"I Don't Want to Go Back to Square One:" Community Mental Health Center Staff Turnover As Experienced By Clients, Staff, and Leadership during the COVID-19 Pandemic

Background and Purpose: Staff turnover at community mental health centers (CMHCs) is an enduring and multifaceted issue. CMHCs are continually underfunded, and many staff members feel underpaid and overworked, leading to high staff turnover, which negatively impacts client care. The COVID-19 pandemic only exacerbated these issues. In the growing body of mental health research on the pandemic, studies that explore the firsthand experiences of those involved in the community mental health system are essential. This study qualitatively explored CMHC clients’ experiences of and perspectives on staff turnover during the COVID-19 pandemic. It also includes experiences and perspectives from five CMHC staff members and six members of CMHC leadership.

Methods: Participants were 15 CMHC clients with serious mental illnesses (SMI), five CMHC staff members (including psychiatric, case management, and counseling service providers), and six members of organizational executive leadership. Clients had been seeking mental health services since March 2020 (for an average of 5.63 years), and staff and leadership had worked at their organization since March 2020 (for an average of 5 and 3.67 years, respectively). Qualitative interviews were conducted and analyzed using a thematic narrative analysis approach.

Results: Clients described struggling to progress in their recovery due to frequent staff turnover, which intensified during the pandemic. It took time to build trust with a new provider, and this process of starting over and rehashing their past could bring up traumatic memories. Clients also described creating boundaries with their clinicians in anticipation of turnover, and withdrawing from the therapeutic process when they learned a clinician had a limited tenure at the organization. Staff described intense burnout and feelings of organizational abandonment during the pandemic. Staff members had many colleagues who left the organization during the pandemic, increasing strain on the remaining providers. Leadership described tensions with staff that arose or magnified during the pandemic. They emphasized conflicts over remote vs in person work policies, and described how the negative financial impacts of the pandemic on their organizations made it difficult to adequately compensate and retain staff.

Conclusions and Implications: These findings illustrate the trickle-down effect of pandemic-accelerated organizational tension and stressful working conditions at CMHCs on clients with SMI. The resultant staff turnover creates difficult conditions for clients to engage in their mental health recovery process. These findings also reinforce the urgent need for CMHCs to address the enduring issue of staff turnover that intensified during the COVID-19 pandemic and continues today.