Death, Institutions or Recovery Substance Abuse, Suicide and Mental Illness in the Veterinary Profession J.M. Roesner, DVM, DABVP Loving Hands Animal Clinic 13775 Highway 9 N Alpharetta, GA 30004 770-667-9022 www.lovinghands.com joanne.roesner@lovinghands.com

Introduction (Me) Now Owner of Loving Hands Animal Clinic Board Certified Active in GVMA Active in Education Married in 1995 to the world's greatest man Productive, Happy, Well Managed Mental Illness Relapse Prevention Plan Suicide Prevention Plan Long Term Recovery Then Undiagnosed Mental Illness Suicide Imminent Incapable of Honesty, Delusional Incapable of Job Performance Absolutely Isolated Active Eating Disorder

My goal is NOT to tell you not to drink. My Goals: Educate you about the disease of Addiction and Mental Illness Dispel prejudice and misinformation, remove stigmas Provide resources Provide prevention strategies which contribute to overall wellness in the profession Convince you that you are likely to encounter these issues in your practice lifetime My goal is NOT to tell you not to drink.

Addiction Biological Basis (Amygdala, dopamine, seratonin) A continued use of a substance or behavior in the face of consequences. Biological Basis (Amygdala, dopamine, seratonin) Environmental, social components. Recognized by the AMA (1955 Alcoholism) & DSM4 (including diagnostic criteria, prognostic information. Is NOT a moral issue Denial is a component Tolerance develops Relapse is a potential

Mental Illness 6% (1/17) people have serious mental illness in the US DSM criteria, illness is not a choice or a moral issue Less than 1/3 of adults and ½ of mentally ill children get mental health help Multiple Forms Need help from trained mental health care provider (therapy, medication, other) Must rule out physical illness to diagnose (e.g. hypothyroid) Genetic, chemical (neurotransmitter), hormonal, situational/traumatic components ACE study (ACEStoohigh.com) 10% of DVM’s report current serious psychological distress. US population 7.9 % Depression: DVM’s 36.7% of females, 24.5% males. General population 22% in females, 15% in males.

SUICIDE DVMs 4x greater than normal population DVMs suicidal ideation females 19%, males 14%. General population 7.1% females, 5.1%males. 10th leading cause of death. More suicides than homicide + war together 25 attempts for each success in the general population Men guns, women overdose

Special Risks for Veterinarians Joe Gloyd in JAVMA " The veterinary student profile includes characteristics such as intelligence, self- starter, highly motivated, capable, set lofty goals, tend to self criticize, disappointment in the face of achievement and lost self esteem." These characteristics are common to addicts, ACOA’s and those of us prone to depression and suicide. I would challenge you. These are characteristics of many of our staff as well.

Susceptibility of DVM's Cont. Highly driven, deeply caring people Unique financial and ethical tensions High levels of stress, low level of well trained para- professional support Little stress management or wellness training in veterinary curriculum Self sufficiency is prized, self reliance is killing us

Susceptibility of DVM's Cont. Little emphasis on community or support in the profession Competition rather than colleagueship Entitlement (44% of pharmacists self prescribe. How many DVM's?) Easy access to drugs with lower accountability than in other professions.

What would you do if...?

You will encounter these issues in your career either in self, colleague or staff: Addiction General population 10% drug addiction, 30% alcoholism (Maybe higher in health care professionals) Mental Illness 1/6 in general population What is the rate in people who go into animal health care? Suicide DVM 4x rate of general population DVM 2x rate of other health care professionals What is the rate in our staff? Each suicide touches at least 6 other people or more

All questions were phrased, “you or anyone in your life…” My Staff Survey Suicidal Ideations, discussion of suicide 85% Depression or anxiety, prolonged period 96% Diagnosed mental illness 88% Use of alcohol or drugs 92% Diagnosed of chemical dependency 77% Compulsive food behavior 58% Diagnosed eating disorder 39% Exposure to domestic violence 58% Exposure to violence outside the home 58% Exposure to incarceration (jail or prison) 58% All questions were phrased, “you or anyone in your life…” N=26

Clinical Signs of Addiction Initially overachievers "Top of the heap" Erratic performance, mood swings Emotional volatility or extreme lassitude Martyr or victim Deterioration in appearance Dishonesty, elaborate excuses Isolation, withdrawal Financial distress Fascination with drug box, pharmacy, etc. The job is the last to go; Family, physical and emotional health will be impacted first.

