Health workforce sustainability in mental health services: A qualitative analysis of factors affecting psychologist retention in Aotearoa New Zealand

Background Mental health workforce shortages threaten health service capacity globally, with Aotearoa New Zealand experiencing an estimated deficit of 1,000 psychologists and public service waiting times extending to 9 months. Understanding factors influencing healthcare professional retention is critical for health workforce planning and service sustainability. This study investigated professional quality of life and retention intentions among registered psychologists to inform evidence-based health workforce strategies and improve mental health service capacity. Methods A cross-sectional, mixed-methods study collected qualitative data from 380 registered psychologists (9.8% of the national workforce) via online survey between May and September 2024. Participants responded to five open-ended questions exploring professional quality of life, burnout causes, turnover intentions, and career satisfaction. Data were analysed using inductive content analysis following established health services research methodologies. The study received University of Otago Human Ethics Committee approval (reference 23/151). Results Analysis revealed complex health workforce dynamics affecting service capacity and accessibility. Retention-promoting factors included supportive team environments, professional autonomy, manageable workloads, and adequate organizational resources. Conversely, excessive caseloads, inadequate resources, professional devaluation within healthcare hierarchies, and systemic constraints threatened workforce stability. Participants reported widespread ambivalence—maintaining commitment to mental health service delivery while simultaneously considering departure from public health services. Workforce migration from public to private practice emerged as a critical threat to service accessibility, creating significant gaps in publicly funded mental health care for vulnerable populations. Conclusions Health service organizations require evidence-based workforce retention strategies that address systemic barriers, enhance professional autonomy, provide adequate resources, and implement sustainable workload management models. These findings offer actionable insights for health service administrators and policymakers to strengthen mental health workforce capacity, improve service sustainability, and maintain accessible mental health care delivery. The research contributes to health workforce planning literature and supports the development of targeted interventions to enhance healthcare professional retention in publicly funded services.