Mental health in veterinary practice

[DrJ7774342]

Hi everyone,

I have been reading some alarming statistics about the suicide rate and current mental health crisis of practicing veterinarians. Can anyone speak to this at all?

Judgement-free.. I would really like to know how and why vets (from newbies to seniors) struggle and, most importantly, what, if any, solutions you believe might begin to address the problem.

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[CalliopeDVM]

Hi everyone,

I have been reading some alarming statistics about the suicide rate and current mental health crisis of practicing veterinarians. Can anyone speak to this at all?

Judgement-free.. I would really like to know how and why vets (from newbies to seniors) struggle and, most importantly, what, if any, solutions you believe might begin to address the problem.

I believe in general it all boils down to unrealistic expectations - on the part of the vets themselves and the public - combined with the free-for-all Wild West of the internet.

There have been several studies citing reasons that vets are depressed +/- suicidal, and more studies ongoing. I believe that big factors are that veterinary medicine tends to attract a lot of Type A perfectionists, and James Herriott's novels and that general mystique set up popular culture to expect unrealistic behaviour from vets (all hours, no to low cost, service anywhere, etc.). Debt does not seem to be a factor, since the problem exists in places with very different schooling costs, and neither does access to euthanasia drugs. Cyber-bullying is definitely a factor, and even in those who aren't anywhere near suicide, the fear of it colours what they do.

 

[dyachei]

I believe in general it all boils down to unrealistic expectations - on the part of the vets themselves and the public - combined with the free-for-all Wild West of the internet.

There have been several studies citing reasons that vets are depressed +/- suicidal, and more studies ongoing. I believe that big factors are that veterinary medicine tends to attract a lot of Type A perfectionists, and James Herriott's novels and that general mystique set up popular culture to expect unrealistic behaviour from vets (all hours, no to low cost, service anywhere, etc.). Debt does not seem to be a factor, since the problem exists in places with very different schooling costs, and neither does access to euthanasia drugs. Cyber-bullying is definitely a factor, and even in those who aren't anywhere near suicide, the fear of it colours what they do.

debt is *definitely* a factor.

it's difficult to switch careers with 6 figures of debt.

 

[CalliopeDVM]

I understand that debt for U.S. vets is extremely high, but if that were true, it wouldn't also be a big problem in other parts of the world where vets graduate with a tenth of the debt.


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[DrJ7774342]

Is there any support or discussion about this in vet school itself or is it kind of the not-discussed, hope-it-doesn't-happen-to-me thing?

 

[DrJ7774342]

I believe in general it all boils down to unrealistic expectations - on the part of the vets themselves and the public - combined with the free-for-all Wild West of the internet.

There have been several studies citing reasons that vets are depressed +/- suicidal, and more studies ongoing. I believe that big factors are that veterinary medicine tends to attract a lot of Type A perfectionists, and James Herriott's novels and that general mystique set up popular culture to expect unrealistic behaviour from vets (all hours, no to low cost, service anywhere, etc.). Debt does not seem to be a factor, since the problem exists in places with very different schooling costs, and neither does access to euthanasia drugs. Cyber-bullying is definitely a factor, and even in those who aren't anywhere near suicide, the fear of it colours what they do.

Wow, I hadn't really even considered cyber-bullying. You mean on the vet's or practice's social media accounts?

 

[DrJ7774342]

I understand that debt for U.S. vets is extremely high, but if that were true, it wouldn't also be a big problem in other parts of the world where vets graduate with a tenth of the debt.


Sent from my iPhone using SDN mobile

Interesting point. Debt seems to play a role but isn't the only factor pushing people over the edge.

(Side note: are there any parts of the world where becoming a vet isn't insanely expensive anymore?)

 

[CalliopeDVM]

Interesting point. Debt seems to play a role but isn't the only factor pushing people over the edge.

(Side note: are there any parts of the world where becoming a vet isn't insanely expensive anymore?)

Yes......in fact, I bet most of the world doesn't have insanely expensive veterinary education, though I suppose "insanely expensive" is relative. In many parts of the world, the government subsidizes higher education for students and residents, so it might be $25,000-$50,000 for vet school, not $150,000-$200,000. In some places, vet school is tuition-free for citizens (and permanent residents maybe?).


If you do a Pubmed search for veterinarians suicide, you'll come up with a lot of resources too.

 

[CalliopeDVM]

Wow, I hadn't really even considered cyber-bullying. You mean on the vet's or practice's social media accounts?

Google "Shirley Koshi" for the most well-known case, but trust me when I say it's not the only case.

