INTRODUCTION
Mental health services in South Korea have gradually shifted from hospital-centered care to a community-integrated approach [1, 2]. However, the community mental health workforce responsible for delivering these services has become increasingly unstable, with high turnover rates emerging as a persistent challenge [3,4]. For the past decade, the South Korean community mental health sector has experienced chronic labor shortages and occupational imbalances [5]. The average tenure of professionals remains at approximately three years, and the proportion of community mental health nurses, in particular, has shown a steady decline [4]. Such trends suggest that the current system may not provide sufficient support for long-term workforce retention [6].
Community mental health services in South Korea are characterized by a dual structure. While these services are funded by public finances and subject to the administrative supervision of local municipalities [6], actual employment and personnel management are handled by private contracted agencies through short-term agreements [5]. This hybrid arrangement forces professionals to navigate a structural inconsistency; they are administrative agents expected to fulfill public health mandates, yet they remain precarious workers bound by unstable, private-sector contracts [6,7]. Such a contradictory environment serves as a critical mechanism contributing to the attrition of skilled personnel, referring to the gradual loss of experienced workers from the system [4], and undermining the foundation of community-based integrated care [8, 9]. While existing literature has scrutinized the weakened public accountability and continuity of services arising from this structure [3,4], empirical evidence regarding how this specific framework shapes workforce retention in South Korea remains limited.
Previous studies have highlighted these structural flaws and consistently called for systemic improvements, such as increased funding and the expansion of public infrastructure [1,10]. However, these macro-level discourses often fail to capture the frontline perspectives regarding the exhaustive nature of caregiving experienced by professionals who must personally navigate these structural conditions [7]. This omission has resulted in a significant disconnect between policy recommendations and lived field experiences. Community mental health services are delivered within a complex intersection of multiple professions and agencies [11], and workforce policies that fail to reflect the actual experiences of frontline professionals are unlikely to achieve meaningful impact. In this context, the present study uses a qualitative approach to illuminate the conditions that either hinder or facilitate workforce retention within the dual structure perceived by South Korean community mental health professionals. By providing an empirical foundation for a deeper understanding of retention, this study aims to derive practical implications for future workforce support strategies.
METHODS
1. Design
This qualitative descriptive study explored the experiences of Community mental health professionals regarding their organizational and workforce environments. Focus group interviews were employed to facilitate interaction among participants and to elicit both shared and divergent perspectives on organizational environments [12].
2. Sample
A purposive sample of 10 professionals was recruited from community mental health service organizations located in a metropolitan region in South Korea, including community mental health welfare centers (n=5), addiction management integrated support centers (n=2), suicide prevention centers (n=1), and psychiatric rehabilitation facilities (n=2). Eligible participants had at least 6 months of experience working in community-based mental health service programs. Recruitment proceeded until data saturation was achieved, with no significantly new insights emerging from the final session. Participant characteristics are presented in Table 1; detailed workplace identifiers are omitted to protect confidentiality. Most participants (n=8) held formal mental health professional certification under the Korean Mental Health Welfare Act.
3. Data Collection
The principal investigator initially contacted several community mental health service organizations in the region and explained the purpose and procedures of the study to organizational representatives. After obtaining organizational agreement, information about the study was shared with eligible professionals through the organizations. Professionals who were interested in participating voluntarily contacted the research team and were provided with detailed information about the study, includ-ing the purpose, procedures, audio recording, and confidentiality protections.
Focus groups were conducted in person in May 2024. Two focus groups were conducted, each consisting of five participants, with one session held per group. Semi-structured interviews were conducted using an interview guide developed from prior literature and refined through feedback from two participants (Table 2). Each interview lasted approximately 120~130 minutes. During data collection, one researcher served as the primary moderator and led the interviews, while another researcher took field notes and posed additional follow-up questions as needed.
