Mental health – to help our colleagues, do we need to change ourselves?
Rosie Allister is the Chair of Vet Helpline, a director of the Veterinary Benevolent Fund and a researcher at the University of Edinburgh studying veterinary wellbeing
The World Health Organisation predicts that, by 2030, depression will be the leading cause of the global burden of disease worldwide. It is already the leading cause of disability and accounts for 14% of the global burden of disease. At its worst, depression can lead to suicide.
It’s not only a major public health problem, but also a very personal issue for the veterinary profession. Too many vets have lost friends and colleagues to suicide. We know that vets are three to four times more likely to die by suicide than the general population, but when a colleague dies, however much we know about the statistics, it is shocking, awful and a human tragedy, which can be life-changing for those left behind.
It is a problem that as a profession we cannot ignore. Yet it can be hard to know how to respond. When someone dies by suicide it leaves us feeling very powerless, wishing there was some way we, or somebody, could have helped them find an alternative way to cope with whatever they were going through.
Rosie Allister
I think we need to talk more about how to reach out and support those who are struggling. We know from research, and from services available to vets, that it is not enough to have a service in place and hope that those in crisis will use it. One of the factors believed to increase risk of suicide in the veterinary profession is our reluctance to seek help. My own previous research with vet students has shown that they are much more likely than the general population to try to conceal mental health problems. Furthermore, a small but powerful study that interviewed 21 UK vets who had attempted suicide or experienced suicidal thoughts found that half of participants had not talked to anyone about their problems because they felt guilty or ashamed.
It can be really hard to know if a vet is struggling, yet suicide doesn’t come from nowhere, all of the research on suicide suggests it is almost always multi-factorial, and preceded by a feeling of an inability to cope over a period of time. However, it isn’t unusual for those bereaved by suicide to say ‘I wish I’d known’. Perhaps vets are particularly adept at hiding problems; at presenting a functioning façade. I wonder if this increases our vulnerability? If we hide our distress it is harder for those around us to know we need help; and when we do ask for help, it isn’t always apparent to professionals or those we reach out to just how much trouble we are in. One thing I’m often struck by when trying to support vets in crisis is that, despite all of the awful things they are going through and trying to cope with, they are often still going to work, still somehow managing to force a smile and present a functioning façade to the world.
In veterinary professional culture there is an incredibly strong work ethic, and a selflessness in terms of routinely making animal welfare a higher priority than our own. We feel that, to encourage clients to trust us and to meet their expectations, we need to appear contained, professional, and flawless. So it is hard for vets to ask for help. Our occupational culture encourages an almost unique combination of perfection, self-sacrifice, independence and omni-competence, which is totally unachievable.
Asking for help isn’t the weak option. It takes real strength. But that can be very hard to see when you are in a dark and hopeless place. Perhaps all of us have to start trying to change our culture to one that is more accepting and supportive and looks out for those in need even when they aren’t able to reach out themselves? The reason this sort of cultural change is difficult is due not only to client and societal expectations of us, but also our expectations of ourselves. Where is the stigma about asking for help coming from? Is it from others or from ourselves? Many vets I know are very accepting and supportive and non-judgemental when it comes to others’ mental health, yet when it comes to themselves, they apply unreachable standards of perfection, experience self-stigma around mental health and judge themselves harshly for a thousand failings no-one else is even aware of.
Perhaps to help our colleagues, part of the change needs to be within ourselves?
Looking to the future, we need to better understand who is most at risk, how to reach out to them, and how we can start to change our culture so that it is OK to ask for help. One of the myths about suicide is that people who are suicidal don’t talk about it, they just do it. In fact, people with suicidal intent usually do try to talk to somebody, but not always directly. Suicide is a taboo subject and people often talk around the issue or allude to it non-specifically, for example, avoiding making future plans or saying they aren’t thinking far ahead. It is important if someone says anything like this to take their distress seriously. When you are concerned someone may be suicidal, it’s really important to ask them. Another myth about suicide is that asking a depressed person about suicide will put the idea in their head. It does not – and there are good empirical studies to support this. Asking someone about it and then listening and responding can be a lifesaving intervention.
