Finding the balance

MENTAL HEALTH AND PHYSICAL HEALTH GO HAND IN HAND— just like livestock farming and veterinary medicine. You cannot have one without the other. Yet, when it comes to mental health, many farmers and veterinarians refuse to discuss it.

“We need to break the stigmas associated with talking about mental health,” said Cliff Miller, DVM, a mixed-animal veterinarian and owner of Green Hills Veterinary Clinic in Moberly, Mo. “We are in this together.”

First observed in May 1949, Mental Health Awareness month was es­tablished to bring attention to the importance of mental health and well­ness. It also celebrates those who are being treated, who are maintaining, and who have recovered from mental illness.

The last two years of pandemic living have made many people realize that stress, uncertainty, depression and anxiety have impacted their well-being. In particular, mental health awareness in the veterinary medical community has come to the forefront with an alarming rise in the number of suicides among veterinarians.

Abby Whiting, DVM, a practitioner at Veterinary Specialty Service in St. Louis, is the chair of the Missouri Veterinary Medical Association’s (MVMA) Wellbeing Task Force. She also serves as a moderator for Not One More Vet (NOMV), a professional organization that focuses on trans­forming the status of mental wellness within the profession.

“COVID pulled back the blanket, revealing many of the issues that our field deals with,” Whiting said. “It has magnified problems such as long hours, not enough vets in rural areas, staffing shortages, burnout, over­whelming debt and not being able to balance work with home life.”

In 2020, the Bureau of Labor and Statistics reported the median salary for a veterinarian as $99,250. However, the average vet school debt, according to the American Veterinary Medical Association (AVMA), is $150,000, with some students reporting more than $400,000 in loans.

“The debt-to-income ratio does not add up, so many leave the profes­sion for higher-paying jobs,” Whiting said.

Adding to the professional stress is when clients try to negotiate the cost and care of the animal, which veterinarians say devalues their services.

“Those of us who are in veterinary medicine are hyper-sensitive to how much our goods and services are,” Whiting said. “We cannot give away services because that is not sustainable. Clients need to understand all the costs and trust that we have their animal’s best interest in mind. We are in the field because we are compassionate people.”

Like farming, veterinary medicine is a career that attracts individu­als who are independent and have a strong work ethic and desire to be self-reliant while helping others. The days are long and grueling, and many times the veterinarian is dealing with life-or-death situations. Emer­gencies and severe trauma to the animal are just as painful to the provider as the owner.

“My generation was told to suck it up,” said Linda Hickam, DVM, who has practiced veterinary medicine for 30 years.

Family life often ends up suffering, Hickam added, because many veterinarians spend so many hours in the office or making house calls and emergency farm visits.

“It is important to find that healthy balance between your work and your home life,” she said. “With our profession, sometimes it is difficult to stop and not take that call as you are walking out the door.”

Hickam, whose daughter is a practicing veterinarian in Kansas, said she thinks the younger generation of veterinarians is doing a better job with that balance.

“I am happy to see that my daughter has a group of people she can reach out to when issues arise,” Hickam said. “Social media has been a blessing for those types of connections. She stays in touch with former classmates, and they seem to be very open to sharing their struggles and supporting one another.”

With 10 years in the field, Jessica Stroupe, DVM, is the owner of Howard County Veterinary Service in Fayette, Mo. She and her staff provide care to large and small animals, while supporting and looking out for each other’s well-being.

“I am very open with my staff about mental health and letting them know that it is normal to feel off,” Stroupe said, adding that she believes most veterinarians are per­fectionists and introverts. “It’s difficult to acknowledge the stress and reach out for help. In my clinic, we foster a positive and healthy culture. When I hire a new vet or staff member, I look for someone who will fit into our culture and who shares our core values. With men­tal well-being, I believe that it is OK to seek help. Do it. You need it. It is not a character flaw. It is a sign of strength and self-awareness.”

To help balance her busy work and home life—which in­cludes two young sons and a baby boy on the way—Stroupe is active with community theater, loves traveling and is an avid runner.

“Daily exercise, healthy eating and weeding out toxic behav­iors keep me on track,” she said. “It is important to recognize that part of mental wellness is having interests that are not part of your profession. Fulfillment outside of the office is vital to staying in check.”

Dr. Hickam agrees. “You need to have a hobby so veterinary medicine is not your only identity,” she said. With an exten­sive background in mixed-animal practices and epidemiology located in rural, commercial and international settings, Hickam’s career has come full circle. She was an associate veterinarian in Mexico, Mo., for 11 years, then moved to MFA Incorporated as the swine vet for three years. She went back into private practice before serving the Missouri Department of Agriculture for 10 years, first as the state veterinary epidemiologist and then as the state veterinarian and Animal Health Division director. Today, Hickam is practicing at the Mexico Veterinary Hospital in Mexico, Mo.

With all of her experiences in the field, she believes that veterinarians are in the profession to develop re­lationships with clients while caring for their animals.

