American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) ISSN (Print) 2313-4410, ISSN (Online) 2313-4402 © Global Society of Scientific Research and Researchers http://asrjetsjournal.org/ Burnout Levels among Professional Counselors in Butabika and Mulago National Referral Hospitals in Uganda Kabunga Amir a, Muya Francis Kihoro b, Njuguna Jane M c, Njuguna Christina N. d, Nginya Mary W. e, Nguvi Mary Muindi f a,d Department of Psychology, Mount Kenya University, Nairobi, Kenya b School of Education, Mount Kenya University, Nairobi, Kenya c Department of Education, Mount Kenya University, Nairobi, Kenya e Department of Early Childhood Education, Mount Kenya University, Nairobi, Kenya f Department of English and Linguistics, Mount Kenya University, Nairobi, Kenya Abstract Counseling profession places unique demands on care-providers and has negative consequences. This study explored prevalence of burnout and its preventive measures among professional counselors in Butabika and Mulago national referral hospitals in Uganda using the Professional Quality of Life-IV (proQOL-IV) questionnaire to determine levels of burnout. A total of ten research questions were used to determine common strategies employed by counselors in mitigating burnout. A cross sectional descriptive study was adopted and simple random sampling was used to select a sample of 123 respondents. The results showed that70% and 68% of counselors had developed burnout in Butabika and Mulago respectively. It was found out that the most effective strategies for mitigating burnout include; attending workshops, social support, travelling, going on vacations, hobbies, social skills, relaxation, spirituality and supervision. The study recommended that a combination of organizational and individual strategies is necessary to prevent burnout. Keywords: Burnout; Professional Counselors; Butabika, Mulago; Uganda 1. Introduction Professional counselors, just like other mental health workers, play a central role in dealing with psychological, emotional and mental issues to promote optimum mental health. However the tasks of counselors are demanding and heavy. According to Altekruse, Harris, and Brandt [1] a counselors’ job description involves guiding their clients in directions that lead to resolutions of problems. The constant interaction between professional counselors and client needs within the therapeutic relationship often leave the counselors vulnerable to burnout. 96 http://asrjetsjournal.org/ http://sw.oxfordjournals.org/search?fulltext=burnout&sortspec=date&submit=Submit&andorexactfulltext=phrase American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2015) Volume 11, No 1, pp 96-103 Burnout, a term first used by Herbert Freudenberger [2] in the mid-1970s is a condition characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment [3]. It is also defined as a psychological condition that involves a prolonged response to chronic interpersonal stressors on the job [4]. It involves three components, namely; emotional exhaustion, depersonalization (cynicism) and reduced personal accomplishment. The element of emotional exhaustion refers to lack of enthusiasm and the sense of emotional draining by clients [5]. Depersonalization is a situation where an individual develops apathy towards significant others [6]. A reduced sense of personal accomplishment involves negative self-evaluation of one’s work with clients or job effectiveness [7]. Therefore counselor burnout can be defined as a situation characterized by depersonalization, exhaustion and a diminished sense of accomplishment. In European countries with elaborate social security systems, especially Sweden and Netherlands, burnout is an established medical diagnosis [8]. This is because burnout individuals may face serious psychological and physical health problems over the course of time [9,10].Professional counselors experiencing burnout are likely to report a variety of psychological, emotional and physical health problems, including anxiety, depression, sleep disturbance, memory impairment, and neck pain [11]. Others include; decreased self-esteem, insomnia, headaches, eating problems, tiredness, irritability, hypertension, alcoholism, and myocardial infarction [12, 13, 14, 15]. At the organization level, problems include lower productivity, absenteeism, financial losses and turnover [16, 17]. Studies have shown that burnout syndrome is an independent risk factor for infections [18], type 2 diabetes and cardiovascular diseases [19, 20]. Counselors who become emotionally, cognitively, and physically exhausted in an attempt to meet demands of the clients may undermine counselors’ abilities to convey empathy, warmth and unconditional positive regards to promote a therapeutic relationship with clients [21]. In one study by Pope, Tabachnick & Keith-Spiegel, [22] among practicing psychologists a whopping 60% of the sample revealed that they had practiced therapy when they were professionally impaired. These findings point to the importance of considering counselors’ personal well-being in relation to their professional functioning. It is therefore important for professional counselors to understand the symptoms associated with burnout as it can place them at a high risk for potential ethical and legal violations. 