Like many diseases, early recognition of behavioral health disorders can improve the process of recovery.
Like many diseases, early recognition of behavioral health disorders can improve the process of recovery.

In virtually any problem-solving scenario, the first step entails recognizing a problem exists. For anyone facing behavioral or emotional disorders such as depression, burnout or substance abuse, taking that first step represents a giant leap toward recovery.

The incidence of behavioral disorders among veterinarians has gained attention in recent years, 2012 study from the U.S. Centers for Disease Control and Prevention (CDC) showed farming, fishing and forestry occupations at the top of the list for suicide rates, with health care professions also accounting for a significant percentage of suicide incidents.

In a 2015 CDC survey of over 10,000 veterinarians approximately 6.8% of male and 10.9% of female respondents were characterized as having psychological distress, compared with 3.5% of male and 4.4% of female U.S. adults overall. Since graduating from veterinary school, 24.5% of male and 36.7% of female respondents reported experiencing depressive episodes, while 14.4% of males and 19.1% of females reported suicidal ideation, and 1.1% and 1.4% of males and females respectively reported suicide attempts. These rates are overall higher than across the male and female U.S. general population, except for suicide attempts .

Veterinary schools, along with the American Veterinary Medical Association (AVMA) and the American Association of Bovine Practitioners (AABP) have recognized this issue, working with veterinarians and mental-health professionals to develop resources and programs to help prevent problems and promote wellness.

Laurie Fonken, PhD, LPC, serves as the psychological counselor for Colorado State University’s College of Veterinary Medicine and Biomedical Sciences, working with students and practitioners in the field. “It can be difficult to recognize and respond when a co-worker seems to be struggling. If you notice a change in their behavior, demeanor or mood note the change and find a quiet confidential place to check in with them. Even if you are met with resistance, stating your concerns in a genuine way, and letting the person know you are there if they need may be just the thing to help them realize it is ok to seek support”

In many veterinary practices, though, there is little or no structure for addressing wellness issues in the workplace, says Aimee Eggleston, DVM, owner of Eggleston Equine, LLC, in Woodstock, Connecticut. This increases the importance of veterinarians assessing their own behavioral health and watching for signs of problems among their associates.

In 2015, the AVMA selected Eggleston as one of 10 veterinarians to serve in their Future Leaders program. The previous Future Leaders class, she says, made veterinarian wellness a priority, and the 2015-2016 group were tasked with continuing that effort. Eggleston says the program “opened her eyes” to the behavioral health challenges veterinarians face, especially those in small or solo practices and in remote areas, with little contact with colleagues.

Learn the signs

Through her work with the AVMA team, Eggleston became involved in QPR (question, persuade, refer) training, a widely recognized system for suicide prevention. QPR gatekeeper training can be completed online in as little as one hour, or at your own pace.

Eggleston says even without specific training veterinarians can potentially help a colleague or even save a life by just asking how someone is doing and “listening carefully, just as we do for our clients and animals in our veterinary services.” This may help by encouraging someone at risk to seek professional counseling , if needed.

Jennifer Quammen, DVM, MPH, and her partner Ryan Smith, and exercise physiologist, founded High Performance Living (highperfliving.com), a program intended to improve health and wellness among veterinary professionals.

Quammen says the High Performance Living system focuses on six areas for assessment and lifestyle adjustments. These include sleep, stress, movement or exercise, nutrition, mental performance and work-life choice. She notes that work-life choice differs from “work-life balance.” Work time for veterinarians rarely “balances” with free time, but professionals can choose how to schedule and use their free time.

Veterinarians often suffer from sleep disorders, stress, compassion fatigue and burnout, Quammen says. The challenge is in differentiating between what is natural and what signs suggest a behavioral health problem. “We can provide rankings on a 1-to-10 scale and track those rankings over several weeks to identify trends” she adds.

“Ask your colleagues about what they see in your behavior,” Quammen suggests. She compares this to getting a second opinion on a case. “What do I see compared to what others see? Am I just having a bad day, or is there an ongoing behavioral change?”

In multi-person practices, incorporating an emotional component into regular team meetings can be beneficial, just to check in on how everyone is doing. This is different from QPR, which focuses on suicide prevention, Quammen says. The idea is to provide regular discussion and feedback on overall wellbeing for the staff. For the process, Quammen suggests “Schwartz Rounds, developed by the Schwartz Center at theschwartzcenter.org.

Moral stress or compassion fatigue are common among veterinarians, Quammen says. Veterinarians offer advice, but the clients fail to follow it. Clients withhold information the veterinarian needs, and they make decisions based on economics. These factors build up to create emotional fatigue among veterinarians.

