Moral Injury in Secure and Forensic Services: the Experience of Psychologists Working in Prison and Secure Hospitals

Background Moral Injury (MI) refers to the distress experienced after violating one's deeply held moral beliefs. The concept appears relevant for secure and forensic environments, including among psychologists working in these settings and facing ethically challenging situations. Aims To explore the lived experience of psychologists working in secure services, and how they experienced, understood, and made sense of the complex and potentially morally injurious events that this involves. Method In-depth interviews were conducted with seven psychologists with experience working in secure mental health services and prisons in the UK. The interviews were analysed using Interpretative Phenomenological Analysis. Results Three Group Experiential Themes with subthemes were identified: Pull to a Different World, Personal Cost, and Surviving a Morally Ambiguous Landscape. They describe the complexities of working within these systems in the context of their initial appeal and how this evolved after they experienced these environments. They represent the interactions with the self, colleagues, the system, and power, and the various ways this was costly. Internal and external means of managing and surviving are discussed. Discussion Clinicians and services would benefit from an awareness of the morally injurious practice of working within these settings, and from tailoring support that works to practically scaffold those involved (beyond staff, including other disciplines and service users), as well as the system. The findings highlight the need to reconsider harmful practices and attitudes. Recommendations are given for policymakers, management, and future research to implement changes and expand the current knowledge base in this area.