When Mental Healthcare professionals cannot do the right thing: An exploration of how clinical psychologists make sense of their experiences of Moral Distress and conflicts of conscience

Background: Moral distress is an established concept in the healthcare ethics lexicon. However, scholarship has mainly been within nursing. Although many of the known sources of moral distress are common across the NHS - where demands have increased, alongside a reduction in resources, support and control - little is known about clinical psychologists' experiences of situations they consider ethically problematic and morally distressing.

Methods: Critical Narrative Analysis was carried out on data collected from semistructured interviews with five clinical psychologists (CP’s) working in the National Health Service to explore their experiences of MD.

Results: The difficulties raised, correspond to long-established issues in the NHS. The clinicians’ narratives positioned CP’s as ‘at war’ with an inaccessible, inappropriate, and unjust healthcare system. They told stories of being constantly confronted with ethically difficult scenarios, imposed by deteriorating, under-funded, under-resourced healthcare services and of being expected to work in ways that they felt unfitting and unsafe. It was witnessing this harm, and feeling powerless in the battle, that led to distress. Although clinicians wanted to create change, often they found themselves silenced, scapegoated and exhausted by the system, whose primary response to distress was to divorce it from context and personalise it. The NHS was depicted “as a depressingly impenetrable system, resistant to change”. Characterised by an epistemically unjust organisational culture, where psychologists were routinely excluded from the decision-making discussions that mattered.

Conclusions: This research adds to the growing body of literature indicating the importance of providing care in environments that align with values and ethics for clinicians, clinical practice and clinical care. If MD is recognised as an issue of organisational culture, the solutions need to be systemic, requiring changes in policy and practice, to make safe spaces for difficult dialogues, and to foster a sense of moral community within clinical practice.