I wrote here for BVA about Vetlife’s work at Christmas time.
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Bouncing back: resilience training, what’s the evidence?
I’ve been invited by The British Veterinary Association to talk about resilience at The London Vet Show. I’ve blogged here, looking at the evidence on resilience training, and some of the problems with understandings of professional resilience:
Supporting practices after a suicide
Vets are three to four times more likely than the general population to die by suicide (Platt et al., 2010). The effect on families, friends and colleagues can be devastating. Every suicide is a tragedy, and for many people bereaved by suicide, the impact can affect them for the rest of their life. People used to say that each suicide impacted on average six other people, but the figure is now thought to be much higher.
There aren’t accurate figures for the suicide rate among veterinary nurses but there are some aspects of their work that suggest that they also may be at risk. As a profession with an elevated suicide rate it’s important that veterinary practices know how to respond if there is a suicide in their practice. It’s an event no one wants to prepare for, but there are several reasons why knowing what to do after a death is important. A lot of focus on suicide in society is on suicide prevention, and rightly so, as well as a human tragedy, suicide is a preventable public health problem and efforts to reduce risks and support people in crisis are vital, but an aspect of suicide prevention that is often overlooked is support for people bereaved by suicide, and what is called suicide postvention.
Postvention is responding to death by suicide in such a way that helps and supports those bereaved without increasing the risk of further suicides. Suicide clustering and suicide contagion are complex phenomena that aren’t fully understood, but some types of response to a suicide can increase the risk in those left behind, or trigger behaviours in those already vulnerable.
Bereavement as a risk factor
Recent research suggests that people bereaved by suicide are themselves at increased risk of suicidal thoughts and suicide attempts. Young people bereaved by suicide are more likely to go on to attempt suicide compared to young people who have suffered a sudden bereavement due to other causes. This effect holds whether the young person is blood-related to the person who had died or not (Pitman et al., 2016).
Suicide clusters, though rare, are an important consideration when responding to a death by suicide. There are two types of suicide cluster: point or space-time clusters occur where there are unusually high numbers of suicides in an institution or small geographical area in a short period of time; mass clusters are where suicides occur in a time period following and related to the publishing or broadcast of a fictional or actual suicide death (Joiner, 1999; Haw et al., 2013). There is evidence that the way suicide is reported in the media can influence future deaths, and Samaritans produce media guidelines on the responsible reporting of suicide to help minimise this effect.
A review of the evidence on suicide clustering found that those at increased risk are teenagers and young adults, men, people who have been directly involved with the person who died by suicide and people with other known risk factors for suicide. Clusters tend to occur in isolated or closed communities like schools, hospitals, prisons, the armed forces, and isolated rural or deprived communities (Haw et al., 2013; Niedzwiedz et al., 2014).
Complicated grief
As well as increasing suicide risk, bereavement by suicide has other profound impacts on those left behind. Grief in suicide bereavement shares characteristics with grief due to other causes but can also be more complex and last longer than grief where death was not due to suicide. The Survivors of Bereavement by Suicide charity is a good resource for information and the charity coordinates support groups for people affected.
People bereaved by suicide describe experiencing a range of emotions, from shock and disbelief. anger, guilt, shame because of the stigma and taboo of suicide, anxiety, fear, despair, and sometimes post traumatic reactions, especially if they have been the one who has found the person after they have died. Sometimes if the person has been suffering for a long time people can report experiencing feelings of relief, which in turn can lead to feelings of guilt. People can also feel guilty that they have survived whilst the other person has died. There is no right or wrong way to feel in suicide bereavement and it’s normal to return to different feelings, sometimes called stages of grief, at different times. Grief is not linear and people can return to stages they may already have experienced.
Practical considerations in the workplace
Suicide in colleagues can have other complications. If the person has died at the practice the police may close all or part of the building for a time to investigate the death. Police have responsibility for investigating the circumstances of a death, and for making a report to the Coroner in England and Wales, or Procurator Fiscal in Scotland. If drugs or equipment from the practice may have been used in the death the police may want access to order logs and recording books and may also want to see CCTV.
