Background: Moral Injury (MI) provides unique challenges for First Responders. Emergency services personnel face unique, career-long, and cumulative exposure to Potentially Morally Injurious Events (PMIEs), including life-and-death decisions, intractable moral dilemmas, organisational stresses, and exposure to moral trauma. Critically, MI in this cohort is not only incurred by operational events but also by organisational betrayal or a workplace moral injury. The impact of MI in this high-risk group is severe and has been connected to an increase in suicidality and treatment resistance in comorbid post-traumatic stress disorder (PTSD). This context may provide a valuable understanding of moral injury sustained by first responders outside of discrete PMIE but as part of an ongoing career.
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Approach: This presentation introduces an enhanced framework for recognising MI, positing that injury occurs not just from exposure to a PMIE, but from a failure to integrate the event into one's existing moral schema—a process heavily influenced by an individual’s moral maturity. Left unaddressed, this can lead to "Moral Drift": an insidious erosion of character where the injured individual's ideals shrink, and they may begin to perpetuate harm onto others. Through a psycho-spiritual, values-developmental approach this presentation will explore key clinical considerations, while ultimately arguing that fostering moral maturity is both prevention and intervention.
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Model: This approach structurally integrates two professional disciplines to provide holistic, interdisciplinary care. Psychologists provide essential clinical governance, offering evidence-based interventions to support trauma processing, comorbid mental health diagnoses as well as assessing and managing clinical risk. Chaplains address vital psycho-spiritual dimensions. They navigate diverse beliefs and values, foster meaning-making as well as promote forgiveness and purpose, which are essential for resolving the guilt and betrayal inherent to MI.
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Interventions & Implications: This framework translates into practical, tiered interventions, including adapting evidence-based group approaches and establishing peer-led moral distress sessions. This presentation offers a transferable strategy that provides a robust framework for fostering career-long moral resilience and preventing moral drift. It highlights the critical importance of interdisciplinary teams and collaboration to provide holistic care, training, support, and intervention for moral injury, pre- and post-PMIEs.