Mental health services with high staff turnover are likely to have higher patient suicide rates, according to a study by the University of Manchester.
The report, titled ‘Healthy Services and Safer Patients’, is based on nearly 14,000 patient suicides which occurred between 2004 and 2012.
Director of the Inquiry, Professor Louis Appleby, who also leads the National Suicide Prevention Strategy for England, says the data shows that high staff turnover could be a ‘warning sign’ for patient safety.
“High staff turnover could compromise safety in that frequent changes of staff are likely to disrupt the continuity of care of vulnerable patients,” he said.
Professor Appleby also clarified what the data may mean for the way health service are organised, saying that the data does not necessarily show changes in staff are causing the higher suicide rates themselves.
“The effect may not be causal: staff turnover could be a marker for something else affecting safety, such as poor leadership.
“What the data shows is that high staff turnover may be a warning sign for patient safety and services should monitor it closely.”
The study also links higher rates of suicide with patient complaints and safety incidents, indicating that staff turnover may not be the direct cause.
One of the authors of the report, Professor Nav Kapur, said that although the report does not necessarily show a causal link the results should still be taken seriously.
He told MM: “There may be a tendency to link the number of complaints and safety incidents to a culture of openness and transparency.
“This may be the case but they may also be an indication that there are real safety concerns that need to be addressed.”
The report recommends that mental health services should aim to reduce their staff turnover and that they treat increased staff turnover and patient complaints as safety alerts.
The findings were welcomed by Ged Flynn, Chief Executive of the national charity PAPYRUS for the Prevention of Young Suicide.
He said: “PAPYRUS has long campaigned for continuity of quality care for those experiencing suicidal ideation and/or exhibiting behaviours which may put their life at risk.
“In a mental health care setting, it is imperative that young people particularly are met with compassion, skilled care and, crucially, have one good link person whom they can trust.
“If we are to save lives from suicide, we would all do well to learn from the findings of the recently published report from NCISH, ‘Healthy Services and Safer Patients’, both within the NHS and in the community where similar lessons may apply.”
Professor Kapur explained that the study did not look for a possible reason for the apparent link, and because the study was purely observational it was not possible to identify specific reasons for the link from the results.
However, he suggested that high turnover could indicate that there is some other problem which may affect the safety of patients.
“Poor leadership or poor staff morale, where staff are frequently looking to leave and the organisation isn’t operating as effectively as it could be,” he said.
“If there is a causative link, it’s possible that high staff turnover causes a disruption in the continuity of care, which impacts on patients, though you can’t say that from this study.”
The study is the first of its kind to show a link between the way a mental health service is organised and the safety of its patients.
Image courtesy of Rengarajan Janakiraman, with thanks.
