Understanding mental health implications for health and care workers in this crisis

Moral injury

I don't know whether the concept of 'moral injury' is new to you. Until this pandemic began, it certainly was for me. Moral injury is defined as 'the profound psychological distress which results from actions, or the lack of them, which violate one’s moral or ethical code'.

Now experts are saying that those on the frontline of dealing with coronavirus may find themselves exposed to such injury: 'Morally injurious events can include acts of perpetration, acts of omission or experiences of betrayal from leaders or trusted others,' according to a recent academic article.

Those health professionals and care workers who develop symptoms (or their relatives do) and then have to self-quarantine at home might 'be unable to return to their frontline responsibilities, for example, at a time when their colleagues are working exceptionally hard. As a result of these exceptional challenges, lives will inevitably be lost that could, in other circumstances, have been saved.

'Non-clinical professionals in other essential roles, such as the justice system, media workers, social workers, etc., may also feel the profound effects of being required to perform already highly challenging duties in a more constrained manner which may lead to risks being more difficult to manage. How such events will impact frontline, key worker teams remains unclear, but it is likely that many will experience a degree of moral distress and some moral injuries.'

'Not a mental illness'

'Unlike post-traumatic stress disorder (PTSD), moral injury is not a mental illness,' the article goes on to say. 'Although experiences of potentially morally injurious events (PMIEs) can lead to negative thoughts about oneself or others (e.g. “I am a monster” or “My colleagues don’t care about me”) as well as deep feelings of shame, guilt or disgust. These, in turn, can contribute to the development of mental health problems, including depression, PTSD and anxiety.'

You may read the full article 'COVID-19 and experiences of moral injury in frontline key workers' in the journal Occupational Medicine here.

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Looking after staff

Another article of interest on this topic comes in the magazine of The British Psychological Society, entitled 'The psychological needs of healthcare staff as a result of the Coronavirus pandemic'. It's written by The British Psychological Society Covid-19 Staff Wellbeing Group.

Guidance for those in charge includes:

• Have a communication strategy.

• Communicate to staff regularly and frequently in simple clear ways. Use video and written means.

• Actively encourage expression of concerns and fears. Listen with patience and compassion.

Employers are urged to look out for the signs of strain among those in their departments:

• Remember – this situation is unprecedented; it is okay to not be okay.

• Experiencing symptoms of stress doesn’t mean you aren’t up to the job, it means you’re human.

• Give staff permission to step back and ensure breaks and rest.

• Do not mandate direct psychological interventions (these are not helpful to everyone in the midst of crisis), but allow psychological support to be available in different ways – speak to your practitioner psychologists.