Abstract

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Summary

It has recently been shown that the veterinary profession in England and Wales has one of the highest incidences of suicide of all occupations¹. The alarmingly high incidence of suicide within the veterinary profession has attracted a tremendous amount of attention in the veterinary press and has also instigated a discussion in the wider media as to why a profession with such a positive public profile had a strikingly high incidence of suicide. Whilst it is widely agreed that the veterinary profession needs to address the issue of suicide, there is no industry wide, clear consensus as to what the response should be. In this lecture I will argue that the most appropriate response is to further explore the issues of suicide through high quality research which will provide the foundation for objective, evidence based initiatives and programmes aimed at reducing the incidence of suicide in the profession. Specifically, I will argue that we need to explore why the veterinary profession has such a high incidence of suicide through a variety of research approaches as well as examining whether this statistic is a reflection of poor mental health well being across the profession. I will outline nine areas which I feel warrant further research and discuss some ongoing work in some these areas.

Do veterinarians have poor mental health well being?

The observation that the veterinary profession has a high incidence of suicide may simply reflect ease of access to lethal means or difference in attitudes towards human euthanasia, but it also represents the 'tip of the iceberg' of a much broader problem of poor mental well being amongst veterinarians. Consequently, one of the most important questions the profession needs to address is what is the incidence of poor mental wellbeing amongst veterinarians, and how does this compare with that of the general population and other health care professions? Furthermore, what particular socio-demographic, personality and work related features predict poor mental wellbeing in veterinarians? A deeper understanding of these issues will enable the profession to establish whether veterinarians have a widespread problem with mental health well being as well as suicide. In addition, greater knowledge of these topics will establish what factors, both work and non-work related, predict poor mental health amongst veterinarians. The RCVS, VBF and SPVS have funded a collaborative proposal by the author and colleagues to explore these issues by sending a questionnaire to 20% of RCVS registered veterinarians. This work will begin this spring and we will publish the findings in the next 18 months. Other workers have initiated a similar project utilising a different methodology.

What is the background of veterinarians who commit suicide?

Very little is known about the demographics and background of veterinarians who died by suicide. A previous study has identified that 10 of the 26 male veterinarians who committed suicide between 1991 and 2000 were younger than 45 years of age but little other information is available. on the demographic background and circumstances of veterinarians who take their own life.¹ Consequently, it is important to clarify these issues so that it can be established if there are particular subsets of the profession, whether these groups be defined by age, personal or work-related parameters, which are at particular risk. A well established approach to addressing these questions is the use of a psychological autopsy where the coroners' reports of people who have died by suicide are systematically reviewed. Similar studies have been undertaken in other professions which have a high incidence of suicide, such as farmers and nurses, and these have been extremely useful in clarifying the background and circumstances of individuals who commit suicide in a very sensitive manner. A review of coroners' reports of veterinarians who have committed suicide is currently on going at the University of Oxford. This study has been funded mainly by Hill's Pet Nutrition with additional support from RCVS Trust and VBF. It is important to highlight that this approach will only review coroners' reports and will not attempt to contact family or friends of veterinarians who have died, the data will be anonymised and the project will undergo strict ethical review and approval by an NHS Ethics Committee.

Is the incidence of alcohol and drug misuse higher in the veterinary profession?

Alcohol and drug misuse are commonly linked to both poor mental health wellbeing and suicide. Given the clear evidence of increased mortality by suicide in veterinarians, it is important to establish whether alcohol and/or drug misuse are commonplace within the veterinary profession. This could be investigated using a number of approaches, notably through consumption questionnaires of veterinary students and veterinarians. A different approach to establish the incidence of severe, lethal alcohol misuse in specific occupations can be undertaken by establishing the incidence of alcohol related deaths in specific professions. Interestingly, recent work found that there was no evidence of increased mortality due to alcohol related deaths within the veterinary profession (Mellanby et al, manuscript submitted). However, this finding should not diminish the need to establish the incidence of sub-lethal alcohol misuse in the veterinary profession as well as exploring the incidence of drug misuse.

How can the transition from undergraduate to practising veterinarian be optimised?

It is widely acknowledged that the transition from undergraduate to practising veterinarian can be difficult and stressful. Recent work has shown that many recent veterinary graduates work with little supervision or support and that many make clinical mistakes which can be extremely stressful to the veterinarian involved.² Therefore, it is crucial that the veterinary profession develops strategies aiming to optimise this transition and reduce the stress faced by veterinarians beginning their clinical careers. Despite the importance of this subject, surprisingly little work has been undertaken to establish the attitudes of recent graduates on their personal transition from student to vet, how this transition can be optimised to the benefit of the graduate, their employers, their clients and animals under their care, and how current support mechanisms aimed at easing the transition are performing. To address this topic, the RCVS Trust Fund has recently awarded a grant to the author and colleagues to undertake a questionnaire based survey of recent graduates' attitudes to mental health well being, job satisfaction, key workplace stressors and the efficacy of current support structures. It is hoped that this questionnaire will provide objective data allowing the profession to develop strategies to ensure that the transition from student to vet is optimised.

Is a high incidence of suicide amongst veterinarians a global phenomenon?

