Identifying and mitigating moral injury risks in military behavioral health providers

The term "moral injury" was initially used to describe the multifaceted pain that service members feel after perpetrating, witnessing, or failing to prevent acts that conflict with their moral codes. More recently the term has been used to describe healthcare providers' pain stemming from their experiences serving on the frontlines of the healthcare system when: a medical error causes serious harm to patients, systems continuously impede their abilities to provide proper care, or providers assess that they have acted in ways that conflict with their professional ethics or oaths to "do no harm." This article explores moral injury risk at the intersection of military service and healthcare by examining challenges that military behavioral healthcare providers face. Leveraging moral injury definitions previously applied to service members (personal or witnessed transgressions) and in two healthcare contexts ("second victim" to adverse client outcomes and system-driven moral distress), as well as literature on ethical challenges in military behavioral health, this paper uncovers situations that may amplify military behavioral health providers' risks for moral injury. It concludes by offering policy and practice recommendations germane to military medicine aimed at alleviating pressures military behavioral healthcare providers face and mitigating moral injuries' potential ripple effects on provider wellness, retention and care quality.