Note: This blog discusses difficult topics including suicide, depression, and homelessness, among others. Reader discretion is advised.
A 2023 article from the New York Times, “The Moral Crisis of America’s Doctors” presents an emerging phenomenon in trauma and stress. The article describes the distress many doctors and nurses experience when they know what their patients need but are unable to provide it due to the corporatization of health care. As the healthcare industry has increasingly focused on profit, efficiency, and cost-cutting, many doctors and nurses find themselves caught between their professional values and institutional demands. The article framed this distress as moral injury, describing many doctors and nurses feeling distraught, depressed, angry, and sometimes even suicidal as a result.
A financial coach interviewed for CSW’s and InsideTrack’s white paper, From Crisis to Resilience, described a similar experience. At her nonprofit workforce development organization, she lamented that she and her colleagues do not have access to all the resources their workforce development clients need to survive and succeed in job training programs and employment. Clients need wraparound support services including affordable housing, childcare, transportation, mental health services and emergency funding, but the system lacks enough resources to provide them.
Does the distress showing up in the workforce development system qualify as a form of moral injury?
What is Moral Injury?
Moral injury is defined as the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct. It affects a person’s sense of identity, values, and meaning. Examples of moral injury include a soldier being required to kill people, when it is against their values; a police officer having to arrest someone when they know what they really need is mental health services; or a human services provider being unable to find housing for a family overnight, leaving them to sleep on the cold streets.
Moral injury is a type of trauma, which is defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. Traumatic events may be experienced by an individual, a generation, or an entire community or culture.”
A moral injury is certainly emotionally harmful in that it can cause one to feel guilt, shame, betrayal, disgust, and anger and lead to depression, withdrawal and loneliness, self-sabotage, and sometimes even suicide. A severe moral injury may feel like an intense betrayal of one’s own self and identity, such as believing, “I or my superior should have stopped the death, abuse, or policy change.” Like trauma, a potentially morally injurious event (PMIE) does not always result in a moral injury. It is important to remember that different experiences will affect different people differently.
Moral Injury vs. PTSD vs. Burnout vs. Vicarious Trauma
Moral injury differs from PTSD in that it is a wound to one’s moral compass or soul, and the person experiences guilt, shame, betrayal, and/or a violation of their values. Post-traumatic stress disorder (PTSD) is triggered by fear and threatening situations or perceptions, and the person experiences the automatic life-saving responses of fight, flight, freeze, or submit. These are different types of experiences but can have similar symptoms, including those mentioned above (i.e., depression, etc.), difficulty trusting others or one’s own judgement, and self-blame, among others. These two types of trauma are not mutually exclusive, and the same horrific event can cause both PTSD and moral injury, complicating diagnosis and treatment.
Similarly, burnout and moral injury have different origins and causes but share some similar symptoms. Burnout is “when ongoing stress leaves you exhausted—emotionally, physically, and mentally.” Its cause is too much stress or work. Moral injury, on the other hand, is rooted in ethical transgressions, systemic failures, and feelings of betrayal. Burnout can also lead to anger, depression, and other symptoms similar to moral injury and other traumas. But the appropriate way to address it is to reduce stress and workload, which are strategies that do not address or mitigate moral injury.
Vicarious or secondary trauma is when someone absorbs another’s trauma experience and has a response similar to actually experiencing trauma. This is a common occurrence for career coaches and other workforce development practitioners. It is a very normal response to the difficult situations they hear from their clients every day. As with PTSD, this type of trauma can be intermingled with moral injury. For example, when a caseworker hears stories of the hardships of poverty, racism, homelessness, unaffordable healthcare, and under-funded supports—experiencing secondary trauma day-in and day-out—they may also feel witness to policy and funding actions several layers above them that violate their values that every human being should have their basic needs covered.
Examples of Moral Injury in Workforce Development
Are workforce development professionals experiencing moral injury? Skeptics may say they are not, because what workforce development professionals are experiencing is not at the same level as military personnel or doctors who have to make life or death decisions. However, several studies indicate that K-12 teachers experience moral injury. One study found that teachers in high-poverty, racially segregated schools experienced levels of moral injury similar to that experienced by military veterans. The guilt, troubled conscious, and desire to leave the distressing field were equally high, whether the source was military combat or in our urban American schools.
Similarly, there are several ways moral injury might be surfacing in the workforce development field including:
Lack of Funding and Resources
Frontline practitioners, such as career coaches, may grow frustrated before becoming distressed, and then potentially depressed or angry when they must turn away participants who do not meet overly narrow eligibility rules or when funding is cut. For example, during COVID, there was an influx of federal funding. “For once,” a financial coach shared , “the funding and resources were actually at the levels necessary to help people overcome their barriers and succeed in training and employment.” But as the pandemic-era resources have dwindled, the system is back to anemic funding and inadequate resources, and she and her colleagues are even more distraught and feeling helpless to provide participants with what they really need to survive and thrive.
Unrealistic Performance Expectations
Workforce development leaders must manage inadequate funding with ambitious and perhaps unrealistic performance measures. They know their staff are overworked but also know that they need to meet performance metrics to maintain funding. They are conflicted between what they believe is right versus what they are required to do, and feel betrayed by the system and morally injured.