4. Data Analysis
During the focus group interviews, the researchers listened closely to participants' narratives and documented field notes on emerging points, key issues, nonverbal cues, and overall group dynamics. Immediately after each interview, audio recordings were transcribed verbatim. To ensure accurate understanding and capture underlying meanings, the researchers repeatedly listened to the recordings and read the transcripts in full at least three times, using sentences and clauses as the primary units of analysis.
Data were analyzed using content analysis following Downe-Wamboldt's analytic procedure [13]. An analysis was conducted to identify patterns across the data, progressing from initial descriptive coding to higher-level abstraction through iterative comparison. This process involved both manifest content and latent content, allowing for an interpretive understanding of how organizational contexts influence workforce retention. To enhance analytic rigor, researchers conducted debriefings and iterative discussions throughout the coding and categorization process. Across five meetings, the researchers reviewed and refined the analytic framework. Finally, the credibility of the findings was reviewed through feedback from two study participants and one scholar with expertise in community mental health services.
Trustworthiness was established based on Guba's four criteria [14]. To enhance credibility, the researchers conducted iterative debriefings and performed member checking after the analysis by sharing the interpreted meanings of the findings with two participants who had agreed to participate in the validation process. They reviewed whether the interpretations accurately reflected their experiences and the intended meanings of their statements. Dependability was ensured by systematically managing the coding process using Microsoft Excel, while confirmability was secured by maintaining an audit trail that documented recruitment, researcher roles, and all analytic transitions in detail. To ensure transferability, detailed descriptions of the researchers' roles, participant recruitment procedures, data collection processes, and analytic methods were provided, allowing readers to assess the applicability of the findings to other contexts. These procedures ensured that the findings were a faithful representation of the data rather than researcher preconceptions.
5. Ethical Approval
The study protocol was reviewed and approved by the Institutional Review Board (IRB number: 1044396-202405-HR-083-01) prior to data collection. All participants provided informed consent after receiving a full explanation of the study purpose and procedures, the intended use of the data, and confidentiality protections. Interview recordings and transcripts were stored in a secure environment, and all potentially identifying information was removed prior to analysis to ensure anonymity. No prior personal relationships or conflicts of interest existed be-tween the researchers and participants. Throughout the research process, the research team sought to minimize bias and maintain analytic neutrality during data analysis and interpretation.
6. Research Team and Reflexivity
The research team consisted of two experts with diverse backgrounds in psychiatric nursing. Specifically, the team included a professor specializing in qualitative mental health research and a certified mental health professional holding a PhD in psychiatric nursing. This collective expertise provided a balanced perspective, enabling the team to critically address both clinical complexities and the socio-cultural nuances of South Korea's community mental health services. Throughout the research process, the team maintained analytic neutrality by documenting self-reflections in reflexive journals. This practice helped minimize potential biases and ensured that the findings remained grounded in the participants' authentic experiences.
RESULTS
To develop strategies to support community mental health professionals, we analyzed participants' experiences and perceptions of their organizational and work environments. We categorized the findings into three domains, six themes, and 13 subthemes to reflect how structural conditions, organizational environments, and individual experiences collectively shape workforce retention. This structure was employed to delineate how systemic gaps and protective factors influence professionals' vocational commitment (Table 3).
Domain 1. Structural Dilemmas in Community Mental Health Services
1) Conflict between bureaucratic performance metrics and the ethos of recovery-oriented care
This theme reflected a fundamental tension between the recovery-oriented nature of mental health services and performance-driven evaluation. Addressing challenges arising from this tension was considered essential for workforce support.
(1) Dominance of quantitative indicators over longitudinal recovery processes
Participants described that quantitative indicators often dominated evaluation, despite the process-based nature of recovery outcomes. This quantitative obsession led to increasing workload demands and emotional exhaustion among professionals, who felt their professional values were consistently invalidated. Participants emphasized that meaningful recovery processes were frequently overlooked because they could not be easily captured through numerical performance indicators. This misalignment between recovery-oriented practice and bureaucratic evaluation systems was perceived as a fundamental source of frustration in their daily work.
