Good evening to everybody logging on tonight live and a good evening to those people accessing, session 2 of the mental health and well-being first responder course for the veterinary profession. And Yeah, a big welcome to you all, really enjoyed last week's session. You guys were so interactive and, that, that just helps so much.
Last week, if you remember, we were focusing on well-being. Today we move into this real sort of, I think it's a really important area, and that's recognising distress. And the level of distress and knowing what what it is that we can do something about.
And what we ought to just be saying to the person, you know, you need help, and here's where to find it. And I think that's one of the hardest things if we're looking after colleagues and we're looking after ourselves is knowing when something stops being a well-being issue. And spills over into a proper bona fide mental health crisis or a proper sort of illness phase of mental health.
So my name's Dr. Mike Scanlon, many of you have done webinars with me before, so we know each other, and I do always feel that there's that lovely sense of a return to people that I know, and I've just been reminded, as I've said that, that there's somebody I've worked with before was just saying, can we Catch up again. So I, I must remind myself to do something about that.
So over the years, I've worked in so many different spheres of mental health, I've been in mental health for, I should think about 30 years now, in various different guises. And, most recently, I've been really, really interested in working at A preventative level, a well-being level, but also in looking at how we can get really good, information out to the masses, and I think Webinar does that so beautifully. So I still work today I was working for the NHS training about 40 clinical psychologists in a depression treatment, and I had a lovely day, .
Doing that sometimes I spend my time seeing people 1 to 1. Sometimes I'm doing sort of webinar enabled work. Another string to my view is I have a parenting charity, Social Enterprise, which looks at how we can help people parent in a more compassionate, warm, .
Effective way really so I'm a I'm a busy man, but I love doing these and tonight is such an interesting and Telling subject really. Because as I said, we're looking at recognising distress and reducing stigma and how we recognise distress and how we work within the veterinary profession. And we worked with you guys and some of you may remember last week I was saying that I suppose when we spoke about putting this course on, I had a bit of a, I am a huge optimist and I had a real sense of what would be lovely is when those of you who participate in the course complete at the end and you feel that you have the knowledge and some of the skills that you might need to become the champion, the mental health champion in your practise.
Or to become, you might use that label, the, the, the practise mental health first responder, you know, and so, and, and I really feel there's a need for this, because in a lot of the work I've done in workplaces, people, are always surprised by this, I think, but actually getting help from our colleagues is enormously powerful because nobody understands. The stressors and the difficulties of working in the veterinary profession more than somebody else who lives and breathes and experiences the trials and tribulations, the highs and lows, the difficulties of working in in your profession, and so Immediately, the very fact that we step in and say, you know, can I help? Just begins to make an impact on stigma immediately.
So just so we can get ourselves in the respondy sort of way, I'm going to ask a question about last week. Do you remember last week we, I shared with you the emotional health check and I was explaining that we use the weebs first, the Warwick and Edinburgh Wellbeing Scale. We then, and out of that normally comes one or two possible shifts I might want to make in my own life to improve my well-being.
And we can also use the when webs as to give ourselves a baseline score or to give our colleagues a baseline score. Step 2 was to do the life balance tool and to look at whether we're living our lives in balance. And if we are, our chances of sustaining and gaining greater well-being are vastly increased.
And then thirdly, to create our own well-being plan based on just making Possibly 3 changes that might well be linked to the Action for Happiness. I remember some of you saying you were going to get the posters from the Action for Happiness website. What a great idea that was.
So, I'm just wondering, I suppose, whether those of you who are on tonight, was anyone able to go back and speak to your practise manager or speak to any of your colleagues about whether or not we could introduce the emotional health checks within your practise, . That that's my question out to you before we really launch in. And secondly, is that something that people have worries about or concerns about?
Because I think we've got us all online tonight. Maybe we can use that as a point of discussion and we can assuage some of the doubts that people might have or understand where you're coming from. So I'd be really interested to know was from last week's session whether anybody went back into their practise.
And was sort of galvanised or found themselves wanting to make a bit of a difference or whether you just use that for yourself and your own well-being, which is equally as important. So if any of you've got any views that you'd like to share. I'm just gonna, click on here and just wait to see if anyone's, and you know how to do it.
You either use the Q&A or you go on there and you use the chat function. And, so I'll just give people a few moments. So I wonder if anyone, from last week's session felt, you know, how, how they wanted to take that forward.
Let's just have a look. And while I'm waiting for people just to share and come in, because as I said before, it's just so lovely to, to get that beginnings of a hi, how are you stuff going on. Let's just move to the next slide.