Colleagues in the practice may be in shock or grieving and may not feel able to continue with work immediately, especially if there are investigations occurring at the practice. As vets we still have responsibilities for the animals under our care. In the immediate aftermath it can help to reach out as a practice and arrange for another practice to cover emergency and 24 hour responsibilities so that police can access the practice and staff can make personal arrangements for support. Such arrangements can also be needed at the time of a funeral so all practice members who wish to can attend.
In England and Wales Coroners will hold an inquiry into the death, and in Scotland the Procurator Fiscal will investigate. These processes can be prolonged and distressing for those bereaved, and inquests can sometimes occur some time after the death, they can be especially difficult the case attracts media attention.
Practices also have considerations such as how to inform clients of a colleague’s death, and, in time, whether to formally remember the person in the workplace. It’s natural to want to remember someone, but some types of memorials can trigger risk in vulnerable people, and permeant public memorials are generally discouraged by organisations working in suicide postvention. Online tribute pages can also pose risks, with comments often published elsewhere without permission, and such pages attracting attacks and bullying. Samaritans advise that public memorials are time limited, and after a period, tributes are sent to the family in private not displayed publicly.
Handling the media
There is often media interest in veterinary suicides, and media contacts can feel intrusive and upsetting. It can help to have a planned response to this as a practice. Nominate a single person as a spokesperson and discourage others in the practice from making comments to the media. Prepare a statement and do not deviate from it, avoid sensationalizing the death, and don’t give details of the suicide method or anything written in a suicide note. Samaritans guidance also encourages people to avoid giving simple ‘explanations’ of a suicide such as ‘they were stressed about a complaint’.
Support
It’s vitally important that people can access support after a suicide, in their own way, and at their own pace. Some people may want to talk with friends, family and colleagues, whereas others may feel they need more professional support. There is no right or wrong way to cope.
Sometimes after a death organisations arrange formal counselling for staff. There is mixed evidence on this, where people want counselling it can be helpful, but some types of debriefing, such as formal group debriefing or critical incident stress debriefing, after a traumatic incident can actually increase the likelihood of developing PTSD, so it is important to be guided by what staff want, offer support but do not force people to take part if they don’t want, or feel ready to talk.
Some people find support groups and meeting others who have been bereaved by suicide helpful, Survivors of Bereavement by Suicide coordinates a network of groups around the UK.
How Vetlife can help
Vetlife, the charity that supports the veterinary community, also offers services to help after suicide. Vetlife Helpline is available by phone or email 24 hours a day for listening and emotional support. Vetlife Health Support can support practices in more practical ways, where a practice requests, Vetlife can visit the practice and support staff who want to talk.
Vetlife financial support can also support the families of vets who have been bereaved by suicide. Some life insurance policies do not cover deaths by suicide, and bank accounts can also be inaccessible to family for a time. Practices can let families know that Vetlife can often help with grants or loans in these situations.
Language
Suicide is stigmatised and it can be a very difficult subject to talk about. Organisations working in this area recommend to consider the language used when talking about a death. For example saying someone has “committed suicide” dates back to when suicide was a criminal offence, and can be stigmatising and upsetting for those impacted. “Died by suicide” or “taken their own life” are less stigmatising alternatives. Similarly, talking about “completed suicide” or “successful suicide” to differentiate someone who has died by suicide as opposed to an “unsuccessful” or “incomplete” attempt, is said by some who have lived experience of suicidal thoughts to increase their distress, as they feel it suggests that they’ve “failed” at suicide, and that dying is a success, or that death makes them complete. When talking about someone who has died by suicide or who has attempted suicide, using alternatives to “successful”, “committed”, or “completed”, is preferable.
Summary
We know from the research evidence that the way people respond to a suicide is a key part of suicide prevention for others, and in managing difficult and complex grief.
In the shock and grief in the immediate aftermath of suicide it can be difficult to know what to do, but there are organisations who want to help, and who can support your practice. Vetlife Helpline is available 24 hours a day, and can signpost you to further resources. The resources below may also be of help.
