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

Objectives 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.

Design 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.

Setting Six NHS Trusts in England.

Participants 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.

Results 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.

Conclusion 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.