Fall 2016

Under Pressure

The first mental health survey of U.S. veterinarians paints a sobering picture: One in six has contemplated suicide. Why are these healers feeling so desperate? And what’s being done to help care for them?

By Genevieve Rajewski

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Illustration: Hanna Barczyk

The house smelled fresh and clean, and sun was pouring through the windows the day that Kim Pope-Robinson sat on the bed, ready to take her own life. Full of hope and joy when she entered vet school 10 years earlier, she now felt broken and alone. A chronic illness had made it too physically painful to practice veterinary medicine anymore, and the daily grind of practice had worn her down to the point where she no longer wanted to live.

Pope-Robinson may have felt alone, but when it comes to vets contemplating suicide, her story was startlingly common. According to the first mental health survey of U.S. veterinarians, published in October 2015 in the Journal of the American Veterinary Medical Association, one in 10 U.S. veterinarians was experiencing serious psychological distress, and one in six had contemplated suicide since graduating. What’s behind these startling numbers? Experts say that for many veterinarians, practice carries environmental risk factors for suicide that are exacerbated by a culture and personality types that are common among veterinary professionals. Now Cummings School is part of a national movement to help vets understand the mental-health risks implicit in practice and recognize when it’s time to get help.

As Pope-Robinson sat on her bed that day back in 2010, and contemplated ending it all, something else suddenly entered her thinking: her horse. Who will take care of him when I am gone? No one will love him the way I do. From there, her certainty that suicide was the only solution to how trapped she felt began to subside.

Most Vets Are Happy with Their Careers

The vast majority of veterinarians surveyed in the JAVMA study said they were pleased with their occupation. “One of the key findings was that 80 percent agreed or strongly agreed they were happy being a veterinarian,” said Randall Nett, coauthor of the study and a physician working at the U.S. Centers for Disease Control and Prevention. “But we must take steps to make sure those who are suffering get the support and mental health services they need.”

“As a student and then through my internship and residency, I didn’t feel like I could show any signs of weakness or talk to anybody about it.”

Nett stressed that only a small percentage of veterinarians are at risk of suicide, but pointed to studies that show vets are anywhere from 1.6 to 4 times more likely to die from suicide than are members of the general population. Determining precise rates by profession is difficult—in part because suicide is believed to be vastly underreported as a cause of death—but data collected in 2015 by the National Institute for Occupational Safety and Health indicated that the suicide rate among veterinarians is the fourth highest among all professions, trailing only physicians, dentists and police officers.

A higher suicide rate among veterinarians likely occurs because of the complex interaction of job-related stresses and personality characteristics common to people who go into veterinary medicine, Nett said. In the JAVMA survey, veterinarians overwhelmingly identified the demands of practice as their key stressor: the long hours and large caseloads, the financial and management responsibilities, the grief related to animal deaths and the ethical challenges posed by the need to euthanize healthy animals or to help clients who lack the means to pay for treatment. Nett said he was inspired to conduct the JAVMA survey after reading a JAVMA News article about the amount of stress associated with the veterinary profession, and in part because he’s married to a veterinarian. “She practices critical care and emergency veterinary medicine,” he said, “and I’ve seen her come home from days at work when she’s had to do eight euthanasias and just been completely wrecked, emotionally and physically and mentally by that. I’ve seen a workload where she’s supposed to work a 12-hour day but she ends up working 18, 19, 20 hours because there’s so much work to be done.”

Driven to Perfection

But it’s not just the demands of the job, said Barry Feldman, the director of psychiatry programs in public safety and an assistant professor of psychiatry at the University of Massachusetts Medical School. Veterinarians tend to be high achievers and perfectionists, said Feldman. “You often see this cognitive style in the medical professions, where there are lots of bright people who were used to doing well in school,” he said. “When they start to struggle, that can feel almost catastrophic.” Indeed, veterinary students are also at risk. In a nationwide survey conducted through the Student American Veterinary Medical Association (SAVMA), 60 percent of veterinary students reported experiencing depression, with two-thirds of them saying that the bouts lasted for longer than two weeks—the clinical definition of depression. Five percent of the students said they’d gone so far as to formulate a suicide plan. “So of the 3,888 students who answered our survey, 194 said yes, they had put a plan in place to kill themselves,” said Michael McEntire, a vet student in Texas A&M’s Class of 2017, who helped convene a yearlong SAVMA wellness task force after learning that one of his classmates had tried to kill herself.

Kimberly Pope-Robinson credits her horse, Toby, for saving her life. Sadly, Toby died recently at age 18.

