Researchers in the United Kingdom reported in March that the suicide rate of veterinarians there is four times that of the general public and double that of other health professionals. While similar research doesn’t exist for the U.S., authorities believe there is a parallel. An Issue Close to Home Jerome Williams, DVM, chairman of the Alabama Wellness Committee and owner of Red Mountain Animal Clinic in Birmingham, Ala., has been in practice since 1969. He says his recovery from an opiate addiction has been extremely difficult and remains a challenge. He believes that professional mental health assistance is essential for a meaningful recovery. Alabama’s wellness program, overseen by the state medical board, assists veterinarians and veterinary technicians in need. An addiction/occupational medicine specialist directs the wellness program. Dr. Williams says a study looked at what became of physicians disciplined for psychiatric problems rather than supported and treated. That group had a very high suicide rate—more than 20 percent killed themselves over 10 years. “Later studies have shown that physicians with psychiatric problems, when supported and referred for treatment and monitored as a condition of continued licensure, do very well with an extremely low suicide rate,” Williams says. No similar study has been done on veterinarians, he says. “The veterinary profession is lagging behind other health care professions,” Williams says. “Both MDs and dentists have some level of national support or coordination. Veterinary medicine has none of these. Greg Skipper, M.D., is the director of both the physician and vet wellness programs in Alabama, and they are basically run as one program.” Williams says that over the past three years, the Alabama Veterinary Professional Wellness Program (AVPWP) has done confidential surveys of veterinary students, veterinary technician students and licensed veterinarians to better identify the state of their health and well-being. “Results have been interesting and of concern,” Williams says. “A survey we performed two years ago showed 18.9 percent of veterinary students have been diagnosed with mental illness—depression, anxiety, bipolar disorder, etc.—and 13 percent had seriously considered or attempted suicide. “Additionally, 40.7 percent had a family history of alcoholism or addiction. Since family history is the strongest risk factor for becoming addicted, early appropriate action might reduce the incidence of active addiction among future veterinarians. The number of participants in this survey was small, but the responses should raise concern and demand a critical self-examination by our profession.” An AVPWP survey of licensed Alabama veterinarians showed stress levels were high. Twenty-four percent of women and 17 percent of men responded that they suffered from high stress. “Mental health concerns were significant, with 27 percent admitting having a mental health problem and 20 percent of women and 22 percent of men reported having untreated depression,” Williams says. “[The AVPWP has] sought to provide leadership on wellness issues and has had excellent support from the Board of Examiners and Veterinary Association,” Williams says. “The veterinary schools at Auburn and Tuskegee and the vet tech program at Jefferson State Community College use the resources of our program,” he says. Now’s the time for national attention, he says. “The AVMA has an obvious duty to provide leadership and commitment of resources if this ticking time bomb is to be defused.” Ignoring foreign studies instead of acting on them and standardizing veterinary health studies, authorities say, will leave the U.S. veterinary industry lagging behind offerings for other health professionals here and abroad. Mental health professionals say suicidal behavior linked to a personality trait evident as early as veterinary school could be predicted through a skilled assessment. People close to the topic say help needs to start at the college level so veterinarians have the resources to deal with the stresses that start in earlier years but carry on throughout life. Universities are the main venue in which veterinary students’ and practitioners’ mental health or depression problems can be identified, treated and resolved. Some state and local veterinary associations create groups of practitioners that respond to veterinarians who need help for substance abuse or mental health issues. But the lack of standardization in such programs inhibits their sustainability, experts say. Understanding Why Although more veterinary students and practitioners come forward now, social stigma prevents many from seeking help when they feel depressed or anxious, suffer compassion fatigue or use drugs or alcohol as coping mechanisms, authorities say. “This is a whole other side of veterinary medicine that most people don’t know about,” says Jennifer Brandt, Ph.D., MSW, LISW, the assistant director for veterinary student affairs at Ohio State University. “For students or veterinarians who are exhausted, stressed and don’t have time to seek help after hours, it’s difficult to get help at all without programs like the one at OSU.” Brandt, also an adjunct assistant professor in counseling and consultation services, has worked exclusively with veterinary students since 2006 but has helped bereaved clients in the veterinary college since 1998. She says that while more veterinary schools are making counseling and other assistance programs available to students, few have someone dedicated solely to veterinary students. AVMA’s Role The Student American Veterinary Medical Association doesn’t offer this support for veterinary students, said Derrick Hall, DVM, assistant director of membership and field services division of the American Veterinary Medical Association. “This type of support is covered mostly at the individual school basis,” Dr. Hall says. “Unfortunately, I do not know how many schools offer this.” The AVMA offers guiding principles for state veterinary wellness programs and says it encourages state VMAs to develop and maintain them. But it doesn’t offer more than the outline for a program. “The report out of Britain confirms some of the anecdotal information that we’ve heard,” W. Ron DeHaven, DVM, the AVMA’s CEO, commented in a statement distributed to the media. “We’ll be taking a hard look at this study over the coming months to see what we can do as an association to improve our outreach efforts and other safety nets to help support our members and students when they are faced with difficult times as individuals and professionals.” Professionals working with veterinary students and veterinarians say having the AVMA take action would greatly improve the care