This blog addresses sensitive issues around stress, burnout and suicide.

In the last few months, you may have seen posts from your practice, or stories on social media, about vets who have died recently.

However, some of these aren’t vets who were killed by dangerous dogs, or angry bulls, or frightened horses. Some weren’t vets who died in a work-related accident, or from catching an infectious disease from a patient. Some of these deaths have been veterinary professionals who have died by suicide, and many of your veterinary team and lots within our community may be grieving the loss of a friend and colleague.

Mental health burdens are statistically high in our profession – one burden that most people outside the profession don’t know anything about. In order for you to understand this complex issue, so you can best navigate these sad posts you may be seeing in relation to your practice, and hopefully helping you to understand how best to support your lovely veterinary team, we have written this article to explain a little more about mental health in the veterinary profession.

Are vets really at risk?

It’s a reasonable question to ask. You may believe that vets, as educated professionals usually with a strong sense of duty and vocation, may have a very comfortable life. 

However their pay is often much lower than comparable professions. Financial worries can be a real concern for many professionals due to a number of factors, but veterinary professionals will struggle with the same cost of living crisis that we are all feeling right now, and often have overheads such as yearly professional registration, professional insurance and other work related outgoings that may add to the worry. Financial stress can impact anyone’s mental health, including veterinary professionals. 

Veterinary surgeons in the UK are three to four times more likely than the general population to die by suicide (Platt et al., 2010). We’re a small profession too (perhaps 33,000 in the UK): any vet you meet is likely to know or have known someone who has taken their own life.

Why are veterinary professionals at a high risk of mental health burdens?

This is a perennial question. And there isn’t a simple answer – because the reasons are complex and multifactorial. Our profession does seem to be more severely affected, but risk factors for poor mental health – and suicide – in the general population include personality factors, depression (as well as other forms of mental illness), alcohol and drug abuse, inherited factors, and environmental factors (including chronic major difficulties and undesirable life events). In the veterinary profession lots of reasons have been suggested in the past for these sad statistics, however it is important to note that although there may be risk factors, the statistics are a reflection of a very complex set of factors and cannot be solely attributed to one thing.

According to Bartram and Baldwin, the following factors may contribute to the increased risk of suicide in the veterinary profession: personality factors, undergraduate training, professional isolation, work-related stressors, attitudes to death and euthanasia, access to and knowledge of means, psychiatric conditions, stigma around mental illness, and suicide contagion. 

This was mirrored in another study that showed common contributory factors were workplace relationships, career concerns, patient issues, number of hours and volume of work, and responsibility. However it is important to remember that two-thirds of participants reported co-occurring difficult life events – it is not all down to all veterinary factors but extremely complex combinations of factors.

So what do they mean about the personality factors?

Vets tend to be high achievers, so any failure is seen as worse than it really is. Many are also academically high-flying, so may not have learnt to deal with failure and this can cause them to struggle with mistakes. It is important to remember that we are ALL human, and mistakes do happen, but it is rarely down to an individual but rather a set of circumstances – this doesn’t stop our profession beating themselves up about mistakes no matter how small. Overall, vets can have tendencies to perfectionism, conscientiousness, and neuroticism, all of which can sadly be risk factors for mental illness.

Is it because we deal with death regularly in the job?

It’s often suggested that vets are very used to making welfare assessments of animals. Vets in private practice are commonly required to engage in the ending of life, a procedure called euthanasia. They may have strong beliefs in quality of life and humane euthanasia to alleviate suffering.

Or is it something about veterinary work?

Some research suggests that the “pinch point” is work-related stress and burnout. Lack of professional support and professional mistakes can have an impact. Education is continuing to improve this, but many professionals can take mistakes very hard. 

Along with other work-related stressors such as long working hours; after hours on-call duties; conflictual relationships with peers, managers, and clients; high client expectations; unexpected clinical outcomes; emotional exhaustion (compassion fatigue); lack of resources; limited personal finances; concerns about maintaining skills; and the possibility of client complaints and litigation can all contribute to anxiety and depression, which increase vulnerability.

Our patients can’t talk, and their owners/carers/guardians don’t always seem to be able to interpret their needs and requirements, so it often feels like that burden falls on us. This puts a lot of pressure on one person who is, after all, only human. 

And then we add in the money issue…

Veterinary medicine is often a “distress purchase” – people don’t want to buy it, but they have to. This makes people angry, and often they take it out on the vet – especially when the outcome isn’t good. 