So, we've had somebody coming back, so I'll go back to that in a moment. The one thing we should never forget as we do these courses is you'll hear me talk today about, you know, the first, the gateway to services is always by your GP practise, and I am aware that if it's anything like locally or in London where I was today, that actually getting a GP appointment is, is not always easy, but maintaining that, and in those are the cases sometimes where we find ourselves using things like the BetLife helpline. But, when we first started working with the vets, I remember working with Anthony and a couple of other organisations, and I was struck by just how sort of, useful it is that you have these organisations.
So just have somebody come back. Remember I only ever use your first name here, and Georgia has just come back to her and she's saying what she's doing is just planning to talk to other people about it and gauge interest before I suggest that they do the emotional health check, and then she's just put that, yeah, emotional health check. Thanks, thanks, George.
I think that's a lovely way in, you know, it's just to say, you know, I did this bit of training, did this course with Mike the other night, and we have this emotional health check, and I wonder whether, that might be something that people would be interested in having a look at. And you know, immediately there I suppose I start to think that what's so important is the nomenclature that we use. So we are calling it an emotional health check.
The word mental health, mental illness doesn't come near it because this is about well-being, and I think that in all of these sorts of professions where you have very high functioning people, competitive professions, if we start to even talk about the word mental health or mental illness, people will run a mile. So using that phrase of it is really just a really light interesting. Very telling emotional health check, and I think that we will look a little bit more at that stigma and stuff.
Jane's come back and again just first name here saying she doesn't have a plan yet, but Jane says that the morale at where she works is currently quite low, and I wondered if this course might be of some help. I, I think it would be of some help, but what I think might be really useful, Jane, would be to suggest that given where morale is, let's do an emotional health check because the emotional health check is very much aimed at improving and obviously with the action for happiness, it's aiming at a happier . More content workforce and goodness me, .
What an important, an important thing that is so. Yeah, thanks for that, and I will be asking, and I'm always so curious about kind of what you guys are finding. And this is a very interesting, this is a very interesting slide, I think, that the mental health continuum, and I'd just like you to look at this slide as we, as the slide sort of unfolds and think about your colleagues at work and think about yourself and where you might have been and whether there are colleagues that you, you know, that you work with.
And whether this might be an interesting useful way to start to conceptualise the difference between somebody that might need a little bit of support and help and somebody who doesn't at all, and we can be quite relaxed about how they are. So the first category that we find in any workplace is the bulk of us, I think, whereas I have no mental health diagnosis, I have no clinical history of depression or anxiety, and I'm really quite well and I'm enjoying my life. But even for that person there, you know, an emotional health check can be so useful in order to maintain.
That sense of being well and enjoying their life. So in terms of good well-being, one category of people is going to be this people, and then we get these. Really interesting conundrum because there are other people that I'm sure we do work with that would never think of themselves as having a mental health problem, but they're really, they have no diagnosis, but they're not coping terribly well with the rigours of the workplace, or maybe they're not even coping very well with the rigours of home life and family and.
Everything that goes with that. And so I have no diagnosis, but I'm not coping and I'm not happy. Now they're the people that really we, we are aiming the emotional health check at, you know, and they're the people, well, both groups actually, but though that group there, the bottom lot, no diagnosis, not coping terribly well, and not as happy as I could be.
Now, that's where a Wemweb's life balance, particularly, I think, I think about the action for happiness stuff and three little changes might make a huge difference. So let's have a look at the next one. I have a mental health diagnosis, but I'm not coping and I'm not happy.
I would lose the, the butt on, on, on that, I guess. I would prefer it if it was, I have a mental health diagnosis and I'm not coping and I'm not happy. You know, there's something about the word but, isn't there, that drains the energy out of the room.
I'm sure you have it when you're speaking to somebody that's bought their pet in and you say, you know, you know, it'd be so much better if they would exercise a bit more. And the client comes back to you and says, Yeah, you think you're right, but, and as soon as you hear the but, you know the outcome will be that, that, that, that animal is not probably going to get more exercise because the butt is like a glottal stop, isn't it? Now those people that have a mental diagnosis and they're not coping and they're not happy, now that moves out of just being.
A well-being issue now, and that's somebody that I think is going to need extra sort of support and I think that what I like about this is look at this next one, and I fit this one, you know, I do have a mental health diagnosis. I suffer and have suffered for years and years and years with anxiety and depression, but not for about You know, 10 years now, but on my, you know, I guess the GP would have me down in a category of people who fit the diagnosis of suffering from depression and anxiety. But at the moment I'm coping really well and I'm really enjoying my life.
So at this point in time I don't particularly need anybody to worry about me. And so Well I think the Well, I think the mental health well-being first responder course, the one we're looking at tonight really fits with our colleagues, is with those people who are struggling. So, They might have a history of depression or anxiety or stress.
