Turnover and Retention Strategies among Mental Health Workers
Debbie L. Young
Doctor of Business Administration, Trophy Club, Texas
*Corresponding author: Debbie L. Young, Doctor of Business Administration, Trophy Club, Texas, USA.
Received: 29 May 2022; Accepted: 06 June 2022; Published: 29 June 2022
Citation: Debbie L. Young. Turnover and Retention Strategies among Mental Health Workers. Fortune Journal of Health Sciences 5 (2022): 352-362.Share at Facebook
Background: The purpose of this study was to explore retention strategies that healthcare administrators use to retain mental health workers in community mental health clinics. The study was guided by the question What strategies do HCAs use to retain their MHWs with more than 2 years of experience?
Methods: A qualitative case study analysis was performed. Interviews were conducted with six healthcare administrators at Fort Worth area community mental health clinics. Interviews were coded using thematic analysis. To increase the study’s reliability and validity, the interview guide was field checked by experts and member checking performed on interview transcripts.
Results: The healthcare administrators identified six strategies for retention: providing good benefits packages, promoting worker health and wellness, providing competitive salaries, giving workers flexible scheduling options, incentivizing workers with rewards and positive reinforcement, and maintaining open communication channels.
Conclusions: The results from this study have positive implications for mental health workers, patients, and community mental health clinics. The strategies identified in this study can be implemented to increase worker satisfaction and reduce turnover. In doing so, patients will receive higher quality care and organizations will be more attractive to prospective employees.
community mental health workers, turnover, retention, healthcare administrators, healthcare management
Mental health workers experience high turnover rates of more than 50% , a factor that has been linked to inadequate quality of care for patients in community mental health clinics . Aside from contributing towards poor quality patient care, high turnover rates among mental health workers impose significant financial burdens on organizations  and increase worker dissatisfaction . Turnover is related to a number of factors such as low salary, poor work-life balance, relationship conflicts, and limited opportunities for career growth . Since high turnover rates among mental health workers can lead to lower quality care, it is essential that health care administrators develop and implement effective retention strategies.
1.1 Turnover and Retention in Healthcare
Since mental health workers work closely with patients to develop trust and deliver high-quality care, it is essential that turnover be reduced. A recent report by the Substance Abuse and Mental Health Administration (2017) indicated that factors such as understaffing, increasing workloads, and a lack of training contributed towards turnover among mental health workers. High turnover rates disrupt the workplace cultures of mental health organizations and can have negative consequences at the organizational and individual level. For instance, organizations that experience high turnover might have difficulty with recruiting skilled professionals , and incur significant costs associated with recruitment and training of new employees . As a result, clinics with high turnover may find it hard to provide high-quality care in the future. Since many workers leave their jobs out of dissatisfaction, effective retention strategies include those that focus on improving employee motivation, workplace satisfaction, and employee engagement .
1.2 Employee Job Satisfaction and Dissatisfaction
Employee satisfaction is driven by factors such as workplace culture, available resources, and satisfaction with the work itself [9, 10]. Workplace satisfaction is driven by intrinsic motivation factors such as the opportunity for personal achievement, recognition, and the difficulty of the work . Dissatisfaction with work is most often associated with extrinsic motivation factors including workplace relationships, salary, and benefits . Within the mental healthcare industry, workers who have the most direct patient contact, such as nurses, tend to experience the lowest job satisfaction . In organizational settings that are highly dependent on teamwork, such as mental healthcare, high turnover can result in increased workloads on the remaining team members, which can increase job dissatisfaction . Mental health workers also often work in stressful work environments, a factor which can further increase their job dissatisfaction .
1.3 Recruitment and Retention
Effective retention strategies capitalize on the factors which motivate workers to join and stay at an organization. Factors that motivate mental health workers to join the field include the desire to care for patients in need . Others may seek to reduce the stigma associated with mental illness through education and awareness about possible causes and treatments . Workers who believe that they are fulfilling these goals are more likely to stay at their jobs. Workplace retention among mental health workers is also influenced by positive relationships with co-workers; the team delivery of healthcare and a shared understanding of human behavior often serve to form positive connections between mental health workers . On the contrary, factors such as small staff-to-patient ratios may serve to decrease retention among community mental health workers . The high-risk environment in which mental health workers work, coupled with inadequate pay, may also increase employee turnover . A lack of positive feedback or recognition , alongside a perceived lack of opportunity for career advancement  also influence turnover rates among mental health workers.
