What factors influence the retention of workers in NHS mental health crisis services in England? A reflexive thematic analysis

TL;DR

This study explores why workers stay or leave NHS mental health crisis services in England, identifying key factors like resource limitations and emotional burden.

Contribution

The study highlights unique retention challenges in crisis services, such as emotional intensity and resource constraints, compared to other mental health roles.

Findings

Five themes influencing retention were identified: resource limitations, organisational culture, fairness, personal agency, and team working.

Crisis workers face higher emotional burdens and complex risk management challenges compared to other mental health roles.

Crisis services are more vulnerable to resource constraints and offer fewer development opportunities.

Abstract

To understand factors that influence the intention of workers to remain in or leave employment in National Health Service (NHS) mental health crisis services and to use findings to formulate recommendations for NHS trusts to achieve improved worker stability in mental health crisis services.

A reflexive thematic analysis was conducted to explore the retention-related experiences of crisis workers. Secondary data was obtained from interviews conducted with crisis workers. This was collected by The University of Sheffield as part of the Retention of Mental Health Staff (RoMHS) study.

Six NHS Trusts in England.

All crisis worker interviews from the RoMHS study were included, totalling 10 participants: 70% female, 30% male, exclusively White British, and mostly occupying leadership roles.

Five themes were identified as influencing the retention of crisis workers: resource limitations, organisational culture and leadership, fairness and consistency, personal agency and team working. These themes are comparable to factors known to affect retention of the mental health workforce more widely. However, this study found a greater emphasis on the emotional burden of crisis work, including the challenges of complex risk management, and a perceived vulnerability of crisis service workers to increased workload and fewer development opportunities compared with other specialist mental health services.

This study identifies that crisis workers face similar retention-related issues compared with the mental health workforce more widely, but with additional challenges related to the emotional intensity of the work and susceptibility of crisis services to resource constraints compared with other specialist mental health services. Further research should focus on employees who left crisis services, under-represented groups within the crisis workforce and the impact of retention-related policy.