Veterinarians, mind your mental health

 

Veterinarians, whether specializing in large or small animals, deal with stress under the best circumstances. But in this time of difficult decisions for pork producers and those who service them due to COVID-19, maintaining mental health is even more of a concern, Athena Diesch-Chham told Pig Health Today. The veterinary social worker in the Veterinary Medical Center, College of Veterinary Medicine at the University of Minnesota said mental health has been a taboo subject for far too long, noting that “the quickest way to break that stigma is for everybody to join in the conversation. This is a population that has held that off for a very long time.”

Statistics on veterinary mental health shocked the veterinary profession when they were released about 6 years ago. The numbers were alarmingly high, but some people remained in denial.

“I remember the first conference I ever went to,” Diesch-Chham recalled. “I actually had a large-animal veterinarian tell me, ‘This is a small-animal problem. We don’t have this in large-animal practices.’”

When the American Association of Swine Veterinarians reached out to Diesch-Chham to speak to swine veterinarians, it was evident to her that the topic couldn’t be ignored. Thankfully, the response has been positive. Swine veterinarians are getting into the conversation and are talking about what they can do to deal with stress.

Unsustainable model

A number of factors contribute to stress, but in reality, veterinarians are part of an unsustainable model, Diesch-Chham said. The high debt and isolation are part of being a large-animal veterinarian because their practices are primarily situated in rural areas. Other characteristics of the profession have existed for a long time, too.

“We could talk about the old standard of veterinary medicine, where you work 100 hours a week, you are on call all the time, you are the lifeline for producers, you don’t take vacations and you don’t say no,” Diesch-Chham said. “You give, you give and you give, and that’s not sustainable.”

Large-animal veterinarians who have reached retirement age are having a hard time finding people to take over their practices, Diesch-Chham said. They want to blame it on a poor work ethic by the younger generations, but it’s more a matter of sustainability, she added, noting the model hasn’t been sustainable for decades.

Caretaker genome

Veterinarians go into the profession because they love animals. The individuals select this profession somewhere between the ages of 5 and 8, and then  build the rest of their lives around becoming a veterinarian, Diesch-Chham said.

“They have a built-in caretaker genome from early on,” she said. “That caretaker gene makes it really hard for [veterinarians] to say, ‘No,’” she added.

It also makes it difficult for them to allow time for themselves. The empathy they have for the animals in their care as well as for the farmers with whom they work overrides their personal wellness at times.

“Veterinarians have feelings, and in veterinary medicine we do not teach people how to manage those feelings,” Diesch-Chham said.

Understanding stress

Diesch-Chham pointed out that not all stress is bad. In fact, manageable stress can help people reach levels of peak performance.

“That’s when we are doing great things, but most of us cannot acknowledge and/or have no awareness of where the line is [between positive and negative stress],” she said. “Almost all of us push ourselves over the curve, and that is when we start to see the signs of burnout.”

When that burnout goes on for a long time, it has, in the past, been called “compassion fatigue” but Diesch-Chham and others in the veterinary mental-health profession refer to it as “moral distress.”

Moral distress

“Moral distress is about going too far for too long with situations that may or may not sit perfectly within your moral compass,” Diesch-Chham said. “If we think about veterinary medicine and how often that happens — how often they are told they don’t have the autonomy to say ‘no’ to certain situations — we get to moral distress.”

Diesch-Chham first heard about moral distress and moral injury about 5 years ago and feels research on the topic has come a long way since that time.

“It’s awesome to see mental-health professionals studying it and applying it to veterinarians,” she said. “I have never met a veterinarian who stopped caring, and I would hypothesize that they care too much for too long.”

Warning signs

When you ask someone how they’re doing, listen to their answer, Diesch-Chham said. “If they say, ‘I’m okay,’ or ‘I’m fine,’ stop right there. Those are canned answers.”

That means the individual is probably not okay. It may mean he/she doesn’t want to discuss details or doesn’t know if it’s safe to discuss details with you, Diesch-Chham explained. Dig deeper, she said. Make eye contact and show genuine concern so the individual will share with you how he or she is really feeling, she said.

Veterinarians may serve as a first line of defense for producers who are struggling with stress, too.

“My dad is a producer, so I’ve watched a lot of this my whole life,” Diesch-Chham said. When things are going well, she sees how he interacts with his veterinarian and producer friends. She also sees what happens when the market tanks or when disease hits.

Active engagement needed

Changes within veterinary medicine need to occur, and awareness of those around us needs to improve, starting with active listening and picking up on cues.

“If a veterinarian walked on my farm and said, ‘Hey, how is your family?’ [he or she] might find out way more about the stressors going on in that farm or in that family than any other conversation,” she said.

The same is true for veterinarians: It’s important for them to communicate and go beyond surface pleasantries when they talk with peers and loved ones.

Diesch-Chham encouraged veterinarians who experience moral distress to reach out to their mental-health community.

“You can’t pull anybody else out of the stream if you’re in it too,” she said. “We need to get veterinarians to a better place. Pull yourself out of the stream so you can help all of us on the banks pull people out who need help.”