From the studies currently available which have investigated the relationship between occupation and suicide, it appears that veterinarians have an almost universal higher incidence of suicide regardless of the country studied. I am unaware of any studies which have robustly demonstrated that veterinarians within a specific country do not have a higher incidence of suicide. It is hoped that as many countries as possible will examine the incidence of suicide within their veterinary profession; the identification of a country which does not have a higher incidence of suicide amongst its veterinarians would offer the global veterinary community an excellent opportunity to develop a comparative research programme, hopefully identifying work and non work related factors which may be protective in certain countries.

How can veterinarians engage more effectively with and ultimately protect high risk colleagues?

One of the greatest challenges facing the veterinary profession is developing specific strategies aimed at reducing the incidence of suicide in the veterinary profession. This is obviously a formidable and highly challenging long term goal which bodies such as VetLife, VBF, Vet Helpline and the VSHSP aim to address. Nonetheless, educating veterinarians to recognise and engage colleagues who might be having thoughts of suicide and to connect them with community resources trained in suicide intervention is widely considered to be crucial in the professions' attempt to reduce the incidence of suicide. However, ensuring that all veterinarians have these skills is difficult and consequently, the veterinary schools need to play a lead role in ensuring that their undergraduates acquire such skills. The RCVS Trust has recently awarded the author a grant to enable the Scottish Association for Mental Health to present a safeTALK half day workshop, which aims to instil basic suicide awareness in first year veterinary undergraduates at the University of Edinburgh. Furthermore, funding has been secured for 6 Directors of Studies to undertake the ASIST (Applied Suicide Intervention Skills Training) two day workshop which gives further training in suicide awareness and intervention. This approach will ensure that a large number of people who have basic skills in suicide awareness (completed safeTALK) can refer concerns to colleagues who have further training in suicide intervention. (completed ASIST). The efficacy of this approach will be evaluated by questionnaires and published in a peer-reviewed journal and if successful this initiative will hopefully become a permanent fixture in the veterinary curriculum.

Is job satisfaction lower in the veterinary profession than other healthcare professions?

The veterinary profession is widely considered by the public and prospective students to be associated with high job satisfaction yet anecdotal evidence suggests that is far from a universal experience. Consequently, it is important for the veterinary profession to assess how satisfied veterinarians are with their jobs, to establish what factors influence job satisfaction and whether job satisfaction influences well being. The medical profession regularly audits job satisfaction amongst its GPs and their initiative affords the veterinary profession an opportunity to compare the satisfaction of its members to their GP counterparts. This analysis will be undertaken in collaboration with the University of Manchester as part of the larger survey of the well being of the profession which has been outlined above.

Do veterinarians have a different attitude towards euthanasia?

Veterinarians often have the responsibility of ending an animal's life through euthanasia and it has been postulated that the routine association with the process of euthanasia may alter the attitudes of veterinarians towards the expendability of human life. A study by Austin Kirwan suggested that this may be the case and his work clearly highlights the need to further expand research in this area.

Is the mental wellbeing of veterinary students different from the wider student population?

As well as considering the wellbeing of the wider veterinary profession, it is important not to neglect the undergraduate veterinary population. We are developing a framework to assess wellbeing amongst our students at Edinburgh which we plan to develop into a long term, longitudinal study which will continue following graduation. This approach will allow us to establish how the wellbeing of students varies during the course and what aspects of the course are particularly stressful, leading to the development of evidence based alterations to the curriculum which will optimise student well being. Furthermore, this approach will yield crucial data on a wide range of issues such as career aspirations, movement between jobs following graduation as well as identifying factors which may lead to veterinarians leaving the profession.

Conclusion

This presentation discusses some of the work which has recently been undertaken in the field of mental well-being within the veterinary profession as well as highlighting some ongoing research in this area. It is hoped that this article will encourage further discussions about future areas of research and promote novel collaborations which investigate the issues surrounding the mental wellbeing of the profession. In addition, it is hoped that funding bodies will be encouraged to support future high quality research proposals and initiatives, especially ones which link interested parties within the veterinary profession with leading academic authorities in disciplines such as psychology, sociology and psychiatry. It is hoped that this research led approach will yield a definitive evidence base on which to build initiatives and programmes which will tackle the high incidence of suicide within the veterinary profession.

Acknowledgements

The author would like to thank the large number of people who are actively engaged in this area in the various collaborations described. Particular thanks are due to Professor Halliwell, Dr Adams, Dr Harrison, Ms Dean, Professor Hawton, Ms Simkin, Ms Platt, Ms Romeri, Mr van Galen, Ms Neumann, Professor Rhind, Professor Gunn-Moore, Professor Platt, Ms Byrne, Mr Kirwan, Professor Sibbald and Professor Lee. I am indebted to the various funders of the studies described in this report which include RCVS, SPVS, VBF and Hill's Pet Nutrition.

References

1.  Mellanby RJ. Incidence of suicide in the veterinary profession in England and Wales. Vet Rec 2005; 157:415-417

2.  Mellanby RJ, Herrtage ME. Survey of mistakes made by recent veterinary graduates. Vet Rec 2004; 155:761-765