Moral Injury and Emotional Labour in Uniformed Public Services - reflections from the UK Psychological Trauma Conference 2026

This was a one-day event that brought together researchers and practitioners to discuss trauma and moral injury across the public services.

About the UK Psychological Trauma Society

The UK Psychological Trauma Society (UKPTS) is a not-for-profit membership organisation that exists to promote evidence-based, trauma-informed approaches to public policy and the treatment of psychological trauma across the UK.

With strong historic links to the European Society for Traumatic Stress Studies (ESTSS), the UKPTS brings together a multidisciplinary community of academics, clinical practitioners, and professionals whose work intersects with psychological trauma.

The Society's core activities include providing a forum for knowledge sharing, producing evidence-based guidance and white papers for organisations and policymakers, offering members access to continuing professional development events, and maintaining strong links with the ESTSS, of which UKPTS members are automatically full members. It also produces public-facing resources to help those affected by trauma navigate available support and understand what to expect from trauma-informed services.

A key part of the UKPTS calendar is its annual conference, with this year's event held at King's College London.

What is moral injury?

Moral injury is a construct that describes the deep psychological distress arising from perpetrating, failing to prevent, or bearing witness to acts that transgress one's deeply held moral beliefs and values. First conceptualised by Jonathan Shay (1994) in the context of combat veterans, the concept was later operationalised by Litz and colleagues (2009), who defined it as the damage done to an individual's moral foundation when they engage in, fail to stop, or witness events that violate their moral code.

Unlike PTSD, which is rooted in traumatic stress and fear, moral injury is fundamentally an injury to the conscience and sense of self, often manifesting as shame, guilt, spiritual crisis, and a pervasive sense of betrayal – either of oneself or by others in positions of authority (Williamson et al., 2021).

In recent years, the construct has gained significant traction beyond its military origins, with researchers increasingly applying it to healthcare workers, police officers, and other uniformed public service professionals who routinely face value-incongruent demands, resource constraints, and institutional decisions that conflict with their professional ethics (Griffin et al., 2019; Greenberg et al., 2020).

The psychological impact of moral injury is wide-ranging and can be profound, affecting an individual's emotional wellbeing, sense of identity, and interpersonal functioning. Those who experience moral injury commonly report intense feelings of shame, guilt, self-condemnation, and betrayal, alongside a loss of meaning and purpose, spiritual or existential crisis, and a fundamental rupture in their worldview and trust in others – particularly those in positions of authority (Litz et al., 2009; Bryan et al., 2016). These consequences can lead to social withdrawal, difficulties in relationships, increased risk of depression, anxiety, substance misuse, and suicidal ideation (Griffin et al., 2019).

What is emotional labour?

The concept of emotional labour was first introduced by sociologist Arlie Hochschild in her seminal work The Managed Heart: Commercialization of Human Feeling (1983), in which she examined how certain occupations require workers to manage and regulate their emotional expressions as part of their job role. Hochschild defined emotional labour as the management of feeling to create a publicly observable facial and bodily display, arguing that emotions themselves become a commodity – something bought and sold in the service economy.

Hochschild identified two key strategies through which individuals perform emotional labour: surface acting, whereby workers modify their outward emotional expression without changing their internal feelings (essentially "putting on a mask"), and deep acting, whereby workers attempt to genuinely alter their inner emotional state to align with the display required by their role.

Hochschild was notably concerned with the psychological cost of this emotional commodification, arguing that when workers are required to subordinate their authentic feelings to the demands of an employer over sustained periods, the result can be a process of emotional estrangement – a disconnection from one's own feelings and a loss of the sense that one's emotions are genuinely one's own.

This foundational framework has since been widely applied across a range of occupational contexts, and remains particularly resonant in research on uniformed public services, where the regulation of emotion is not merely an organisational expectation but a deeply ingrained professional and cultural norm.