So, many vets and vet students work under tremendous pressure, and some of them are predisposed to take failure—or the perception of it—especially hard. The final piece of the puzzle is that veterinarians also have easy access to a means to actually do themselves harm: the drugs used for animal euthanasia. “You find that when veterinarians die from suicide, they more often die from self-poisoning compared with the general population, which makes sense,” Nett said. “Even compared with physicians, they really have unparalleled access to lethal drugs and the knowledge of how to use them. Our study also found that, compared with U.S. adults, veterinarians actually reported fewer suicide attempts, and unfortunately that’s probably because they’re more successful at completing suicide.”

“There’s a pervasive myth that asking someone if they’re depressed or having thoughts of suicide plants the seed for suicide. But research absolutely refutes that.”

Nicholas Robinson, an associate professor and pathology section head at Cummings School, is all too familiar with the faces behind these statistics. During his time at veterinary school in Australia, Robinson knew of a local vet who died by suicide, as well as a vet student who took his own life. After moving to the U.S. to work as a pathologist at an academic veterinary medical center, Robinson met a resident who ended up killing herself. “The afternoon before, I was sitting right next to her during a rounds seminar, and she seemed to be doing really well,” he recalled. “The whole place wasn’t the same after that. It was obviously tough on a personal level. But in retrospect, a few years on, the thing that was really eye-opening was the degree to which people went to not talk about it.”

Not talking about suicide has dangerous consequences said Feldman, who specializes in suicide intervention and prevention. “There’s a pervasive myth that asking someone if they’re depressed or having thoughts of suicide plants the seed for suicide. But research absolutely refutes that,” said Feldman, who spoke last summer, at the invitation of Tufts adjunct associate professor Michael McGuill, V91, at the American Veterinary Medical Association conference in Boston. “Telling someone that you’re worried about them and asking directly if they’re thinking about ending their life can actually serve to help get them into the mental health arena. I find it really encouraging that there’s finally a lot of very open dialogue about opiate addiction and opiate overdoses. We need the same kind of discussion around suicide.”

“The people who need the help the most, as far as mental health treatment goes, appeared to have the highest degrees of perception of stigma against those with mental illness.”

That’s especially important—and challenging—when it comes to vets. Nett said that the JAVMA study found that veterinarians, particularly those suffering from significant psychological distress, were less likely than the rest of the population to believe that people are generally caring toward those with mental illness. “So the people who need the help the most, as far as mental health treatment goes, appeared to have the highest degrees of perception of stigma against those with mental illness,” he said.

The Cummings Community’s Response

To begin changing that, Cummings School students and faculty have made it their mission to promote mental health and to openly discuss their personal struggles. Two behavioral health counselors and one career counselor are available to meet with students on campus in the newly established Cummings Support Center, and licensed counselors are also available 24/7 on a confidential phone line. The school also supports its faculty, staff, residents and interns with an on-campus behavioral health counselor, as well as additional in-person counseling and a 24/7 hotline.

Over the past academic year, students have also organized several first-of-their-kind events to address mental health. For instance, Pamela Bay, V18, invited a nationally known vet to give two SAVMA talks on burnout and compassion fatigue. And as part of the first wellness week ever held on campus, Stephanie Chubb and Justina Bartling, both V18, organized a panel discussion in which faculty and other practicing veterinarians talked about how they’ve successfully coped with personal issues. During Diversity Week, meanwhile, a comedian performed a show about his personal struggle with depression that was followed by a discussion.

Heartened by the reaction on campus, the Tufts chapter of SAVMA has established a permanent wellness committee to plan monthly events about mental health and positive coping strategies. And this coming academic year, Cummings School will begin offering The Healer’s Art, a 15-hour selective for first- and second-year students led by Jennifer Graham, an assistant professor and exotics veterinarian, and associate professor Flo Tseng, the director of the Tufts Wildlife Clinic. The program—taught at 90-plus U.S. medical schools and a small, but growing number of veterinary schools—encourages students struggling with the stresses of the profession to focus on what drew them to it in the first place, and to make peace with the impossibility of curing every patient. Last, Bill Wagner, V16, started a conversation about work-life balance for students in the clinical year—a period, the SAVMA study found, during which self-reported rates of depression, suicide ideation and self-harm increased among veterinary students. Faculty members are using the document to craft new recommendations for clinical rotations.

The goal of all these efforts is to change the culture of the veterinary profession. “As a student and then through my internship and residency, I didn’t feel like I could show any signs of weakness or talk to anybody about it,” Graham said. However, not long after Graham finished her residency, her mother died by suicide, a devastating loss that pushed her to finally seek help for her own feelings of deep depression resulting from compassion fatigue “and a pretty intense struggle with my own sexual orientation. I share all this openly now because it worries me that someone I could influence might be feeling like they can’t reach out for help,” she said.

