Future recommendations

In addition to the various research papers described above and the recommendations concluded, we have conducted further research exploring the moral injury treatment and potential future directions. 

A qualitative study explored the lived experience of UK veterans to gain insight into how these veterans experienced existing mental health treatments. The results highlighted multiple features of existing treatments which were reported as helpful and several which were unhelpful. Additionally, veterans expressed potential recommendations for future treatment such as focusing on core values, writing reflections through letters, incorporating a close companion session, and building a strong rapport with the therapist. Veterans also reported limitations of current treatment such as the lack of effectiveness in treating key features of moral injury (e.g., guilt and shame are not central targets of traditional PTSD treatment).  

A recent editorial explores the concept of moral injury and introduces the potential of art therapy as a treatment for moral injury. Art therapy may provide a non-verbal form of expression and an avenue to reduce distress and improve adaptive coping. With new research into moral injury expanding, this editorial recommends that art therapy be considered and evaluated as a potential treatment option for moral injury. 

Key future recommendations:

Further evaluation of Restore and Rebuild (R&R)

• Assess the potential suitability for a wider NHS evaluation project.
• Adapt R&R for use with other high-risk groups such as first responders.
• Explore potential implementation and evaluation in other countries and settings. 
• Adapt R&R to be used in active service personnel/reservists.

Increased focus on prevention

• Build on the findings from the CARE study in prisons aiming to co-design a prevention intervention for staff moral injury. More work is needed to explore how moral injury can be prevented in high-risk populations.

Expand investigations of moral injury and its impact in under-researched populations

• Potential neglected populations can include: staff working to prevent community violence, UK police officers, search and rescue teams operating in the Channel, and immigration detention centre staff.

Explore the role of moral injury in emerging treatment options

• Investigate how moral injury interacts with outcomes in post-trauma psychedelic-assisted therapy.