Moral injury in secure mental healthcare part II: experiences of potentially morally injurious events and their relationship to wellbeing in health professionals in secure services

ABSTRACT

Healthcare workers in secure psychiatric settings operate within highly restrictive legal frameworks and are often exposed to ethically complex scenarios. They also have an increased risk of experiencing a constellation of occupational traumas, resulting from exposure to violence and self-harm, which cumulatively can affect wellbeing and violate deeply held moral codes. Moral injury, which results from perpetrating, failing to prevent, witnessing, or learning about acts that transgress deeply held moral beliefs and expectations, has been posited as a construct that can account for a range of deleterious psychological outcomes. The current study sought to explore whether moral injury was endorsed, and related to wellbeing, within a secure psychiatric setting. The cross-sectional survey data (N = 237) showed that exposure to potentially morally injurious events and distress resulting from such events, were prevalent in healthcare professionals. Furthermore, moral injury was predictive of higher secondary trauma and burnout, and lower compassion satisfaction. The perceived impact of COVID-19 was also predictive of secondary trauma and burnout, though held no relationship with moral injury nor compassion satisfaction. The findings indicate that models of occupational distress would benefit from including consideration of the morally challenging nature of working in secure settings.

KEYWORDS:

• Moral injury
• healthcare professionals
• secure
• intersectional
• wellbeing
• psychiatric

Disclosure statement

No potential conflict of interest was reported by the author(s).