Reprinted with permission by Stuart Bruère, Wairarapa
The Elephant in the Room – Vets, Suicide and Depression
Kim Kelly is to be congratulated for writing a well-researched and frank letter to Vetscript in October 2013. She rightly challenged the suitability of the current veterinary practice model and was honest enough to offer some thoughts about contributing factors to many tragic suicides in our profession.
Suicide has touched many families in New Zealand, mine included. The range of emotions expressed is broad; however, it is common for the family remaining to be left with an initial feeling of anger at the “selfishness” of the person to commit suicide. Why didn’t they just talk to someone! It is also common for people to express at the funeral that “they didn’t see that coming”. And here in that last statement lays a clue – many, many people who do commit suicide appear to conceal their intention and plan meticulously to conceal the “plan”.
Before September 8, 1998 I had no clue about the signs you would see in a person prior to an episode of depression or suicide. I woke that morning at 6.30 and felt as if I had run into a concrete wall at 100 miles per hour. I was tearful and really couldn’t understand what was wrong. I was very fortunate my wife clearly recognised there was a problem and she immediately arranged for me to seek medical attention.
My G.P. took this event very seriously and sought out a referral to a psychiatrist via the “Vets in Stress” helpline. It was a few days before I was able to visit the psychiatrist so appropriate medication was started immediately. At the time I was forty years old. When I met the psychiatrist (a very happy Pakistani doctor with a great sense of humour) he started by telling me that an acute episode like this was quite common in men of my age. He then went on amusingly to tell me that at my age there were three common scenarios when men worked under stress – “Stuart” he said “you could have had a heart attack, you could have had a stroke or you could have had an acute episode of depression. From a physical perspective depression is the best of these options.” I could actually see his logic and immediately “connected” with him and was willing to follow his advice. He then explained to me the chemical processes going on inside my brain that led to this episode. He also explained the role of the medications and warned me that it would take time for them to start to work. He said that some medications don’t suit some individuals and that they may need to be changed. He was happy to continue to see me but also offered to refer me back to the mental health services provided by the Wairarapa DHB. I trusted his judgement that I would be okay to see the local psychiatrist. You still have this fear that if this becomes “widely known” your clients, friends and anyone else who knows you will think you have gone “nuts” and they will just write you off. He assured me this wouldn’t be the case.
A few days later I visited the Wairarapa Hospital in Masterton and was offered a range of services including individual sessions with a psychologist and group sessions with a counsellor. Even from the depths of depression there was still enough “spark” there for me to recognise I wanted to be “fixed” and the faster the better. I opted for both services. The value of the individual sessions was to help identify how my mind dealt with the challenges of life. These sessions also gave me the tools to use to “reprogramme” my mind to function in a different way when placed under stress. They also taught me to recognise the signals of impending problems and how to divert the danger and move forward. The group sessions were also essential. There were two clear rules – what is said in these sessions’ remains within the group and all contributions from individuals are valued. Fair enough I thought. It wasn’t immediately clear to me why the group sessions were so important, but it didn’t take too long to figure it out. The group sessions taught me to be confident to tell my “story” in a safe environment. The big picture here was that if I could do this, eventually I would be confident to share my story with the wider community and feel okay about it. How they responded was their problem, not mine.
The following months did have several ups and downs as medications were flushed out and changed, as I learnt to deal with panic attacks and as I “reprogrammed” myself. I did go to some very dark places including suicide as an option. I was indeed fortunate to have a gorgeous 18 month old daughter at the time – I couldn’t do that to her. She’s 21 now and is a wonderfully independent vibrant young woman. I also have three other adult children who are now adult friends. So far they have provided four beautiful granddaughters and a handsome grandson. I remain truly grateful to my wife Pam for her patience as I was repaired. We are about to celebrate our 40th wedding anniversary.
Over a period of about 12 months I returned to work fulltime, was able to get on without any medication and most importantly share my story. In fact I remember sitting at our dining table one evening about 12 months later having a beer with a client reflecting on my experience. Gavin listened and just so gently said “Stu we knew you were a bit “off calibration” but we knew you would come right and we just waited”. I remain indebted to Gavin for saying that because it gave me the confidence to tell other clients.
The outcome of sharing my story blew me away – many farmers felt safe to talk to me one on one about their mental health struggles. In some cases they made an appointment with me to talk mental health, not animal health! To my knowledge, no clients abandoned me. I took the view that if they were that shallow, it was probably better they saw someone else anyway.
Being a clinician, I would often project my mind out of my head and observe my progress as I improved. Gradually I saw my quips of humour return. An observation I made was that it took about 5 years for all my personality to return. Full repair from depression is not a fast process. It is not something you “snap” out of!!
So what were my signs? I had gradually become withdrawn from social contact with all but my very closest friends, I was unreasonably irritable, many of my thought processes were completely irrational and distorted and I had very significantly disturbed sleep patterns. I would often go to bed at 9pm and sleep for about three hours then remain awake for the rest of the night as my head spun with sheer exhaustion.
What were the likely triggers to my depression? Before disclosing these it is important to state I hold no malice towards work colleagues with whom I had worked with in the years leading up to and just prior to these events. This was of a time when mental health was for “nuts” and associated with becoming a social outcast. Sadly few of us recognised or knew what the signs were and consequently had no idea of the triggers. On reflection I recognise I was working long hours, I wasn’t communicating well with colleagues, business was tough and I wasn’t taking enough leave. It is important to recognise this is a chronic process with an acute episode at the end. In my case this probably built up over the preceding 3 – 4 years.
Suicide is a tragic event almost always preceded by at least one episode of clinical depression. Initially the challenge for all of us is to recognise and act on the symptoms when we see them in ourselves or colleagues. If you are working long hours and starting to feel resentful towards friends who appear to have a much better lifestyle than you, you are probably already in the early stages of depression. Be brave now and seek medical help.
The challenge for employers is to provide a safe work place for employees. This means you need to make sure work days are planned so that on most days the start time is around 8am and everyone goes home by 5.30pm. Make sure everyone gets a lunch hour. Train reception staff to take messages with the commitment that “we will come back to you soon”. Time off during the day is important. Employees are entitled to 4 weeks annual leave – make sure they take it. As a practice owner I do understand that some days the “proverbial” does hit the fan and employees do have to work longer, however, it is my view that if this regularly happens more than twice a week, the practice is understaffed. Think “team” – well trained vet nurses and vet techs can do a great deal of what we do. Let them “interface” with clients and discharge animals etc.
I have no reason to doubt the data Kim supplied from the UK is any different to here. Suicide is the iceberg we can see. Under the surface there are many many cases of depression. A study published from Sydney University a number of years ago concluded that over the period of a veterinary career, 100% of practitioners would experience at least mild symptoms of depression on at least one occasion.
We take Heart Attacks and Strokes seriously. We need to do the same with mental health issues.
Thanks again Kim for bringing the “Elephant” into the room. Now let’s recognise it and talk about it. Who knows, if we do this well, the horrendous rate of attrition of young veterinarians from our profession may decline or even stop.
If you or someone you know is struggling, please seek immediate medical support.