Steps to Address Moral Injury in First Responders

posted in Mental Health

Post-traumatic stress disorder (PTSD) and mental health issues are common in first responders across the board. They deal with traumatic situations at work almost daily, without much time to navigate how they feel about it. Many police services work odd shifts, long shifts, double shifts, and sometimes even triple shifts in order to keep their short-staffed services working to serve people. This on top of seeing traumatic events while on the job adds up to what is called “moral injury.” Find out more about what this is and why it is so important to provide support for first responders.

Hero’s Stigma

Stigma is a big reason why first responders don’t reach out to ask for help. The hero perspective that people have of police, firefighters, and other first responders saving lives is not true-to-life. Emergency services and supervisors hold high standards, along with public scrutiny, which makes it hard to feel like heroic work is being done. The problem often lies in thinking they have to maintain a heroic stance in their jobs when they are simply doing the best job they can. In their own minds and hearts, when they don’t live up to these standards, they feel like a failure at work.

This can lead to mental health issues that exacerbate the hero’s stigma. At another level, veterans who cannot meet the demands of the job might feel they are unacceptable. If they cannot keep their whole platoon safe and one dies or is injured, they feel the injury, too. The shame and stigma can sometimes be too much. The level of stigma comes from the service itself. Letting go and releasing some of the stigmas can be a large part of moving into recovery from the pain of dealing with a moral, physical, and emotional injury.

Exhausted Workers

Filling shifts with workers who are exhausted can be a daunting task. When people ask off from work or want to take a vacation, their comrades have to step in. Other members often get frustrated when they don’t get holidays off they want, work more overtime, or feel they are not able to rest as much as needed before yet another shift comes along. Short-staffing of workers in first responder work is common, yet challenging. Feeling totally exhausted makes it difficult to work those long shifts. This makes them more vulnerable to things like depression, anxiety, and feeling the effects of their work wearing them down over time. Exhaustion manifests as many things and it can be difficult to work through it without taking an extended amount of time off to cope.

Symptoms of Moral Injury

One focus of addressing moral injury in first responders is to recognize the symptoms. Operational stress injuries (OSIs) contain moral injury as one component of how first responders experience the burden of suffering. The moral injury affects a person’s entire being. A moral injury might be something done that was right but it was not something a person wishes they had done.

It may also be something witnessed that was morally wrong. The loss, injury, or witnessing of this act can disrupt a person’s feelings about their moral values and beliefs. Any standard that is not met can set the stage for moral injury. Some of the symptoms a person may experience can include:

  • Shame and guilt
  • Overwhelming sadness
  • Feeling the place they served may not take care of them as much as
  • they hoped
  • Feeling like a failure
  • Scapegoating feeling
  • Feelings of being unfairly being punished
  • Feelings of betrayal or injustice
  • Inability to sleep at night (insomnia)

Hope for Healing

Acknowledging the reality of moral injury is the first step. The mental and emotional costs of war and trauma from working on the front lines are very real and often not spoken about. Research on moral injury is not as widespread as that of PTSD or other similar health conditions. Trauma and the severity of it can co-occur with moral injury, making it even more challenging to deal with. Treating PTSD will not treat the moral injury but it can help alleviate symptoms to support their healing journey.

Finding Help

Resources for treating moral injury usually come with working out the incidents and figuring out where the person feels most injured. Treatment of moral injury is usually defined as looking at one’s beliefs and values now and helping them come to terms with what they experienced as best they can. Confronting moral injury includes talk therapy, dialogue with religious and spiritual advisors, art, writing, gathering with others who understand, and working with counselors to deal with their feelings.

Alternatives like equine therapy can also be helpful. Breaking the silence around moral injury is the starting point. It comes from talking about the issues at hand and dealing with it in a way that helps the person cope with the injury and find healing. They may never be able to recover and heal fully but they can learn to integrate experiences into who they are now so they can find freedom from the challenges they faced in the past and move forward into a better future.

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