Or, or, substance abuse, whatever it might be. And on top of that kind of historical context, they're currently not coping and not feeling terribly happy. Now those are the people that I think in the veterinary profession we hide this stuff, we keep it quiet, and we put on a front, and these are the people I think that, you know, if we don't have a real sort of warm.
Engaging process in our workplaces where we feel able to talk about this stuff and we feel able to ask for help and we feel able to ask for help from the person that has put their hand up and said, Do you know, I'm someone and I would quite like to help. Just doing that opens the door hugely. And the other people that I think we use for the mental health first responder and well-being first responder course, is the bottom right there.
No diagnosis, but currently not coping and not as happy as I would like to be. And the importance of this is just as it would be in any animal, I guess with any condition that you would treat, the sooner you catch it, and if we catch it before it develops into something that's well pathologized, the better the outcome for that pet, for that animal, and exactly the same within mental health. And I think this is why I think this course that we're doing tonight is, is really so important.
So, Yeah, Samantha's just come back and said, I'm really lucky that my manager's encouraged me to take the course, and I'm planning to feedback that we should be doing emotional health checks on a regular basis and all staff in manager roles should be taking this course. I guess that's in order for them to be able to carry out an emotional health check. Thank you so much, Samantha.
That's really, that's a very positive thing, I think. Yeah, thank you. So that's the mental health continuum that I think we're we're working within.
So let's just be really clear now about what is a mental health first response, and it's so essential we get this right because none of you guys are coming on this course because you want my job, you know, you're very happy working in the veterinary profession, I'm sure, perhaps not always, but you know that's your chosen profession, and I wouldn't ever try to turn anybody into an unpaid, unresourced mental health professional. So a mental health first response is just feeling equipped enough to offer help to a person who may be developing the beginnings of a mental health problem or is experiencing that, and we come to, we come, we become aware of that, or experiencing something of a mental health crisis, and that might be linked to bereavement, it might be linked to very, very stressful work conditions. It might be linked to loss of relationship, you know, and loss is very not, very often, a major factor there.
And so mental health first response suggests that what we're looking for is to offer help where people are beginning to struggle and to offer help when we notice when we are made aware that somebody has moved into a crisis situation. And what we are as first responders in exactly the same way as when we come across somebody that has had an accident on the pavement, you know, in the high streets, and we come across them and we stay with them and we offer them appropriate treatment, you know, we might raise their arm if they were a limb if they were bleeding. You know, we might put a tourniquet on, we might sit down with that person if they're in shock and keep them warm to prevent hypothermia, but we're only doing that until support.
And professional support arrives or until the crisis that person is in resolves and the crisis that we might come across, you know, we sit with that person and we stay with them until the crisis has passed and the person is able to function once more. And so important is that this course and the role is not meant to be a substitute for counselling. It's not meant to be seen as medical care.
It's certainly not as we would see peer support, which is where we have This refers to somebody with training who has an experience of their own mental health difficulties within the NHS, and it's certainly not a course where we would be offering anybody in our practise mental health treatment. So I think that's quite an important slide, and I hope you're finding that really reassuring because there is no expectation that we do anything more than stay with people and give them appropriate support and help. Until we can get them the help that they need.
In a sustained evidence-based useful way. And so I guess when we think about the veterinary profession. Why, why is there a need for this?
And I've got a couple of slides later that elucidate that even more. But I think the first thing is that we know, don't we, that mental health issues, problems, presentations are really common. In the veterinary profession, you know, you as a profession you work in very stressful conditions.
You work with extreme emotions sometimes. You work in a in a profession that is fast moving, can be hectic, you know, you work with not only the animals' feelings, but their, their, their owners, the people that love them, their feelings, so you are. In a, in, in a profession that lends itself to the very conditions from which might be the seedbed of mental health distress.
And I think . Even though we've really worked so hard over the last few years to try and make a difference to stigma, I know that stigma is alive and well. And a really nice example of this, happened, was sent to me as a, it was kind of a really lovely email I got from somebody saying, you know, Mike, we've done so much work, but And I know that stigma is alive, is alive and well within my practise, and this person was a vet and obviously I'm I'm protecting their anonymity and confidentiality, but they just told me this wonderful story saying that they had one of my workbooks and it was the one I did a course a few about a year and a half ago which was about the black dog.
It was a, you know, working how, how we prevent depression and how we work with depression and how we treat depression ourselves when we find ourselves there. And she said a colleague got into the car and your manual was on the back seat and the colleague was being really lovely and kind and said, Oh gosh, let's just turn that around. We don't want anyone thinking that you've got depression.
