Fixing the patchwork that is veterinary wellness support
The question posed in Dr. John D. Jacobson's talk, "State veterinary wellness committees: Do they work?" was answered before he even said a word. Just his presence was a testament to their success.
Dr. Jacobson served on the faculty at Virginia-Maryland College of Veterinary Medicine for 10 years in the '90s. But that came to an end when he was arrested for stealing narcotics at the teaching hospital. He was sent to the closest psychiatric hospital, then went home over the weekend, came back on Monday, and met with a psychiatrist who told him: "We'd bring in two retired physicians and put you on a plane to treatment, but because you're a veterinarian, I don't know what to do with you." Dr. Jacobson made an appointment with a psychologist for two weeks later.
"I needed help and wasn't getting it," Dr. Jacobson said.
But then, Dr. Richard S. Hawe, head of the Virginia VMA's wellness committee, got wind of Dr. Jacobson's situation and helped get him into treatment for his alcohol and opioid addictions within a few days.
"The truth is, the (physician health) program he got me into that allowed me to stay licensed in Virginia and go back to work didn't exist until two years prior to my arrest. Before that, there wasn't a good path to go to," said Dr. Jacobson, who is now a postdoctoral fellow and clinical psychologist who sees patients at Duke Integrative Medicine in Durham, North Carolina.
Limitations in getting help
Two resources typically exist at the state level.
State wellness committees—usually connected to a state VMA—have been set up primarily to do interventions. These are always composed of veterinarian volunteers and occasionally include veterinary technicians, veterinary students, and AVMA Auxiliary members. In the past, Dr. Jacobson notes, it was often just one or two veterinarians in the state who wanted to help and allowed their phone numbers to be published. Some states have statutes that protect these committee members from liability. "The role of state wellness committees is now largely open to the imagination and will of the vets in the state," he said.
Another resource has been physician health programs. These programs are established by state medical societies or are created after winning contracts with the state licensing agencies. In either case, they are funded by licensing fees under state statues that allow their existence and determine the nature of their relationship with the state board of examiners. These are typically run by administrators and mental health professionals who evaluate and monitor other health professionals in need, with the goal of returning them to work. That is to say, this happens among the better-managed ones. In reality, the quality of services provided by each varies widely across the U.S. Some are effective and have even expanded their function. Some have been developed recently, Dr. Jacobson said. Others exist with limited function, have ceased to exist, or never were developed.
"If we can get impaired veterinarians to resources and get help with flexibility in their schedules, that doesn't mean it will totally work out, but if they know they're in an environment where they don't have to hide their distress and put energy into that, that's a game changer. It takes stress off the community when that person is getting help," Dr. Jacobson said.
"Getting help shouldn't be dependent on where you live—not in a profession that cares this much."
Recent efforts aim to correct that. The AVMA Division of State Advocacy team—along with the Veterinary Wellness Steering Committee that formed as a result of the Veterinary Wellness Roundtable convened by the AVMA in March 2016—performed extensive research to identify state veterinary wellness programs as well as applicable confidentiality policies and regulations. The AVMA State Wellness Programs for Veterinary Professionals was launched in July.
Advocacy efforts also have started in the 14 states that do not have specifically outlined wellness committees or confidentiality protections, said Ralph Johnson, CEO of the Veterinary Medical Association Executives, Colorado VMA executive director, and member of the AVMA steering committee. This will require changes in statutes and rules to put resources in place for licensees and for state boards as well, he said.
"Wellness committees have been a little sleepy. They were typically addressing alcoholism, and programs were responsive to that issue, and that's important for sure, but now what we're seeing is more structured programs addressing not only substance use issues but also emotional health issues," Johnson said. "They're broadening the view of what resources can be and are making pathways to access (treatment) resources so they're more visible both to those who want to voluntarily access them and state boards connecting licensees to them before the licensee or public is endangered."
Dr. Jacobson also observed, "It's important for state boards to identify where impairment is coming from. It's not always psychiatric issues. There could also be physical disability, training deficits, ethical negligence, or otherwise."
Treatment depends on the mental health issue and can range from medication to cognitive behavior therapy to residential treatment to support groups. Dr. Jacobson himself did a three-month residential treatment program that cost $27,000 and says this kind of treatment has gotten even more expensive. He noted that the Alberta VMA in Canada provides loans for practitioners to get treatment, and every loan has been repaid.
"We're talking about our colleagues, our people. These are folks who, for the most part, are incredible and good vets, and if they are in a community that helps them get back on track, they remember that. They become role models for others. I think there's a greater cost in not doing it in the short run. Economics are a big deal. We're almost at a point where money doesn't matter," Dr. Jacobson said.
During Dr. Jacobson's time in treatment, Dr. Hawe wrote letters to everyone from Dr. Jacobson's former department head to the state veterinary board of examiners members to pave the path for him to return to work. "I don't expect everyone to do that, but he went to any length for sure, and he hadn't even met me," he said.
Dr. Hawe died two weeks after Dr. Jacobson got his license back, and he's never forgotten the help he received. "I'm doing this because he's not around to do it," he said.
Exploring more options
The Veterinary Wellness Steering Committee continues to evaluate other potential areas where help would be most effective. Members are researching the feasibility of offering a national veterinary-specific hotline or other member assistance programs to develop a sustainable model for 24/7 assistance. Several programs are under final review to identify which will provide the best resources for the entire profession, including students and veterinary support staff.
The steering committee also is looking at the potential for collaboration with the Royal College of Veterinary Surgeons in the U.K. and emulating its Mind Matters Initiative. Representatives from the Royal College visited the AVMA in late August to discuss an international version of the initiative.
Launched in December 2014, the U.K. initiative is supported by a task force comprising eight veterinary organizations that represent students, schools, veterinarians, veterinary nurses, and practice managers.
Its main activities are research, a communications program to increase awareness and reduce the stigma associated with mental health issues, and identifying aspects of the profession's structure and activities—from veterinary education to retirement—that exacerbate stress and mental health problems and examining how they may be addressed.
Finally, the next Veterinary Wellness Summit will take place, April 15-17, 2018 in Schaumburg, Illinois. The focus will be sharing best practices and creating a culture of well-being in the workplace.
"Never more than now has the AVMA and the steering committee been responding to difficulties in the veterinary community. What's been happening in the past two to three years is amazing and heartwarming. I hope we can continue to maintain momentum and still go in a direction to improve the culture of the veterinary profession and make it a healthier community and allow people to more easily ask for help and get that help," Dr. Jacobson said.
Related JAVMA content:
Momentum keeps building for well-being initiatives (Jan. 15, 2017)
Veterinary mental health initiatives taking shape nationally, locally (Oct. 15, 2016)
Reversing the downward spiral (May 1, 2016)
Veterinary wellness roundtable advances conversation (May 1, 2016)
Studies confirm poor well-being in veterinary professionals, students (May 1, 2016)
RCVS puts money toward mental health resources (April 1, 2015)