Community mental health professionals and the municipality see things very differently. For us, it matters when a person who drinks every day does not drink on the day we visit for case management. But from the municipality's perspective, because they continued drinking overall, it is seen as a failed case. (N8)
The municipality only looks at the numbers. Even when a service user moves from staying at home to living in the community, that alone can be a major step toward reintegration, but it is often not recognized as an achievement. (N6)
We're constantly told to increase performance, and it's burning us out. (N5)
(2) Performance pressures exceeding practical service capacity
Performance expectations imposed by municipalities remained unchanged despite persistent staffing shortages or prolonged vacancies. Participants noted that such rigid performance targets further constrained their ability to deliver recovery-oriented care. This systemic insensitivity resulted in the concentration of excessive workload burdens on both existing and newly hired staff, quickly creating a vicious cycle of further attrition.
A newly hired staff member was expected to achieve a full year's performance targets within just six months. Because there was no adjustment of workload, the new staff member felt overwhelmed and resigned after only three days. (N4)
Our workload keeps accumulating. When staff leave, their positions often are not filled right away. (N5)
Domain 2. Systemic Deficits in Infrastructure
1) Gaps in systemic and organizational governance
Participants identified a critical gap in municipal expertise, noting that administrative disconnects often hinder effective practice. This theme encapsulates the necessity of synchronizing external municipal support with internal organizational leadership to ensure a sustainable working environment. Participants emphasized that the gap between bureaucratic evaluation demands and actual recovery-oriented practice can only be bridged through enhanced administrative expertise and stable, visionary leadership.
(1) Municipal administrative disconnect and lack of expertise
Participants identified a profound disconnect between municipal administration and the clinical realities of mental health practice. They argued that for service delivery to be effective, municipalities must transcend rigid bureaucratic routines and develop specialized expertise that facilitates genuine collaboration rather than mere supervision. Unplanned, top-down initiatives were highlighted as significant stressors that disrupt the systematic implementation of programs. Participants suggested that the absence of specialized knowledge within municipal administrations often leads to policy decisions that overlook the operational realities of frontline practice.
I think the municipality needs to change. It feels like they keep relying on old ways of doing things. (N4)
I wish there were someone at the municipality who truly understands mental health programs and has the expertise to communicate and collaborate effectively with us. (N8)
The problem is that some of these programs were never part of the original plan. Even if we suggest postponing them to next year, the municipality still requires us to proceed. (N2)
(2) Structural instability due to part-time directorship
Leadership was identified as the linchpin for strengthening organizational capacity and ensuring clinical stability. Participants pointed out a critical structural flaw in the South Korean system: the prevalence of part-time directorships in most community mental health centers. They strongly advocated for the transition to full-time leadership to provide consistent strategic direction, a clear organizational vision, and protection from fragmented administrative demands. Participants emphasized that consistent and visible leadership is essential for mediating between municipal expectations and frontline service delivery.
I believe the director's competence is the most important factor. If leadership does not provide clear purpose, vision, and goals, staff can easily be pulled in different directions. (N6)
I think it is important to have a full-time director. We need a leader who can help programs move for ward efficiently. (N8)
2) Structural vulnerabilities in compensation and staffing systems
This theme addresses the critical impact of inadequate compensation, unstable employment conditions, and limited physical resources on workforce retention. Participants highlighted these factors as primary stressors that undermine professional motivation and disrupt service sustainability.
(1) The inherent precarity of compensation and budget structures
Low wages and limited allowances were consistently framed as major drivers of turnover and reduced motivation. Participants emphasized that the current compensation system does not adequately reflect the intensity and complexity of community mental health work, leading many professionals to reconsider their long-term career trajectories in the field.
Given the intensity and volume of the work, low pay is a major reason people leave. (N3)
Participants described that the integration of personnel and operational budgets generates structural tension, as increases in wages are perceived not as improvements in compensation but as reductions in available program resources.
