Workforce Sustainability: Factors Influencing Clinical Psychology Career Decisions and Moral Injury in Mental Health Workforce

Baily, Hannah Louise Sheila (2026) Workforce Sustainability: Factors Influencing Clinical Psychology Career Decisions and Moral Injury in Mental Health Workforce. Doctoral thesis, University of East Anglia.

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Abstract

Workforce sustainability within mental healthcare in the United Kingdom (UK) is being impacted by moral distress and injury, and organisational factors leading to poor retention. This, in turn, impacts the quality of patient care and outcomes. Supporting, retaining and building the mental health workforce is therefore an important part of the NHS’s 10-year plan.

A systematic review found seven qualitative studies showing the organisational and systemic factors associated with moral distress and injury among UK mental health staff that are impacting staff wellbeing, retention and patient quality of care. A thematic synthesis (Thomas & Harden, 2008) was completed to find five analytical themes of 1) Systemic obstruction of morally valued care, 2) Chronic exposure to system-level moral compromise, 3) Institutional betrayal and staff disposability, 4) Internalisation of systemic failure and 5) Societal devaluation as moral context.

An empirical study followed with 30 Clinical Psychologists (CP’s) completing consensus via a 3-round modified Delphi survey, looking at conditions they needed met to increase their hours in NHS commissioned services. This was then followed by a mini-focus group with three CP’s who had completed the Delphi survey, to further explore these findings. Thirteen of eighteen conditions reached consensus after round one (≥70%, IQR = 1) as very/extremely important for increasing NHS hours. The top six of these reached a strong consensus (≥80%, IQR 1) for; ‘feeling able to delivery good quality care to service users’, ‘strong/supportive leadership/management’, ‘positive team culture’, ‘flexible working hours’ , ‘opportunities for professional development’ and ‘better working environment’. Three Reflective Thematic Analysis (RTA) (Braun and Clarke, 2006) themes were: 1. Enabling Meaningful and Ethical Psychological Practice. 2. Creating Sustainable and Flexible NHS Careers. 3. Fostering Valuesaligned Leadership and Team Cultures. There was some variation between career stages.

The portfolio sheds light on the organisational factors impacting the mental health workforce sustainability in the UK, with a particular focus on how to support the increase of CP’s hours in the NHS. The findings of both the review and the empirical paper are discussed, alongside their strengths and clinical implications, to the limitations and recommendations for future research.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Bethany Turner
Date Deposited:	04 Nov 2026 12:35
Last Modified:	04 Nov 2026 12:35
URI:	https://ueaeprints.uea.ac.uk/id/eprint/104975
DOI:

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