Taking mental health in a positive direction

For the past few years, the veterinary profession has increasingly studied and grappled with how it is affected by certain mental health issues, including poor well-being and suicidal ideation. Results from the Merck Animal Health Veterinary Wellbeing Study released this year show veterinarians have slightly lower degrees of well-being than the general population and that 24.9 percent of veterinarians have considered suicide at some time in their lives. The problem isn't isolated to the U.S. and is also a concern abroad.

Recognizing the scope of the issue, leaders from the AVMA and the Royal College of Veterinary Surgeons, the veterinary licensing body for the U.K., started a conversation a few years ago about how to work collaboratively and share best practices to help practitioners improve their mental health. Recently, the two organizations released a joint statement on mental health and well-being in the profession.

"It's such a small profession," said Dr. Stuart Reid, former RCVS president and principal of the Royal Veterinary College in London, estimating there are 25,000 veterinarians in the U.K. and 115,000 in the U.S. "There's so much that can be got from working together. We have to look at where we're doing things that we can both learn from, areas of synergy that could be augmented by doing things together, and where there are the gaps."

An important piece of that work, he emphasizes, is focusing on how to create positive mental health.

"We're trying to give people the tools to support their colleagues and give skills they need to flourish," Dr. Reid said, as well as trying to prevent mental illness by understanding what it is about the veterinary profession that is causing these problems in the first place.

Making a difference

Over the past 10 years, the stress levels and psychological health of veterinarians have been consistently highlighted by U.K. researchers as important issues for the profession to monitor and address (Soc Psychiatry Psychiatr Epidemiol 2009;44:1075-1085).

We have to watch that we spend an equal amount of time talking about how to enjoy our careers and flourish so people don't think that mental illness will inevitably happen to you. So, you understand the risk, but also recognize it's a brilliant career, and there are lots of positive aspects to it.

Dr. Stuart Reid, chair, Mind Matters

One study found U.K. veterinarians experiencing high stress levels may suffer from insomnia, mental health difficulties, alcohol and drug abuse, difficulties in balancing their personal life and their career, and reduced job satisfaction (Soc Psychiatry Psychiatr Epidemiol 2012;47:223-240). According to the study, work-related stressors that contribute to poor psychological health among veterinarians include long work hours, excessive after-hours duties, low pay, unexpected outcomes of clinical cases, managing client conflict, performing euthanasia, and lack of control over treatments due to clients' cost constraints. Suicide risk among veterinarians in the U.K. was found to be approximately three times that of the general population (Occup Med 2010;60:436-446).

The independent charity Vetlife, formerly known as the Veterinary Benevolent Fund, has been helping. It was founded in 1978 to provide free and confidential support to anyone in the U.K. veterinary community who may have emotional, health, or financial problems.

2017 marked the 25th anniversary of its Helpline. This service is supported by trained volunteers and offers 24/7 independent and confidential phone and email support for veterinarians, veterinary nurses, and students. In 2016, the Helpline had 1,285 calls and emails.

Dr. Reid said there was the realization a few years ago by RCVS leadership that while Vetlife does important work, more needed to be done with awareness training—as people may not recognize they have a mental illness—as well as efforts to reduce the stigma and to get the word out about support services that are available.

"We felt that, although there were support services out there, we could do more to make people realize when they needed them, understand how to access them, and have no fear of being stigmatized if they did. As a regulator, it's important we play our part in supporting vets and nurses to be at their best," Dr. Reid said.

Enter Mind Matters. The initiative, created and funded by the RCVS in 2014, seeks to increase the accessibility and acceptance of support, encouraging a culture that is better equipped to talk about and deal with stress and related mental health issues, and ultimately help to reduce triggers within the profession. Mind Matters is supported by a task force comprising eight veterinary organizations that represent students, schools, veterinarians, veterinary nurses, and practice managers in the U.K.

Lizzie Lockett, who is RCVS chief executive and director of Mind Matters, said that from the start, Mind Matters has been investing in things that will make a difference in the lives of veterinarians and other veterinary professionals.

Some of the recent activities from Mind Matters have included the following:

• Offering online mindfulness training and continuing education.
• Providing training and tailored courses for practice managers in mental health awareness.
• Launching the "&me" mental health anti-stigma campaign with the Doctors' Support Network. The aim is to encourage senior members of the health care professions to come forward with their stories to show that a mental health problem does not exclude people from achieving leading roles in health care. Stories can be shared on social media using the hashtag #AndMe.
• Holding the first Mind Matters Initiative Research Symposium, in January 2017 at the University of Edinburgh, entitled "Understanding and supporting veterinary mental health." Organizers will hold another symposium in 2019.
• Releasing "A Guide to Enhancing Wellbeing and Managing Work Stress in the Veterinary Workplace," published in January. The guide is designed for anyone with an interest in the well-being of the veterinary team, providing practical advice to veterinary workplaces on managing stress and promoting well-being.
• Creating the Vet Well-Being Awards, with the British Veterinary Association's Society of Practising Veterinary Surgeons, which are meant to highlight well-being in the veterinary profession and to celebrate those practices that value the health and engagement of their team.

