Confidentiality and psychological treatment of moral injury: the elephant in the room.

Morally injurious incidents may present ethical or legal quandaries, yet how military or civilian clinicians should manage such disclosures is poorly understood. Individuals who experience moral injury may be reluctant to seek help due to concerns about the legal ramifications of disclosure. Guidance on breaching patient confidentiality differs by regulatory body but also by profession, geography and context. As moral injury continues to become recognised in clinical practice, in the military and elsewhere, clarity is needed regarding best practice in managing moral injury cases and the dilemmas they present.
Competing Interests: Competing interests: NG is the Royal College of Psychiatrists’ Lead for Military and Veterans’ Health, a Trustee of Walking With The Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. SW is a Trustee of Combat Stress and Civilian Consultant Advisor to the British Army, both unpaid.
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