And I paused just to let you hear that, and I think that was the colleague being enormously well-being and caring because they, they were worried for their, their colleague that another one of their colleagues might suspect that they'd done that course with me because of the, you know, gosh, we don't want anyone to know that you've ever had, you know, problems with your mood. And what was lovely was the vet in question smiled and said, No, no, no, she said, don't worry about it at all. She said, I'm absolutely happy to share the fact that I've been low and I've come out the other side.
She said, in fact, she said, you know, it's great that people notice that and ask me, and that felt good to me. It really did. I think why mental health first response is, you know, I was working for a big mental health service today in London, and what we know is the waiting lists, contrary to government rhetoric, are there, and professional help isn't always, you know, that accessible and carries stigma with it too.
And so many people within the veterinary profession kind of. Are put off from seeking help because they do have to get through the initial gatekeeper of the GP first. And if you can't get an appointment, we very often fall into that sort of trap of just going, oh well, you know, I can't, I can't be, I can't wait two weeks to talk to the GP about this, so I just won't bother.
And then as we know within the veterinary profession, and we know this from the suicidal stats that many individuals within the within the veterinary profession who develop some distress, developed some difficulties just don't seek help, you know, they sit and they try and sort it or they hide it. And unfortunately still within this profession there are swathes of people that just aren't that well informed about mental health problems and who will jump to conclusions that because I'm suffering with depression means that I shouldn't be, I shouldn't be in work or perhaps my capabilities are restricted rather than actually asking us, you know, Are you OK? Do you need any help?
Is there anything we can do to help you, you know, manage if you have been feeling difficult? This thing about making assumptions, but the real, top reason why our colleagues will look down or avoid or steer away from emotional distress is so many people just don't know. You know, what do I say?
What do I do? And if I ask the wrong questions, you know, will I, the old classic, if I ask somebody a question, start talking, will I uncover a can of worms? And I always think with that one that a can of worms squirming and moving around with the lid firmly on is a pretty unpleasant place.
To be in, sometimes I think just asking questions doesn't uncover a can of worms. What it does is it enables that person to start to seek help. So.
From what I've seen of the veterinary profession and my experience with you guys, I would say that a mental health first response. It's something that the veterinary profession would benefit from for these very reasons. And within that, Our curriculum, what we I think we ought to be looking at and, and, and, and, and, and helping with is .
Two sides really and the sort of crises that we'll come across are very often, and I think it's really important that we feel comfortable, those of you taking these calls, in actually asking about suicidality, you know, and . Being able to recognise when people are experiencing feelings of panic, you know, what I don't think we can cover on this course, however, is all of that, because what worries me about a course that tried to cover all of the stuff on the left there would be that . My own view is that actually if there's even the beginnings of noticing psychosis or the beginnings of alcohol abuse or aggressive behaviour even, our first step needs to be to Enable and encourage that person to seek help.
I think where we're working with is much more around depression and anxiety within the workplace and of course dealing with crisis situations and helping somebody in the practise when we do have something that's traumatic, difficult, hugely emotional that happens. To our colleagues and how our first response helps them deal with a critical incident. And that's pretty much what we're going to cover over the next tonight and the next couple of weeks.
So let's start with recognising. Depression and anxiety. And I think that the first thing I'd say is that .
Depression and anxiety are the two most common mental health conditions that we will see in the workplace and particularly I think it's important within your workplace for the reasons that I shared earlier. So if we're working and we notice that colleagues who would normally, You know, come in and eat a lunch, . Avoiding food or have lost their appetite.
I think what we're, what we're just checking out there is . You know, is, is this normal, keep an eye on people, but also where clients are beginning to, their, their eating habits are changing, so we're eating much more emotionally. I don't suppose we're going to have much opportunity to become aware of our client, of, of our colleagues bowel functions, but we certainly are going to be able to experience.
Some of these symptoms, particularly the ones I'm just going to hover over now, particularly that sense of people actually, we call it psychomotor retardation, horrible phrase, but what we're looking for there is being slowed down. So clients that are usually, you know, quite vital, clients that are usually, their pattern of speech is, is quite quick, their concentration is pretty good. You know, and, and what we'll, what we'll start to see is a bit of a shift there.
The other ones that we probably will see, which is what I'm covering tonight, I think it's much more useful, is just a change in how people present. And this was always something that would show up in myself when I used to get struggle with depression. It's just kind of not bothering so much with the, you know, how I'm looking, how I'm dressing, you know, whether or not I had hair in those days, whether or not I'd bothered to sort of, you know, .
Look after my health and look good and and and and come in looking smart. The other one that I think we listen out for and is a great determinant of whether somebody's mental health is beginning to struggle is if clients are saying and you notice it and we're aware of it and we're actually switched on to it and people are not clients, our colleagues are talking about their sleep, really bad night's sleep last night. Really struggled to get up this morning.
