Psychiatrists Report Moral Injury Amid Mental Health Crisis

Medscape

25-06-2025

Delayed access to psychiatric treatment is causing 'moral injury' to UK psychiatrists and harming their patients, the Royal College of Psychiatrists (RCPsych) has warned.
College President Dr Lade Smith told delegates at its International Congress 2025 that psychiatrists face 'growing emotional and ethical distress' as they navigate a mental health system 'stretched beyond its limits'.
The survey, which ran from 3 February to 2 March this year, received responses from 1012 psychiatrists in England, representing 6.3% of working members in the RCPsych database.
Four in 5 (81%) respondents said they had directly experienced or witnessed moral injury during decisions about patient admission or discharge. The college defined moral injury as a strong cognitive and emotional response following events that violate one's moral or ethical code.
Almost three quarters of respondents (73%) admitted making admission or discharge decisions 'based on factors other than the patient's clinical need and best interests'. Almost half (47%) reported daily delays in timely admissions or provision of inpatient mental health treatment due to capacity shortages.
Almost as many (44%) said they regularly heard about patients waiting for treatment in emergency departments or places of safety.
Worsening Mental Health Crisis
NHS data indicate that one in four adults experience at least one diagnosable mental health problem each year. Mental health issues are the largest single cause of disability in the UK.
A January report from the Health Foundation highlighted a recent sharp rise in mental health-related economic inactivity. The number of workers aged 16-34 limited in work by mental health has more than quadrupled in the last decade.
The mental health charity Mind estimates that poor mental health costs £300 billion a year in England alone.
Chronic Underfunding and Resource Shortages
RCPsych criticised the longstanding underfunding of mental health services. Although mental illness accounts for more than 20% of England's disease burden, it will receive less than 9% of health funding this year.
Smith told the conference in Newport, Wales, that the consequence of systemic issues, long-term underinvestment, and a failure to follow an evidence-based approach to care, have resulted in 'an erosion of standards in the mental health system'.
The college reported that patients are becoming increasingly unwell or in crisis 'due to an inability to access timely psychiatric treatment'. They also face disrupted continuity of care that creates difficulties maintaining therapeutic relationships.
Local capacity pressures may affect professional decisions and put patients at risk, Lade said.
Consequently, practitioners are left feeling that their treatments standards fall below what they consider to be acceptable. This leads to feelings of guilt, shame, burnout, frustration, and isolation, according to the RCPsych.
Increased Use of Unsuitable Out-of-Area Placements
One in three psychiatrists who responded to the survey reported weekly admissions to inappropriate wards. Patients are often placed far from home where they are separated from their families. This leads to longer stays and higher NHS costs, despite government pledges to end this by 2021.
The RCPsych's mental health watch dashboard shows that inappropriate out-of-area placements rose 22% from 32,617 between February-April 2024 to 39,779 in the same period this year.
Survey respondents linked lack of community mental health investment and supported housing with increased crises, delayed discharges, impaired recovery, and more readmissions.
Financial Pressures Override Clinical Judgement
The college said that the survey findings painted 'a distressing picture of psychiatrists carrying the weight of trying to deliver the best possible care to people with mental illness, with limited means to do so'.
'Provisions are now so threadbare that psychiatrists are having to make life and death decisions based on financial rather than clinical concerns,' Smith said.