Workforce Sustainability: Class in Clinical Psychology and Moral Injury in the Mental Health Workforce

Westwood, Thomas George (2026) Workforce Sustainability: Class in Clinical Psychology and Moral Injury in the Mental Health Workforce. Doctoral thesis, University of East Anglia.

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Abstract

NHS workforce retention is an issue of continued importance as staff are being asked to support the general public with ever shrinking resources (Harding et al, 2025; Moscellli et al, 2022; Palmer et al, 2021; Stinton , 2025). It is vital to consider all potential factors that may impact staffs’ roles and responsibilities and what may be leading people to leave the NHS, with the goal of addressing them to support staff wellbeing and retention. A systematic review exploring the prevalence of moral injury in mental health staff in the NHS identified five studies that met inclusion criteria, yet, was unable to obtain data relating to the prevalence of moral injury amongst NHS mental health staff. However, supplementary analysis revealed that mental health staff appeared to endorse factors such as transgressions of others and betrayal more readily than other factors on the Moral Injury Events Scale (MIES). Social class may be another factor impacting overall staff experience as being working-class has been shown to negatively impact trainees’ experiences, leaving them feeling out of place or misunderstood (Place, 2023). An empirical study was then conducted to explore the experiences of working-class clinical psychologists in the NHS, private practice and those splitting their roles between the two. Semi structured interviews of 13 participants were analysed using Braun and Clarke’s reflexive thematic analysis (Braun & Clarke, 2022). Four interconnected themes were constructed: Money and class, Experiences of Class Migration, The Push and Pull of the NHS and the Working-class Clinician and Us and Them (Seen/Unseen, Heard/Unheard differences). This portfolio highlights the challenges faced by NHS mental health staff and the factors that may be most salient to moral injury. It also highlights the need for more research into the prevalence of moral injury among the mental health workforces to fully understand this issue. Furthermore, it sheds light on the impact of class and class migration on working-class clinical psychologists and what may bring them back to the NHS or cause them to leave, as they navigate their careers. Future research should examine the prevalence of moral injury among mental health staff, as well as explorations of other aspects of identity and their impact on clinical psychologists’ experiences in and out of the NHS post-qualification.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	09 Nov 2026 10:40
Last Modified:	09 Nov 2026 10:40
URI:	https://ueaeprints.uea.ac.uk/id/eprint/105008
DOI:

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