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Mental health nurse turnover linked to suicide rate


Mental health services with higher levels of staff turnover have higher patient suicide rates, according to UK researchers.

The study found suicide rates were higher in mental health trusts with the highest levels of staff turnover, especially for nursing, suggesting the importance of organisational factors.

“A workforce that is constantly changing is likely to affect the continuity of care and this could compromise safety,” said Professor Nav Kapur, lead author and head of suicide research at the Centre for Suicide Prevention at Manchester University.

Meanwhile, the researchers also suggested that key improvements in NHS mental health care over recent years may have helped to reduce suicide rates in England.

As well as organisational factors, like staffing, they examined the adoption of 16 recommendations for safer services made in 2015 by the National Confidential Inquiry into Suicide and Homicide by people with Mental Illness.

These covered factors linked to ward safety, availability of community services, staff training, adoption of specific policies, and adoption of clinical guidelines.

The researchers analysed patient suicide rates during 16 years between 1997 and 2012, including data on 19,248 patients in contact with mental health services in the year before they died.

Centre for Suicide Prevention at Manchester University

Mental health staff turnover linked to suicide rate

Nav Kapur

They found that, by 2012, 94% of services had implemented at least 10 of the changes recommended by the inquiry and 55% had implemented all 16.

Those most widely implemented were removal of non-collapsible ligature points on wards, policies to reduce absconding on in-patient wards, and a mechanism to implement National Institute for Health and Care Excellence guidelines.

The five changes linked to the biggest falls in suicide were increasing the availability of specialist community services like crisis resolution and home treatment, better management of patients with dual diagnosis, reviews and information with families after suicide, policies to help manage transition to adult services and implementing NICE guidelines on depression.

Each of the 16 recommendations were linked with 20-30% decrease in the suicide rate, said the study authors in the journal The Lancet Psychiatry.

Importantly, implementing the five key changes had a greater impact in services with low levels of non-medical staff turnover and higher levels of reported safety incidents, said the researchers.

Professor Kapur said: “Our study suggests that many of these interventions may prevent suicide and save lives.

“The data also show that at least as important as these initiatives might be the organisational context in which they are introduced,” he said.

Centre for Suicide Prevention at Manchester University

Mental health staff turnover linked to suicide rate

Louis Appleby

Professor Louis Appleby, director of the National Confidential Inquiry and a study co-author, added: “This study shows that how clinical staff work can make a difference to patient suicide risk.

“Mental health trusts with low staff turnover, and where staff reviewed suicide deaths with families had lower suicide rates suggesting that healthy, learning organisations may also be safer,” he said.


Readers' comments (3)

  • Not really surprising. High staff turn-over rates have a detrimental effect on all aspects of the care system, including on the remaining staff trying to deliver that care.

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  • The issue seems to be not simply down to high turn over rates but its association to likely presenting organisational factors, which is a polite way of saying toxic influences. But also there is a threat where high regular discharge numbers occur it is also a problem resulting in potential revolving door syndrome and higher harm rates due in part to pushing out patients from bed pressures and toxic approaches such as false QI lean improvement. Lean is so dangerous in this regard and we need to identify bed pressure not only for admission but for discharge. The premise on community care is causing a lack of beds and dismises issues on the need for some to have sanctuary. Counter intuitively for some personality based disorders the over forging of stay associated on maladaptive dependency might also be a factor towards suicide attempt. And so the drain on staff not geared for specific presentations, emotional demands and fear for therapeutic risk taking will result in burn out with potential for anticipatory anxiety and PTSD. Also the notion of resilience is faulty and what should be looked at is what is reasonable as it doesn't matter how strong you are where emotional demand and constant dramas have an eventual effect. Also the rock and a hard place scenarios are plenty in MH services and so fear of the NMC with poor distant management decisions is leading to high turnover. In effect MH nurses need a new regulator to understand polarity of action is not so clear cut in MH. We also have environmental safety given little premise other than reactive cause by management and is often second to faulty performance of difficult situations. Couple this with nurse documentation, legality and low numbers with little understanding by coroners you have a recipe for disaster. The only solution is higher numbers of staff, beds and operational leaders on every shift not just rank and file nurses. High numbers = more input and more visual and so less harm. Everything this government is doing including NHS Improvment and Jeremy Hunt. Imagine saving life after life and constantly fighting with crap vague management. And plus not just scientific approaches but also understand Insight, foresight and more sight are essential - how many academic newly qualifiers Turkey have this?

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  • Oops spell checker gone awry meant to read everything the government are doing wrong. And I don't know where Turkey came from. Doh sorry lol

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