MHM Magazine

2 | MENTAL HEALTH MATTERS | 2023 | Issue 2 MHM which in retrospect was not optimal. Such decision and policy changes defined the workplace culture in which healthcare workers delivered and continue to deliver service. Workplace culture and moral injury In a paper by Griffin and colleagues, they recognised that there is not yet a consensus definition and gold-standard measures for moral injury. Despite this limitation, He and colleagues found that moral injury may contribute to the prevalence of suicide ideation and that mental health conditions, especially depressive symptoms, play a significant role as mediators of moral injury. Moral injury, as initially defined by Litz et al in 2009 as “an act of transgression that creates dissonance and conflict because it violates assumptions and beliefs about right and wrong and personal goodness..” is often a result of the workplace environment and prevailing culture. The original definition of moral injury by Shay in 1995 (quoted by Wiinika-Lydon) emphasised three key elements of behavior that constitutes moral injury, 1. a betrayal of what is morally right, 2. by someone who holds the legitimate authority, 3. in a high-stakes situation. Shay further observed that it is the feeling of powerlessness in these situations that leads to helplessness and hopelessness (key elements of depression) as well as feelings of guilt and shame. Shay goes on to link these feelings to erosion of trust, social withdrawal and isolation and emotional numbing. Koening et al link such experiences to the features of DSM-5 defined posttraumatic stress disorder (PTSD) as indicated in the figure below (adapted from source). A workplace culture where healthcare workers are disempowered to make critical decisions and are unable to care for themselves and their colleagues leads to feelings of helplessness and hopelessness, subsequent moral injury and the resultant mental health concerns. The workplace culture should be one of empowering and enabling healthcare workers. Looking after our healthcare workers is looking after the nation. References available on request. Guilt Shame Moral Concerns Betrayal Loss Of Trust Difficulty Forgiving Loss Of Meaning Self-Condemnation Religious Struggles Loss Of Religious Faith/Hope Criterion B (Intrusion) Criterion C (Avoidance) Criterion D (Cognitions/Moods) Criterion E (Hypervigilance) Moral Injury DSM-5 PTSD Symptom Clusters