Study to examine why veterans might not seek help for a moral injury
A moral injury is psychological distress from committing or witnessing acts that conflict with moral standards
A new study by the Lawson Health Research Institute will be the first in the world to explore why concerns about confidentiality in mental health care might act as a barrier to Canadian veterans seeking treatment for a trauma known as moral injury.
Moral injury is psychological distress experienced when a person performs, witnesses or fails to prevent acts that conflict with deeply held moral standards.
An example might be a veteran who saw women and children injured in the battlefield but due to rules of engagement could not intervene to help them, said Anthony Nazarov, a post-doctoral associate at Lawson.
Another example, said Nazarov, could be potentially feeling guilty or responsible for the death of a fellow soldier or an ally, whether it was their actual responsibility or not.
Evidence suggests that moral injuries are on the rise among deployed members of the Canadian Armed Forces and that those exposed to such events are at a higher risk of developing post-traumatic stress disorder and depression.
Nazarov says it's difficult to estimate the actual number of cases because of concerns about potential violations of confidentiality.
"Not only are we wondering whether there is open and honest reporting in the clinic setting, we're not sure if people are actually opening up as well", said Nazarov.
He said some individuals may feel that their medical information is not fully protected and fear there could be repercussions, like career loss.
It's a concern within the civilian population, as well, but researchers want to know if it's a greater concern among those who have suffered moral injury because of the ambiguities around whether their conduct was ethical.
Nazarov acknowledged that a potential breach of confidentiality in a medical setting raises ethical issues for the clinicians involved.
"There there are several safeguards that are in place currently. There are professional body regulations that dictate that information should be kept confidential. And that's why we're interested in these perceptions and where they may be coming from."
Veterans receiving care at the Operational Stress Injury (OSI) Clinic at St. Joseph's Health care in London, Ont. will be interviewed for the two-year study, while other veterans and military personnel will be asked to participate in online surveys. Mental health professionals will also be interviewed for their perspectives on the issue.
"Many veterans seek help for mental health, and that's great to see. We've come a long way in reducing stigma and barriers, but there's more work to be done," says Dr. Don Richardson, the physician lead at St. Joseph's OSI Clinic.
"If veterans do not feel comfortable disclosing certain details because of perceived mistrust related to privacy, we need to know why that is and what we can do to address this issue."
The study is being funded by Veterans Affairs Canada and the St. Joseph's Health Care Foundation.