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Confidentiality and psychological treatment of moral injury: the elephant in the room
  1. Victoria Williamson1,
  2. D Murphy2,
  3. S A M Stevelink3,
  4. E Jones4,
  5. S Wessely5 and
  6. N Greenberg6
  1. 1 KCMHR, Institute of Psychiatry, Psychology & Neuroscience, Department of Basic and Clinical Neuroscience, London, UK
  2. 2 Combat Stress, Leatherhead, UK
  3. 3 King’s Centre for Military Health Research, Institute of Psychiatry, London, UK
  4. 4 Department of War Studies, King's College London, London, UK
  5. 5 King's Centre for Military Health, King's College London, London, UK
  6. 6 Academic Department for Military Mental Health, London, UK
  1. Correspondence to Victoria Williamson, KCMHR, Institute of Psychiatry Psychology and Neuroscience Department of Basic and Clinical Neuroscience, London SE5 9RJ, UK; victoria.williamson{at}


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.

  • psychiatry
  • forensic medicine
  • law (see medical law)

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  • Contributors All authors contributed to the content of the manuscript and approved the manuscript prior to submission.

  • Funding The authors had financial support from a Forces in Mind Trust grant (FiMT17/0920E) for the submitted work. This paper represents independent research part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (SAMS). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.