available. But they said if the AVMA isn’t taking a stance, they are willing to continue helping one day at a time. “Literally since the first day I started, students were lined up outside my door asking if we could talk,” Brandt says. “People entering veterinary medicine have many of the same qualities, like wanting to please others and a willingness to work 100-hour work weeks. These qualities combined with the stress of the job can make them predisposed candidates for depression.” Brandt says tough competition for admission to veterinary colleges means that only those who were academic leaders in high school and as undergrads are accepted. However, once in vet school, with the playing field leveled, students who were high school valedictorians are rated somewhere in the middle, and the stress to perform well can be overwhelming. “Almost every candidate applying to veterinary school says he or she always wanted to be a veterinarian,” Brandt says. “When you make it to veterinary school after wanting it for so long, then realize how difficult it is, fear of failing is debilitating. These students have been so focused throughout life with this single goal that they lose insight, miss milestones and social experiences because it’s always been about this one goal.” Different Stresses Veterinary Stress Summit Veterinary stress and other topics will be explored at the second Veterinary Social Work Summit. The conference, set for May 13-16 in Knoxville, Tenn., is sponsored by the University of Tennessee College of Veterinary Medicine. “Mental health challenges need to be recognized as treatable conditions instead of the American tendency to label them as weaknesses,” says Elizabeth Strand, Ph.D., MSSW, a licensed clinical social worker at the university. This year the program will teach social workers to handle veterinary-related issues such as grief, loss, compassion fatigue, animal abuse, animal assisted therapy and mental and substance abuse. The keynote address will be delivered by Lee Zasloff, MA, Ph.D. Visit utcvmfs1.vet.utk.edu/VSW for more information. Authorities say suicide isn’t an emerging job hazard; it has always existed. A veterinarian’s job may not seem like one prone to stress. But most people probably don’t know that veterinarians experience death at five times the rate of human doctors and that their patients are often animals they have cared for a long time. Veterinarians graduate with an average educational loan debt of $110,000, not including undergraduate debt, and can face an overwhelming amount of responsibility. Now that women outnumber men in the profession, additional roles pile onto those experienced in college or at work. “Women experience depression at a higher rate than men,” says Elizabeth Strand, Ph.D., MSSW, LCSW, a clinical assistant professor and director of veterinary social work services at the University of Tennessee in Knoxville. “In the more traditional role for male veterinarians, women took care of the home and [the men] could work really hard and focus on their career,” Strand says. “Now, female veterinarians have work and home responsibilities and no one is handling everything for them at home. This is role overload and the setting lends itself to more mental health issues.” Brandt notes that veterinarians often assess their patients’ quality of life but overlook their own. Adjusting the work ethic and acquiring productive coping mechanisms to deal with stress can mean getting past these issues and leading a healthier life. “Men’s mental health issues typically manifest in drinking, anger and job dissatisfaction, while women internalize their stress and suffer from depression,” Brandt says. “Mental health issues and substance abuse go hand-in-hand. These are ways to deal with stress and it typically starts off with one or two drinks when they get home, then it becomes a problem.” Time Is Now Many say the British research, while it isn’t news to the profession, is a call to action. “There are consequences to not acting on this information,” Brandt says. “This isn’t just sad; people are dying. The magnitude of ignoring these issues is horrific, and not just for the veterinarians but for their patients, clients and families. “It’s not an overnight fix, but talking to veterinarians and students experiencing difficulty assures them that they are not alone and gives them tools to get past their issues,” she says. “When you’re new to the profession, it’s a bad time to realize you’re not good at handling death, stress or other job demands. I see at least 25 percent of the 140 students per class for mental health issues and an additional 10 percent for related issues. We’ve seen a gamut of problems from cutting, drinking and withdrawal from friends to passing out or vomiting before tests.” Professionals close to the issue say veterinarians need to feel safe asking for help without fear of repercussions, such as having their license revoked. Such help is available in human medicine. In Britain, multiple layers of support are offered to veterinarians to deal with work-related stress. These include the Vet Helpline, a Veterinary Surgeons’ Health Support Program (VSHSP) and the website VetLife.org.uk, says David Bartram, a Ph.D. student in mental health at the School of Medicine, University of Southampton’s School of Medicine. He co-authored the British report, “Veterinary Surgeons and Suicide: A Structured Review of Possible Influences on Increased Risk.” “Veterinarians regularly found help through the assistance offered in the U.K.,” Bartram says. “Independent audits have demonstrated that the VSHSP has a very good track record of supporting veterinarians into recovery and back to work.” Jeff Hall, DVM, of Birmingham, Ala., founded Veterinarians in Recovery in 1990 after personal experiences with depression and substance abuse. He returned to work in the veterinary industry after a lengthy recovery. “I still get calls from all over the country from vets asking for support, and I refer them to International Doctors in Alcoholics Anonymous,” Dr. Hall says. “I can’t support and chase down every situation anymore. It is too vast a problem—one person can’t handle it and AVMA doesn’t prioritize it.” Tennessee’s Strand says she was excited to recently find a new post on the university’s veterinary social work LISTSERV. “There is a glimmer of hope for us,” Strand says. “We saw a wanted post for a veterinary social worker at a specialty veterinary practice in Georgia. It showed the practice wanted this position in-house. It would be such a great benefit to the profession if more practices were willing to offer this level of support.” <HOME> This article first appeared in the May 2010 issue of Veterinary Practice News
