProQOL 5 scale, which has implications for conceptual clarity of compassion fatigue as a theoretical construct.

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