Mental health trusts with a higher staff turnover and more complaints are linked to a greater risk of patient suicide, new research has found.
Academics from the University of Manchester’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness found the rate of suicide was around 30% higher in services that also had high rates of written patient complaints.
They also found that a larger number of suicides were associated with a greater turnover of non-medical workers, which included nursing staff and other qualified therapeutic professionals.
“What the data shows is that high staff turnover may be a warning sign for patient safety”
In their report – called Healthy Services and Safer Patients: links between patient suicide and features of mental health care providers – researchers said these factors should act as a “safety alert” to providers and commissioners.
The investigation aimed to find out whether suicide rates were related to the way NHS mental health services were organised by analysing staff and patient surveys and national database information on patient suicides between 2004 and 2012.
Researchers looked at 13,960 people who had died by suicide within 12 months of being seen by mental health services, which represented 27% of all suicide that occurred in the UK during the same time.
They said that while it was possible that frequent changes of staff could disrupt the provision of consistent care and lead to more suicides, it was not clear whether this was definitely the cause.
The report suggested that high suicide rates could encourage staff to leave, or both suicide rates and staff turnover could be linked to another factor such as changes in service configuration.
In its key messages to service providers, the report also notes that while higher rates of complaints and safety incidents are sometimes taken as evidence of an open reporting culture, its findings suggest they may also reflect real safety concerns.
Professor Louis Appleby, director of the inquiry and who also leads the National Suicide Prevention Strategy for England, said: “High staff turnover could compromise safety in that frequent changes of staff are likely to disrupt the continuity of care of vulnerable patients.
“However, the effect may not be causal – staff turnover could be a marker for something else affecting safety, such as poor leadership,” he said.
“What the data shows is that high staff turnover may be a warning sign for patient safety and services should monitor it closely,” he added.