1.4 Purpose of the Study
Recognizing that research on possible retention strategies for mental health workers is limited despite the burden high mental health worker turnover imposes on patients, employees, and organizations, the purpose of this study is to explore multiple retention strategies healthcare administrators use to retain their mental health workers with more than two years of experience in Texas community mental health clinics. The research question guiding the study is: What strategies do healthcare administrators use to retain their MHWs with more than 2 years of experience? For the purposes of this study, health care administrators (HCAs) were defined as nonclinical professionals who make decisions related to the day-to-day administrative operations of health care facilities and hospitals and ensure adherence to healthcare laws and regulations . Mental health workers were those who provide treatment, documents care, and meet the primary health care needs of patients with mental illness or behavioral problems .
A qualitative case study design was selected for this study. Since the goal of this study was to develop an in-depth understanding of a specific phenomenon (in this case, strategies for retaining mental health workers), a qualitative methodology was the most appropriate . While quantitative methods can be fruitful ways to developing more generalizable conclusions, such an approach is typically useful when the purpose of the research is to investigate a relationship between two or more variables acting on a large sample population . Since this study involved conducting a small-scale investigation into how a certain phenomenon happens, qualitative methods were more appropriate. Furthermore, a case study design was selected so that the retention strategies employed by HCAs at multiple locations could be investigated. Other popular qualitative designs, such as ethnography and phenomenology, emphasize in-depth investigations of specific cultures  or meanings behind lived experiences , and so were not appropriate.
2.1 Recruitment Procedure and Participants
The participants in this study were recruited using purposive sampling from community mental health clinics in Fort Worth, Texas. Eligibility criteria were that participants had to be healthcare administrators with more than two years of experience with hiring and retaining mental health workers within their clinics. Healthcare administrators were chosen as the target population because they have the ability to implement new retention policies and are responsible for overseeing mental health workers. Approval was obtained from the Walden University Institutional Review Board (IRB). Initially, the head of Human Resources at community mental health clinics in Denton and north Tarrant counties were contacted to identify the appropriate person to obtain authorization for conducting the study. Personal invitations were emailed to identified HCAs with information about the purpose, methods, and potential benefits of the study. An informed consent document was also included in the emails. Interviews were only scheduled once administrators replied to the email with their consent within a 7-day period. Of the 11 interested volunteers, six satisfied the eligibility criteria. Since the goal of case study analysis is to collect in-depth data about a specific phenomenon , six participants were deemed an acceptable sample size. Interviews were guided by an interview protocol that followed a set of 7 pre-determined questions (see Appendix A). Three days after the interviews, interview summaries were prepared and sent to participants for member checking .
2.2 Data Analysis Procedure
Member checked interview summaries were analyzed with the aid of NVivo 12 software. Data was analyzed using thematic analysis, a technique used in qualitative studies used to generate themes based on careful analysis of interview data . The phases of thematic analysis include familiarization, coding, initial theme development, theme revision, theme finalization, and report generation . During the familiarization phase, interview transcripts were read several times to identify key words and phrases related to the research question. Codes were then used to describe these key words and then grouped together to generate the initial themes. Themes were revised to form more concise thematic groupings before the final list of themes was developed.
2.3 Reliability and Validity
In qualitative research, the researcher must ensure that the study’s credibility, transferability, dependability, and confirmability are upheld . In this study, an audit was used to increase dependability. The interview guide was tested by Human Resources professionals with more than 10 years of experience with implementing successful retention strategies to ensure that the interview questions were designed to answer the research question. Interviews were also member checked by participants to enhance credibility . Detailed methods procedures help uphold the transferability of this study by making it easier for future researchers to replicate this study or apply its findings in another context . Confirmability was maximized by reducing bias through the use of a validated interview instrument and assessing the potential sources and contributions of researcher bias throughout the study process.