Because personnel costs and program operating funds are provided as a single combined budget, we feel pressured whenever our wage step increases. (N8)
(2) Persistent staffing deficits and resource constraints
Chronic staff shortages were described as directly disrupting work-life balance and sustainability, particularly during critical life events like parental leave. Limited personnel funding often results in centers operating with minimal staffing, making it impossible to expand services despite increasing community need. Participants described staffing shortages as an enduring structural challenge that intensifies workload demands and restricts the operational capacity of community mental health centers.
When someone takes parental leave, coworkers have no choice but to cover their work. That is why it is very difficult for female staff to stay employed. (N5)
Due to limited personnel funding, our center is currently operating with one staff member per team. Although new guidelines encourage us to expand services, we do not have enough staff to take on additional programs. (N8)
3) Inadequate crisis protection and coordination
This theme addresses the pervasive safety concerns inherent in field-based mental health work, particularly during crisis interventions. Participants highlighted that the lack of institutionalized safety nets and the inadequacy of inter-agency coordination leave professionals vulnerable to both physical injury and psychological trauma.
(1) Insufficiency of organizational protections following critical incidents
Participants described existing organizational support as superficial, failing to provide substantive protection against the physical and emotional aftermath of critical incidents. Participants also noted that organizational responses to serious incidents were often limited to informal reassurance rather than structured institutional support, leaving professionals to cope with emotional distress on their own.
A service user died by suicide in the past. At that time, the director did not take it seriously and brushed it off. That response left me emotionally hurt. (N2)
Participants emphasized the need for legal protections beyond internal manuals.
During home visits, we should go in pairs for safety, but staffing shortages often make that impossible. There is no legal basis that truly protects our safety. (N8)
(2) Fragmented inter-agency coordination in emergency situations
Professionals reported being exposed to direct physical violence while waiting for law enforcement or due to the limited scope of police cooperation, which often fails to prioritize practitioner safety. Participants described emergency response situations as particularly precarious, as professionals are often required to manage volatile circumstances without reliable inter-agency support.
When we arranged an emergency hospitalization and called the police, the service user pulled my hair and threw something at me. (N2)
It is not realistic to expect the police to accompany us and fully dedicate their time. (N5)
Domain 3. Intrinsic Drivers of Professional Resilience
1) Supportive and relational organizational culture
This theme highlights that supportive leadership and a collaborative organizational climate are indispensable conditions for sustained work engagement. Participants identified that trust-based supervision and horizontal communication serve as critical emotional buffers against demanding work environments.
(1) Transformative supervision and professional recognition
Trust, recognition, and consistent supervision from leadership were described as key factors that enhance job satisfaction and enable staff to endure high-pressure conditions. Participants felt that being recognized as professionals by their superiors provided the necessary motivation to remain in the field. Participants emphasized that supportive supervision functioned not only as managerial guidance but also as professional validation that strengthened their sense of belonging within the organization.
My team leader provides a great deal of support. That support is what helps me endure and keep going. (N5)
The director trusts each staff member and provides ongoing supervision. That makes me feel recognized and supported. (N10)
(2) A flexible and collaborative organizational climate
A horizontal organizational culture characterized by open communication and psychological safety was described as more influential for long-term retention than extrinsic rewards alone. Participants emphasized that the ability to voice opinions without fear of rigid hierarchy is a primary reason for their organizational commitment.
I think people matter most. No matter how good the pay and working conditions are, it is hard to stay in a rigid workplace where you cannot speak up and constantly have to read the room. (N1)
A horizontal organizational culture, clear leadership roles, and open communication are why I want to stay in this organization long term. (N8)
(3) Relational capacity through mutual support
Beyond formal leadership, the informal "relational capacity" among colleagues was identified as a vital protective factor. Emotional support between staff members and transparent communication were perceived as essential for maintaining the collective capacity required to meet complex service user needs.