If you need to talk, support is available 24 hours a day, Vetlife can be called 0303 040 2551, or freephone Samaritans 116 123
Resources
Survivors of Bereavement by Suicide (SOBS) website: http://uk-sobs.org.uk/
Support after a suicide, SOBS booklet: http://uk-sobs.org.uk/wp-content/uploads/2014/02/SupportAfterASuicide.pdf
Samaritans postvention advice: http://www.samaritans.org/your-community/supporting-schools/step-step/step-step-frequently-asked-questions
Vetlife website: www.vetlife.org.uk
Vetlife helpline: 0303 040 2551, or email via the Vetlife website
References
HAW, C. et al. Suicide clusters: a review of risk factors and mechanisms. Suicide Life Threat Behav, v. 43, n. 1, p. 97-108, Feb 2013.
JOINER, T. E. The clustering and contagion of suicide. Current Directions in Psychological Science, v. 8, p. 89-92, 1999.
NIEDZWIEDZ, C. et al. The definition and epidemiology of clusters of suicidal behavior: a systematic review. Suicide Life Threat Behav, v. 44, n. 5, p. 569-81, Oct 2014.
PITMAN, A. L. et al. Bereavement by suicide as a risk factor for suicide attempt: a cross-sectional national UK-wide study of 3432 young bereaved adults. BMJ Open, v. 6, n. 1, 2016.
PLATT, B. et al. Systematic review of the prevalence of suicide in veterinary surgeons. Occup Med (Lond), v. 60, n. 6, p. 436-46, Sep 2010. ISSN 1471-8405.
SAMARITANS. Media guidelines for reporting suicide. 2013. http://www.samaritans.org/media-centre/media-guidelines-reporting-suicide
Complaints, fear, and hope
Every year in the springtime I ask several hundred vet students two questions:
What do you hope for from your veterinary career, and what do you fear?
Within the first few fears, someone will mention complaints. Even before starting out in practice, and never having received one, complaints are a source of worry for the vet profession. I’ve written about complaints before. There has not been much research on the impact of complaints on vets, but several recent papers from the medical profession make concerning reading, and have parallels for vets and vet nurses.
Last year, Professor Tom Bourne and colleagues published a study showing that doctors who had recently received a complaint of any kind were 77% more likely to suffer from moderate to severe depression than those who have never had a complaint. The impact was most serious when the complaint led to a referral to doctors’ regulatory body the General Medical Council (GMC). Doctors who had received a complaint were also at double the risk of having thoughts of self-harm and more likely to experience suicidal thoughts.
For professions like medicine and veterinary medicine which have elevated suicide rates compared to the general population, understanding factors like this which contribute to suicidal thoughts is vital.
A follow up to this research was published yesterday in BMJ Open. It’s a qualitative analysis of survey responses to three questions:
1. Try to summarise as best as you can your experience of the complaints process and how it made you feel.
2. What were the most stressful aspects of the complaint?
3. What would you improve in the complaints system?
It won’t come as a surprise to anyone who has received a complaint as a vet or vet nurse that complaints had a profound impact on many of the doctors in the study. Complaints caused emotional distress, left doctors feeling powerless and impotent, they impacted on the way that the doctors worked by increasing defensive practice, and almost a quarter considered leaving medicine altogether. Feeling unsupported was not uncommon, nor was feeling the process was unfair or weighted against them. Worryingly too, only 6% felt the complaint had been a learning experience.
It is important and necessary that people can complain about doctors and vets, but when such a small proportion of those investigated say they have learnt from the experience, and it causes so much harm, including in some cases contributing to suicidal thoughts and behaviour, something needs to change. This is further highlighted by the finding that the way doctors feel after a complaint actually makes their practice less safe for patients because of defensive practice, not more so.
We need to repeat this work in vets, and I’m currently working on a study that has spoken with vets about the impact complaints have had on them. It’s important to understand if this study from medicine translates to vets, but there are a number of types of evidence that suggest that it might.
