When Our Care Fails: Burnout, Moral Distress, and the Cost of Uncontained Leadership

People who take on roles in public service and care work are often dealing with significant challenges—helping others through difficulty, making tough decisions, and managing competing pressures. So are the people who lead them. And so are the people who lead them. It’s understandable then that we won’t always get it right. The question, if we accept that is the case, is how we create spaces where they can process the weight of their roles and responsibilities, without it spilling out in ways that cause harm and poison caring cultures.

During a research trip to America, I visited a therapy service in Kansas City. One of the team members told me their guiding principle: to speak about clients the same way whether they are in the room or not. It struck me as a gold standard for maintaining my own integrity and the dignity of the people I work with. When people trust us to support them, especially when we've stuck our hand up to say that they can, we should endeavour for that trust to be upheld in every setting.

Recent reports about staff at Skye House, a psychiatric unit for teenagers in Glasgow, highlight what happens when this trust is broken. An internal NHS investigation found that young people experienced humiliation and cruelty instead of care (STV News). Similarly, the MPs’ WhatsApp group revealed elected officials engaging in cruel and judgmental conversations instead of reflecting on the demands of their work (The Guardian).

These incidents speak to individual failures. We cannot grow without getting to grips with our own personal responsibility and accountability. The incidents also raise a broader issue: what spaces are created for people in high-pressure roles to reflect, offload, and course-correct in a way that doesn’t compromise their purpose? As a therapist, I have regular supervision—dedicated time to process what stays with me after sessions. It’s a safeguard against burnout and against my own stress leaking into the space I create with someone. Where is the equivalent for those in public service? A snatched conversation with their line manager once a month, with a 'chat' about how they are doing buried somewhere in between the business of work?

When individuals in high-stress roles do not adequately process their moral and emotional challenges, the consequences can be dire. Unaddressed moral distress—knowing the right course of action but feeling powerless to act—can lead to burnout. As outlined by Freudenberger and Gail North, burnout progresses through stages, beginning with excessive ambition and culminating in depersonalisation and a complete absence of empathy. In this state, individuals may become cynical, detached, and, at worst, engage in harmful behaviors toward those they are meant to serve. In the proper sense, burnout is not about being tired or knackered - it is about losing grip on the reasons and vocation that took us into the space.

The allegations made about the treatment people received at Skye House and the derogatory exchanges within the Labour Party's WhatsApp group exemplify the manifestation of unprocessed distress. In both cases, the lack of empathy and the presence of cruelty or callousness suggest a failure to manage internal moral conflicts in a healthy way.

If we don’t create outlets for people to talk about their own distress, we will keep seeing situations where pressure turns into cynicism or much worse. As well as framing this as a matter of good or bad individuals and their personal failings, we could also be asking: how do we build a culture where people can acknowledge the hard parts of their roles without it leading to cruelty? How do we make it easier to call people in before things go too far? And how do we ensure that those who are responsible for others have ways to reflect on their work without it undermining and harming the very people they are there to help?