
A Psychiatrist, a Veterinarian, and an Emergency Physician Resolve to Improve Mental Health
Professionals in our fields are even more reluctant than the general public to seek mental health care because of stigma and negative career consequences. Here are 10 ways to address mental "unwellness."
COMMENTARY
Dr Moffic is an editorial board member and regular contributor to Psychiatric Times. He was a tenured Professor at the Medical College of Wisconsin. Currently, Dr Moffic is focused on three major advocacy initiatives: physician burnout, climate change, and Islamophobia. Dr Gaspar is a veterinarian at Veterinary Information Network, Chicago,IL. Dr Levin is Chair, Wellness Section, American College of Emergency Physicians, Milwaukee, WI.
Between animal and human medicine there are no dividing lines-nor should there be.
–Rudolf Virchow, MD, father of cellular pathology
On the shortest day of the year in December 2018, the American Psychiatric Association’s (APA) daily featured a dark subject about the suicide rate in veterinarians, also reported in the
A terrible truth of student suicides is that those who start medical school and residency are generally psychologically healthy. One can deduce, then, that
Moreover, suicide is the tip of the iceberg of our personal psychological distress and disorders. Our mutual professions have higher rates than the general population for clinical depression, epidemic rates of burnout, and related problems. Those healers with the most compassion seem
For the public, the prevalence of mental disorders has increased to over 20%, and most never receive any effective treatments. Outside of formal diagnostic disorders, a host of other public
The American Psychiatric Association Foundation, the funding arm of the APA, called for “A Mentally Healthy Nation for All” in 2018. However, simple math suggests that we are
Historically, beyond a general altruistic calling, many believed that those who chose to be veterinarians, psychiatrists, or other kinds of physicians, were often doing to so to address some traumatic and/or inspiring medical or psychological experience in their childhood. For veterinarians, that would likely involve beloved animals. That emotional tie to the past could leave us vulnerable to frustration in helping our patients. Such frustration results more and more from the systems we work in that have become more corporate and business-oriented, with the consequence of controlling how we practice, decreasing our empowerment, and providing obstacles for our ability to heal and fulfill our callings.
Along the way, those entering our fields start out under a mountain of debt with an income that fails to keep up with opportunities to alleviate that debt. That can lead to career choices that emphasize reimbursements over the passion to treat certain populations which may not be as financially lucrative. A balanced home life with children and family is a dream that is pushed more into a distant future.
With all these stressors, it would not be surprising that mental health care for ourselves would be needed. Indeed, when psychiatrists conducted more psychotherapy, psychiatrists in training were expected to receive their own psychotherapy. But no more. Professionals in our fields often are even more reluctant than the public to get such care because of stigma and the negative consequences of people knowing about one’s mental illness. Many fear loss of jobs and/or licensure. The tragedy is that intervention is often successful, and the recipient can enjoy the benefit of true empathy for the psychological suffering of everyday patients
Until recently, psychiatry has not focused much attention on mental health challenges less severe than diagnosable disorders. Unfortunately, the field has largely neglected wellness and burnout, even to the extent of not trying to better understand and define what these colloquial terms mean.
What a loss it has been, and will continue to be, if psychiatry does not expand its range of concerns and seek to resolve them. Perhaps our absence is even associated with the rise of burnout at epidemic levels. After all, our expertise in deeper psychological processes, which are often counterintuitive, has been missing. For instance, there has been an almost universal quest for more resilience in physicians. Certainly, developing resilience is helpful for psychological and post-traumatic growth. Yet, that resilience is almost part and parcel of becoming a veterinarian or physician. Can we have “too much” resilience-that is, do we ignore psychological problems and instead soldier on as we have been taught to do?
Psychiatry and veterinary medicine
We in psychiatry can do better with veterinarian patients, who have unique challenges. The desires of animal owners, who are the clients, may conflict with how the veterinarian wants to help the animal patient. Owners can be critical of the costs and blame the veterinarian for being greedy and not loving the animals “enough,” causing unnecessary guilt. Fortunately, some of us in psychiatry have experience trying to help animals, whether that be behavior modification techniques, the use of medications, and appreciating that service dogs can be ancillary healers. Animals and humans, too, share some of the same mental health challenges, including loneliness and loss.
In turn, perhaps veterinarians can help us deal with death. Although rare in psychiatric practice, deaths directly related to psychiatric practice are suicides, homicides, and medication adverse effects. Veterinarians have an acute understanding of death in their animal patients. Those who have learned to positively cope may help psychiatrists in processing the rare patient suicide. The potential to work together is mutual, as our expertise in grief can help veterinarians who are overwhelmed by such losses. For some veterinarians, can taking the lives of so many animals blur the ethics of taking one’s own life?
Only in recent years has psychiatry become familiar with euthanasia. Physician-assisted deaths are now available in some states and various European countries. The role of psychiatry in screening and/or treating patients who request death varies.
Emergency medicine and burnout
Emergency medicine has made strides in developing programs to increase wellness and to reduce burnout after burnout rates soared to epidemic levels. Attention expanded from focusing on individual physician wellness to the greater influence of systems that dis-empower physicians from healing as best as we know we can. In 2018, Medscape
Addressing mental “unwellness”
The alarming
1. Label our high rates of suicide, mental disorders, burnout, and xenophobia a national mental health care crisis and find the best ways to communicate this to the public and politicians.
2. Normalize self-disclosure of our own emotional problems; and convey as much compassion, validation, and mercy to one another as we do to our patients.
3. Expand psychiatry beyond integrated medicine into integrated veterinary medicine.
4. Consider the use of safe, accurate, and effective screening tools for suicidality, depression, trauma, burnout, racism, and resilience.
5. Help develop research-based interventions for conditions that may be less severe than DSM disorders.
6. Develop psychologically engaging communities via prevention, treatments, maintenance, self-actualization, community actualization, and disaster planning.
7. Include veterinary medicine with all the medical specialties in the National Academy of Medicine coalition that is working on wellness and burnout and, in turn, have psychiatry included in joint endeavors like the One Health Initiative, which is devoted to the well-being of people, animals, plants, and the environment.
8. Learn from emergency medicine that these problems will not be solved quickly but need an ongoing commitment.
9. Pull together conferences, books, small retreats, and related projects that include all healing professions and physician specialties, mental health care professionals, nurses, dentists, veterinarians, and other allied health caregivers.
10. Be active politically to advocate for leadership that embraces the mental health of mankind as its business.
The three of us know through experience that our fields can work together successfully, as illustrated by a retreat last October for veterinarians from all over America. With the facilitation and overlapping expertise of the authors, they shared and discussed their workplace stories that needed to be heard.
Therefore, as the year 2019 begins, we hope that we are representing our professions well, and we resolve to do whatever we can to solve our mental health challenges. Will you join us?
Have something to say? Contact us at editor@psychiatrictimes.com and your comment might be considered for posting at the end of this article with a response from the authors.
References:
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9. Peckman C. Medscape National Physician Burnout & Depression Report. Medscape. January 17, 2018.
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