People may imagine that, compared to others who work with people in our community, a mental health practitioner’s life is safe. We do not drive into bushfires, rescue people from floods or confront drug and alcohol affected patients in emergency departments. Yet there is another risk for those who work with highly distressed, complex, co-morbid situations and particularly those with child protection elements. This is ‘moral injury’, defined as ‘lasting psychological, spiritual, and social harm caused by one’s own or another’s actions in a high-stakes situation that transgress deeply held moral beliefs and expectations.’ This construct was developed by psychiatrists working with returning soldiers from Vietnam whose symptoms of enduring emotional distress, loss of trust and meaning were not encapsulated by a diagnosis of PTSD. Unlike this, which entails a threat to life, moral injury occurs where there is a threat to deeply held and sacred moral beliefs where the mismatch between these and events can result in a “threat to the integrity of one’s internal moral schema.” Guilt, shame, rage, and depression are the consequences.
This construct underpinned a study by Height et. al. who administered a modified version of the Moral Injury Events Scale followed by semi-structured interviews with child protection workers. The results indicated that some workers were injured by their involvement with vulnerable families they were entrusted to help but to whom they caused harm. This was due to ‘under-resourced systems, problematic professionals, unfair laws and policies, abusive parents, an adversarial system, systemic biases, harm to children by the system and poor-quality services.’ Some expressed doubt about their capacity to function in an ethical or moral manner in a system that was so inept and experienced anger, sadness, emotional numbing, guilt, and shame. Many reported seeking different employment.
Our work entails an understanding of and management of the entire system including that of the agencies in which we work. Unless these are different to our clients, the malaise that afflicts them will certainly affect us.
Wendy Haight, W., Sugrue, E., and Calhoun, M. (2017) Moral injury among Child Protection Professionals: Implications for the ethical treatment and retention of workers Children and Youth Services Review Vol 82, p27-41
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