A similarity in the handling of complaints about doctors and vets is investigation by a professional regulator. For doctors in the UK, this is the GMC, and for vets, the RCVS. Concerns relating to fitness to practice which may be from complaints, or performance or health concerns, can be taken up by the regulator, and subject to a process of investigation. In the study of doctors, complaints that had gone to the GMC caused the highest levels of distress, depression and anxiety.
Between 2005 and 2013, 28 doctors with an open GMC case died by suicide. Last year the GMC commissioned Professor Louis Appleby to review their disciplinary process to make it less harmful to doctors. His draft recommendations have now been published, and include:
- Avoiding full investigations whenever possible in cases that are (solely or primarily) about a doctor’s health.
- Reduce stress in all investigations through changes to process, communication, and duration.
- Pursue consensual conclusion as the preferred outcome.
- Expand support for doctors during the fitness to practise process including a tribunal hearing.
The study published yesterday also has suggestions for how to reduce the harmful impacts of investigation, including attention to the timeframes of complaint investigations. One of the biggest causes of distress in vets in my research who have experienced complaints is the time it took for the complaint to be resolved. Investigation processes need to meet statutory requirements and protecting the public, and in vets case, also protect animals. They must also be fair, and there can be many good reasons for delays, but limiting the time of investigation could help reduce the potential for harm.
It’s good to hear that there is soon to be an external review of RCVS professional conduct processes. To reduce the veterinary suicide rate we need to understand how to make investigation and regulation safer for vets, as we know complaints and investigations contribute to suicidal thoughts and behaviour. I’d like to see changes to processes to reduce the unintended harm that can be caused, and support for vets who have experienced a complaint or investigation. We need to understand the fear that vets experience associated with complaints. Research suggests even people who never receive one can be impacted by having witnessed colleagues or heard of complaints about others. It can be hard to imagine the anguish and fear vets going through complaints processes can experience in those situations. We need to listen to them, and learn how to better support them, no one should have to go through that alone. We also need to think about how complaints processes can be improved so that the fear and perceived blame culture changes, and complaints are safe for the clinician going through the process, the complainant, and also the patients and public we serve in future. We need learning where things have gone wrong and development, not defensive medicine.
Vetlife Helpline is available 24 hours a day for vets and vet nurses in distress and often takes calls about complaints, call 0303 040 2551 or email via http://www.vetlife.org.uk
What does it mean to be a vet?
I wrote an editorial for The Veterinary Record about what it means to be a vet. You can read it here.
Exercise and wellbeing – what’s the evidence
This article was first published in Practice Life, March-April 2016 p23-25
Exercise and physical activity at work: what’s the evidence?
A cruel irony of veterinary practice is that whilst vets are often great at preventative medicine for our patients, our lifestyles and work demands don’t always leave much time for us to look after ourselves.
In the typical veterinary day free time is often short, and multiple competing demands mean our own health can come low on the priority list. Spending most of our working time on other-directed care giving; care for ourselves can be neglected.
If you just had a few minutes a day to take back and use to look after yourself, what would be the best evidenced thing you could do?
There’s lots of advice out there on this, when talking with vets about wellbeing I sometimes look at ways to incorporate the Five Ways to Wellbeing into the working day. Connecting, taking Notice, learning, giving, and being active might sound simplistic, but there is good evidence that they can help with mental and in some cases physical wellbeing.
Perhaps the largest evidence base lies with the last one of the five: being active. If you’ve just spent all day on your feet operating, or lifting obese and poorly packaged pets in non-ergonomically designed carriers onto a consult room table, I know from experience the most appealing way to spend your small amount of free time may be with your feet up, but the evidence for activity for health is compelling.
Benefits of exercise
So what is the evidence for physical activity?
The government and Chief Medical Officers issue recommendations for physical activity based on a large and detailed evidence base:
Physical activity: definition and current UK recommendations. Reproduced edited from CMO (2016) and NICE (2016)
Definition
Physical activity includes everyday activity such as walking and cycling, work-related activity, housework, DIY and gardening. It also includes recreational activities such as working out in a gym, dancing, or playing active games, as well as organised and competitive sport.
National recommendations
The CMOs’ current recommendations for physical activity state:
– Adults 19 years and over should aim to be active daily. Over a week, this should add up to at least 150 minutes of moderate intensity1 physical activity in bouts of 10 minutes or more.
– Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or combinations of moderate and vigorous intensity2 activity.
– All adults should also undertake physical activity to improve muscle strength on at least 2 days a week.
– They should minimise the amount of time spent being sedentary (sitting) for extended periods.
– Older adults (65 years and over) who are at risk of falls should incorporate physical activity to improve balance and coordination on at least 2 days a week.
– Individual physical and mental capabilities should be considered when interpreting the guidelines, but the key issue is that some activity is better than no activity.
1 Moderate-intensity physical activity leads to faster breathing, increased heart rate and feeling warmer. Moderate-intensity physical activity could include walking at 3–4 mph, and household tasks such as vacuum cleaning or mowing the lawn.
2 Vigorous-intensity physical activity leads to very hard breathing, shortness of breath, rapid heartbeat and should leave a person unable to maintain a conversation comfortably. Vigorous-intensity activity could include running at 6–8 mph, cycling at 12–14 mph or swimming slow crawl.
There is a causal relationship between the amount of physical activity people do and all-cause mortality. Physical inactivity is now the fourth biggest risk factor for global mortality. Regular physical activity (30 minutes of moderate intensity physical activity on at least 5 days a week) can reduce the risk, and help to manage over 20 chronic conditions, including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions. Even small increases in physical activity are associated with some protection against chronic diseases and an improved quality of life. Benefits of physical activity can also extend beyond health, improving workplace productivity (WHO, 2010; Chief Medical Officers, 2011.) There is a curvilinear dose–response relationship between physical activity and diseases such as coronary heart disease and type 2 diabetes, it generally holds that the higher the level of physical activity or fitness, the lower the risk of disease (Department of Health, 2004). There isn’t enough evidence yet to recommend specific amounts of activity to prevent different conditions, but as the evidence base grows we are understanding more about what types of activity can help.
Exercise and mental health
Having worked in veterinary practice, and spoken to a lot of vets in different areas of veterinary life through Vetlife Helpline and my research one of the areas I’m particularly interested in is how physical activity can benefit mental health and wellbeing.
Physical activity can have a positive effect on wellbeing, mood, sense of achievement, relaxation and release from daily stress (Chief Medical Officers of England, 2011). The Royal College of Psychiatrists makes recommendations for the types of exercise that can help with mental health and wellbeing, (Box 2), emphasising how exercise can give back feelings of control, offer an escape from other pressures, and be a source of companionship.
Activity for Wellbeing, from Royal College of Psychiatrists (2016): Physical Activity and Mental Health
Activity for mental health should:
– Be enjoyable – if you don’t know what you might enjoy, try a few different things
– Help you to feel more competent, or capable.
– Give you a sense of control over your life – that you have choices you can make (so it isn’t helpful if you start to feel that you have to exercise). The sense that you are looking after yourself can also feel good.
– Help you to escape for a while from the pressures of life.
– Be shared. The companionship involved can be just as important as the physical activity.
For those living with symptoms of a mental health condition, meta-analysis and reviews suggest that exercise and physical activity can have benefits too. Physical activity has a significant effect reducing depressive symptoms across a range of mental health conditions (Rosenbaum et al., 2014). We still need to understand more about what can help people with mental health conditions with adherence to exercise, it can be difficult to function at all when affected by severe depressive symptoms and fatigue, and exercise may not feel achievable. The Royal College of Psychiatrists recommends using SMART goals and to increase exercise gradually (RCPsych, 2016).
S – Specific (clear)
M – Measurable – you will know when you’ve achieved them
A – Achievable – you can achieve them
R – Relevant – they mean something to you
T – Time-based – you set yourself a time limit to achieve your goals
Sacrifices and barriers to exercise
NICE and CMO guidance also discusses the importance of understanding the barriers to physical activity (NICE 2008, CMO 2011). When I’ve talked with vets in practice about their options for exercise, time is often felt to be a major obstacle, or physical factors such as the ease of access to safe exercise when working long hours on call.
