This chapter looks at the stresses that mental health workers, particularly psychiatrists, experience and the potential adverse consequences of these stresses. In tune with contemporary psychological thinking, we also look at the positive aspects of working within mental healthcare, sources of resilience and how organisations can better look after their employees. The authors have worked in mental health services in the UK, but the problems and solutions presented have wide relevance across all advanced healthcare systems (Lasalvia & Tansella, 2011). We draw on the empirical evidence and our own experiences as a clinical psychologist with a particular interest in staff stress (J.C.) and a psychiatrist and former medical manager (F.H.). We aim to offer practical suggestions as to how psychiatrists can manage the stresses they inevitably experience. We also highlight the legitimate expectations staff should have of their managers and employers.

There have been recurrent crises surrounding morale, recruitment and retention in psychiatry (Mukherjee et al, 2013). Kendell & Pearce (1997) noted that large numbers of experienced psychiatrists were opting for early retirement and explored the reasons for this. The reasons people gave for leaving the profession early were poignant and provide insights into potentially remediable sources of distress (see Box 32.1). They include: the impact of serious adverse events, such as patient suicide, serious violence or homicide; a pervasive feeling of accountability without power to influence the actions of others; and alienation from the edicts of a ‘management’ that is perceived as remote, critical and unaware of day-to-day clinical reality.

These findings remain relevant (Kumar, 2011). The 1990s were a time of upheaval and radical change for mental health services, marked by severe shortages of acute in-patient beds in the context of rapid, and ultimately successful, deinstitutionalisation. After a decade of rapid growth in mental health services, the 2010s have seen significant disinvestment and increasing stresses on the care system.

In the past, doctors could expect, after considerable early sacrifices in their working lives, to have a high degree of autonomy in their work and to be treated with deference and respect in return for good-quality clinical care.