“We never think our very accomplished professors or classmates are going through anything.”

In that spirit of open discussion about the challenges and stresses of being a veterinarian, Michael McEntire, the Texas A&M vet student, has worked with SAVMA to create a series of online video interviews in which vets and vet students who’ve struggled with their mental health discuss the importance of talking with others about feelings of depression. “We never think our very accomplished professors or classmates are going through anything,” McEntire said. “It always seems like they’ve all got their acts together.”

Nicholas Robinson, the Cummings School associate professor, said that it all comes back to addressing the perfectionism that seems to define so many vets and vet students. He noted that, at least once in their career, most veterinarians will be written up for something, even if they do everything right. “That happened to me my first year out of school, and it turned out as well as it could have gone, but the process took six months and I had a hole in my stomach the whole time, I was so upset,” he said. “You don’t have to like being wrong,” he told the audience during a recent student-run wellness panel at Cummings, “but you have to know how to learn from and deal with it.”

“I was still distraught, but I chose life. I just had to figure out the way that I wanted to live now.”

As Kim Pope-Robinson sat on her bed thinking about taking her own life, the thought of her horse and who would care for him gave her a crucial pause. From there, she considered her husband, and the awfulness of him having to find her body. Before long, she’d decided against suicide. “If you can just wait, that moment might pass,” Pope-Robinson told Cummings School students during a recent teleconference about mental health. “I was still distraught, but I chose life. I just had to figure out the way that I wanted to live now.”

For Pope-Robinson that meant leaving her position as a veterinary medical director supporting multiple locations across a large geographic area in California, where she had become mired secondhand in the emotional pain and struggles of the veterinarians who reported to her. After stepping away from veterinary medicine to work in the pharmaceutical industry, she eventually chose to become a veterinary career coach and industry speaker focused on helping vets confront the emotional tolls of practice and find healthful ways to cope with them. “I hope to help us all move from the mindset of ‘name it, blame it, judge it’ to ‘recognize it, accept it and then manage it, ’ ” she said.

Recently, as she prepared to speak at a conference, Pope-Robinson admitted that, despite her fulfilling career, she still struggles with moments of professional paralysis. “Right now I’m overwhelmed with everything coming at me. I just want to curl up in bed and do nothing. I constantly have the fear of disappointing people,” she said. “But I am working on being OK with that, because there are enough people who care about me that I want to be here. And not just people, but my dog.”

Contact Genevieve Rajewski, the editor of this magazine, at genevieve.rajewski@tufts.edu.


RESOURCES FOR HELP

If you are in crisis, call the National Suicide Prevention Lifeline at 1.800.273.8255, or dial 911 or go to a hospital emergency room.

Cummings School students can meet with behavioral health counselors on campus at the Cummings Support Center: Beth Milaszewski on Tuesdays from noon to 8 p.m. or Mintz on Thursdays from 10 a.m. to 6 p.m. Call 800.756.3124 to schedule an appointment (be sure to identify yourself as a Tufts student). Licensed counselors are also available to provide phone support 24/7 via that confidential line.

Cummings School faculty, staff, residents and interns can meet with behavioral health counselor Adam Mintz at the Cummings Support Center on Thursdays from 10 a.m. to 6 p.m.; call 800.756.3124 for an appointment. Additional in-person counseling and a 24/7 hotline are available through Tufts’ Employee Assistance Program by calling 1.800.451.1834.

Samaritans of Boston offers texting support to anyone dealing with suicidal ideation or feelings of isolation and despair. Text to 877.870.4673.

The American Foundation for Suicide Prevention explains risk factors and warning signs of suicide: bit.ly/AFSPrisks.

S.A.V.E. (Suicide Awareness in Veterinary Education) provides mental health information to vet students: www.vet.utk.edu/save/education.

Active Minds is a nonprofit organization that empowers students to speak openly about mental health in order to educate others and encourage help-seeking: activeminds.org

The national Student American Veterinary Medical Association (SAVMA) has created a series of video interviews with veterinary students, faculty and clinicians about their struggles in veterinary school and in practice: bit.ly/savmavoices.

“Not One More Vet” is a private Facebook support group strictly for veterinarians. To join the group, go to Facebook.com and message Carrie Jurney, Nicole Blackmer McArthur or Jason Sweitzer with some evidence that you are a veterinarian (your graduating class, where you work or where you’re licensed) and your email address.

The Survivors of Suicide website seeks to help those who have lost a loved one to suicide: survivorsofsuicide.com.

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