Moral injury and associated context, contributors and consequences within mental healthcare professionals: a scoping review

ABSTRACT

Objectives

We sought to examine the contributory factors as well as consequences of moral injury amongst healthcare workers within mental healthcare settings.

Methods

Several databases were searched for relevant studies from database inception until May 2023. Keywords and concepts included moral injury and distress in mental healthcare and psychiatry. We identified 961 studies, of which 48 were assessed for eligibility. Eventually, 35 studies were included in the review. Papers were selected for inclusion if 1) they included mental healthcare professionals (MHP) regardless of practice setting, 2) moral injury as experienced by MHP was one of their main variables of interest, 3) were written in English. Year of publication, location of study, participant characteristics, study design, settings in which injury occur (context), factors contributing to moral injury (contributors), and its effects on MHP (consequences) were extracted from the studies.

Results

The majority of studies were conducted in the West (n = 26, 74.3%). Contributors to moral injury were found at the individual (e.g. poor competence), practice setting (e.g. lack of resources), and organizational levels (e.g. inconsistent policies). Moral injury had negative repercussions for the individual (e.g. psychological and physical symptoms), healthcare teams (e.g. lack of trust and empathy), and healthcare system (e.g. staff attrition).

Conclusions

Seen through the moral habitability framework, interventions must include an acknowledgment of the influence of various factors on the ability of MHP to enact their moral agency, and seek to establish safe moral communities within a supportive moral climate.

KEYWORDS:

• Moral injury
• mental healthcare
• moral community
• psychiatry
• moral habitability

Declaration of funding

This paper was not funded.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

Author contributions

Qian Hui Chew was involved in the design of the methodology, formal analysis, and writing of the original draft. Tih-Shih Lee was involved in the conceptualization, design of methodology, and reviewing and editing of the draft for important intellectual content. Kang Sim was involved in the conceptualization of the study, design of the methodology, formal analysis, reviewing and editing of the draft for important intellectual content, and supervision of the work. All authors have read and agreed to the final version of the manuscript.