Forces in Mind Trust (FiMT) has awarded £270,830 to the King’s Centre for Military Health Research (KCMHR) at King’s College London, in partnership with veterans’ mental health charity Combat Stress, to design and conduct a feasibility study of a psychological treatment for morally injured[1] UK veterans.

The project follows on from a previous FiMT-funded study on veterans’ and clinicians’ experiences of moral injury in the UK, The experiences and impact of moral injury in UK veterans. One of the key findings from the research, which is due to be published later this year, was that there is currently no standardised guidance for the effective treatment of moral injury-related mental health problems in UK veterans. This new award seeks to fill this gap by funding the development, design, and evaluation of a new treatment.

The research team, led by Dr Victoria Williamson and Professor Neil Greenberg at King’s College London, and Dr Dominic Murphy at Combat Stress, will conduct a comprehensive review of UK and international treatments for moral injury, and consult with leading professionals in the field, as well as with veterans who have been treated for moral injury related psychological problems. The team will then test the final treatment model for acceptability, appropriateness, and clinical relevance with 20 morally injured veterans who are receiving treatment from Combat Stress. The findings will be used to inform professionals working with both veterans as well as with other occupational groups vulnerable to moral injury such as health care workers and first responders.

The project is expected to start in October 2020 and be conducted over 27 months.

Ray Lock, Chief Executive of Forces in Mind Trust, says: “The initial research provided us with a robust evidence base on the under-researched topic of moral injury in UK veterans. Now we know how morally injurious events can negatively impact upon ex-Service personnel, it is important that further research is carried out to examine how we can best support them. This project will contribute to the fundamental aims of FiMT’s Health Programme, to fund evidence generation that will increase expertise, awareness and understanding of the health needs of the ex-Service community, and ensure that the subsequent service delivery and support appropriately reflect those needs.”

Dr Dominic Murphy, Head of Research at Combat Stress, said: “By the end of this project we plan to have learnt the best way to treat veterans who have experienced moral injuries. Given the current morally complex challenges Covid-19 is presenting healthcare professionals with, we would hope that our findings can then be applied to support other groups of individuals as well.”

Dr Victoria Williamson from the King’s Centre of Military Health Research, King’s College London said: “There has been an increasing awareness around the concept of moral injury and, although first described in military personnel, it has become especially relevant in light of its application to COVID-19 frontline workers who may have experienced psychological distress resulting from actions, or lack of them, that go against their moral or ethical code. No evidence-based approaches to treat those who experience moral injury-related mental health difficulties currently exist. Our feasibility trial, kindly funded by the Forces in Mind Trust, will be the first of its kind in the UK to develop, design and evaluate a treatment module for moral injury-related mental health difficulties in UK military veterans. We hope the result of this study will eventually help those affected by moral injury across the UK and globally.”

[1] Moral injury is the psychological distress which results from actions, or the lack of them, which violate one’s moral or ethical code. Individuals who experience moral injury often report negative self-attributions as well as high levels of guilt and shame. These cognitive and emotional states can contribute towards the development of psychological problems, including posttraumatic stress disorder (PTSD), self-injury and depression.

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