How can mental health professionals best be supported in working with people who experience significant distress?

Working with people with severe psychological and social problems can affect workers' mental health. People associated with a diagnosis of personality disorder in particular have been described as evoking high levels of anxiety in workers.

This study aimed to explore what mental health workers find most challenging in their work, whether challenging aspects of the work are related to diagnoses of personality disorder and what sources of support staff would find most helpful.

This is a qualitative study. Data were collected via a series of focus groups and analysed using a grounded theory approach.

An overall model, working with significant distress, brings together eight categories that escribe aspects of working in mental health services, which can be challenging: joint working, eligibility criteria, complexity of reality, models of understanding, system processes, needs of workers, interventions and interface with diagnosis.

Workers report that the most challenging aspects of their work involve struggles within and between different parts of systems, rather than being associated with particular diagnoses. A number of suggestions are made for better meeting the needs of workers.