 

[Doktor Timo]

There's a theory that vets become used to the idea of humanely ending a life when the patient is suffering, which may create a subconscious inclination to be more open to the idea of suicide, as in euthanizing yourself. I'm not aware of any actual data to support this but it's interesting to consider.

 

[CalliopeDVM]

There's a theory that vets become used to the idea of humanely ending a life when the patient is suffering, which may create a subconscious inclination to be more open to the idea of suicide, as in euthanizing yourself. I'm not aware of any actual data to support this but it's interesting to consider.

Not all vets who commit suicide do so in a way that would be considered humane (eg hanging or gunshot)....but most are "self-poisoning" with barbiturates.

 

[dyachei]

Yes......in fact, I bet most of the world doesn't have insanely expensive veterinary education, though I suppose "insanely expensive" is relative. In many parts of the world, the government subsidizes higher education for students and residents, so it might be $25,000-$50,000 for vet school, not $150,000-$200,000. In some places, vet school is tuition-free for citizens (and permanent residents maybe?).


If you do a Pubmed search for veterinarians suicide, you'll come up with a lot of resources too.

in many areas of the world, even with cheap education, vets aren't paid enough to make a living. Portugal, for instance.

so, yes, it plays a role. It's not the ONLY thing, but certainly the pressure that financial concern adds is a big deal in more than 1 place

 

[pinkpuppy9]

Is there any support or discussion about this in vet school itself or is it kind of the not-discussed, hope-it-doesn't-happen-to-me thing?

Speaking for my school only, there isn't too much discussion coming from the school itself, but the students are making huge strides. We have a private FB group that any student can join for tips on self care/local mental health resources and we just started an anxiety/depression support group. The school did waste little time in replacing our guidance counselor who had retired, too.

If you're in a school where the conversation isn't taking place, start it yourself. I'm lucky in that some of our upperclassmen are really driven in this regard and are passionate about mental health in the profession. They've laid the groundwork for all of us to hopefully start out vet school on the right foot.

Not all vets who commit suicide do so in a way that would be considered humane (eg hanging or gunshot)....but most are "self-poisoning" with barbiturates.

There's a theory that vets become used to the idea of humanely ending a life when the patient is suffering, which may create a subconscious inclination to be more open to the idea of suicide, as in euthanizing yourself. I'm not aware of any actual data to support this but it's interesting to consider.

That is a really interesting theory, I'd like to hear more about that. I've never thought of it that way, but it makes perfect sense.

There are studies showing that women who commit suicide have a strong tendency to do so in a 'non-violent' manner (pills, carbon monoxide, etc.) with overdosing on drugs being the most common method. Females also attempt suicide at a higher rate than males, but are less successful because OD's take time and intervention often occurs during the attempt. So we're looking at a profession that is now mostly women who have access to a host of potentially deadly drugs 24/7, including pentobarbitol. You can't really save someone from an OD if they use pentobarb, especially when they know exactly what dose they need.

Some people have suggested that veterinarians be mandated to see a counselor every 6 months as part of their licensing requirements, which seems like a decent idea on paper. I'm sure there are at least some cons to it.

 

[lilylilac]

Is there any support or discussion about this in vet school itself or is it kind of the not-discussed, hope-it-doesn't-happen-to-me thing?

At my school, we have two certified psychologists who are always available to talk to about anything, school related or not. We also have a psychiatrist that comes to our campus once a week for those that need it. As students, we also go through suicide prevention training. My school places a huge emphasis on mental health and well being, and it was one of the reasons why I felt confident in my choice to come here. They realize that it is a big issue in the profession and they want to do everything they can to help us.

 

[battie]

Is there any support or discussion about this in vet school itself or is it kind of the not-discussed, hope-it-doesn't-happen-to-me thing?

Really depends on the school. Like PP said, Illinois is working towards more awareness, but it's not super obvious.

Some people have suggested that veterinarians be mandated to see a counselor every 6 months as part of their licensing requirements, which seems like a decent idea on paper. I'm sure there are at least some cons to it.

I actually don't automatically agree with this. Where does the line get drawn on who should have mandated counseling meetings? If veterinarians do, should ER doctors? Oncologists? Human doctors working in geriatrics? I'm not a fan of someone else mandating my personal health if it doesn't effect public health situations (like with vaccines). The biggest thing I have learned in my mental health training and situations I've been through, people need to want the help before it will do them any good.

 

[pinkpuppy9]

Really depends on the school. Like PP said, Illinois is working towards more awareness, but it's not super obvious.



