Moral disengagement in psychiatric inpatient care for individuals who engage in self-injury: a conceptual framework for understanding staff responses and patient experiences.

Psychiatric inpatient care for individuals who engage in self-injury involves tensions between preventing harm, respecting autonomy, sustaining relational care, and managing organizational demands. Staff may experience emotional burden and moral distress, while patients may experience care as invalidating, coercive, or insufficiently responsive to their needs. This article develops a theory-informed conceptual framework applying Albert Bandura's theory of moral disengagement to psychiatric inpatient care for self-injury. Drawing on an interpretive synthesis of Bandura's theory and clinical literature identified through a focused, non-systematic search, it examines how moral disengagement-related processes may shape the interpretation, justification, and normalization of problematic care practices. The framework maps Bandura's eight moral disengagement mechanisms across four loci of moral self-regulation: conduct, agency, consequences, and recipients. It illustrates how practices may be interpreted as protective, reframed through euphemistic language, or made acceptable through comparison with more severe alternatives. Responsibility may be displaced onto institutional authority or diffused across teams, while the interpersonal and psychological consequences of care may be minimized or treated as secondary to immediate safety demands. At the recipient locus, patients may be dehumanized through reduction to diagnoses, risk profiles, or behavioral categories, or blamed for their self-injury and for the emotional and organizational burdens associated with care. The framework situates these mechanisms within a recursive multilevel process in which staff appraisals, care practices, patient responses, and team and organizational conditions may mutually shape one another over time. The analysis is conceptual and hypothesis-generating, not an empirical demonstration that moral disengagement has occurred in specific situations. Rather than locating problematic care primarily in individual failure, the framework directs attention to the relational, organizational, and societal conditions under which ethical responsiveness may be weakened or restored. Future research should operationalize these processes and examine them across staff and patient perspectives and individual and collective levels.