That's a really good cue. How are you? Are you OK?
Is everything else all right? And just to meet that with a lovely sort of curiosity. And the other thing we're really looking out for is more of those somatic symptoms.
People sort of reporting aches, pains, and particularly, headache or tight chest. Any of these sort of symptoms, what we, what they are is they're a lovely opening for us when when we notice that one of our colleagues is sharing this sort of stuff or talking about this sort of stuff, or it becomes obvious that a client looks, a colleague looks very tired or a colleague is dropping off in the meeting. Which I know happens and it's then that quiet word afterwards, so just, you know, can help noticing, just checking, you know, is there anything I can help with?
And that, that's, that's just all, is there anything I can help with? And just being there and being aware of the danger that somebody gives you the rebuttal, no thank you. And accepting that that that may happen.
In a, in a way I think which is I think very interesting is that depression is far harder to spot than anxiety, but just look at the correlations between the two there. So what we're probably going to see with depression is some with an anxiety, but particularly anxiety with the change in appetite is. When we're feeling anxious, we really struggle to eat, so we very often do see those of us who are people feeling very anxious, our colleagues, really just real changes in their, in their diet and beginning to see that.
We might find them complaining of chest pain. We might find them yawning. You know, really yawning a lot more.
We might see again classic talking about sleep problems and that again back to the somatic symptoms, and we might actually notice those colleagues holding their breath and subsequently sort of panting a little bit more and complaining of, you know, feeling overtired and yawning and sighing. Yawning and sighing are really good indicators. And all I'm suggesting here is that before we even get into, you know, you know, screening, which we would never do because that's not your role, but it's if you do come across colleagues or you yourself are starting to experience some of these very obvious symptoms, very obvious changes, then.
Mental health first responder feels That they can just reach in and just ask, Are you OK? Is there anything I can help with? You're OK on its own.
It's too easy to say yes, thank you, fine. We just need to make sure we say, Is there anything going on I can help with? Would it be a help to talk?
I'm really happy, happy to listen. So we're just kind of creating an atmosphere within our practises where we know that we're looking out for each other. Do you remember on session one I talked about the circle of kindness, and when we looked at that last week, it was just this beginning of a workplace where we get the impression and we get the feeling that we are looking after ourselves, and I just think that being able to recognise or get an inkling that, oh gosh, you know, this, this, this colleague of mine.
I think it is a little bit down. This colleague of mine is more stressed than it is helpful for them. Let me just step in and just check whether I can help in any way.
So let's just sum some of that stuff up. So whether it's depression, Low mood or worry or anxiety. You notice the difference there.
So there's depression, which is clinical, and there's low mood which is not clinical. There's worry which is not clinical and there's anxiety which tends to be. And what's interesting is that it's very rare that depression or low mood presents on its own.
It nearly always is accompanied by the anxiety. And as we found last week, what we shouldn't do is wait until it becomes something diagnosable, you know, and that's why I think the emotional health check we did last week is so, so crucial because if we can prevent mental distress, we really should. Now if you notice here the duration for 2 weeks distress and disabling, this is a really good way for us to be able to get a very good indicator as to whether or not this is becoming something that is possibly clinical in nature.
So as a rule of thumb, if somebody has Been experiencing low mood or anxiety most days for two weeks, that's the first day, then that. That, that, that leads us to start to think, gosh, you know, I wonder, and if that . If that level of low mood or that level of anxiety has been distressing for them.
On most days over a two week period. And has affected their functioning. That's the other D, the disabling.
So it's actually affected their functioning, so they're not functioning as well. Then the three D's. If we get that in any one of our colleagues, that's when we really have a very good inkling that, do you know what, can we talk?
Would it be helpful just to sit down and see what's going on here? But the three Ds together would nearly always sort of prompt us to say, encourage that person to perhaps make an appointment with their GP and ask for help, because if we get the 3 D's. And the duration, been there for a couple of weeks at a level that's distressing and is affecting my functioning, then.
You, you're pretty sure, and you could be fairly confident that when they go to the GP, the GP will recognise that this is turned into something beyond just being a well-being issue. So I hope you found that very useful. A lot of people like that to use the 3Ds as a sort of indicator.
So Let's just be The sort of anxiety conditions that you will see in a in a veterinary practise is the most common one of all is generalised anxiety disorder, and generalised anxiety disorder is when we worry about stuff that hasn't happened yet, but we worry about sort of everything, you know, it's not a focused worry about one area. People with GAD or generalised anxiety disorder, find that they nearly all the worries are future-based, and they worry about everything. Social anxiety disorders, when someone just starts finding it really difficult to be in meetings, it's starting to find it very difficult to be with clients sometimes, you know, and we're struggling with, we used to call it sort of extreme shyness, but it really isn't.
