Have you ever had days at work that left you questioning the difference between right and wrong, and then feeling dismissed out of hand when you’ve tried to explain that to your manager?

That can be the experience of those who feel their moral code has been violated – not by their clients, patients or the public, but by their employers.

Defined as moral injury, this only recently officially recognised area of mental health has been gaining attention in medical and employment spheres.

In 2025, it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSMMD) and, earlier this year, the inaugural Australia and New Zealand Moral Injury Conference was held in Launceston, Australia.

One of the organisers was senior Police chaplain Ants Hawes. Though he was involved through his chaplaincy connections, his motivation was to raise awareness of moral injury among his Kiwi colleagues, especially now that it features in the DSMMD.

Defined as an injury that arises when a person is exposed to events or actions that deeply conflict with their moral or ethical beliefs, it was originally identified in military veterans in the United States and Canada more than 20 years ago.

Now, it is believed that moral injury can affect a range of professions in which moral codes can be tested, such as police, paramedics, firefighters, doctors, nurses and social workers.

When trust is broken

Ants says there are two types of harm to these workers: one gained through their own actions, because of what they were directed to do or were involved in, or an injury brought about or worsened by the actions of their employer or superiors.

The second category is the most debilitating, he says, because it involves broken trust.

“For police, moral injury can result from enforcing decisions that feel unfair, seeing vulnerable people suffer because of organisational choices and feeling let down after doing something you believe is wrong. It becomes far more damaging when a
person feels unsupported or even punished by those in authority.”

Dr Jonathan Shay, the American psychiatrist who coined the term moral injury in the 1990s, characterised the condition as creating profound, long-lasting negative emotions.

Ants says it is important to note that while moral injury and post-traumatic stress disorder (PTSD) are “cousins”, they are not the same and cannot be treated in the same way.

“PTSD is rooted in fear and life-threatening situations. Its symptoms include startle reflex, memory loss, fear and flashbacks. Moral injury symptoms include grief, shame, guilt, loss of trust, social isolation and inability to enjoy previously pleasurable activities.”

A presenter at the Launceston conference described it this way: “If it hits you in the head, it’s PTSD; if it hits you in the heart, it’s moral injury.”

'It's an employment issue'

Ants has sent his conference report to Police headquarters. It includes recommendations such as educating the workforce, particularly senior sergeants and inspectors, on what moral injury is and how to prevent it, and inclusion of the subject in recruit wing training.

While acknowledging that Police has a lot on its plate at the moment around behaviour, he says this is an area that needs to be taken seriously because it is an employment issue.

“The moment we feel our employer has turned against us, that’s huge and that is where morality starts to tip. It’s very real and it affects a number of our staff, to varying degrees.”

It’s also easily treatable. “It doesn’t need a huge therapeutic response. Between 80% and 90% of people can be helped by being heard, understood, accepted and affirmed. Just having it acknowledged or an apology is often enough.”

While moral injury is not commonly recognised in Aotearoa, it is in Australia in first responder environments and in its Defence Force, which routinely supports and treats staff in this area.

One of the hurdles to having the concept taken seriously, Ants says, is that it is not always easy to understand and most people haven’t heard of it. To help explain, he provides the pending introduction of “move-on orders” as an example.

“Many officers have already expressed concern about being required to enforce these orders, knowing that many homeless individuals have nowhere else to go. Officers join Police to help people, not harm them, and being forced into actions that conflict with that can risk causing moral injury.”

Closer to home

Ants tells the story of a doctor deployed to a Pacific disaster zone.

He was told at the end of the operation that the unused medical supplies he wanted to donate to help the local hospital would have to be shipped back to New Zealand and destroyed. The reason? Because that was the protocol for such equipment.

“That would have been very hard decision for a doctor to accept and to be forced to do,” Ants says.