Breathing noisily, a 14-year-old dog stood in the corner of an examination room at the Virginia-Maryland College of Veterinary Medicine’s Veterinary Teaching Hospital.
The dog’s owner, motionless in a chair against the wall, wept openly. Crouched before her, a resident looked directly into her eyes. “You’ve made the right decision,” he said gently. A veterinary student standing by the examination table lowered his head in agreement.
At that moment, the dog approached and licked his owner’s hand. The resident rose and backed away to give them space. The owner rested her forehead on the dog’s head and caressed his sides. A few quiet minutes passed.
Then, with great care, the resident led the dog out of the room, followed by the student.
In human medicine, when a patient is facing death, a chaplain might be brought in and a social worker called to guide the grieving, bewildered family. Likewise, pet owners facing health care decisions for their beloved companions need direction, compassion, and support — as do the caregivers themselves.
In veterinary medicine, ever-intensifying stress and compassion fatigue among practitioners handling case after case have begun to take a heightened toll on clinicians and vet students alike. Within this climate of hard work, suffering and pain, fatigue and despair, veterinary wellness burst into the public consciousness and became an issue of national significance, especially at teaching hospitals.
Five years ago, the Centers for Disease Control and Prevention released the results of the first-ever mental health survey of U.S. veterinarians, which was conducted by researchers with the National Association of State Public Health Veterinarians, Auburn University, and the CDC.
According to an article in the Journal of the American Veterinary Medical Association, respondents were “more likely to suffer from psychiatric disorders, experience bouts of depression, and have suicidal thoughts compared to the U.S. adult population.” In addition, the data suggested that “nearly one in 10 U.S. veterinarians might experience serious psychological distress, and more than one in six might have contemplated suicide since graduation.”
In early September, another study published in JAVMA, revealed that “Suicides and deaths of undetermined intent among veterinary professionals from 2003 through 2014 in comparison to the general population were 1.6 times more likely and 2.4 times more likely, respectively, to complete suicide.”
“Increasing rates of suicides, depression and compassion fatigue, and decreasing personal and professional satisfaction among veterinarians emphasize the importance of creating a wellness culture within veterinary professional programs,” said Jacque Pelzer, director of admissions and student services at the veterinary college.taken by successful programs at the University of Tennessee, Knoxville — which established the country’s first program in 2002 — North Carolina State University and The Ohio State University. That is, a veterinary social work program is available to support not only pet owners considering treatment options and navigating end-of-life care for their pets, but also for clinicians, caregivers, and students who daily encounter health crises and profound grief.
A licensed clinical social worker who treated students from all walks of life at Virginia Tech’s Cook Counseling Center for the past five years, Trish Haak has moved seamlessly onto the Veterinary Teaching Hospital (VTH) health care team. She facilitates communication and well-being among the hospital’s clinicians, staff, students, and clients.
“Three years ago, I started working with Trent Davis’ yellow Lab, Moose, providing animal-assisted therapy,” Haak said. “I identified clients whom I thought would benefit from Moose’s presence, and it was truly remarkable how his presence would break down barriers in the sessions. Through my work with Trent and his growing animal-assisted therapy program, I was inspired to pursue veterinary social work.”
Her interest fully piqued, Haak discovered the Veterinary Social Work Program at the University of Tennessee and has gone on to pursue an extensive post-graduate certificate that requires coursework in compassion fatigue, animal-assisted therapy, bereavement and grief, and the link between human and animal violence..
As her first order of business at the Veterinary Teaching Hospital (VTH), Haak is establishing a comprehensive veterinary social work program to address wellness issues at the college. The program provides support, crisis intervention and grief education. The college hosts wellness workshops that serve the staff, students and clients.
Haak plans, as well, to introduce animal-assisted therapy at VTH.
“Because this is a new role, I have visited each of the hospital’s services to acclimate myself,” Haak said. “Now, I am spending some time discovering the best ways for that particular service to refer clients. Every clinician has his or her own preferences, and each service works a little bit differently.”