It's, it's social anxiety. Phobias are where somebody has an extreme anxiety reaction to a particular stimuli. Panic attacks are interesting, and panic attacks can show up in us as humans just at any time.
And a panic attack is when someone has an extreme anxiety condition which is characterised by very extreme physiological . Expression, so we do feel heart pounding, sweating, and very often a very fearful sort of sense of doom and danger associated with the panic attack. And what we find is that person just wants it to end as soon as possible.
And the last one is of the anxiety conditions, much rarer, but it's where somebody has developed, Checking behaviour has developed . An inability to carry out a task that they once could do without first putting in lots and lots of safety measures. Now, What I'm not expecting is that As part of this course that I'm expecting you to diagnose, I just feel that it's important that we equip you with just a little bit more knowledge and a little bit more confidence in being able to recognise what some of our colleagues may be presenting with.
And to help us to do that and as you found possibly . In your booklet, . You will have found that We can help with this, so.
If we are We've gone beyond and we are speaking to one of our colleagues, and we suspect that there's been distress around for a couple of weeks. They've been feeling low at a level that's distressing and it's beginning to affect their functionings. We can do a really simple couple of questions and I, I've included this in your packs, but if we just ask during the last month, have you often been bothered by feeling down, depressed, or hopeless?
And if they say yes, at that point there, we ask the second one. During the last month, have you often been bothered by having little interest or pleasure in doing things? If we get just a yes to either one of those two questions, then Really That person, we ought to be saying to them, do you know what, let's not mess about anymore.
Would you like me to help, or is there a way we can get you in to see your GP? And here comes a really good tip. Primary care and our GPs always have an emergency appointment.
And if it's depression and somebody is in a real place of struggle, don't get put off by the receptionist saying, well, somebody can see you in 2 weeks' time. Ask for a phone call. Encourage your colleague to get themselves seen and to say, no, you know, I really do need to be seen as a matter of some urgency because as we know, depression begins to spiral if we don't once we've caught it, if we do nothing with it.
Similarly, if we suspect anxiety, Really simple. Do you feel nervous, anxious, or on edge? Over the past month, have you felt nervous, anxious, or on edge?
And do you feel unable to stop worrying? A yes to either one of those two has about a 90% specificity that what we're probably looking at is that this person would benefit from getting some help, professional help for their anxiety. And we always supplement it because this is about choice, isn't it?
And is this something with which you'd like some help. So our job as the responder is to be curious and in a very skilled way, as I'm sharing with you tonight, enabling us to be able to, get a grip and get an idea of whether this possibly is depression, anxiety. And if it is, is this something that you'd like some help with?
And if the client says no, or sorry, I keep saying client, if our force of habit from 30 years in the NHS, if our colleague says, you know, no, I don't want any help with that, I think we just say, would you mind if, you know, me and you just met up a bit later on in the week just to check how we're doing and so we're keeping the door open. But very often when we just ask that, those questions there, and then gosh would you like help with this? 9 times out of 10, someone will say, you know, I think maybe I ought to.
What they've been waiting for is for somebody to actually notice it and be brave enough to address it so that we don't get that situation where people sit there where everyone around them knows. So Once we, we, we, a client, a colleague of ours opens up to us just a little bit and starts to talk to us and say I might be struggling. Our job is very simple.
It's just to listen actively. What I mean by that is make sure that we nod, we . Ask for clarification if we need it, and what we're looking for is how is this affecting you and what aspect of this is troubling you the most?
What are you doing at the moment that's helping you cope just a little bit and if there's anything we can offer them at that point, you know, some help with concentration, some help with. You know, maybe just start eating a breakfast again. Really small stuff.
And I think that the other thing we can do is to offer a really warm, lovely, empathic comment. Remember empathy is about. Sharing that, you know, I too sometimes struggle, and there are days in this practise where I feel really struggled and I feel a bit low, so you're not on your own.
Just beginning to offer empathy and understanding will take us right in. And this moves us to the bit that I think most of you are going to find most uncomfortable, but probably given Where the veterinary profession is at the moment, the most important of all is It's so important that if we think one of our colleagues is in a place of struggle, struggling with depression, anxiety, crisis, mental health difficulty, we must always just ask about suicide. And there's a big worry that people sometimes share with me when I do this, and they say, Mike, I dare, sometimes I sort of dare and ask that question just in case me asking it sort of gives them the idea and they go ahead and do it.
Let's lose that because it's a fallacy, you know, somebody is not going to kill themselves because you've given them the idea. You know, asking about suicide and the way we ask for it is, you know, I just wonder, have you had any thoughts about hurting yourself or taking your life? I'm sorry I have to ask that, but gosh, I just do need to know.