Signs of Mental Illness Personality change Inability to cope Strange or grandiose activity/ideas Excessive anxiety Mood swings Prolonged sadness, apathy Changes in sleeping or eating Substance abuse Talking about self harm or suicide Risk seeking behavior

General Risk Factors for Suicide Mental illness Significant loss Substance abuse History of trauma or abuse (ACE questionnaire) Physical illness Impulsivity Feeling hopeless Family history, exposure to suicide Access to means Lack of health care

Suicide Warning Signs: I Ideation S Substance Abuse P Purposelessness A Anxiety T Trapped H Hopeless W Withdrawal A Anger R Recklessness M Mood change

Special Risk Factors for DVM’s and Suicide Culture of self reliance Personality profile of those entering profession Stigma for seeking help Lack of awareness Lack of information on how to help Managerial burdens (little training, hard to find help) Long hours, heavy work load Financial Stress Poor work – life balance Difficult client relationships Availability and knowledge of means of ending life Burn out rate Inadequate professional support

Please consider helping. Intervention Addicts, people contemplating suicide, and sometimes those with mental illness are typically incapable of recognizing the reality of their situation. Action by a concerned party is often required to save a life. Please consider helping.

Substance Abuse Intervention Planned Focuses on facts and events Loving and non-judgemental but clear and firm Caring confrontation detailing losses and consequences of substance abuse Ends with choice of consequences verses help (AA, NA meeting, treatment) Must involve appropriate professional Help to guard against risk of self-destructive behavior on the part of the addict.

Intervention for Suicidal Ideations or Mental Illness Caring, concerned Let the person talk, don’t censor, judge or discount, do not immediately suggest solutions Ask direct questions Are you thinking about killing yourself? How would you do it? Plans? If suicidal ideations call hotline or if imminent call 911 Help person find mental health resources or bring them with you Stay with the person while they make the call Involve a mental health professional We are vets not therapists Make plans for tomorrow

Please do not do Nothing! Intervention Saves: Lives Families Careers Please do not do Nothing!

Support for loved ones You didn’t cause it You can't cure it You can't control it

Support for loved ones Anguish, guilt, rage, anger and the like are common feelings directed toward the addict or to someone who commits suicide. The disease of spouseaholism or codependency is a common finding in family members. Family and friends may recover even if the addict does not. Alanon Nami.org SAVE at utk.edu

Recovery of Any Kind Is not a salvage operation Is not about bad people getting good Is the beginning of a life worth living Is about ill people getting well Results in the return to function of people who have something to give back to society and our profession

Substance Abuse Recovery Involves: A desire to get well A desire to accept assistance Active participation in 12 step meetings Putting something in place of substance (i.e. new coping techniques, stress management, recreation, community, spirituality) Accountability Wellness committee Random testing Peer support and groups

Mental Health Management/Recovery Mental health professional Support network Coping skills training Reprogramming negative self talk, affirmations, guided imagery Spirituality for some people Service animals, emotional support animals Medication for some people Healthy life style (food, exercise, sleep, recreation) Focus, dedication, sometimes outside monitoring

Wellness Committees Disseminate information, educate, facilitate interventions or make referrals Advocate and mentor, liaison for employer monitoring contracts

Resources States Wellness Committees AVMA 800-321-1473 ext. 625 avma.org > Wellness www.al-anon.alateen.org www.alcoholics-anonymous.org www.na.org (Narcotics Anonymous) Listings in phone directory Suicide Prevention Lifeline 800-273-TALK www.suicidepreventionlifeline.org www.nami.org www.samhsa.gov www.nmha.org utk.edu > SAVE