“So far, most clients have come to me from emergency situations,” Haak said. “I suspect that emergency services and oncology, given their roles in health care, will continue to be the largest referral source for clients who might need extra support.”
Going forward, Haak’s plan is to “get out there, build awareness of this resource, and offer support every day.” She explained that the VTH’s veterinary technicians have been particularly helpful in her onboarding: “They’re the boots on the ground to gauge client needs. I think that the more they see me, the more they’ll understand the services I offer.”
Not unexpectedly, the services that Haak has introduced at the veterinary college have been embraced as both necessary and timely.
Well-being at Vet Med
The college has several initiatives in place to support student well-being, raise awareness of mental health issues and connect the veterinary community with mental health resources.
Before they even begin classes, incoming veterinary students receive QPR (“question, persuade, refer”) training during orientation. Often compared to CPR in its speed and urgency, QPR teaches students how to identify suicidal people and guide them to the resources they need.
Along with free counseling services at the Cook Counseling Center, Virginia Tech’s Psychological Services Center offers low-cost mental health services to all students.
Aligned with the pervasive idea that asking for help is a sign of weakness, the fear of exposing their vulnerability keeps many veterinary students and practitioners from reaching out or expressing their distress, a conundrum that deepens a potentially dangerous situation. Such reticence obviously obscures others’ ability to discern that someone is struggling, which in turn makes interventions more difficult.
In an effort to counteract these sorts of situations and help those who may be suffering, the veterinary college has partnered with Jody Russon, assistant professor in the Department of Human Development and Family Science in the College of Liberal Arts and Human Sciences.
“Veterinarians are more than two times as likely to die by suicide than is the general public,” said Russon. The daughter of two veterinarians, Russon points out that a range of realities potentially contributes to this unpleasant statistic, the most significant of which may be that veterinary medicine is the only profession that euthanizes its patients.
As the principal investigator on a research project at Virginia Tech, Russon set out to determine how to best implement a suicide and mental health screening tool into the context of the veterinary college as a means to mitigate suicide. “The whole goal of this study,” she said, “was to determine if a suicide screening tool would be feasible and acceptable and to identify what barriers might prevent putting such a tool into place, one that could catch suicide ideation early and then allow triage in an effective way.”
Russon enlisted the aid of three co-investigators based at the veterinary college. “The first thing we did was engage an advisory board that included organized veterinary medicine, practicing veterinarians, research veterinarians, and public health specialists to help us design the way we would conduct this research and design the actual questions to receive more responses,” Russon said.
Using mixed methods, several quantitative questions were asked first, for example, “What is your comfortability asking about suicide? If you were struggling, would you seek help?” These questions were followed by several qualitative questions: “Talk about the stressors at the veterinary college. If there were a screening tool put into place, would you like that?”
Just as Russon had anticipated, a theme surfaced that could be considered a barrier to implementing a successful screening process.
“Because no one is immune to the stigma of mental illness, one of the core themes we detected in our qualitative interviews was this concept of mental toughness,” Russon said. “If we show vulnerability, our struggles, we may be perceived as being too weak or not having the grit to succeed in this intense profession. Or, we would perceive ourselves as not having the grit to deal with this difficult profession.”
“Students put on a front,” Russon said. “They save face, which undermines the identification of their struggles.”
Russon was pleased that the majority of the interviewees revealed positive perceptions. “Students, faculty, staff, and administrators were overwhelmingly excited about and accepting towards this kind of intervention and screening tool,” she said. Put plainly, most respondents said that the tool was important and a good idea.
Having presented these preliminary results to the veterinary college in early November, Russon said that the next course of action is to secure funding to implement the screening tool at the college.The research team will then determine if the tool promotes help-seeking behavior or reduces the amount of mental health distress during the course of the year. If successful, the tool will be expanded and disseminated to other veterinary colleges that may be interested.
“Suicidality often occurs later in one’s veterinary career,” Russon said, “so the idea is that early intervention is essential. If we teach people that it is acceptable to struggle and receive help, that they can be helped in an effective and confidential way, then maybe different strategies will be used later in life.”