Depicting professional cultures of mental health workers: development and validation of the Bicocca Mental Health Professional Culture Inventory

The process of care in Mental Health services (MHS) could be influenced by a number of different staff related factors, such as staff morale and burnout levels, staff technical and interpersonal skills, attitudes and values. Social processes are particularly relevant in the Mental Health sector, since workers deal with clinical conditions and care procedures that rely on professional social constructions. Mental health services staff in middle and high income countries is composed mainly by specialized workers such as psychiatrists, nurses, social workers, psychologists and support workers organized in multi-professional teams whose composition is determined by local level regulations. Beside the professional knowledge, each profession is also constituted by the social dynamics that are proper of a specific social group. The creation of a professional role, such as mental health nurse or clinical psychologist, leads to the development of a system of values, schema and knowledge, shared among the members of that professional group and that orient professional behavior and coping. Those shared cognitive and behavioral schemata constitute the “professional culture” (PC) that could be considered as a subsystem of the broader organizational culture and it also linked with further constructs such as professional identity, professional role, attitudes and beliefs toward clients, professional values, cultural artifacts and affective issues related to team working, inter-professional collaboration and clients. Currently, there's lack of studies that try to develop a comprehensive model professional culture of mental health professionals (PCMHP). This dissertation makes an attempt to define the construct of professional culture of mental health professionals using a bottom up approach to derive theoretical construct from empirical data. The first chapter introduces the issue of professionalization in mental health services. The main idea is that professionalization of mental health staff is the result of cultural changes in the history of the western countries that created a complexification of task and organization of mental health services. In the second chapter is presented a synthesis of the current literature performed using the meta-ethnographic approach to link together relevant qualitative studies on mental health staff work experiences. The results show that professionals working in mental health field share some common elements of PC such as the importance of the interpersonal relationship with users, the relevance of values in the professional practice and the need of keep a mindful and reflective attitude toward the work. The third chapter describes the development of a new questionnaire, the Bicocca Mental Health Professional Culture Inventory (BMHPCI) in collaboration with the research center of the Institut Universitaire en Santé Mentale de Montréal. A pilot phase was conducted to determine whether linguistic or cultural differences could affect items’ comprehension to prevent reductions of internal validity. BMHPCI validation phase is presented in chapter 4. Questionnaire validity and reliability was tested through a survey of a representative sample of mental health services workersThe instrument developed shows good psychometric properties and statistically significant correlations with team climate and burnout scores. Statistically significant differences in BMHPCI subscales were found between professional roles and mental health settings.