3. Results and Discussion
Participants discussed a variety of different retention strategies that their organizations used to improve worker satisfaction and retention. These strategies are summarized in Table 1 below:
Number of Responses
Providing good benefits packages
Promoting the health and wellness of mental health workers
Providing competitive salaries
Providing flexible scheduling options
Incentivizing workers with rewards and positive reinforcement
Open communication between workers and administrators
3.1 Providing good benefits packages helps retain employees
All of the participants identified good benefits packages as a successful retention strategy. When participants were asked about strategies, they have adopted to increase worker retention; four explicitly referenced their organization’s benefits package. For example, Participant 6 stated, “We offer competitive benefits and salary packages including flexible schedules when possible.” The other two participants implicitly referred to their organization’s benefits as helping retain workers, with participant 4 explaining, “we offer school loan repayments, paid time off (PTO), if needed, time extended for patients’ treatments, flexible schedules.” Other empirical research has also highlighted the importance of good benefits packages in retaining employees, with Read & Laschinger (2015) claiming that employee benefits may determine whether a business retains or loses its seasoned employees to their competitors who may offer more attractive benefits and salaries.
3.2 Providing competitive salaries helps retain employees
Half of the participants claimed that competitive salaries compensation helped retain workers. It is important that employees receive a salary that reflects their station and is competitive with that of similar positions at other organizations . For some workers, a fair salary may outweigh other aspects of their job that are dissatisfactory . If workers do not feel that they are fairly rewarded for their work, they may be more likely to leave, even if the organization offers other strong benefits. Therefore, it is essential that HCAs ensure their mental health workers are receiving fair and competitive salaries.
3.3 Promoting employee health helps retain employees
Another common retention strategy identified by participants was providing support and resources to workers experiencing work-related stress. Five of the six HCAs interviewed said that mental health and wellness strategies were used to improve worker satisfaction and retention. This is especially important in the mental healthcare field, where the stressful nature of the work can take a negative toll on the mental health of the workers . Participant 1 recognized that sometimes mental health workers need time to take a break by stating that “even though they are mental health professionals, these workers also need mental health days off when they are feeling overwhelmed.” Participant 5 emphasized that their company provides multiple communication channels to mental health workers to help them cope with stressful situations. These responses demonstrated that HCAs are aware that their workers’ mental health can be impacted by the stressful nature of their jobs, and that stress-relieving strategies are a commonly used tool to increasing worker retention.
3.4 Flexible scheduling options help retain employees
Five participants highlighted providing employees with flexible schedules or sufficient paid time-off as a strategy for improving worker satisfaction and retention. Four participants used the exact phrase “flexible schedule” when describing their worker retention strategies. However, it is important to note that flexible schedules are just one of many possible incentives that can be provided to mental health workers. Other motivators such as salary and positive workplace culture can also help contribute to increased worker satisfaction and retention . Other research has identified time-off, employee awards, mentoring programs, and promotions as strategies for targeting internal factors to increase worker retention.
3.5 Incentives may help to retain employees
Four participants listed incentives or bonuses as another strategy for retaining employees. Two of the four participants described how they provide yearly bonuses to employees, while the other two participants did not mention whether their bonuses were offered at certain intervals. This finding aligns with those of Read and Laschinger (2015), who demonstrated that the benefits offered to employees are critical to retention efforts. Organizations that do not offer such benefits risk losing their experienced employees to competitors that are willing to offer a more substantial compensation package. Bonuses and other incentives also present a more feasible retention option to organizations that cannot afford to increase the salary of all of their workers.
3.6 Open communication helps retain employees
Maintaining clear and open communication was another strategy repeatedly referenced by participants, with four of the six participants highlighting the important role that open communication channels between workers and administrators play in worker retention. As a result, workers are able to receive feedback and provide feedback to leadership.  Previously identified that a lack of employee engagement through administrative indifference could lead to work dissatisfaction among seasoned employees. By providing an outlet for workers to express their opinions and engage with leadership, organizations hope to prevent worker dissatisfaction. Sinha and Thaly (2013) offered similar suggestions, arguing that poor engagement among seasoned employees may result from poor communication or limited opportunities for worker involvement in decision-making.
