As such, staff should and usually do feel that it is something to be proud of. In the UK, most NHS staff may have felt, with some justification, that with all its faults, the NHS gives the sickest people the greatest chance of recovery. This may be similar to the unprecedented nature of the challenges healthcare staff are currently facing.
Moral injury has already been described in medical students, who report great difficulty coping with working in prehospital and emergency care, 4 where they were exposed to trauma that they felt unprepared for. Whether someone develops a psychological injury or experiences psychological growth is likely to be influenced by the way that they are supported before, during, and after a challenging incident. 2 Equally, some people who have to contend with significant challenges, moral or traumatic, experience a degree of post-traumatic growth, 3 a term used to describe a bolstering of psychological resilience, esteem, outlook, and values after exposure to highly challenging situations. These symptoms can contribute to the development of mental health difficulties, including depression, post-traumatic stress disorder, and even suicidal ideation. But those who develop moral injuries are likely to experience negative thoughts about themselves or others (for example, “I am a terrible person” or “My bosses don’t care about people’s lives”) as well as intense feelings of shame, guilt, or disgust. 1 Unlike formal mental health conditions such as depression or post-traumatic stress disorder, moral injury is not a mental illness. Moral injury, a term that originated in the military, can be defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code.
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