Moral Injury in a Broken System

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Moral Injury

The article makes a number of excellent points. I am currently retired and do a small private practice. The work is satisfying. I spent most of career either Community Organization, Administration and Program Development. In these areas I found I was able to effect Mezzo and Macro changes working on developing Evidence Based Practice for ACT. But what I did most of my career was to design and fund programs that had a significant impact on the lives of the people we serve.

In all aspects of social work practice, there is an unfortunate Dichotomy in most of these areas we all face balancing the Care aspect of the equation with Compliance standards and collecting enough revenue to keep the doors open so to say. There is simply no getting away from the fact that in order for systems of care to operate the monetary aspects are critical.

Essentially, no margin ( break even) no mission is possible. As I used to advise the staff if we don't earn any money they can't get paid. What is critical is not forgetting why we are there and that is to provide the best care one can offer. One of the best complements I ever received while sitting in Board meeting of a large MH organization one of the Regional Mangers asked to present to us stated that Tom (me) was the only one here who actually care about Client outcomes. So no matter what level of care you find yourself at direct care worker or Executive Director making sure the person we serve get the best outcome possible and it is possible.

When I taught Grad School I saw so many students wanting to work in private practice or clinics. Which is not bad but we as a profession need to focus on working in systems that can affect peoples lives from a broader prospective than one to one. There are opportunities out there. So I urge young Social Workers to explore Mezzo/Macro opportunities.

Thomas Patitucci 161 days ago


As a white child welfare supervisor, I advocated for my worker who was experiencing a racial injustice by management. As a result, I was marginalized and was marked down in every area of my
performance evaluation despite no change in my outstanding performance from previous years. If I weren’t planning to retire next year, would I leave when walking away allows these injustices to continue? No. Racial injustice will continue unless we strategically stand up to power. I’ve found my support system in other allies and we use our privilege to advocate for change, formally and informally on a micro, mezzo, and macro level.

I believe social work education should use a realistic lens when teaching about advocacy. It can involve personal risks, pushing against unrelenting powers of oppression over the long term. It involves a strong sense of mission to advance justice, not only learning advocacy practice skills. It involves deep self-reflection on whether one will be part of the solution or part of the problem when there is no middle ground. It involves a high potential for moral injury. It involves lifelong study of the masters such as MLK. It also helps to have a base of spirituality to remind one of the higher purpose when times are especially tough.

Thank you tor this insightful article.

Anita Martineau 170 days ago


Thank you for articulating so well what most of us are all too familiar in experiencing. Glad you were were energized by shifting gears, it's a good reminder that walking away from a broken system is necessary, not a personal failing...

Paula 172 days ago

Thank you!

Scott - thanks for your eloquent words and for putting into print what so many social workers struggle with in their daily work. I also appreciated the strategies you proposed for navigating through these challenges. So often we can articulate the problem but are less able to think about what to do about it. You did both beautifully in this article. Thank you!

Lori Watsen 174 days ago

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