And have you had any thoughts about hurting yourself or taking your own life? And I think that the reason why I think this is so important is that I've included the reference there. A recent study interviewed 21 UK vets who'd attempted suicide or experienced suicidal thoughts, found that half of them hadn't talked to anybody about their problems because they felt guilty or ashamed, you know, and If we are reticent in asking these sorts of questions, The message we get back is that this is something to be guilty and ashamed about, so it's our openness and it's our warmth and the way we do this is so important.
And when we ask that question, I look at this stat here and I think that, you know, the distress that these people were going through, had somebody just asked that question much, much earlier, what a, what a lot of distress could have been mitigated or possibly even prevented. So If we As a veterinarian organisation, an organisational approach, I believe, would be that it's so important that we are aware of the risk factors that You know, when we're talking to somebody. We call them actorial risk factors.
So when we start to add them together, they make that person's risk sort of incrementally more risky, I suppose. So what we're interested in, is, you know, what, what, what tells us that that person is, is, is, is, is at risk is if somebody's ever tried to kill themselves before then. Or they've made an attempt at any time in their life, there's an increased risk.
If they've . If somebody in their family or someone close to them has ever Made an attempt of suicide. If the person is engaged in a substance abuse or there's the presence of of any mental health disorder.
And then look at the next view here. And people are more prone and more at risk if there is access to lethal drugs or other means, and I suppose in a veterinary, I don't know this for sure, but I'm hoping you guys can help me here. But I would guess that you really do have greater access to memes than most.
Yeah. Oh, Dawn's very kindly sent that reference through. Thank you so much there, Dawn.
But look at the other one there. Is that stigma is an issue that impacts on the fact that more people in this profession go on to actually kill yourself, but the other one there is the feelings of isolation, and there's none so isolated as those people that feel alone amongst friends and colleagues but unable to ask for help, you know, so I think. These are the sort of factors that would be suggesting, and I'm not asking or making even the suggestion that the, that you should be asking questions around it.
I just think it's useful that you have this information. However, there is a really. Very short, very effective, questioning routine that we could use.
And we call it PIPA. So have we, if we do have a colleague that we're really worried about, really, really worried about, and they're saying, oh no, you know, I'm OK, I don't want to go and see the GP, but we've asked mood-related questions and we think there probably is a bit of depression, anxiety or a mental health difficulty, in the category of putting them into a category of a place where they're struggling to function. At that point, We ought to say, do you know, have you had any thoughts about hurting yourself?
And if they say to you, categorically no, not at all, you know, please, please rest assured. We've asked the question and we've got the answer. However, if they come back and say, Well, you know, recently I have been sort of, it's crossed my mind a few times, then we use the PIPA, you see.
So if somebody says, Gosh, not at all, you know, no, no, no, please don't worry about that. I promise you, you know, there's not, no. Suicide is not something you need to worry about.
Well, there's no need then to go on and and interrogate, is there? However, if the person does say, Well, I have been struggling a bit and I've had a few thoughts, you know, and sometimes people use a more sort of . A more nuanced way of saying that, well, sometimes I think that life isn't worth living.
I'm sure we've all heard that. And that's when we just go in and say, can I just ask, have you ever tried to do anything before? First P.
And are you having, you said, you know, there's a few ideas around how often are they showing up? Just be curious about that. And then, have you actually made a plan?
You know, is there, have you, have you, have you thought about how you might do it? Now, at this stage, you know, so many people have a bit of previous history, have some ideas, have thought about how they might do it, but the really core question comes now. And can I just ask, you know, do you intend to, you know, is there some intent to, to hurt yourself at the moment?
And if we get a yes there. You know, and if we have a yes at all around intent, then this isn't something where we say to our colleague, Perhaps you ought to. This is, I think, where we actually say, do you know what, I really think we need to get some help now, and I think that's the point where we need to be assertive and we need to be brave enough to actually help.
And within your profession, I think if we can move to being This little bit more proactive, I think we can, we can make a significant difference to that dreadful stats around suicide in the veterinary profession. The the access to means is A question I will say, you know, have you thought about how you might do it and have you got what you need? Unfortunately, for those of us working, those of you who work in the veterinary profession, there's a lot of stuff about, isn't there?
A lot of sharp stuff, a lot of substances, a lot of medications, I guess. And the last one, which is such an important question that we should never lose, is, do you know, what is it that really matters in your life? What are the strengths that you've got that you can employ to help yourself?
So my recommendation is, is that we, we become. We become assertively curious with a colleague that we think is in a place of struggle. We do use the stuff that's in your manual.
