Suicide Prevention in Veterinarians: A Call for Action

1. OneLife Suicide Prevention Strategy“Every Veterinarian’s Business”November 2011

2. WHY SHOULD I BE CONCERNED AS A VETERINARIAN? – I AM OK. • You may be ok now but we want to keep you that way and if you are not we can help you. • One Perth city veterinarian stated that out of his class of 45 students he knew of 3 veterinarians that took their own lives. I had three friends, all veterinary colleagues take their lives. This waste should be totally unacceptable to all of us. • You may have to deal with a colleague, employee or a family member that becomes suicidal. • You need to know where to direct an individual in trouble to and this may be in a real hurry and at the wrong time for you. • Depression and anxiety are common conditions in veterinarians and may need to be treated. It does not always entail medication. • Suicide is usually a fleeting desire and suicidal people should not be left on their own. Ideally they should see a doctor ASAP, preferably skilled in mental health, and a clinical psychologist soon after.

3. FACTS ABOUT SUICIDE IN VETERINARIANS • More people die through suicide than die in motor vehicle accidents in Australia. The suicide rate in veterinarians is at least 4 times the rate in the general population. • Suicide is the tip of the iceberg in terms of mental health. • Why do intelligent capable and caring veterinarians take their own lives? We are only starting to find out, but we believe contributory factors include long working hours, work pressure, poor business skills, desensitisation to euthanasia , poor work/life balance, problems with clientsand untreated mental illness e.g. depression, anxiety, and bi-polar disease. • What tips them over the edge? Various triggers can tip veterinarians over such as relationship breakdown, substance abuse, financial difficulty. • Who is at highest risk? We know in the general population it is those that have tried to suicide in the past . Male and female veterinarians suicide. It is not gender based.

4. FACTS ABOUT SUICIDE • Suicide generally affects 20 people around the person that takes their own life. These people, often family members and friends, are sometimes left with life long guilt that they could have done something. • Suicide is totally unacceptable in our profession. Talking about it is not. Using drugs off the shelf just makes it tougher for the whole profession. • Suicide is a permanent solution to a temporary problem. • Is talking about it going to make it worse? No. Best not to talk about methods but we do need to get the subject out in the open. • Most people intent on suicide give warning signals they are not coping beforehand. • To get to the point of suicide individuals have unmet needs: Unloved, Unwanted, Powerless, Worthless, Helpless, Hopeless and No Control. In veterinary practice we have to make sure none of our employees get into this situation.

5. Suicide prevention includes developing a Veterinary Community Action Plan: • Circulate resources and information promoting health and wellbeing; encourage active health awareness rather than suffer illness or mental health problems. • Promote personal understanding and alertness to signs of distress and despair, and a willingness to seek help early before things get worse e.g. procedures that go wrong. • Use professional networks, social and sporting groups to build resilience and coping strategies, support, skills and awareness. • Provide supports and structures for people at high risk to get themselves through hard times. e.g. support for colleagues that lose their jobs. • Promote acceptance for talking about emotional issues and difficulties. e.g. city born veterinarians working in remote areas undergoing relationship breakdowns. • Provide education, awareness and resilience-building programs such as Mental Health First Aid or suicide Prevention Training, communication and coping techniques, managing complex workloads and dealing with relationship and family issues.

6. MANY FACTORS MAY CONTRIBUTE TO DEPRESSION INCLUDING: • a family history of depression • emotional stress (e.g. bereavement, job loss, relationship breakdown) • personal beliefs – a belief that life’s goals and expectations will not be met • medicines (e.g. some cancer and heart medicines) • medical conditions – such as thyroid and other hormone problems, or battling a chronic or terminal illness. • personality – the type of person you are and how you respond to life events • social support – whether you have sufficient supportive people around you. Vets isolated away from home may lack important social support.

7. USEFUL TIPS FOR HELPING A VETERINARIAN WHO MAY BE DEPRESSED: • Think about the best way to approach the person – given what you know about his/her personality and temperament. • Discreetly let the person know you have noticed a change in his/her behaviour. Indicate that you are seriously concerned. • Talk openly about depression and suggest the person visits a doctor, or speaks to a health professional recommended by a doctor. • If appropriate help the person to make the appointment; perhaps consider going with him/her – and follow up after the appointment. • If you think the person won’t listen to you, consider: Who does this person usually confide in, feel comfortable with, and/or trust? Maybe that person could make the approach and encourage him/her to seek assistance?

8. MORE WAYS TO HELP A COLLEAGUE IN A DEPRESSIVE STATE: • Try to find ways of reducing the person’s isolation ( physical or emotional): - Make an extra effort to stay in touch, preferably in person. - Encourage other close friends and family to do the same. • Encourage the person to exercise, eat well and become involved in social activities. • Provide the person with information about depression; give him/her this presentation – or refer the person to www.beyondblue.org.au

9. MANAGING THOUGHTS AND SELF-TALK • When veterinarians become depressed, they often think negatively about themselves (“What have I ever achieved?”, “I’m no good at anything”), their circumstances (“There’s no way out of this mess”, “It’s all pointless…everything I’ve tried has just made things worse”), and the future (“Things will never really change, they’ll only get harder”). • How we think and what we say to ourselves in our head (self talk) can have a profound effect on our mood and mental state. • It can also cause paralysis in problem-solving and decision-making.

10. STRUCTURED PROBLEM-SOLVINGIt’s common for veterinarians who are depressed to feel more overwhelmed by problems. Adopting a new way of tacklingproblems can be very helpful.Structured problem-solving is a method designed to help youfeel in control of your problems, and to enable you to deal moreeffectively with future problems.THE KEY ELEMENTS OF THIS METHOD INCLUDE:• Identifying and ‘pinning down’ the problems that havecontributed to you feeling overwhelmed.• Thinking clearly and constructively about problems.• Talking the problems or issue out with others to gain another perspective• ‘Taking stock’ of how you’ve coped in the past: yourpersonal strengths, and the support and resources availableto you• Providing a sound basis for important decision-making.

11. THINGS TO REMEMBER:• Depression is common and treatable.• Help is available.• With the right treatment, most people recover from depression.• It’s important to seek help early – the sooner the better.• Depression is an illness, not a weakness and veterinarians shouldn’t feel ashamed to seek help and males should not hesitate to visit a doctor. There are doctors that have a special interest in mental health.

12. Where to next if vets are to flourish? Learn how to take care of yourself and others Engage with the strategy Passonthe information Make it your business to help get the suicide rate to zero “Suicide a permanent solution to a temporary problem”

13. HELP• For suicide emergency situations Call Lifeline 13 11 14How to respond to a suicidal personBy showing your concern and care. Help the person express their thoughts and feelings. You can make a difference. Help them to achieve their needs in other ways and to seek help, don’t keep the secret or assume that things ‘will be okay’.Appropriate Services and Self HelpIf you think someone might harm themselves, seek help immediately by callingSuicide Call Back Service - 1300 659 467 Take the person at risk to your local hospital emergency department• The AVA has generously opened its website section on mental health to anyone interested www.ava.com.au /For Veterinarians/ VetHealth• Another excellent site for veterinarians is www.vetlife.org.uk• Information is also available at www.beyondblue.org.uk

14. Contact Details Brian Mc Erlean MVB MRCVS Community Coordinator Next Gatekeeper Course ( 9.30 am – 4.30pm with lunch provided) is over two Saturdays 10th and 17th December 2011 There are still places available and it is free to you but paid for through Government funding. You have to be a veterinarian to attend but you do not have to be an AVA member. For more information: nervoustransmitter@bigpond.com