I think it matters whether staff have the emotional capacity to look out for one another. When someone is able to do that, it makes a big difference in how the team functions. (N1)
Communication within the team is essential. Without communication, we do not know what others are working on, and it becomes harder to respond quickly to service users' needs. (N6)
2) Professional meaning and growth through practice
This theme highlights that the sense of professional fulfillment and the profound meaning derived from clinical practice serve as powerful anchors for continued employment. Participants emphasized that beyond systemic challenges, the multifaceted nature of their roles and the witnessing of service users' recovery were primary drivers of their vocational commitment
(1) Vocational meaningfulness through dynamic roles
Participants noted that the diverse range of responsibilities made their work engaging and contributed significantly to their professional development. The opportunity to engage in multiple roles was described as fostering a sense of professional growth and autonomy.
I get to do a wide range of things at work—designing programs, running them, and taking on tasks I never expected. That variety is what I find meaningful about this job. (N9)
(2) Internalized satisfaction and value-transformation through recovery
Participants found the most profound meaning in the incremental and humanistic changes of service users, even when such progress was not captured by formal performance metrics. Witnessing these recovery processes not only provided professional satisfaction but also led to a transformation of the professionals' own personal values and worldview.
I do not think there is a clear success or failure in service users' cases. Even if a service user eventually passes away, I still consider it meaningful if their experience with the center was a good memory. Seeing people change over time has also changed my own values in life. (N8)
When service users genuinely improve their symptoms, the change is dramatic. Having experienced moments like that a few times makes me feel I cannot do any other kind of work. (N7)
DISCUSSION
This study explored how community mental health professionals in South Korea experience their organizational and job environments, focusing on factors that hinder or support workforce retention. Three key findings emerged, illustrating the practical implications of South Korea's unique dual structure.
The findings highlight a structural tension between recovery-oriented practice and performance-driven evaluation within community mental health services. Participants reported that although the most meaningful outcomes of community mental health services emerge through sustained engagement, their work is evaluated through quantitative indicators. This misalignment reflects the inherent difficulty of reducing recovery-oriented practice to numerical outcomes [8,11]. Importantly, professionals perceived this as a structural condition that undermines professional identity and contributes to burnout [15,16]. Consistent with prior studies, performance-driven systems may prioritize measurable outputs over clinically meaningful processes [17], widening the gap between practitioner values and institutionally recognized achievements [18]. These findings underscore the need for evaluation systems that recognize the intrinsic value of recovery-oriented practice.
A second key finding concerns the role of structural deficits within the organizational and institutional infrastructure. Poor working conditions were identified as a major barrier to retention, rooted in structural deficits and a South Korea's unique structural inconsistency of responsibility. Low compensation was perceived as disproportionate to the complexity of the work, which frequently involves emotional labor and crisis response. Extending previous research on mental health workforce instability, participants also emphasized governance gaps and safety vulnerabilities that further compound these challenges [19-21]. Beyond compensation, professionals reported frequent exposure to risk during field-based work while institutional protections remained inadequate [10]. These findings suggest that compensation, employment security, and safety resources are interrelated structural determinants of turnover. Without improvements in these foundational conditions, workforce policies focused only on recruitment expansion are unlikely to achieve sustainable retention [22,23].
At the same time, the findings reveal that professionals continue to sustain their work through various forms of professional and relational resilience. Despite adverse conditions, protective factors were identified, highlighting a reliance on informal resilience rather than formalized institutional support. A supportive organizational culture, including trust from supervisors, and recognition of professional capacity, was particularly important for sustaining commitment under heavy workloads [24]. In addition, professional growth derived from diverse role engagement and service users' recovery contributed to sustained engagement [25]. These findings suggest that peer relationships and a sense of vocational meaning function as informal protective mechanisms that buffer practitioners against structural stressors.
