The Experience of Moral Injury in Mental Health Clinicians with Lived Experience of Systemic Injustice

Background Publicly funded services across the UK are under significant pressure, and the demand for mental health care is increasing. This is against the backdrop of numerous reports stating that health inequalities are widening for those from minoritised communities. The NHS has put forward commitments to addressing inequalities under the NHS long term plan and NHS long term work force plan. Furthermore, there is growing evidence that those working within publicly funded services are experiencing discrimination based on their minoritised status. There is also evidence showing increased experience of moral injury and distress among healthcare staf nationally. Minimal research has been conducted to think about how systemic inequalities and moral injury may be intersecting for those working in mental healthcare in the UK. Methodology This study used a constructivist grounded theory methodology, underpinned by a modernist social constructionist stance. 10 participants took part in in-depth interviews, followed by a focus group comprising of 2 of the 10 participants who were able to take part. All the participants self-identified as having lived experience of systemic injustice and professional experience of moral injury while working in publicly funded services. Results A constructivist grounded theory (CGT) model was constructed which spoke to multiple processes across macro, meso, micro and individual levels that contributed to their experience of moral injury. Core to this model was the idea that in being part of services that function under kyriarchy which contributes to health inequalities, professionals were in the position of being both a helper and a harmer by sheer virtue of their professional roles. This led to cognitive dissonance for most, and moral distress for all participants. Conclusion This research has contributed to our understanding of moral injury experienced by mental healthcare workers. It also invites us to move away from thinking about distress as being about an individual, or within the small systems that create our context. Instead, this model encourages us to consider wider, systemic factors and how this plays out in our services. Finally, we can think about the impact of this and how it feeds back into upholding systems that create inequalities.