Let’s talk about Moral Injury
❓ Have you heard about Moral Injury? It's something I often mention in my Wellbeing training for staff. Moral injury refers to the psychological distress that arises when our actions, or inability to act, deeply contradict personal ethical beliefs. Initially recognised in military veterans, this concept now extends to professionals in the “caring” sectors, including healthcare, housing and homelessness, social work, and emergency services.
❗ The reason we should be talking about this widely is because of course, those of us in the caring sector often face situations that challenge our ethical codes, such as systemic limitations like understaffing or resource shortages, which can make it impossible to provide an ideal level of care or support.
🦺 For examples, think about your own setting, if you work in “frontline” services. In my early twenties, I worked in an emergency night shelter, where newly homeless young people would be accommodated for a total of nine nights while staff assessed their needs and attempted to move them into longer stay accommodation. Sometimes that accommodation just wasn't available and there were times that young people were literally put back onto the street to sleep rough. This was over twenty years ago, and I still feel remorse and shame that I had to do that. This was at the start of my career and just one simple example to make my point.
😞 Over the twenty eight years I’ve worked in the sector, I could count hundreds of other examples where my practice has been subject to “the rules”- based on contractual obligations, professional boundaries, codes of conduct, recognised good practice and other regulations which are all necessary and (mostly) correct, but have meant that my personal moral or ethical compass has wobbled. I’ve seen young people abandoned by statutory social services. I’ve experienced Commissioners and Police advising us to evict young people who had been victims of Child Criminal Exploitation because they had also committed crimes. The authorities saw them as perpetrators only, rather than victims as well. Unfortunately, there are so many more examples I could draw on, and I know you’ll all have your own too.
📖 Such actions, while adhering to rules and policies, can clash profoundly with personal moral beliefs, leading to guilt, shame, and a sense of betrayal by the system. It could be that there are large, significant events that lead to moral injury, but it's most likely an accumulation of small actions, choices and decisions that are made over time which chips away at our belief system. This not only causes emotional distress but can also impact job performance and increase staff turnover, underscoring the need for systemic reforms and open discussions about moral injury in caring professions.
How do we spot moral injury?
Emotional Effects: Staff may experience emotional exhaustion, decreased job satisfaction, and a loss of personal accomplishment, potentially leading to disengagement and deep cynicism.
Behavioural Changes: This can include withdrawal, increased absenteeism and often results in staff leaving their job, or the sector.
Professional Performance: The strain of moral injury can impair critical skills such as concentration, decision-making, and communication, directly affecting quality of care and support and increasing the risk of workplace errors.
What can we do about it?
Supportive Leadership: I cannot stress how important it is that we start to create an environment where ethical concerns are openly discussed and addressed. Our sector could begin by openly acknowledging that trauma is an occupational hazard, rather than normalising it.
Training and Resources: Offer Emotional Intelligence or Wellbeing training and access to wellbeing support to help staff manage ethical dilemmas and reduce stress. Reflective practice is also really important, and a choice to debrief after incidents. Provide training for Managers so they know how to support their teams around these matters.
Institutional Changes: This one may be easier said than done, but it is still important to consider how we can implement structural changes like better staffing ratios and realistic job expectations to alleviate work-related moral conflicts.
🫵 I’d really love to hear about your own thoughts and experiences of moral injury- whether experiencing it yourself firsthand, or supporting your team. I certainly saw a rise in this during the pandemic, although we didn’t have the language to name it as such.
And as always, please do let me know if I can support you or your team in any way.