I actually don't automatically agree with this. Where does the line get drawn on who should have mandated counseling meetings? If veterinarians do, should ER doctors? Oncologists? Human doctors working in geriatrics? I'm not a fan of someone else mandating my personal health if it doesn't effect public health situations (like with vaccines). The biggest thing I have learned in my mental health training and situations I've been through, people need to want the help before it will do them any good.

The people who have brought this idea to the table never said the mandate should stop at veterinarians, but the context of the entire discussion was veterinary medicine.

 

[pooter]

The hazing ritual that gets force-fed to many new grads as "training" doesn't help matters. And not just abusive internships, though those might be the biggest culprits contributing to overwork, compassion fatigue, and destruction of self-esteem. But, I've also known plenty of grads who went straight into private practice who ended up in similar situations (usually with even fewer resources and opportunity for mentorship).

And going back a little earlier, many vet schools aren't so great with the support (though it sounds like OSU is making progress, and that's great). When I was in school, we had the option of using the University's counseling services (for a limited number of visits, in an office tucked away in a downtown storefront like a dirty secret). Appointments were 9-4, Monday through Friday. Classes for pre-clinical students were 9-5 Monday through Friday and the thought of missing an hour of a clinical rotation to see a counselor was laughable. I suspect they would have allowed it had anyone pushed the issue and invoked "reasonable accommodations for people with disabilities," but I doubt anyone would risk speaking out for fear of being labelled difficult, uncommitted, or not cut out for this. Some time during my fourth year, the University tried to revamp the office and offer expanded hours (following a highly publicized spate of suicides among the undergraduates). I dunno what came of it, but I'm not hopeful, especially given how much the state is cutting their funding this year.

Yeah, I went through a couple Bad Periods and I was far from the only one. I'm not big on the usual discussions about how mental health is a problem because we're all too sensitive or because there's too many Type A personalities or too much unrealistic idealism or too many women in the profession (and, yeah, underneath the concern a lot of the generic critiques/explanations have gendered undertones). There are real, concrete ways that vet med as a whole consistently fails veterinarians and causes needless suffering. Talking about James Herriott or perfectionism may be helpful for the individual sorting through their own issues (preferably with the help of a licensed professional), but when we talk about it on a structural level, it feels like a distraction from real and fixable problems.

(Disclaimer: my frustration is not directed at the people on this board, but at the profession as a whole and the cowboy mentality that so often seems to come with it.)

 

[CalliopeDVM]

There are real, concrete ways that vet med as a whole consistently fails veterinarians and causes needless suffering.

What are those real, concrete ways, and what do you think are the real, fixable problems? I see some real societal problems that make the profession increasingly difficult, but I don't think they're within the profession's (or individual's) power to fix.


(edit: spelling)

 

[pooter]

Getting some decent support in vet school would be a good start. I guess I was spoiled as an undergrad by having a Counseling and Psychological Services office that was actually accessible to the average student. I wouldn't have graduated, much less been accepted to vet school, if it hadn't been for support from that office. Also, we could at least talk about getting some sort of oversight for veterinary internships and residencies. I almost crashed my car a couple of times after working ER 20 hours straight and then having to hop in the car and drive half an hour to get home so I could get up in 3 hours and do it all again. People who aren't getting enough sleep to avoid *car crashes* definitely aren't getting enough sleep to avoid exacerbating depression/anxiety/ect. Again, some schools (and some training programs) are making an effort and that's great, but that wasn't my experience. The AVMA accreditation standards would be a good place to start. Right now, there's a vague, one-off reference requiring "appropriate services to support student wellness." By clarifying the language, they could at least send a clear message to the schools that mental health should be taken seriously.

 

[pinkpuppy9]

Getting some decent support in vet school would be a good start. I guess I was spoiled as an undergrad by having a Counseling and Psychological Services office that was actually accessible to the average student. I wouldn't have graduated, much less been accepted to vet school, if it hadn't been for support from that office. Also, we could at least talk about getting some sort of oversight for veterinary internships and residencies. I almost crashed my car a couple of times after working ER 20 hours straight and then having to hop in the car and drive half an hour to get home so I could get up in 3 hours and do it all again. People who aren't getting enough sleep to avoid *car crashes* definitely aren't getting enough sleep to avoid exacerbating depression/anxiety/ect. Again, some schools (and some training programs) are making an effort and that's great, but that wasn't my experience. The AVMA accreditation standards would be a good place to start. Right now, there's a vague, one-off reference requiring "appropriate services to support student wellness." By clarifying the language, they could at least send a clear message to the schools that mental health should be taken seriously.

