Moral Injury--An Insidious Infliction of Veterans and First Responders PCIS Natalie Summit B815 Officer Dan Antrim 1160 City of Scottsdale Police Department Crisis Negotiation Team/Crisis Intervention Team

So, Where Does The Disconnect Happen? Lieutenant Colonel SLA Marshall <25% 60-70% 85-90%

What is moral injury? Moral Injury is the result of reflection on memories of war or other extreme traumatic conditions. It comes from having transgressed one’s basic moral identity and violated core moral beliefs. Moral Injury results when individuals violate their core moral beliefs, and in evaluating their behavior negatively, they feel they no longer live in a reliable, meaningful world and can no longer be regarded as decent human beings.

What is moral injury? (cont.) Consequences of Moral Injury: Overwhelming Moral feelings of guilt, shame, despair, angst, remorse, anger, outrage, grief, disgust, worthlessness, demoralization, self- condemnation, and betrayal Feel as though they lost their soul and are no longer who they once were Abandon the values and beliefs that gave their lives meaning and guided their moral choices. Decide no one can be trusted and isolate themselves from others Take their own lives in order to eliminate the shame and guilt and despair: “Its torments to the soul can make death a mercy.”

Moral Injury vs. Post Traumatic Stress Moral Injury is not the same as PTS. Some symptoms may overlap and look similar but there are very large differences and they are managed differently.

Moral Injury is Different than PTSD PTSD Moral Injury “Startle” Reflex Memory Loss Fear Flashbacks Hypervigilance Sorrow Grief Regret Shame Alienation Anger Depression Anxiety Insomnia Nightmares Self Medication Intense Fear Reaction Core Moral Beliefs Violated Nash, Bill & Woods, D., “Moral Injury,” Huffington Post, March 18 2014

Moral Injury vs. Mental Illness Moral Injury does not imply Mental Illness. The symptoms may look similar but there are differences and they are often managed differently. However, there may be overlap. For Example…

Questions, Comments, Concerns??? PCIS Natalie Summit B815 nsummit@scottsdaleaz.gov 480.312.2976 Officer Dan Antrim 1160 dantrim@scottsdaleaz.gov 480.312.5034