1. Death, Institutions or Recovery Substance Abuse, Suicide and Mental Illness in the Veterinary Profession J.M. Roesner, DVM, DABVP Loving Hands Animal Clinic Highway 9 N Alpharetta, GA

2. 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

3. 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.

4. 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

5. 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.

6. 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

7. 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.

8. 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

9. 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.

10. What would you do if...?

11. 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

12. 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 %
Use of alcohol or drugs %
Diagnosed of chemical dependency 77%
Compulsive food behavior %
Diagnosed eating disorder %
Exposure to domestic violence %
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

13. 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.

14. 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

15. 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

16. 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

17. 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

18. 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.

19. 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.

20. 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

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

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

23. 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

24. 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

25. 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

26. 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

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

28. Resources
States Wellness Committees AVMA ext. 625 avma.org > Wellness (Narcotics Anonymous) Listings in phone directory Suicide Prevention Lifeline TALK utk.edu > SAVE