2. Causes of burnout Research on burnout has suggested that the syndrome has structural causes in the work environment, mainly high job demands and lack of job resources [23]. This research also indicates that individual factors such as neuroticism and perfectionism play a significant role in the development of burnout, because these features influence individuals not to cope in the right way with high job demands [24]. Other risk factors include; high caseload demands; lack of a supportive work environment; social isolation; work setting; income; long working hours; time spent with clients; performing other professional tasks and severity of clients’ presenting problems [25, 26, 27]. Generally there are three categories of demands that comprise the antecedents of burnout. The first category consists of job and role characteristics. This includes the characteristics of the counselor-counselee relationship. Role characteristics consist of role overload, ambiguity, and conflict. The second category, 97 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2015) Volume 11, No 1, pp 96-103 organizational characteristics, includes job context, rewards, and punishments. The third and last category deals with personal characteristics such as personality traits and demographic variables [28]. Mulago is the national referral hospital and Butabika is the psychiatric national referral hospital. Mental health patients from all over the country are referred to these two facilities for intervention [29]. They serve the entire country's estimated population of 36 million. Therefore high caseload demands become challenges leading to burnout among care-givers. Despite its prevalence and association with a number of negative outcomes, little attention has been directed towards reducing or preventing burnout among counselors particularly in Butabika and Mulago national referral hospitals. This study therefore was to this gap. 3. Materials and methods 3.1 Study objectives i. To establish the levels of burnout among practicing counsellors in Butabika and Mulago national referral hospitals in Uganda ii. To find out the effective strategies employed by counsellors in handling burnout in Butabika and Mulago national referral hospitals in Uganda 3.2 Research Method This study was conducted using cross sectional descriptive study. A sample of 123 was selected by simple random sampling. Data on burnout was collected through use of Professional Quality of Life questionnaires and analysis of data involved using descriptive statistics such as percentages and frequencies using STATA version 18.0. Continuous variables were summarized as the mean, standard deviation and median. The prevalence of burnout was determined and reported together with its corresponding 95% confidence limits (95% CL). The burnout levels were arrived at by summing the scores of Professional Quality of Life variables. 4. Results Table 1: Levels of burnout among study counselors Counselors’ Burnout levels Low % Average % High % Butabika 30 39 31 Mulago 32 35 33 A large percentage (70%) of counselors in Butabika had developed burnout. In Mulago, 68% of counselors had developed burnout. The levels of burnout in two hospitals also compared marginally, with 39% in Butabika hospital and 35% and 33% in Mulago hospital having developed low and high burnout levels respectively. 98 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2015) Volume 11, No 1, pp 96-103 Table 2: Strategies employed by counsellors in handling burnout From the table 2; it was found out that the most effective strategies for mitigating burnout include attending workshops, social support, travelling, going on vacations, hobbies, and movies, social skills, relaxation, developing a spiritual life and receiving supervision. 5. Discussion The first objective was to establish the levels of burnout among counsellors. The study revealed that 70% of counselors in Butabika and 68% Mulago had developed burnout. The results almost corroborate a study among maternal health professionals at a referral hospital in Malawi [30]. In this study, 72% respondents reported emotional exhaustion, 43% reported depersonalization, while 74% experienced reduced personal accomplishment. Similarly in a study of 591 mental health practitioners in New York, 31 found high levels of burnout, particularly emotional exhaustion and depersonalization. Another study performed in a Kenyan psychiatric hospital 32 described similar findings. In this study the main determinants of the high rates of burnout appears to have been high job demands, number of hours worked and lack of social support. High levels of burnout among counselors are a concern and likely to contribute to the high turnover. The results however slightly contradict the findings of the study conducted by Acker 33 which showed that 56% of the participants reported moderate to high levels of emotional exhaustion and 45% reported low levels of personal accomplishment. Studies in the United Kingdom reviewed by Oddie and Ousley [34] also reported a range of 21% to 48% of general mental health workers having high emotional exhaustion. The differences could be attributed to differences in sample size and tools used. It could also be attributed to Employee Assistance Programme put in place to mitigate work-related stress. Variable Responses No % Yes % Discuss client’s cases with colleagues 79 21 Attend workshops/Education 19 81 Social support 12 88 Travel, vacations, hobbies, and movies 16 84 Chart with colleagues between sessions 54 46 Social skills 9 91 Relaxation 16 84 Limiting number of case load 34 66 Develop spiritual life 1 99 Receive supervision 3 97 99 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2015) Volume 11, No 1, pp 96-103 The second objective was tofind out the effective strategies employed by counsellors in handling burnout. The study revealed that the most effective strategies for mitigating burnout include attending workshops, social support, going on vacations, hobbies, social skills, relaxation, spirituality and receiving supervision. Raising awareness about burnout is important and counsellors should understand the causes, consequences and solutions to the burnout problem. Social support is also important and should be included in the management and addressing of the burnout [35]. Most studies show that burnout is mainly predicted by work overload and lack of social support [36]. Studies have also shown that care providers who seek supervision tend to experience lower levels of burnout than their counterparts who do not [37]. 6. Conclusion and recommendations Burnout has negative consequences for the health and well-being of counselors. The results of this study show that majority of professional counselors in both Butabika and Mulago national referral hospitals had developed symptoms of burnout. Therefore a combination of organizational and individual strategies is necessary to prevent burnout. 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