Moral injury refers to the psychological, social, and spiritual impact of events or acts that a person performs, witnesses, or fails to prevent, which conflict with one’s own deeply held moral beliefs and values.

Moral injury is a specific type of psychological injury that reflects an enduring impact on an individual’s self-image and worldview.

When a moral injury occurs, the range of outcomes is broad and can include:

  • Feelings of guilt, shame, anger, sadness, anxiety, and disgust
  • Intrapersonal outcomes include lowered self-esteem, high self-criticism, self-destructive behaviours, and feelings of being bad, damaged, unworthy, or weak
  • Interpersonal outcomes include loss of faith in people, avoidance of intimacy and lack of trust in authority figures
  • Existential and spiritual outcomes include loss of faith in previous religious beliefs and no longer believing in a just world

While moral injuries are strongly linked to military service members due to the conditions of deployments or traumatic events, moral injuries are not limited to serving personnel and Veterans.

Moral injury can also impact:

  • Social workers
  • Media professionals
  • Health care workers
  • Legal professionals
  • Aid workers
  • Veterinarians, and others

Racial Inequities and Moral Distress: A Supplement to Moral Stress Amongst Healthcare Workers During COVID-19 A Guide to Moral Injury

The King’s Centre for Military Health Research released a video about moral injury – view it below:

Causes

There are three identified primary causes of moral injury.

  • An act of commission: when someone does something they should not have done, or that strongly goes against their own moral code.
  • An act of omission: when someone should have done something but did not.
  • Betrayal: when someone feels betrayed by others, particularly by a higher authority who either acted, failed to act, or compelled an individual to act in a way that goes against their moral code.

Moral injuries typically result from events that fall into one of those three categories. These could be traumatic or morally challenging circumstances with vulnerable people or populations, events where a person is unprepared for the emotional consequences of their role, or a lack of social support.

Impact and treatment

The effects and impacts of moral injury vary for everyone.

Some people feel no lasting effect. Others will recover in the short term. Others will find that the lingering effects of their actions – or inaction – only become more intense over time and develop into a mental health crisis.

Research shows that people suffering from a moral injury are vulnerable to other disorders, including Post-Traumatic Stress Disorder (PTSD), depression and suicidal thoughts.

Moral injuries also act as barriers that stand in the way of recovery. Those suffering a moral injury often avoid seeking treatment, and refuse to discuss their injury with their support team or medical providers because they feel shame, anger or guilt, or even because they fear legal consequences from their actions.

While there is no single, defined treatment for moral injury, it is vital that anyone suffering from it discuss their feelings with a mental health professional. Treatment and therapy can begin to help make sense of a person’s feelings and actions, which is an important first step towards healing.

Research status

The research and clinical communities are in the early stages of understanding what moral injury really is, how best to treat it and potentially how to prevent it.

Evidence suggests that moral injuries are common among military personnel and Veterans. Research, including research from the Atlas Institute, has shown that military members who are exposed to potentially morally injurious events are at an elevated risk of developing adverse mental health outcomes such as PTSD and depression.

Researchers also recognize that moral injury may resonate with those who work in high-pressure environments such as health care. During the COVID-19 pandemic in particular, front-line health-care workers have faced moral stress from making critical decisions, often with limited resources.

By exploring this important new area of study, we can help to understand and treat this complex facet of Veterans’ mental health.

Moral injury toolkit

Professions where individuals risk their lives in service of the care, protection, and safety of others are by their nature hazardous, and this has become even truer during the COVID-19 pandemic. Organizations and leadership teams have an obligation to protect their workforce from these hazards, including those that are psychological in nature, such as moral injury.

Encountering moral and ethical challenges can’t be designed out of the work in these high-risk fields. Therefore, preventative and early intervention structures need to be created within organizations and teams to provide proactive universal support to all staff.

Our toolkit provides leaders with an understanding of moral injury in an organizational context, and includes tools, templates, and tips for understanding what preventative and early intervention structures are already in place, and what more might need to be done.

What is moral injury and what does it mean for my organization?

Want to know more about moral injury and concrete actions you can take to address it organizationally and as a leader? This is the place to start. Check back soon to explore videos of inspiring stories from fellow leaders about what moral injury has meant for them and their organizations. 

Moral Injury Taking Action to Prevent Moral Injury: Quick Tips for Leaders

Moral Injury What Is It and What Can Leaders Do about It?

Listen to Learn Understanding the Needs and Stressors of Your Team

Effective Communication During times of Stress and Uncertainty

Showing Gratitude For Your Team

A Conversation Guide Helping Leaders Talk about Moral Injury

Asset-mapping through the lens of moral injury

Already feel like you have a grasp on moral injury and looking for what to do next? Well, you aren’t starting from scratch. Chances are, your organization has structures in place that support overall psychological health and wellness, which also can protect against moral injury. This section contains tools and tips for how to work with your team to map out and communicate those assets. 

Mapping Your Assets Looking Through a New Lens

Identifying Your Assets

Amplifying and enhancing supports

Mapping your assets is a great place to start, but not a place to finish. Critical examination of your asset map can signal initiatives you may want to promote and communicate, but also reveal gaps in the existing supports. In this section, you will find tools and tips to use your asset map to the fullest to identify gaps, prioritize, and action chosen initiatives. 

Planning for implementation

You’ve strategically used your asset map to identify priorities and now you need to make them a reality. Maybe your priority is to effectively communicate your current assets, or maybe it is to implement a team leader moral injury conversation guide. Whatever it is your team has prioritized, this section contains tools and templates for making it happen.

Evaluating, improving and keeping it going

Whether you’ve implemented something new, scaled up something existing, or communicated the beneficial supports you already have in place, it is critical that you evaluate your efforts and plan out how to keep it going. This section contains everything you need to know to assess what went well, what didn’t, and how to improve it and sustain it in the long term.

Find more resources

Browse the knowledge hub for more evidence-based information, factsheets, reports and tips.