Warning: This blog post talks about issues related to suicide, depression, and mental illness. If you are having thoughts of suicide please contact the National Suicide Prevention Lifeline immediately at 1-800-273-8255 (TALK). No matter what you’re going through, your life has incredible value and the veterinary community loves you and is here for you.
The Veterinary Mental Health Crisis
My intention when I started this blog to accompany the launch of Doc Wags was to stick to lighter, fun conversations and that is still my plan going forward. However, I feel that it is important for this company to always unapologetically do the right thing and sometimes that means tackling heavier, important topics like this one.
Veterinary medicine is facing a mental health crisis. Male veterinarians are 2.1x more likely to die by suicide and female veterinarians are 3.5x more likely to die by suicide than the general population. From 2000-2015 about 10% of all deaths among female veterinarians were by suicide. A 2015 study found that 1 in 6 veterinarians have considered suicide. It is impossible to connect this trend back to a single cause or issue because there isn’t just one issue at play: the practice of veterinary medicine is a “perfect storm” of factors coming together to put veterinary healthcare workers at risk of depression and suicide. In this post I’ll be tackling a few of the challenges facing veterinary healthcare workers:
The decision to become a veterinarian is rooted in a deep empathetic drive to help animals in need. However, empathy is a double-edged sword. Those who are more naturally empathetic, prone to internalizing feelings of guilt for the emotions of others, and trend towards altruism are prone to empathetic distress, an exaggerated emotional response that can put them at risk of depression. The same personality and emotional characteristics that make veterinarians such good caregivers to their patients and clients also put their own mental health at risk.
The cost of veterinary medical school in the US well in excess of $200,000 and veterinarian salaries fall on average about 2.5x lower than physician salaries despite a similar level of educational debt. Decades of financial stress often follow veterinarians beyond graduation and can snowball with all of the other stressors in their lives. Heavy indebtedness has been linked to poor mental health outcomes, meaning that the student debt crisis is playing a role in worsening the mental health crisis in veterinary medicine.
Working in veterinary medicine is hard and the hours are long. The work is physically, emotionally, and mentally taxing. Veterinarians have a habit of bringing a lot of their work home with them, both directly and indirectly (I’ve lost more nights of sleep than I can count worrying about my patients and the decisions I’ve made for them). Poor work-life balance is associated with many negative mental health outcomes including anxiety and depression.
Impostor syndrome is a common issue in high-achieving professions, particularly among those who are embarking on a new stage in their career (new graduates, changing jobs, etc). Impostor syndrome often coexists with depression, anxiety, low self-esteem, somatic symptoms, and social dysfunctions. This means that whether impostor syndrome is a cause or a symptom, we should see its prevalence in veterinary medicine as a sign of widespread poor mental health.
Rationalization of death
Being a veterinarian means spending a lot of time talking about death and being frequently present for the end of life. Veterinarians need to develop a level of comfort with the idea of death as a natural stage of life, but that rationalization process can be twisted in the mind of someone dealing with depression, suicidal ideation, and feelings of hopelessness. We frequently talk about euthanasia as a means to end physical suffering in our patients, but someone who is in the midst of a mental health crisis may be prone to drawing inaccurate comparison between their patients’ physical anguish and illness and their own emotional anguish and mental illness. However, unlike our patients who are facing terminal physical illness, there are effective treatment options for depression.
Ease of access to means
Due to the nature of their work, veterinarians and other veterinary healthcare team members have access to medications which are capable of ending life. According to a CDC study two-thirds of female veterinarian suicide and one-third of male veterinarian suicide was by means of poison, with euthanasia drugs likely representing a substantial portion. Restricting ease of access to euthanasia and anesthetic medications may be useful in reducing veterinary suicide. There are some good suggestions for restricting ease of access in veterinary hospitals including Dr. Andy Roark’s “4 eyes” system although it may prove difficult to fully restrict access to euthanasia and anesthetic medications in many practice settings.
Emotional blackmail and online bullying
I’ll lead this off by saying that the overwhelming majority of pet parents are great people who treat their veterinarians well. However, all it takes is a few negative interactions every week to cause progressive emotional drain and burnout. Pet parents come to us understandably upset that their pets are ill or injured, and they occasionally handle fear, guilt, and grief in hurtful ways. A lack of understanding of a veterinarian’s lack of control over the cost of care (See my blog post on why vet care costs so much) often fuels these negative interactions. Veterinarians frequently find themselves acting as emotional punching bags.
Online bullying is a concerning new trend. By taking their complaints online, pet parents turn a dispute with their vet into an online witch hunt and mass bullying and harassment. In these scenarios client/patient confidentiality means that only one side of the story will be heard. If you’ve ever considered participating in online bullying please think first and remember that you’re only hearing one side of the story.
While progress continues to be made in eliminating stigmas around mental health issues, unfortunately many people still feel uncomfortable talking about and seeking care for mental health concerns and often fear consequences or retribution from peers and employers.
Where do we go from here?
- Mentality shift in veterinary medicine: Tackling stigma and raising awareness: The first step towards solving a problem is admitting there is one. We need to equip vets with the tools and training to recognize symptoms of depression in themselves and their peers before it reaches the point of crisis. Vets who need time and help to work through crisis need support from their peers and their employers. Organizations like Not One More Vet are already working tirelessly to tackle these issues, but there’s still much work to be done.
- Address work-life balance: Shifting the perception of healthy work-life balance needs start all the way back in veterinary medical school. Vet med students need to be taught healthy boundaries. During my clinical year in vet med school I was frequently working 80-100+ hours per week on rotations alongside clinicians (interns all the way up to attendings) working similar hours. Normalizing healthy work-life balance in clinical practice starts by addressing unhealthy work-life balance in academia. What is learned in school shapes the norms in the profession after school.
- Fight for more affordable veterinary medical education: Excessive debt is bad for mental health. Educational debt has skyrocketed in the veterinary profession and most new graduates enter the profession with an extreme debt-to-salary ratio. Accreditation for veterinary medical schools should include cost control measures including limits on administrative costs. The veterinary profession also needs to focus on fighting to restore the reduced state funding for many veterinary medical schools.
- Provide better mental health resources: Veterinary employers and professional bodies need to ensure that veterinarians have access to affordable mental healthcare whenever they need it.
- All veterinary practices should have proactive policies for handling abusive clients and cyberbullying: Veterinary practices shouldn’t be trying to figure out how to handle a cyberbullying incident on the fly.
- Educate veterinary healthcare workers on ways to promote personal mental wellness: Mental healthcare shouldn’t just be reactive. Just like preventative medicine is important for our pets in stopping problems before they start, taking a proactive approach to mental health is also important. Exercise, meditation/mindfulness, and making sure staff have enough vacation time and are able to use it can all help.
- Educate the public on how their words and actions impact veterinary healthcare workers: Kind words have power, as do hurtful ones. I have cards up on my refrigerator from clients who wrote kind words to me about the care of their pets. I can also remember every one of the times that a client has yelled at me and how it took me hours, sometimes days to feel like I wasn’t a crappy vet again even though I rationally knew they weren’t right. Words are powerful and we should always be focused on using those words for good.