I’m often struck when talking with new graduates or final year vet students about their involvement in sport and exercise is just how many of them have sacrificed activities they were talented in and got great pleasure from to prioritise study. Work is important but the benefits of exercise are strongly evidenced, and are worth protecting time for where possible.
Having non veterinary activities in your life can also be protective psychologically. A vocation like veterinary work that can give great value and meaning when veterinary life is going well, but if there is a problem at work, a bad clinical outcome or complaint, if all someone has is veterinary they can be vulnerable to difficulties of wellbeing. Having non veterinary friends and activities can help protect people at times like that, and help them to get through difficult veterinary times without them having such a catastrophic impact.
How employers can help
Employers can help task saturated time poor veterinary staff to increase their physical activity. NICE, The National Institute for Health and Care Excellence publishes guidance on physical activity in the workplace (NICE, 2008). They recommend employers in organisations of all sizes should develop an organisation-wide plan or policy to encourage and support employees to be more physically active. This should be based on consultation with staff and include measures to maximise the opportunity for all employees to participate. It should be supported by management and have dedicated resources. They recommend an organisation-wide, multi-component programme to encourage and support employees to be physically active, including:
- flexible working policies and incentive schemes
- policies to encourage employees to walk, cycle or use other modes of transport involving physical activity (to travel to and from work and as part of their working day)
- the dissemination of information (including written information) on how to be more physically active and on the health benefits of such activity. This could include information on local opportunities to be physically active (both within and outside the workplace) tailored to meet specific needs, for example, the needs of shift workers
- ongoing advice and support to help people plan how they are going to increase their levels of physical activity
- the offer of a confidential, independent health check administered by a suitably qualified practitioner and focused on physical activity
The evidence this guidance is based on is interesting, one study on workplace activity found that posters to encourage stair climbing may have an effect, but only in the short term; others found that using pedometers and goal setting can increase step counts; that workplace screening and health checks can help to increase physical activity; and that health information can in some cases help too.
Physical environment is also important, and a way in which employers can help with facilities and practice behaviours. It may not be possible for vets to avoid driving to calls or to work if they need a car for on call, but providing safe facilities for exercise whether that be through subsidised gym membership or facilities at work for people working long hours on call.
Employers can also help to combat the impact of sedentary behaviour on veterinary staff. Evidence suggests sedentary behaviour is independently associated with all-cause mortality, type 2 diabetes, some types of cancer and metabolic dysfunction. There’s also an association between sedentary behaviour and overweight and obesity. Interestingly these relationships are independent of the level of overall physical activity, so, spending large amounts of time being sedentary may increase the risk of some health outcomes, even among people who are active at the recommended levels (Sedentary Behaviour and Obesity Expert Working Group, 2010).
Standing desks, facilitating brief activity breaks and periods of walking to break up periods of sedentary work can help. The evidence on this is growing, there isn’t yet enough data to recommend a maximum amount of time to be sedentary for health, but based on the current evidence, the guidance is that reducing total sedentary time and breaking up extended periods of sitting is strongly recommended (Group, 2010, Chief Medical Officers of England, 2011).
Some tips to increase physical activity:
Buy a pedometer or tech:
Some people find pedometers, wearable tech or apps that measure physical activity through the day can be motivating and help increase activity and energy expenditure.
Look out what’s available for free:
There are lots of free schemes which can help with community and group participation in exercise, for example:
Parkrun offer free weekly 5K timed runs, currently at 379 locations around the UK. There are http://www.parkrun.org.uk/
Sustrans is a UK charity enabling people to travel by foot, bike or public transport for more of the journeys, they can work with employers to promote active travel and work to develop high quality walking and cycle networks. www.sustrans.org.uk
Take the stairs:
As simple as it sounds.
Stand up:
Also simple. Consider standing desks, stand up while talking on the phone.
Walk:
Even 5 minute walking breaks can help physical and mental health.
Have walk meetings, Where you can, turn meetings with others in the practice into a short walk. Difficult conversations can be easier when walking too!
Find a sport you love:
As well as increasing daily physical activity through everyday activity such as active work, and active recreation like walking, structured exercise like sport or fitness training can bring further benefits.