However, current workforce retention is largely sustained through informal relational resilience rather than institutionalized structures. This reflects a precarious balance where the system pushes professionals out while vocational commitment pulls them in. In this sense, the present findings extend prior research suggesting that nonprofit and community-based sectors often rely on professionals' personal dedication to compensate for systemic limitations [7]. Such reliance on individual capacity is inherently unsustainable. Workforce retention requires opportunities to experience meaningful work and professional growth alongside alignment with recovery-oriented values [26]. Accordingly, strategies to strengthen retention must encompass both system-level reforms and organizational structures that enable ongoing professional development [27]. Formalizing peer support mechanisms, structured supervision, and organizational practices that sustain professional meaning may therefore represent practical strategies for strengthening workforce resilience in community mental health services.
Taken together, these findings suggest that turnover in South Korea's community mental health services is shaped by a structural mismatch between recovery-oriented values and deficits in governance, safety, and resources. While similar structural challenges have been documented internationally [20, 28], South Korea's dual employment structure may further intensify professionals' perceived responsibility and burden [6].
Based on these findings, several priorities for workforce support should be considered. Given the identified gaps in governance and administrative expertise municipalities should establish administrative leadership positions staffed by professionals with clinical backgrounds, alongside full-time center directors with administrative authority. Second, the performance evaluation system should be reformed by implementing qualitative key performance indicators that recognize the quality of recovery [18]. Such reforms would better align evaluation systems with the relational and longitudinal nature of recovery-oriented practice. Finally, a robust legal and organizational safety net is imperative. Legal provisions are needed to ensure that the state assumes responsibility as the legal protector of professionals during crisis situations. Such measures would shift the burden of risk from individuals to the public system, ensuring safer working environments [10].
1. Strengths and Limitations
This study provides a bottom-up account of workforce experiences, offering empirical evidence for structural reforms by documenting the gap between frontline realities and rigid organizational systems.
Several limitations should be noted. First, participants were recruited from community mental health service organizations located in a metropolitan region in South Korea, which may limit the transferability of the findings. Second, this study focused exclusively on frontline professionals; future research should include municipal officials and center directors to address administrative disconnects. Finally, although the sample was predominantly composed of certain professional groups, professionals across different disciplines in South Korea perform nearly identical tasks with overlapping roles [1]. Consequently, these findings sufficiently capture the shared structural pressures facing the community mental health workforce as a whole. Nevertheless, additional studies should be conducted to explore whether there are unique discipline-specific dynamics that were not captured in this study. In addition, participants in this study had a wide range of years of professional experience, which may influence how organizational contexts and retention are perceived. Future research should therefore examine whether workforce retention experiences differ according to years of experience.
Finally, although the declining proportion of community mental health nurses has been noted as an important workforce issue in South Korea, the present study did not specifically examine the underlying reasons for this trend. Future research should therefore investigate the factors contributing to the reduction of the psychiatric nursing workforce in community settings and explore discipline-specific dynamics that may influence retention. Such efforts would contribute to improving the quality management of community mental health services by informing tailored workforce strategies across professional groups.
CONCLUSION
This study demonstrates that workforce retention in South Korea's community mental health services is fundamentally constrained by a structural mismatch between recovery-oriented values and bureaucratic management systems. The current structure creates an unsustainable environment where public service responsibilities are performed under private-sector risks, forcing professionals to rely on informal relational resilience to compensate for systemic deficits. While supportive organizational cultures and vocational meaning provide temporary anchors, they cannot indefinitely substitute for formal institutional protections.
To ensure a sustainable mental health workforce, a paradigm shift is required: moving from metrics-centered governance to a support-oriented framework. This reform must include the institutional recognition of the recovery process through qualitative evaluation, the establishment of administrative expertise within municipalities, and the creation of a robust legal safety net for professionals. Ultimately, without dismantling the structural inconsistency of responsibility, the goal of stable, community-integrated mental health care remains precarious.
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