“I love the interaction I have with clients; that is what I love most about my practice,” Hickam said. “It is wonderful to see how these relationships develop and evolve through time. You need to be mentally and physical healthy for your clients and their ani­mals to be a successful vet.”

Dr. Miller, who served as president of the MVMA when the Wellbeing Task Force was founded in 2018, notes that 1 in 6 veterinarians have had suicid­al thoughts due to the stress of the job.

“The epidemic of suicide in our profession is a com­plex topic that requires a multi-factorial approach,” Miller said. “The MVMA leadership team asked what we should be doing to help our members with addressing mental health issues so we don’t reach that extreme.”

To help navigate these issues and to provide resources and support, the MVMA hosts an annual convention with wellness seminars and offers remote learning for its districts.

“We offer continuing education to increase resilience and to support vets and their staff who are dealing with stress and anxiety,” Whiting said. “The Task Force publishes a newsletter and has resources on the MVMA website for those in need. We are also creating a client code of conduct.”

The American Veterinary Medical As­sociation offers a free online course called “Question. Persuade. Refer.” (QPR) to help veterinarians and their staff to talk about ways to deal with those who need help.

“I want to be the bridge to lead people to all the resources we have,” Whiting said. “After taking this class I now know what to say to people—just asking them if they are doing okay.”

The University of Missouri Extension and College of Veterinary Medicine are also working to prevent suicide and promote mental well-being among veterinarians. The Missouri Farm and Ranch Stress project provides free mental health (Mental Health First Aid), suicide prevention (QPR Gatekeepers) and personal well-being (Taking Care of You) programs as well as free telepsychology counseling sessions that include veterinarians and their dependents.

“You are not alone,” said Karen Funkenbusch, project manager for Missouri Farm and Ranch Stress. “There are many resources to help veterinarians, just like there are places for farmers and ranchers to seek help.”

Addressing the issues of stress and anxiety for veteri­narians while they are still in training may help. Toward that end, the MU College of Veterinary Medicine has re­cently embedded a psychologist within the school. This allows students to access the services with greater ease and flexibility since their schedules are so demanding.

Illness and disease—physical as well as mental— strike everyone. Someone who appears to be very healthy and happy on the outside could be fighting cancer or debilitating depression on the inside. There is no difference. However, society often views cancer diagnosis as a battle, while depression can be seen as weakness in character.

Veterinarians are among those who want to see that change.

“We need to open the door and talk about mental wellness. The more we talk, the less of a stigma is attached,” Whiting said. “You are not a bad person or doctor if you seek treatment. There are many people out there willing to talk to you about it. Check on your staff, your classmates, yourself. Together we can have a positive impact on mental health and well-being.”

Self-care for Veterinarians

Well-being isn’t a single measure of health. It is composed of nine unique dimensions that touch upon every aspect of our lives: occupational, intellectual, spiritual, social, emotional, physical, financial, creative and environmental. These dimen­sions work together and collaboratively contribute to overall mental health. By the same token, when one area is lacking, the others will also be impacted.

According to the American Veterinary Medical Association, these are the dimensions of well-being:

• Occupational — Being engaged in work you find satisfying that aligns with your values, goals, and lifestyle
• Intellectual — Learning new things; participating in activities that foster critical thinking and expand your world views
• Spiritual — Having a sense of inner harmony and balance
• Social — Surrounding yourself with a network of support built on mutual trust, respect, and compassion
• Emotional — Being able to identify and manage your full range of emotions, and seeking help when necessary
• Physical — Taking care of your body by getting enough sleep, eating a well-balanced diet, exercising regularly, etc.
• Financial — Being aware of personal finances and adhering to a budget that enables you to meet your financial goals
• Creative — Participating in diverse cultural and artistic experiences
• Environmental — Taking an active role in preserving, protecting and improving the environment

In each area, assess where you are currently, and decide if you are satisfied with how you are doing. You can then identify areas to target for improvement. For more information and resources, visit www.avma.org/resources-tools/wellbeing.

If you or someone you know needs help with managing mental well-being, these are among the resources available for vet­erinarians, practice management, practice staff, producers and families.

American Veterinary Medical Association Tools for Well-being

avma.org/resources-tools/wellbeing

Not One More Vet: Online and anonymous peer-to-peer support

NOMV.org

University of Missouri Extension Show-Me Strong Farm Families

extension.missouri.edu/programs/ agrability/show-me-strong-farm-families

Show Me Hope Crisis Counseling Program

moshowmehope.org/

facebook.com/MoShowMeHope/

University of Tennessee Veterinary Social Work Program (for any veterinarian)

vetsocialwork.utk.edu/

Missouri Crisis Line

573-445-5035 or text HAND to 839863

Show Me Hope Crisis Line

800-985-5990

National Suicide Prevention Hotline

1-800-273-8255 or text HOME to 741741