If you’re interested in more about ways to increase physical activity, The University of Edinburgh have a free online course, starting in summer 2016. More details here: https://www.coursera.org/learn/get-active
References
CHIEF MEDICAL OFFICERS OF ENGLAND, S., WALES, AND NORTHERN IRELAND 2011. Start active, stay active: a report on physical activity from the four home countries’ Chief Medical Officers. Crown.
SEDENTARY BEHAVIOUR AND OBESITY EXPERT WORKING GROUP, 2010. Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health.
HEALTH, D. O. 2004. At least five a week: Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. .
NICE 2008. NICE Guidelines: Physical Activity in the Workplace.
RCPSYCH. 2016. Physical Activity and Mental Health [Online]. Available: http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/physicalactivity.aspx [Accessed January 2016].
ROSENBAUM, S., TIEDEMANN, A., SHERRINGTON, C., CURTIS, J. & WARD, P. B. 2014. Physical activity interventions for people with mental illness: a systematic review and meta-analysis. The Journal of clinical psychiatry, 75, 964.
WHO 2010. World Health Organization Global Recommendations on Physical Activity for Health
One thing to improve wellbeing – what would you choose?
I was recently asked if I could do just one thing to help improve wellbeing in the veterinary profession, what would it be? The answer I gave surprised some people.
Vets are three to four times more likely than the general population to die by suicide. There are lots of factors affecting veterinary wellbeing, and my background with Vetlife Helpline means I am passionate about ensuring everyone in crisis can access support. However the answer I gave was about management.
The evidence from the literature suggests that the role of the immediate line manager is a crucial one in workplace mental health. Research from the military suggests good leadership may even protect against development of certain conditions (Mulligan et al, 2010). We also know that work can be very important for good mental health, giving purpose, reward, meaning, social contact, structure, and more. This is true for vets as well, work can have significant personal meaning. Many vets I have spoken to in research on wellbeing at work say that work is a big part of what they live for.
We are learning more about features of veterinary work and working conditions that may contribute to stress and mental ill health, and line managers have a crucial role, not just in recognising and responding to mental ill health in the workplace and supporting staff who have been off sick to return to work, but also in prevention, and in creating and leading healthy working environments where vets can thrive. Managing mental health in the workplace can sometimes feel daunting to veterinary managers, often through good intent, we are worried about saying the wrong thing, making things worse, or feel unsure where our responsibilities lie. It can help to have a well developed sense of what you are and are not responsible for as a manager, have processes and policies in place to make sure staff who are struggling are supported and people’s legal rights are respected. ACAS has some great resources for managers wanting to promote positive mental health at work.
The Mental Health Foundation today published guidance for workplace mental health. It’s well worth reading.
Chris O Sullivan, MHF Programme lead blogs about it here, and his top four tips for healthy line management relationships can all be applied to the vet profession:
- Give time
- Be present
- Listen and be heard
- Recognise unhealthy relationships
Good line management is crucial for veterinary mental health. And it’s not just about response, line management can help address some of the causes of poor wellbeing too. Being a vet isn’t just about surviving in a sometimes difficult and challenging job, we should be creating workplaces where vets can thrive.
This post isn’t to say that we should just do one thing to improve wellbeing in the profession, we’ll have the most impact if we use a range of approaches; more on that soon..
If you need support Vetlife Helpline is available 24 hours a day on 0303 040 2551.
I also offer training for vets on wellbeing at work, including for line managers, if you’d like to know more please get in touch.
References
ACAS. Promoting Positive Mental Health at Work [Online]. Available: http://www.acas.org.uk.
MENTAL HEALTH FOUNDATION 2016. Mental Health in the Workplace. https://www.mentalhealth.org.uk/sites/default/files/CR00233_Ebook_dualbranded_interactive.pdf
MULLIGAN, K., JONES, N., WOODHEAD, C., DAVIES, M., WESSELY, S. & GREENBERG, N. 2010. Mental health of UK military personnel while on deployment in Iraq. The British journal of psychiatry : the journal of mental science, 197, 405.
