Moral injury

The delivery of Sandstories training for more than a decade has coincided with many years of so-called austerity and reductions in resources for vulnerable children. This has meant that local authorities and other agencies have been very noticeably “raising the threshold” for the provision of services, in order to ration diminishing resources – all while demand increases.

What I have frequently observed are the moral dilemmas and subsequent “moral injury” caused to practitioners and decision-makers, who feel they are too often expected to compromise their professional and personal ethics in order to comply with process and procedures. These processes are directed by political and financial drivers, rather than the needs of children. 

It’s not uncommon for practitioners to weep when they describe to me the expectations on them to compromise their professional integrity and personal values. The stories shared by participants in my training sessions, of children and young people who are turned away from support services because they don’t meet the “threshold”, are too numerous to count. These children’s stories often keep practitioners awake at night.

I have an emerging hypothesis that the moral injury caused by the expectation of compliance with “thresholds” and resource-centred (rather than child-centred) practice is a major contributor to burnout, mental ill-health, and stress-related illness among frontline practitioners and first-line managers.

Whilst it has long been recognised that high caseloads become overwhelming for practitioners, I sense that moral injury is an additional, powerful and invisible layer to this story.

Interestingly, references to moral injury have become more frequent in recent commentary about the NHS response to the Covid-19 pandemic. The appalling dilemmas faced by some health practitioners who have to decide who can be given a bed or intensive care treatment, or even oxygen, have been recognised as increasingly unbearable for all of those involved.

There is also a body of literature focusing on the moral injury experienced by military combatants in situations of conflict. This is compelling material and I recognise shared themes between the experiences of battlefield/military leadership and those on the frontline of child protection and their strategic decision-makers.

If a person is directed to act in a manner that conflicts with their sense of right and wrong; if they find themselves compelled to act in the face of wrongdoing but do nothing; if they acted with the best of intentions but find their actions led to the worst of outcomes, it is very likely that the individual’s sense of themselves will be adversely affected.

Why? Because the principles that gave point and purpose, and meaning and direction, to their life, have been denied or violated in such a manner and to such a degree that the person is alienated from themselves and estranged from the world.

War and Moral Injury: A Reader, ed. by Robert Emmet Meagher and Douglas A. Prior,
2018, p 191-2

It’s my greatest hope that Sandstories creates a meaningful and respectful space in which to recognise and respond to the practical and ethical dilemmas faced by a multi-agency workforce which is working so hard, in the face of great adversity, to reach out to vulnerable children and young people.