K-State radiology resident commits suicide this just happened, too. Of course, we can't possibly assume that the demands of her residency drove her to her death and I'm not insinuating it by any means. I think sometimes people have a mindset of 'okay, fourth year and an internship...those are the two horrible years I need to plow through in order to reach my goal' but residencies can be just as demanding, if not more so.

I've heard far too many people in my own school's administration say "you're put through 48 hour shifts and called in every 30 minutes for TPRs because it's you who needs to know how well you function without sleep!" and my favorite from our own dean: "We'd be doing you a disservice if we didn't test your limits." Are you kidding me? People die from this sort of stuff. A certain hospital my fourth year friend interviewed with (for the match) literally bragged about how they had an intern go into kidney failure this year after a week of non-stop work. How is that something to be proud of? Another fourth year friend told me she was going home for the first time in three days and had only had about 6 hours of sleep over that period of time. Awful.

 

[deleted498041]

K-State radiology resident commits suicide this just happened, too. Of course, we can't possibly assume that the demands of her residency drove her to her death and I'm not insinuating it by any means. I think sometimes people have a mindset of 'okay, fourth year and an internship...those are the two horrible years I need to plow through in order to reach my goal' but residencies can be just as demanding, if not more so.

I've heard far too many people in my own school's administration say "you're put through 48 hour shifts and called in every 30 minutes for TPRs because it's you who needs to know how well you function without sleep!" and my favorite from our own dean: "We'd be doing you a disservice if we didn't test your limits." Are you kidding me? People die from this sort of stuff. A certain hospital my fourth year friend interviewed with (for the match) literally bragged about how they had an intern go into kidney failure this year after a week of non-stop work. How is that something to be proud of? Another fourth year friend told me she was going home for the first time in three days and had only had about 6 hours of sleep over that period of time. Awful.

No one knows why Christina killed herself. According to her friends and colleagues, it was completely unexpected and after the end of a completely normal day. So sad that now I feel like that's a theme...

You're totally right with your first point. When I was applying for match, that was 100% my mentality. I'm hoping to go into a competitive specialty and so the mentality of "I can do anything for a year. I can live anywhere for a year. I can put up with anything for a year," is there. For me, personally, it's true... at least right now. I guess I can't make that judgment until I'm actually in the thick of it.

I agree with other posters about the lack of school resources, or making them sound less than enticing if they were there. I will never forget the meeting the Dean had with third year students when I was a third year. He had a great platform on which to detstigmatize mental health at a point in the curriculum when we were all feeling low and when I know for a fact that several classmates had started antidepressants simply to deal with that year. Unfortunately, he made comments about how we weren't "mentally ill, but mentally unhealthy," and we don't need to "seek a professional," but should instead "talk to [our] friends," because they know us best... Such awful advice for someone that is actually suffering from clinical depression or anxiety. There is no shame in seeking professional help and no shame in needing pharmacological intervention. I really wish he'd pushed that, instead of telling us that none of us in the room were mentally ill.

 

[pinkpuppy9]

No one knows why Christina killed herself. According to her friends and colleagues, it was completely unexpected and after the end of a completely normal day. So sad that now I feel like that's a theme...

You're totally right with your first point. When I was applying for match, that was 100% my mentality. I'm hoping to go into a competitive specialty and so the mentality of "I can do anything for a year. I can live anywhere for a year. I can put up with anything for a year," is there. For me, personally, it's true... at least right now. I guess I can't make that judgment until I'm actually in the thick of it.

I agree with other posters about the lack of school resources, or making them sound less than enticing if they were there. I will never forget the meeting the Dean had with third year students when I was a third year. He had a great platform on which to detstigmatize mental health at a point in the curriculum when we were all feeling low and when I know for a fact that several classmates had started antidepressants simply to deal with that year. Unfortunately, he made comments about how we weren't "mentally ill, but mentally unhealthy," and we don't need to "seek a professional," but should instead "talk to [our] friends," because they know us best... Such awful advice for someone that is actually suffering from clinical depression or anxiety. There is no shame in seeking professional help and no shame in needing pharmacological intervention. I really wish he'd pushed that, instead of telling us that none of us in the room were mentally ill.

That's awful. I've feel that most older people think we're all just a bunch of snowflakes that can't handle pressure, work, etc. I think we're far more in tune with our mental needs than any other generation before us, but when you're essentially being hushed down like that...

 

[Doctor-S]

That's awful. I've feel that most older people think we're all just a bunch of snowflakes that can't handle pressure, work, etc. I think we're far more in tune with our mental needs than any other generation before us, but when you're essentially being hushed down like that...