For confidential support call Vet Helpline on 0303 040 2551 or email via https://helpline.vetlife.org.uk/
Rosie Allister is the Chair of Vet Helpline, a director of the Veterinary Benevolent Fund [http://www.vetlife.org.uk/] and a researcher at the University of Edinburgh studying veterinary wellbeing. You can read her regular blog at http://veterinarywellbeing.wordpress.com/
Read more about Rosie Allister →
Suicide History and Repercussions
Twenty nine years ago an assistant in our Practice committed suicide. It all occurred in a very well prepared manner with letters and euthanasia also of his pets. He hated hot weather and it was extremely hot for a long period that Summer. The day before he had been in the office, with several of us, booking in his horses for the Royal Welsh. The evening concerned he ate with friends and left early saying he needed a cool shower. Next morning there was a note from him on the Office desk asking the duty vet to dispose of the syringe, beside his bed, safely .
We all went through an introspective period and periods of self blame for not spotting the symptoms. To this day the reasons are unclear and we all still feel upset at having failed to spot it. He was found to have had three distinct groups of friends, none of which knew of the other group.
After that time the Vet Helpline was set up to act as a contact for similar people but I still suspect that the problem was within him. Interestingly his father had committed suicide also. Our guilt still remains however even though he escaped his “problems”. Talking has to be a way forward but despite employing over thirty vets without problems, identifying the vulnerable is obviously difficult within the pressurised Practice. I suspect those working within the Franchise and Corporate Practices are potentially at greatest risk due to the inherent business “targets”.
Mindfulness should be taught in the undergraduate course. Helping each other is also needed but at times of most stress we are often alone and need ‘survival skills’. Also, other caring professions have debriefing opportunities- there should be grants available for a visiting service to practices to enable this.
Incidentally I think it very telling that a discussion about business and managerial skills incl suggestions of possibly adding it to the undergraduate course was discussed before this topic.
I had a stress reaction/anxiety state about 3 years after graduating, and I discovered that is a common point in time for major stress. I learned a great deal, and gained a lot of strength from that experience which involved 2 months in hospital. Key to opening up the support for potential and real sufferers is to work at ways of removing the stigma still attached to what is an illness of the brain’ as opposed to an illness of the heart or limb for example. Another key is professional development and the lifelong learning structure developed through RCVS CertAVP as an important development to provide support and real development opportunities for ambitious caring veterinary surgeons who want to achieve against what they often perceive as an environment working against them or which has many obstacles for them to overcome, and for which they need the tools and competencies to do this.
There are many parallels regarding companion animal veterinary practice and that of our GP medical colleagues. A major difference is in the network available to GPs to enable them to deliver patient care. In addition to the nursing team, comprising nurse practitioners, midwives, community nurses, psychiatric nurses, GPs can refer patients to the Mental Health Team, psychologists, counselors, physiotherapists, social workers and,of course, to a wide range of specialist services in hospitals which are often local to the patient. Our lives as veterinary surgeons would be much less stressful if such services were available to our patients free of charge. Having such a network also provides those in human health care with an invaluable support network of colleagues who understand the stresses and challenges of medicine. When we set up our companion animal practice over 30 years’ ago we established professional links with colleagues in the health and social care professions, in education, probation service and police force. This was achieved through reaching out to them to provide them with information about the human-animal bond relevant to their professional work. This multidisciplinary community network had unintended benefits – no longer did we feel “alone” when difficult situations arose such as clients with challenging behaviours. We always had colleagues to whom we could turn for advice on human issues. The input from social workers attuned to the importance of the human animal bond was particularly helpful. A number of veterinary colleges in the USA and the Animal Medical Centre in New York have social workers on staff and find their contribution to student training and their support to distressed owners invaluable. They also provide support to students and staff when needed. The presence of social workers in our veterinary faculties would be very beneficial and is overdue. Veterinary practices would also greatly benefit from having access to social work support.
Well said Liz!
Thank you so much for this analogy Elizabeth – I believe that development of this sort of honest thinking is important of we are to make some positive cultural changes that uplift our collective wellbeing.
It is interesting that there is a sizeable and fundamental difference between the core structures of human and veterinary medical work support – I found it quite revealing that I was totally unaware of any attempt to represent the vulnerable members of my profession in a manner similar to the longstanding and professional looking developments within BMA. The role of BVA is in stark contrast to how the equivalent association represents the human medical profession:
http://bma.org.uk/about-the-bma/what-we-do/bma-as-a-trade-union/the-doctors-trade-union
I cant imagine BVA saying that sort of thing
We have something unionists that potentially looks dodgy and unloved… and it has possibly remained so for a number of years – certainly BVA and BSAVA have a different view of their members needs than the BMA.
http://www.unitetheunion.org/news/call-for-a-shake-up-in-vets-regulatory-system/
It wouldn’t take much to dislike anyone in a “veterinary union” within our present culture and with our present information supply… yet sometimes I would appreciate a supportive buddy making sure I am being managed fairly.
http://www.bvu.org.uk/objectives.aspx
Maybe this fundamental aspect of our two historical differences needs to be factored in ….
