Moral injury and psychiatrists in public community mental health services

Abstract

Objectives This study aims to provide a clinical update on moral injury from the perspective of a public sector community psychiatrist, and to outline approaches to addressing the issues raised. Conclusions Although not considered a mental illness, moral injury is an important condition for psychiatrists to have an awareness of, as it is associated with psychological distress and/or impairments in emotional, social or behavioural functioning. Potentially morally injurious events (PMIEs) for community psychiatrists may include staff shortages and deficient resources rendering it difficult to provide an acceptable standard of professional care; time constraints negatively impacting teaching, supervising and mentoring medical students; cost-prohibition regarding preferred medication choices; lack of gender and cultural diversity of available psychiatrists; and work environments not conducive to psychiatrists speaking out about their concerns. The COVID-19 pandemic has exposed and exacerbated PMIEs for some community psychiatrists. Whether or not a PMIE transitions to a moral injury may be influenced by the individual’s resilience and the quality of emotional, psychological and administrative support they receive before, during and after the potentially precipitating event. Preventative strategies to mitigate susceptibility to a moral injury may be implemented at both a systems level and individual level, and include collective healthcare advocacy action.

Automated Decision Support For Community Mental Health Services Using National Electronic Health Records: Qualitative Implementation Case Study

“…The pilot was useful in addressing issues with the software and elucidating the challenges of implementing a disruptive software into CMHS [ 50 ]. Further trials are needed to determine whether applications like AI 2 that support early intervention can help reduce overall demand on the already overburdened Community Health Services, but this may require a period of transition that involves additional work for existing staff [ 51 , 52 ].…”

Penumbra of the pandemic workplace for psychiatrists and trainees in Australia

“…For HCWs there are additional risks of collective moral injury (exposure to an injurious event such as observing, causing or failing to prevent adverse outcomes transgressing moral values and the resultant psychological distress) 17 from pandemic care burdens. 18 Pandemic-related moral injuries are superimposed on those that already due to under-resourcing of public psychiatric services.…”

“… 18 Pandemic-related moral injuries are superimposed on those that already due to under-resourcing of public psychiatric services. 17 Even in Australia, which has otherwise fared relatively well, persistent pandemic health impacts and service shortfalls may increase moral injury risks.…”

“…Extensive media coverage of the pandemic, including international impacts, may have negative impacts on the mental health of the population and HCWs, such as anxiety and depression; with recommendations to limit pandemic, and especially social, media exposure. 16 For HCWs there are additional risks of collective moral injury (exposure to an injurious event such as observing, causing or failing to prevent adverse outcomes transgressing moral values and the resultant psychological distress) 17 from pandemic care burdens. 18 Pandemicrelated moral injuries are superimposed on those that already due to under-resourcing of public psychiatric services.…”

Psychiatrist and trainee moral injury during the organisational long COVID of Australian acute psychiatric inpatient services

“…Educative programmes to increase awareness of PMIEs, moral injury, and burnout as well as understanding bullying and harassment. 15,16 5. Encouragement of peer support amongst psychiatrists and trainees by providing protected time during work hours to meet, enabling specific discussion of challenging situations, including PMIEs, if required.…”