Defining and identifying potentially morally injurious experiences for secure mental healthcare workers: A Delphi study

Abstract

Purpose: Staff in secure mental healthcare settings face unique occupational challenges that may conflict with their personal or professional moral code. Initial research has established the presence of moral injury in this population, though insight into the specific sources and driving factors at the root of this syndrome is limited.

Method: To address this gap, a three-round expert Delphi survey was conducted to gain consensus on the conceptualisation, types and drivers of potentially morally injurious
experiences (PMIEs) for secure mental healthcare workers. Healthcare professionals and academics in the field were recruited.

Findings: A high level of consensus (≥80%) was achieved on several sources of moral injury, which related to aspects of the healthcare system, the secure context, relational dynamics and individual practices, behaviours and attitudes. Experts also agreed on several items relating to the definition of a PMIE, the factors driving the occurrence of PMIEs, and the factors increasing risk for the subsequent development of moral injury.

Practical implications: The findings suggest that current definitions of PMIEs may, in isolation, be too narrow, prompting the need to attend to the broad range of PMIEs
experienced by secure mental healthcare staff. Additionally, recommendations for the primary and secondary prevention of moral injury in secure mental healthcare staff are
offered, recognising the particular need for intervention at a systemic level.

Originality: This study is the first to consider the range of sources of moral injury faced by staff providing for people with complex forensic and mental health needs.