Are the Workers Alright? Moral Distress Among Mental Health Researchers

By Adam L. Fried, Ph.D.

Psychologists and psychiatrists have devoted increased attention to their own self-care in response to high levels of stress in treating individuals with serious mental health conditions. Little attention, however, has been paid to those conducting research with these populations and the unique moral dilemmas encountered by researchers on the front lines.  This is especially true for the graduate students, research assistants, and other research staff who are out in the field or in hospitals providing research-related clinical assessments and interventions, as well as other more traditional research tasks, such as participant recruitment and enrollment, with individuals with high levels of anxiety, depression, and trauma.

Tensions associated with the discharge of professional responsibilities and personal concerns for the care and wellbeing of their sometimes quite vulnerable participants can lead to a condition among workers known as moral stress.  A recent survey study with a sample of research workers conducted by Fried and Fisher illuminated some of specific moral stressors associated with this work. For example, in many instances, research workers are required to follow standardized or manualized treatment protocols that prevent them from addressing the particular participant’s clinical needs, leading to increased stress and other negative feelings.  These particular moral challenges come into play when a research worker wants to do what he or she believes is right but may be prevented by their job or organization.  Examples of these include:

  • Worry that participants mistakenly believe that research protocols were actually prescribed clinical services solely designed to treat their conditions
  • Concerns that participants who do not qualify for the research study but participating to receive financial or other benefits
  • Personal safety concerns, especially when working with individuals who have unpredictable or perhaps violent behavioral histories

But how aware are research scientists, who are often supervising research staff in the administration of study-related tasks, of the types of stress faced by workers?  Although survey respondents were generally quite positive about their workplace environments and results suggested that support for workers and available resources may protect against workplace distress, a significant minority of those surveyed did not feel comfortable speaking with their supervisors about stressful work-related experiences.   As a result, many supervisors may be unaware of the types of stress faced by these frontline workers and consequently, not attending to the possible threats to the fieldworker’s staff’s mental health and the integrity of the research.

Drawing on the growing self-care literature that has proliferated among psychologists and psychiatrists as a way to address stress associated with working with those with serious mental health conditions, research supervisors and organizations should consider adding opportunities for workers to discuss stressful work-related situations, such as debriefing sessions, supervision, or on-site counseling provided by trained outside professionals.  Other general self-care strategies have been published by the American Psychological Association for mental health professionals and could be adapted to clinical research settings (click here and here to view more information about work-related stress and self-care strategies).

Research with individuals with mental health conditions can be extremely rewarding but also highly stressful.  Clinical research on mental health conditions has the potential to provide great benefit to those afflicted with debilitating psychiatric conditions but also requires attention to the effects of moral and other types of stress on both the front-line staff working with vulnerable populations as well as the integrity of the research.

Click here to view a presentation of the Fried and Fisher study.  Click here to view a presentation of a related study by Fisher et al.

For additional information, click here to view a presentation by Dr. Celia B. Fisher on measures of moral stress among drug research frontline staff.

Dr. Adam L. Fried is the Assistant Director of the Center for Ethics Education at Fordham University, and the Director of the Master of Arts Program in Ethics and Society.

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