FWIW ... I'm an older person and my colleagues and I do not think vet med students (or human med students) are snowflakes. There is a difference between an individual who always complains (just for the sake of complaining, and for no other reason) and someone else who has an actual "reason" for complaining about something. A significant difference.

I have seen my share of anxious, depressed and suicidal students, post-docs, staff, faculty, attendings and residents, too many of them. Where I am, mental health is taken seriously and we have no interest in labeling anyone as a "weak" person or hushing them. No way. For that reason, among other things, we have a dedicated team of licensed mental health professionals who are available 24/7, including experienced clinical psychologists, psychiatrists and social workers. We make sure everyone is aware of these services; they are not secretive, hidden, nor stigmatized. Hopefully, more universities will provide these types of services and supportive resources in the future.

 

[CalliopeDVM]

mental health is taken seriously and we have no interest in labeling anyone as a "weak" person or hushing them. No way.

I agree......I've been a vet for over 15 years and I don't see any of my colleagues belittling or trying to bully anyone into hiding or pretending they don't have a problem. However, I do see vets who believe that people need to look after their own health and not make it their boss' problem, but that's a different thing entirely (i.e. if you're having problems with clinical depression (for example), better to take time to deal with it than come into work unable to do the job properly. Just like you would do if you had the flu or diabetes.).

 

[pinkpuppy9]

It's not necessarily just colleagues (or I supposed I should refer to them as mentors/teachers/clinicians in my case), but society in general. There's still a stigma around mental health and seeking out mental health services. It certainly is getting better, but every single day is seems I come across comments that essentially call someone who commits suicide weak and incapable of handling the "obstacles of life." I've also heard/seen a heck of a lot of 'well, we didn't have it nearly as good as you do when I was your age, you have no reason to be unhappy/depressed/etc.'

For the vet who euthanized herself after being featured in a news segment about shelter work...I saw so many comments along the lines of 'well she just wasn't tough enough' too.

 

[dyachei]

That's awful. I've feel that most older people think we're all just a bunch of snowflakes that can't handle pressure, work, etc. I think we're far more in tune with our mental needs than any other generation before us, but when you're essentially being hushed down like that...

there are some vets that believe this, but they are a vocal minority, not the majority.

 

[CalliopeDVM]

It's not necessarily just colleagues (or I supposed I should refer to them as mentors/teachers/clinicians in my case), but society in general. There's still a stigma around mental health and seeking out mental health services. It certainly is getting better, but every single day is seems I come across comments that essentially call someone who commits suicide weak and incapable of handling the "obstacles of life." I've also heard/seen a heck of a lot of 'well, we didn't have it nearly as good as you do when I was your age, you have no reason to be unhappy/depressed/etc.'

For the vet who euthanized herself after being featured in a news segment about shelter work...I saw so many comments along the lines of 'well she just wasn't tough enough' too.

I agree there's definitely a stigma about it in society, but I was commenting about the profession more specifically.

 

[RadRadTerp]

The debt sucks, but doesn't depress me. Being a perfectionist is hard, but that doesn't depress me. Losing patients is always going to be tough but life is temporary. What gets me is trying my best and feeling as if my efforts count towards nothing when a client accuses vets of being "greedy, soulless, cold" because we dare charge for our services. Someone wrote that on a yelp review and specifically called out a colleague of mine. Or they go online and lie about what a vet did or did not do. It's hard to focus on the majority of clients who are appreciative, kind, and grateful when you get one or two rotten apples every once in a while who show no respect at all for what we do. I wish I had thicker skin because as much as I pretend nasty comments about my profession don't bother me when they come out of the mouths of awful people, they do upset me even if they're not about myself in particular.

 

[WhtsThFrequency]

The debt sucks, but doesn't depress me. Being a perfectionist is hard, but that doesn't depress me. Losing patients is always going to be tough but life is temporary. What gets me is trying my best and feeling as if my efforts count towards nothing when a client accuses vets of being "greedy, soulless, cold" because we dare charge for our services. Someone wrote that on a yelp review and specifically called out a colleague of mine. Or they go online and lie about what a vet did or did not do. It's hard to focus on the majority of clients who are appreciative, kind, and grateful when you get one or two rotten apples every once in a while who show no respect at all for what we do. I wish I had thicker skin because as much as I pretend nasty comments about my profession don't bother me when they come out of the mouths of awful people, they do upset me even if they're not about myself in particular.

I think we have the same colleague. Saw her post that on FB recently.

 

[RadRadTerp]

I think we have the same colleague. Saw her post that on FB recently.

Yeah, super messed up!