Who has been looking after us all this time and who is really looking after us all now? Where is our leadership powerbase, where has it been, and why has it been like that for so long? Do we like the idea of better representation, if so would it look similar to BMA or would it be very different? Which voices calling for change say things worth listening too and who is a ranting nutter?
Are we just really carrying on as we were before with our alleged alarming wellbeing issues and declining profession entrant prospects and if so why?
Kind regards
S
Hi, you make some interesting statements,and ask interesting questions. Firstly the doctors basically work for one large employer which is not so with vets so representation of vets requires a different approach . The rcvs certavp provides a structure for professional development from which vets can develop their careers and negotiate with their employers or develop their own performance in their own practice . Both routes have their own rewards. The vet profession is essentially an entrepreneurial one. SPVS does a lot for practitioners and VCF is an example of an organisation providing a buddy and mentoring service for their members . There is
Lots if support available for vets so perhaps the real question is why are they not accessing and making more use of it? Regards. Paul Manning
From my own experience of depression this article is so true.
In this career when we are not well for any reason we try to keep going and keep working to avoid putting more pressure on colleagues, to be there for our clients and because we may feel we should be stronger and not give in to illness. Hence yes we put on a charade of things being ok, albeit not great. Sometimes by carrying on with milder depression we may come out of the other end naturally or due to varying occurrences during that time. Personally I have found I try, keep trying and eventually cannot manage any more(or feel I am at risk of making errors in my diagnosis or treatment of my patients – A HUGE WORRY) so at that point seek help from the GP as I have already shut myself down and away from those nearest and dearest to me (the worst thing to do). Once I have sought help I immediately feel a step up from the low I have been in although it doesn’t sort the problem itself but acknowledging to yourself that you need help then acting to get that help are the first 2 steps back up. When I’m well I know how precious friends, family and acquaintances can be if we just give them the chance to help. I have also found that being honest to employers and colleagues has meant they give lots of help in as many supportive ways as they can – whether it be reduced hours, picking work only that you feel you can manage, another ear to listen to the negativity etc.
Extremely well written, and brilliantly articulated by Rosie.
I’m not entirely sure how well my own professional facade was maintained in some dark months a couple of years ago, but I was an example of the vets she mentions who worked up until the day I was taken into hospital as a psychiatric inpatient in 2012… I had told noone how bad things were, scared of the reaction from my bosses, but I was one of the lucky ones and owe my life to my GP and a very good referral, as well as the practice’s health insurance (in an NHS short of beds I was taken into the Priory) Thank you Paul for your comment which have me the courage to comment too! Natalie and Elizabeth’s comments are both extremely good; it’s not just mindfulness we need to teach to our undergrads but the full range of coping skills and positive mental health tools that are becoming increasingly evidence-based. I am currently working with the NHS to write and deliver such a course to young adults who have suffered mental health problems, but the skills we are teaching are all those which I wish I had been taught before leaving the support of vet school and entering the world we work in as vets xxx
Reflecting on some of the comments, I think there are fundamental principles of professional development, having a supportive and positive learning environment, good working practices that make a difference to mental health and performance. The research I and colleagues have done through the Centre of Excellence in Work based learning at Middlesex University has been invaluable on this, and for me was a way of finding solutions to things I personally found highly stressful about being a veterinary practitioner.
For some vets the solutions to mental health challenges do lie in the development of planned professional development, and that is very true when many vet graduates have been high achievers until they enter practice and find themselves developing interests in the practice situation. For others, some find stress in making decisions, lack of confidence in many and various aspects of practice work and life, and some of these issues prevent them from developing. It seems to me that there are several tiers of support that are required, and these include the many ladders in lifelong learning for people to hang on to and climb up. Creating greater awareness in vets of the need for themselves to recognise the various support systems and how to use them is critically important to the future.
It hard atimes that somebody can commits suicide due to depression .Iknow of people who have gone as far as injecting themselves drugs or even swallow some poisons.If somebody have depressions he should seek counselling earlier.