Why Do Mental Health Employees Leave Their Job? Exit Survey Results

Background and purpose: Employee turnover is a significant problem for many community mental health organizations (CMHOs). Excessive turnover could negatively impact the organization (e.g., extra cost for new hires/training), individual employees (e.g., diminished well-being), and the quality of care for clients (e.g., disruption to service continuity). Several factors for turnover have been suggested in the literature, including demographics, job well-being, and organizational support. However, most existing studies have been conducted within specific research contexts (e.g., intervention research). Exit interviews/surveys of people leaving the organization at their natural job settings can be useful for understanding turnover. Yet, exit interviews/surveys are not often utilized to address the issue. The current study aims to address this gap in the literature by analyzing exit survey data collected at a CMHO, and provide implications to address urgent turnover issues.

Methods: We conducted exit surveys at a CMHO that employed approximately 300 workers in an urban area for 18 months. We invited employees who submitted resignation notifications to the organization to complete an online exit survey. The open-ended exit survey questions asked about the most critical reasons for leaving, what made them stay until then, and what changed for them to decide to leave. The demographic information of turnover cases was obtained from the organization. Qualitative analyses using a constant comparative method were conducted to identify emerging turnover themes. Member-checking was provided through 1-hour focus group sessions with 14 current employees at the organization.

Results: Sixty-one invitations were sent and 35 people completed the survey (58% response rate). There were no statistically significant differences between those who responded to the survey and those who did not in terms of demographics, tenure years, or wage. Survey respondents had an average age of 37.2 (±10) years, an average tenure of 3.8 (±4) years, and an average salary of $21.2(±6)/hour. Eighty-six percent were clinical staff, 60% were Caucasian, and most were female (74%), single (66%), non-exempt (74%), and 57% had masters degree or beyond. Most respondents (82%) indicated positive experiences with the organization, co-workers, and/or clients as the primary reason why they stayed at the organization until they decided to leave. The qualitative analyses identified five major turnover themes, including: (1) struggles in current job roles, (2) negative experiences with upper management, (3) quality of care concerns, (4) no foreseeable future, and (5) personal/family reasons. Member-checking confirmed turnover themes and highlighted the dynamic nature of turnover decision-making processes, including employees’ struggles when managing work demands and balancing work motivation, challenges, and quality of care they provide to clients.

Conclusions and implications: Social workers are the critical workforce in CMHOs that often struggle with high turnover. Exit survey utilization was found as a useful method to identify turnover factors that may facilitate evidence-based turnover prevention and employee retention strategies. In particular, the current study suggests that organizational social work leaders should shift their management practice from organizational and management efficiency to supporting the quality of work among employees, which may eventually help reduce turnover.