Preventing psychological injury during the covid-19 pandemic

Greenberg and colleagues rightly state that the development of psychological injury is “influenced by the way [staff] are supported before, during, and after a challenging incident.”1 But identifying, supporting, and treating people after they have developed moral injuries can be very difficult, so we need a greater focus on preventive measures. Healthcare organisations, with their duty to protect the mental health of employees,2 should adopt three key strategies urgently: enhanced decision making support; the provision of time and space for clinicians to decompress; and staff working consistently in the same team.

Complex decisions are more likely to lead to moral injury. Although evidence is limited, we think that sharing (moral) responsibility with other clinicians will help to reduce the intensity of dilemmas and reduce the emotional arousal. This would fit with the well established social psychological principles of diffusion of responsibility and moral disengagement. Local clinical ethics committees or similar might also have a role if a further opinion is needed.

Time to process events and to decompress is key to limiting moral distress (a precursor to moral injury). Early evidence indicates that healthcare professionals need time and space to rest and to be able to talk about their experiences if they want to.3 Repeated long or intense shifts are not conducive to this, so we need workforce rostering that balances and rotates the intensity of working environments.4

Working in, and having rest periods with, consistent teams allows development of mutual support, reduces emotional and moral distress, and aids with recognition and prompt response to distress as doctors are much better at picking up distress in their colleagues than in themselves. Again, appropriate rostering considering teams is key here.