Forced Firings and Layoffs
Federal and state agency staff who witnessed, and maybe even had to assist in carrying out, mass firings and layoffs of their colleagues in 2025 may be suffering from moral injury. Staff may experience moral injury when witnessing programs losing funding despite evidence that they work and are needed by communities. They may also be distressed when unable to speak openly about these concerns because of political or legal constraints.
How to Treat Moral Injury
While the concept of moral injury is not new—morally ethical dilemmas have always existed—the focus on treating and healing from moral injury has emerged relatively recently. Most research on moral injury has been with military service members and veterans, beginning with Vietnam veterans in 1994 by Dr. Jonathan Shay. More recently, research on moral injury among teachers has been conducted. A tool for assessing moral injury symptoms was only developed in 2023—the Moral Injury and Distress Scale (MIDS).
Many of the early approaches to treatment of moral injury resemble trauma treatments. The staff at CSW are not clinicians, we do not diagnose, and we do not treat trauma or mental health conditions. We do, however, provide training and resources to help practitioners and leaders be more trauma-informed about potential moral injury you may be experiencing yourself, or you may be seeing in others. Here are some initial steps:
Explore if what is happening is a moral injury rather than stress, burnout, or something else.
Does your experience feel like a betrayal, a grave wrong, an affront to your moral code because the circumstances constrained you from doing what you believe is right? If so, it may be moral injury. It is critical to understand the underlying cause of your distress and integrate strategies that address that cause(s).
Acknowledge it—moral injury is a real mental health condition.
Moral injury is officially recognized by the American Psychiatric Association (APA) in the newest version of its Diagnostic and Statistical Manual of Mental Disorders (DSM) as of September 2025. An experience of moral injury is real and legitimate.
Do not blame yourself for the morally questionable or wrong actions of others.
You are not responsible for the perpetration of the offensive or unjust act. Your role in the offensive act may have been outside your control and you may have been unable to prevent it. This concept is sometimes referred to as the “locus of control;” distinguishing between what you can: (a) control, (b) influence, or (c) not control or influence at all. Additionally, however you may have been involved, forgive yourself. Give yourself grace in the face of a terrible situation.
If you are a leader, be transparent about potential moral injuries that you cannot control.
The U.S. Department of Veterans Affairs recommends: “Leaders can help by increasing communication with employees, particularly around changing policies and the decisions that are being made. Send a clear message that during times of extreme stress, high volume of cases and changing circumstances, guilt, shame, anger and difficulty functioning may occur.” Provide mental health support to your staff always, but especially in these situations.
Take action.
Building from the locus of control, recognize that you may not be able to control the morally injurious situation, i.e., you don’t control the state workforce development budget and funding cuts. Then, consider what actions are within your control to take. At the workforce development service level, perhaps you can organize your colleagues to create a list of community resources that might compliment and backfill workforce development funding cuts. Taking action can reduce the feeling of helplessness and doing it as a team can strengthen teamwork and connection with your colleagues.
If you are the leader of an organization, forge creative partnerships with other community organizations along the continuum of care your participants need. For example, CSW is in a national partnership with Futures Without Violence and Women Employed to support collaborations of workforce development, domestic violence, and education organizations to work together to improve employment opportunities for victims of domestic violence. The leaders of these collaborating organizations are enabling staff to counter the moral injury they witness in domestic violence with meaningful and collaborative action.
Reframe when change is not immediately possible.
If you are stuck in the situation causing moral injury, i.e., you need the income from your job at the career center and don’t feel confident engaging in a new job search, you may need to reframe to cope and survive through the situation. This is only recommended if the moral injury is mild and does not seriously harm your mental health (in that case, definitely seek professional help).
To reframe, you can “zoom out” to take a longer, historical look at the situation. Ask if you, the organization, the country has been here before and, if so, how did we survive it? Ask what we can learn from the situation—from how we got here to how we’ll emerge and recover. Envision the future you want to see and take action toward that vision. Reframing is not about ignoring harm or accepting injustice, it is about maintaining perspective and hope when you cannot control the cause of the moral injury.
Whatever the situation, if you are feeling morally injured, draw on your internal strength, your self-care and resilience-building tools, as well as the strength and support of others. Especially with this type of trauma, it is helpful and healing to be in community with others and gain strength in solidarity.
A Call for Thoughts and Input
It is clear that the workforce development system is suffering from significant levels of stress. Is moral injury one of those stressors? If any of this resonates with you, we would appreciate hearing about your experience. Please share your thoughts at info@skilledwork.org.
If you feel trauma or moral injury is overwhelming your ability to cope, please contact a mental health professional ideally through your healthcare plan or using one of the resources below.
Additional Resources
Meet the Author
Vickie Choitz
Vickie Choitz is the Director of Trauma and Resilience at Work. The CSW Trauma and Resilience at Work team advances workplaces and workforces that are culturally responsive, trauma-informed, healing-centered, resilience-building, and supportive of mental well-being. Continue Reading >>
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