title: Working on the Edge: Stresses and Rewards of Work in a Front-line Mental Health Service.
abstract: This study sought to investigate frontline mental health professionals' perceptions of work stress and the rewards and demands associated with their work. Locally known as 'linkworkers', and from a variety of professional backgrounds, these staff worked mainly in general practice settings. Individual interviews were conducted with nine linkworkers, and the interview transcripts were analysed thematically. The main themes identified were the following: demands, coping, individual resilience, ownership and creativity, boundaries, secure base and service philosophy and ethos. Themes, categories and sub categories were presented and discussed with seven of the linkworkers in two focus groups. Focus group transcripts were analysed, and additional themes of recognizing limitations, disillusionment and the dilemma of setting boundaries were identified. These themes overlapped with those previously identified but were associated with service changes over time. The themes of ownership and creativity and service philosophy and ethos are significant, not only in relation to their impact on individual linkworkers but also in terms of their relevance for establishing and maintaining morale, engagement and a reflective culture within a service. The relevance of this work to accessible and newly developing mental health services is considered.
  
  
  CONCLUSIONS
  Supporting and listening to staff and allowing time for informal contact are valued by staff and enable the provision of empathic, compassionate services. Without space for reflection, staff groups may be vulnerable to the development and effects of unhelpful organizational defences, which reduce the effectiveness, quality and efficiency of caring services and increase perceived workplace stress. Services which foster staff engagement, ownership and creativity and employ "bottom up" approaches to service development are valued by staff and appear to increase staff morale and capacity to cope adaptively to change.
authors.affiliation: Norfolk and Suffolk NHS Foundation Trust, Great Yarmouth and Waveney Locality, Great Yarmouth, Norfolk, UK.|University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Gillian Elaine
authors.initials: GE
authors.lastname: Bowden
authors.affiliation: Norfolk and Suffolk NHS Foundation Trust, Norfolk Central Locality, Norwich, Norfolk, UK.
authors.forename: Joanna Christina Elizabeth
authors.initials: JC
authors.lastname: Smith
authors.affiliation: Cambridgeshire Children's Social Care, Cambridge, Cambridgeshire, UK.
authors.forename: Pamela Anne
authors.initials: PA
authors.lastname: Parker
authors.affiliation: Norfolk and Suffolk NHS Foundation Trust, Great Yarmouth and Waveney Locality, Great Yarmouth, Norfolk, UK.
authors.forename: Matthew James Christian
authors.initials: MJ
authors.lastname: Boxall
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D004651:Employment / Q000523:psychology*; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008605:Mental Health Services; D055500:Resilience, Psychological; D012201:Reward; D013315:Stress, Psychological / Q000523:psychology*
keywords: Mental Health; Work Stress