Eggleston and Quammen recommend veterinarians use the Professional Quality of Life assessment (ProQOL) offered through the AVMA. Designed for health professionals, ProQOL is a widely validated, self-administered assessment tool that measures the negative and positive effects of helping others who are experiencing suffering and trauma. According to AVMA, it can be used as a guide to assess your balance of positive and negative personal and work-related experiences. The tool can help you measure how you are being affected in three areas that are critical to mental wellness – compassion satisfaction, compassion stress, and compassion fatigue – and may help you identify areas where you want to focus your self-care.

Remain vigilant

Fonken also encourages veterinarians to watch for signs of burnout or depression among their peers. “

“Take the time to observe your colleague's behavior,” she says, and look for the following signs:

·         Withdrawal, avoiding social contact and invitations.

·         A change in performance.

·         Arriving late to work, calling in sick or increased absences.

·         An increase in irritability, and quick to respond with anger.

·         Appearing exhausted emotionally, physically or mentally.

·         Seeming disconnected, going through the motions without the normal level of commitment and care.

·         A change in their physical appearance, disheveled, unclean.

·         A negative disposition focused on what is wrong, what is missing and what is not going well.

·         Signs of substance abuse.

·         Appearing down, low on energy and unmotivated.

·         A change in their ability to concentrate on and perform normal tasks.

·         Compulsive behaviors such as overspending or overeating.

Start the conversation

Fonken notes that many people, after noticing a co-worker is behaving unusually, are unsure how to approach them or how to offer help. In spite of the discomfort, it is important to have the conversation. Before you have the conversation make sure you:

·         Have the time it may take to listen and talk through the situation.

·         Are willing to be a support and follow through with what might be needed.

·         Have a few resources to which you can refer your colleague (some are listed at the end of this article.)

·         Find a quiet and confidential place where you will not be interrupted.

 These steps will create a level of safety for both you and your co-worker and will help facilitate trust.

Next begin exploring the situation. Tell your co-worker you are concerned and you wanted to reach out to check in with them.

1.       Share specific examples of what you have noticed and observed. Give examples:  “I noticed you seemed distracted and upset when we were working with Mr. Smith.” “Over the past three weeks you have arrived at least 30 minutes late on more than six occasions.”

2.       Ask open ended questions which invite your co-worker to talk about what they have been experiencing. “Over the past few weeks I have noticed you seem to be irritated with me, and not looking me in the eye, can you help me understand what is going on?”

3.       Listen generously without judgement or coming to conclusions. After they have spoken repeat what you have heard to check for full understanding.

4.       Do not steer the conversation away from your co-worker by saying things like “oh, that happened to me once and I did……” this is a time to listen to their story. Though at times it is helpful to share our own experience, this initial meeting is not that time.

5.       Be ready for emotions or silence. Much of getting to the bottom of what is going on will come out if you allow for the silence. Though it may be uncomfortable it is important.

6.       Resist giving advice or jumping to how you think this situation can be “fixed”. If you move too quickly into solutions it can change the focus and your co-worker may stop sharing and feel you really do not care, you just want a resolution.

7.       Ask your co-worker what support and resources they already have, and what additional support they feel might be helpful to them.

8.       Remember you are not a therapist, however, you can provide support to your co-worker and help them in identify and accesses appropriate resources. Reassure your co-worker they matter to you and you are there to help.

 

Resources for assessing behavioral health

 

While serious behavioral problems indicate a need for professional counseling, a wide variety of online resources, several tailored specifically for veterinarians or agricultural workers, can provide a good start toward recovery.

·         AVMA Wellness and Peer Assistance website: www.avma.org/ProfessionalDevelopment/Personal/PeerAndWellness

·         National Suicide Prevention Lifeline: 1-800-273-8255

·         Ag Behavior Health website, from Iowa farmer, cattleman and clinical psychologist Mike Rosmann, PhD:  www.agbehavioralhealth.com.

·         Tools for self-screening: www.mentalhealthscreening.org.

·         National Institute of Alcohol Abuse and Alcoholism: www.niaa.nih.gov.

·         Man Therapy – “Therapy from the creators of pork chops and fighter jets”: http://mantherapy.org.

·         Locate a therapist in your area: http:/therapistlocator.net.

·         QPR (question, persuade, refer) training: www.qprinstitute.com

·         Online counselling: https://get.talkspace.com

·         High Performance Living for veterinarians: www.highperfliving.com