Lockett emphasizes that Mind Matters is for the whole veterinary team—veterinary technicians, students, practice managers, and people who aren't in the clinical environment. In fact, Mind Matters is putting together a working group specifically looking at how to tailor the program to help veterinary nurses more.

Making a statement

Leaders from the AVMA and RCVS first began to talk about collaboration while attending the Association of American Veterinary Medical Colleges' Veterinary Health and Wellness Summit in November 2016 at Colorado State University. The AVMA and RCVS both recognized common areas of interest and ways to provide support, Lockett said. Since then, the two organizations have had increasing contact collaborating on well-being issues.

As a result of an August 2017 meeting at the AVMA headquarters in Schaumburg, Illinois, leaders from both organizations agreed to pursue a joint statement relating to improving veterinary mental health and well-being, with its corresponding benefit to the profession and to animal and public health. On July 11, the AVMA Board of Directors approved a joint statement with the RCVS titled "Statement on Mental Health and Wellbeing" (see sidebar).

Dr. John de Jong, AVMA president, said, "As two highly respected veterinary organizations in the increasingly global veterinary community, it is both logical and important that the AVMA and RCVS stand together speaking to the topic of mental health and well-being that affects people in our profession as much or more than the general public."

Dr. Reid, who is also chair of Mind Matters, said, "The bottom line is there can be a whole new level of awareness and advocacy by making joint statements together and drawing others in."

Jen Brandt, PhD, AVMA director of member well-being and diversity initiatives, said the two organizations are also looking at developing case studies, sharing speakers for conferences, and implementing each others' existing programs. For example, the RCVS wants to learn more about the training program the AVMA offers to help members identify and aid individuals who may be at risk for suicide. The AVMA has taken an interest in how Vetlife is set up and run and in the Well-Being Awards.

"Our goals are well-being issues across national boundaries. It's not specific to the U.S. or U.K. We're creating an opportunity to open up dialogue and opportunities to work together on behalf of veterinary medicine internationally," Dr. Brandt said.

Dr. Reid added that the overall goal is to provide welcoming support, training, and a culture change to the entire profession all over the world.

"If we wanted to capture people's attention, we could focus on the negative," Dr. Reid said. "That's just the nature of the beast—that grabs the headlines. We have a responsibility to educate proportionately and appropriately. Well-being is a much bigger picture. It's about developing life skills to enable us all to enjoy the positive aspects of the profession.

"We have to watch that we spend an equal amount of time talking about how to enjoy our careers and flourish so people don't think that mental illness will inevitably happen to you. So, you understand the risk, but also recognize it's a brilliant career, and there are lots of positive aspects to it."

"Statement on Mental Health and Wellbeing"

From the Royal College of Veterinary Surgeons and the AVMA

We believe that for veterinary professionals to realise their full potential and the global veterinary profession to remain sustainable, maintaining high levels of mental health* and wellbeing for all members of the veterinary team is a priority.

Improving veterinary mental health and wellbeing has a positive impact on individuals, the profession at large and, ultimately, animal health and welfare, and public health.

Our approach for supporting mental health and wellbeing within the veterinary profession includes the following:

• Prevent: addressing the systemic issues that lead to poor levels of mental health, including the risk of suicide, and sub-optimal wellbeing across the veterinary team. This includes researching the issues, and developing and advocating policies and interventions that are supportive of positive mental health.
• Protect: providing and promoting the skills and knowledge required by individuals and organisations to increase levels of wellbeing and improve mental health in veterinary medicine. Making such interventions evidence-based and widely accessible.
• Support: ensuring suitable expert support is available to veterinary professionals who need it, provided in a confidential and safe environment, and accessible without fear of judgement.

Furthermore, we commit to ensuring that veterinary professionals with mental health issues are treated fairly and without discrimination.

We will reduce the stigma and prejudice around mental ill-health through education, advocacy and access to services. We will work to promote a safe and supportive culture in which individuals are able to seek appropriate help and, ultimately, flourish.

*"Mental health" is used as defined by the World Health Organization, August 2014, i.e.: "a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community."
who.int/features/factfiles/mental_health/en

Related JAVMA content:

Suicide trend in the profession stretches back decades (June 15, 2018)

Mental health, well-being problem serious, not dire: study (Feb. 15, 2018)

UK leads by example when it comes to wellness (Jan. 1, 2016)

Study: 1 in 6 veterinarians have considered suicide (April 1, 2015)

RCVS puts money toward mental health resources (April 1, 2015)

Finding calm amid the chaos (Feb. 15, 2013)