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High staff turnover at mental health trusts linked to patient suicide risk

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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”

Louis Appleby

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.

  • 2 Comments

Readers' comments (2)

  • Having just watched a BBC TV programme about the suicide of a female patient of the Avon and Wiltshire Mental Health Trust this evening, who was allowed to self harm in a controlled environment with a staff member in attendance, but then committed suicide two days later this excellent report is of no surprise to me.
    At the last board meeting of this trust, long term staff sickness was increasing with stress, anxiety and depression of staff being the main reason.
    Staff shortages are the norm, agency staff accounting for even larger numbers of staff working on wards at any one time.
    From my experience, poor leadership IS a major contributor to staff leaving - but of course staff are unwilling to state the truth on their exit surveys - tell the truth about your experiences here and we give you a bad reference ??
    Written complaints are also an indicator - but only if the trust actually records written complaints accurately - and only if it responds to them !
    Regretably, commissioners of AWP MHP NHS T rely on SELF REPORTING by the trust itself - so of course everything looks fine - even when its clearly not.
    High staff turnover MOST CERTAINLY IS LINKED TO SUICIDES OF PATIENTS - especially when good staff get fed up and leave, no one else wants to work for a failing organisation ( staff talk and prospective employees WONT work for a failing trust , especially if it has a terrible long term reputation ).
    It appears some trusts have had to arrange some kind of deal with their local media NOT to report numerous incidents, and trusts can go to extreme lengths to silence those who tell the truth.
    Staff still fear to Whistleblow - I believe AWP MHP NHS T had - EIGHT - qualified whistles blown in the last 12 months reporting period , but I wonder if staff were not so scared to whistleblow it could be nearer to 8000 ?

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  • This report raises more questions than it answers. A lot a chicken and egg stuff. Do staff leave because of high suicide rates or are there high suicide rates because of high staff turnover? Either way, senior management at the trusts and up to Government level with poor staffing and poor funding are no doubt high on the agenda for responsibility. Unfortunately little or nothing will be done, the poor nurses and other health providers will be blamed and the situation will just carry on.....

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