Ethics Under Constraint: Moral Conflict, Institutional Power, and Ethical Self-Negotiation Among Mental Health Workers

Ethical practice in mental health care is often conceptualised as individual adherence to professional codes and moral principles. However, such frameworks inadequately capture the lived ethical realities of mental health workers operating within institutional systems shaped by bureaucratic control, legal mandates, risk management protocols, and hierarchical power relations. This study examines how mental health professionals experience, interpret, and navigate ethical conflict when professional values collide with institutional constraints. Adopting a qualitative, interpretivist design, in-depth semi-structured interviews were conducted with psychologists, counsellors, psychiatric social workers, and psychiatrists working across public, private, and non-governmental mental health settings. Data were analysed using reflexive thematic analysis to foreground participants’ moral reasoning, emotional responses, and adaptive strategies. Four interrelated themes emerged: institutional moral dissonance, hierarchies of power and constrained ethical agency, moral distress and emotional residue, and ethical negotiation as a survival practice. Participants described ethics not as a stable set of principles but as an ongoing process of negotiation shaped by organisational expectations and power asymmetries. Ethical compromise was experienced less as personal failure and more as a structural inevitability, producing enduring emotional consequences such as guilt, exhaustion, and ethical numbing. To sustain professional functioning, participants engaged in pragmatic ethical recalibration—seeking to minimise harm while preserving dignity within constrained systems. The findings challenge individualised models of ethical accountability and argue for a structural understanding of moral distress in mental health care. The study highlights the need for ethics education, supervision, and institutional policies that acknowledge ethical ambivalence, legitimise moral distress, and address the organisational conditions that constrain ethical agency. By centering practitioners’ lived experiences, this research reframes ethics as a relational, embodied, and contextually situated practice rather than a purely normative ideal.