Sadly, 85% of vets reported to the British Veterinary Association (BVA) that either they or a member of their team have felt intimidated by a client’s language or behaviour. Those vets who work with companion animals or in a mixed practice are particularly likely to have experienced difficult clients with 89% reporting some form of intimidating experience. Younger vets and female vets were significantly more likely to have experienced some form of intimidation. The survey revealed that animal owners’ intimidating language and behaviour is often related to the cost of treatment, with 98% of vets saying that at some time they feel under pressure from clients to waive fees or to accept the promise of late payment.

Added to that is the “moral injury” issue: where a vet knows they could help, and wants to help, but cannot because the client cannot afford it. Unfortunately, veterinary care is expensive (I suspect most people in the UK have no idea how much stuff costs!). And the vet’s salary is a small percentage of the bill – usually less than 20%. So even if the vet worked for free (and ended up starving themselves), it still wouldn’t significantly affect the bills for £5-10k that we commonly see for dealing with complex injuries or illnesses.

…And a growing “blame culture” in our society

We regularly hear from vets who struggle with people who leave abusive reviews of them, for example, and this is a significant stressor – it’s happened to us too!

The best thing to do is not engage in or support any attempts of other owners trying to socially shame – you often do not know the entire picture of the events. 

The end result? Burnout

UK Mental Health define burnout as “a state of physical and emotional exhaustion. It can occur when you experience long-term stress in your job, or when you have worked in a physically or emotionally draining role for a long time.”

During the pandemic, many veterinary practices enforced minimal-contact procedures. (For the protection of their staff, and their clients, but above all the protection of animals because if all the vets are too sick with Covid to work then there’s no-one to look after them). This wasn’t the wrong decision; but it has left a stressed and exhausted profession, on top of the existing burnout risk (research is conflicting, but anecdotally it appears to be substantial).

it isn’t clear whether burnout is a suicide risk – but it is definitely a major problem in the profession, and a commonly cited reason why vets leave clinical practice.

Do they seek help?

Vets tend to resist seeking psychological or social help (this used to be true but we hope it’s changing fast)

The stigma around mental illness is known to influence the accessing of mental health services. Such stigma may be particularly problematic for those working in professions in which their identity is firmly entrenched as “the helper”. The need for “helpers” to seek rather than offer help, especially as it relates to mental health, may be perceived as a sign of weakness; engendering feelings of guilt and shame as well as worry about career implications. Stigma is problematic, as it reduces help-seeking behaviour.

The willingness to seek help is also protective, giving those who recognize the need for and value of assistance the edge to build resilience. Likewise, proper interventions (diagnosis and treatment) are protective.

If you need to seek help please contact your GP, local mental health trust. Or if you’re a vet or vet nurse, Vetlife on  0303 040 2551

So what is the reason for the increased suicide risk?

Suicide is always multifactorial, and a vet’s professional life isn’t necessarily the cause. There’s no-one thing that makes a person make that decision.

It is a hard topic to talk about, and it’s important to talk. But it is very important how we do that. When we talk about suicide remember we must be careful with our language; not oversimplify or point fingers at a single cause; we must respect the bereaved; be careful with memorialisation and above all be there, be supportive and signpost to help at all times.

What can we do?

Try to be supportive of our vets, friends and colleagues. This isn’t an issue confined to the veterinary profession, although the risk factors are clearly higher than in most. Talking to people, so they know they aren’t alone, and there is support, is very powerful.

If you’re a veterinary professional reading this, and are struggling with any problems – please, please, please talk to someone about it! A friend, a family member, or the great people at VetLife on 0303 040 2551. Vetlife is there for you 24/7 – anytime. You do not need to be at crisis point to reach out.

And please do remember when you want to complain or make negative comments that there’s a real person behind the professional face. If you need to make a complaint – do so. But don’t make it personal, don’t be abusive, and try not to perpetuate the cycle. Only ever complain constructively.

And if you can – think about donating to Vetlife, the support charity for the veterinary industry.

If you don’t read anything else from this article…

Remember that being stressed and burnt out doesn’t mean there’s no way out. Many, many people suffer from these problems, and make a full recovery. What you feel now isn’t forever; and there are people all around you who you can turn to for help. All it takes is to say “I’m struggling”.

All of us, vets, nurses, animal owners, need to work together to support each other.

References and Further Reading:

Many thanks to Rosie Allister for her input to this article.