3.7 Implications and Recommendations
The strategies for mental health worker retention identified in this study may be employed by HCAs in other clinics to increase the satisfaction and retention of their employees. Across the country, mental health worker retention rates have been estimated to be as high as 50% , highlighting the urgency with which successful retention strategies need to be implemented. An inability to retain mental health workers negatively impacts the facilities that demand MHWs and their services. Additionally, since high turnover rates are associated with inadequate patient care for patients at community mental health clinics, the results of this study have positive implications with regards to improving patient care . By understanding and implementing effective retention strategies, the findings of this study may also help organizations increase the number of qualified and experienced MHWs, improving the quality of mental health services they offer. The retention strategies identified in this study also have positive implications for mental health workers themselves, as participants in this study reported their workers are more satisfied with their jobs.
The retention strategies discussed in this study should be implemented based on an assessment of current retention strategies and job satisfaction levels of mental health workers. Based on current workplace policies and worker satisfaction, administrators may choose to offer more flexible scheduling options, enhanced compensation packages, or incentives to support the satisfaction of mental health workers. Alternatively, administrators may also choose to adopt stress reduction practices in order to enhance the health and wellness of mental health workers, thereby reducing job dissatisfaction and preventing occupational burnout. Upper administration of organizations should encourage administrators, particularly those who are involved in hiring, managing, and engaging with workers within the mental health field, to consider the potential implications of the current study’s findings, conclusions, and recommendations.
There were several limitations to this study. Since this study had a sample population of only six HCAs working in the same two counties, it is difficult to generalize the findings to organizations outside of the Fort Worth area. While data gathered from the interviews enabled the development of an in-depth understanding of certain factors that influence mental health worker retention, it certainly did not capture all of the factors related to worker retention. Additionally, it is not possible to make statements of causality, correlation, or prediction from qualitative methods alone. For instance, while this study demonstrated that flexible scheduling options can help improve worker satisfaction and retention, it is not clear if a lack of flexibility is a cause of worker dissatisfaction and attrition. Therefore, future research on retention strategies used to retain mental health workers should integrate quantitative methodologies to investigate questions of significance, causality, and correlation. Quantitative studies also typically deal with larger sample sizes, meaning the results are more generalizable. Future research should also consider including HCAs who work in different healthcare settings. Mental health workers who work in inpatient hospital settings experience a different work environment than workers who work in community clinics; therefore, it is likely that worker satisfaction and retention is influenced by different factors. Investigating how HCAs can improve the retention of mental health workers across a variety of care settings can contribute to the growth and development of the mental healthcare field more broadly.
Healthcare administrators can implement several strategies to increase the well-being and retention of mental health workers at community clinics. Such strategies include providing good benefits packages, promoting worker health and wellness, providing competitive salaries, giving workers flexible scheduling options, incentivizing workers with rewards and positive reinforcement, and maintaining open communication channels. Doing so will help mental health clinics deliver higher quality patient care, leading to improved patient outcomes. Additionally, these retention strategies will help increase worker satisfaction and lead to the development of a more positive workplace culture, making the organization more attractive to prospective employees. While the results of this study provide important insights into how retention of mental health workers can be improved, more research across different healthcare settings is needed to determine what factors cause worker dissatisfaction and attrition so that more comprehensive retention strategies can be developed.
List of Abbreviations
ORCID Open Researcher and Contributor ID
CITI Collaborative Institutional Training Initiative
HCA Healthcare Administrators
IRB Institutional Review Board
MHW Mental health worker
PTO Paid Time Off
SAMHSA Substances Abuse and Mental Health Services Administration
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Appendix A: Interview Questions
- What retention strategies do you use to retain your MHWs with more than 2 years of experience?
- What retention strategies have you found work best to prevent job dissatisfaction through understaffing of your MHWs with more than 2 years of experience?
- Based upon your organization’s experience, how, if at all, do your retention strategies decrease job dissatisfaction by addressing the increased job demands on the MHWs with more than 2 years of experience?
- Based upon your organization’s experience, how, if at all, do your retention strategies increase job satisfaction through ongoing training processes to motivate your MHWs with more than 2 years of experience?
- Based upon your organization’s experience, how, if at all, do your retention strategies increase job satisfaction by including employee input, suggestions, needs, and demands regarding their jobs?
- Based upon your organizations’ experience, how, if at all, does your leadership staff support your current retention strategies to retain your MHWs with more than 2 years of experience?
- What additional information can you share about your retention strategies for decreasing high turnover rates with MHWs with more than 2 years of experience?