SJ’s presentation: When Emotion Work is Morally Injurious: Exploring the Psychological Impact of Emotional Silencing in the Context of Trauma within Paramedicine and Policing

I (SJ) presented this paper with Dr Jo Mildenhall, who is the Psychological Health and Wellbeing Manager for the Royal College of Paramedics. Jo is also a serving paramedic and qualified psychotherapist, while I am an ex-police officer and trainee psychotherapist.

My PhD examined emotional labour in policing, and my subsequent research has led me to identify emotional labour as a form of moral injury. Jo’s PhD took a social psychological approach to explore social identity processes in paramedics' collective experiencing of trauma during the Covid-19 pandemic. We both used qualitative methods (interviews/audio diaries) to capture data from serving ambulance staff and police officers.

This project saw us bring together data from both of our PhDs. Through many discussions, we identified a number of similarities between paramedicine and policing, particularly in culture and a shared working space (street level and private homes):

• Shared cultural characteristics and working practices (Charman, 2013).
• Shared responsibilities and purpose – to save and protect life.
• Exposure to both challenging and mundane incidents.
• Collective working environments.

We therefore reanalysed our data with the aim of exploring the relationship between emotional labour and moral injury within the uniformed public services of the ambulance service and police service, with a focus on how organisational culture contributes to moral injury through emotional regulatory performances.

We found that ambulance staff and police officers shared experiences of:

• Being compelled to act against moral integrity while performing expected emotional responses.
• Inability to prevent harm due to policy/ procedural constraints while maintaining a professional demeanour.
• Implicit social pressures to suppress emotional expression regarding personal mental health and others’ suffering.

Our overall conclusions were that:

• Within both policing and paramedicine, participants held shared expectations around emotional labour.
• Experiencing of moral injury through organisational betrayal of enforced emotional labour – silencing through normative social expectations.
• Professional socialisation and organisational cultural rules impressed deeply engrained beliefs around duty to serve – even at the detriment to one’s own psychological health – ‘man up and get on with it’ – push on, until at breaking point.

Clare's presentation: Emotional inequities: exploring qualitatively the relationship between gender, emotional labour and well-being in UK prison officers

Clare presented a poster based on her research into emotional labour with prison officers. This study has used interviews to explore how male and female officers manage their own emotions, as well as those of co-workers and inmates.

Findings reveal that emotional labour negatively impacts officer well-being and mental health. Framed by an ecological approach, these psychological outcomes can be understood as operating on multiple levels: individual, interpersonal, organisational and societal.

At the interpersonal level, relationships at work play a key moderating role when it comes to well-being. For most prison officers, relationships with their fellow officers provided a sense of camaraderie and were a continued source of (dark) humour. However, relationships with managers were overwhelmingly described in negative terms and were often reported as having a detrimental effect on officer well-being.

The poster also featured an infographic (above). This was created in collaboration with an artist (Julian Burton, Delta 7) and summarises five recommendations for improving officer well-being, all of which are grounded in the interview data:

• More balance
• More time for check-ins with managers
• More time for peer support
• External support where needed
• A single point of contact to signpost support

The image generated lots of interesting conversations at the conference and shows how creative/visual outputs can stimulate debate.

Next steps

For SJ and Jo, our next step is to draw this work into an academic paper, but also to use this study to drive recognition in the uniformed public services that mental health and ‘resilience’ are not an individual’s responsibility, but the outcome of organisational silencing and a culture that stigmatises emotions and help-seeking. Or, if we can be so blunt: poor mental health in uniformed public services is a consequence of organisational harm.

For Clare, a significant next step will be to use the infographic as a platform for a dialogue with the prison service. Following ‘sense-checking’ with prison officers, the aim will be to share the infographic with as many agencies and stakeholders as possible. A number of papers are also being prepared for publication.

Dr SJ Lennie, Associate Professor, CEEUPS and Dr Clare Rawdin, Research Associate, CEEUPS