We do just check in and check out, but we always should ask the suicide question if we're worried that a person's mental health is deteriorating or they're in a place of struggle. And I think if we do that and we do that in this way, then I would be sending somebody. To their GP if they had ideas, but in terms of knowing that, you know, I don't want them going home or I don't want to leave this 2 or 3 days or a couple of weeks, that's why I really think we should be using something.
Like the PIPAS, I think we should be using PIIAS because it just gives us a bit of a framework to make sure that as first responders, we're doing the very best and we're, we're behaving in the safest way possible. So I think I've talked quite a lot about stigma today, but I just wanted to share that. I shared it with you earlier, didn't I, that, you know, stigma was the issue.
And one of the sort of hints around how we talk to people really is when we are talking to people we need to have that lovely openness, you know, cause these sorts of conversations when we ask a colleague, you know, are you OK? Is there anything I can help you with? We need to be open.
We need to keep the conversation in a nice private room, you know, we need to be nonjudgmental in the way we speak about this. We need to give them the right to say, actually, you know, I'm fine. I don't want any help.
We need to be aware of making no assumptions, you know, the way we talk to them needs to be respectful, and we need to ask questions. And if at any time, you know, we have doubts, you've got the VET Life helpline, and we all have a GP. And at any point that we feel that this is becoming uncomfortable for me as the first responder, straight to the VetLife helpline and take the person, sit down with them, encourage them to ring, get it onto the speakerphone so that we're actually there, let the person know because having someone with you and someone that cares is one of the greatest mitigating factors for whether or not somebody will go on and hurt themselves.
Remember what we said at the start. Your job as a first responder, let's go back. I think it's really important just to reiterate this.
I'm, I'm sure there's a better way to, to do this. So, what we're doing is we're offering help to somebody who's struggling or in crisis, and we're giving the appropriate. Treatment, support, guidance, checks.
Until that person can get the help or the crisis resolved, but we are not assuming that, you know, we are the people that provide treatment, not at all. We're first responders. We're supporting them, keeping them safe until such time that they can get good professional help, so.
As a rule of thumb, I'm not sure this is in the order that, that, that it needs to be. I kind of felt it was, but. If we really suspect that somebody is in a place of struggle and that, that this, this is becoming more than a well-being issue, and we've consolidated that with that very simple .
Lovely open questioning, then it might be that primary care, you know, and don't get that fobbed off stuff, see you in two weeks. Our role as first responders is to make sure they get seen, you know. But you have got the wonderful VetLife helpline which is going to give people so much support.
Very often there will be a plethora of counselling services in your region or in your area, and some of those counselling services will be linked to the GP practise, and that will probably be the improving access to psychological therapy teams known as the IAT team, and they will be trained to work with this level of depression and anxiety. There are so many third sector organisations, Mind, SAN, etc. That are out there.
And it might be worth at this point if you did take on the mental health first responder sort of role within your practise, it might be worth just Sort of collating some mental health resource that you could send people to. You would never actually send somebody to secondary care mental health services. I just slid that in just to let you know that that's that might be where they, they sort of end up.
So, We've had quite a few people coming in and sharing your thoughts, and I am aware that we've moved tonight from an emotional health check and a well-being level right into the beginnings of what we do as first responders. We identify what's going on and we offer. Appropriate help and support, but it's about being able to differentiate between what is normal, bit of a low mood, you know, a bit of a bad day, and what is actually a pattern of stuff that leads us to suspect that this person might actually need more help.
And that's what we provide is the gateway to help as a first responder. So I'm hoping people have found this interesting and useful. So let's just go .
Ah, here we, here we are, really good, Greg. As an employer, if I don't use PIPA and an employer commits suicide, does that make me legally liable for that employee's death? Not at all, you know, not at all, because actually, .
Before mental health first aid, before mental health first responder, you know, before this stuff was about, even if nobody asks, suicide is a decision that somebody makes, and the Royal College of Psychiatrists put out a statement that suicide is something that can never be prevented. It can only, it can only be assessed for vigorously. You know, so not at all.
And should there be a legal requirement for employers to provide mental health care? I kind of think not. And that that feels to me, Greg, as though if we make it a legal requirement, I think it should be, there should be a sort of kite mark perhaps that veterinary practises, I'm going to stick to veterinary practises for this veterinary practises that look after their staff.
And engage with mental health awareness should, I think they should, they should be lauded. They should be seen as being real beacons of how we would like the profession to be, and that would become something perhaps that becomes . A, a, a service that other people would like to work for.
So in terms of re retainment and recruitment, it made it, it made it, a very, laudable service to be part of even. And some of you have come in and said, Yeah, access is a real issue within the veterinary profession because there are vets and people working in this profession do have access to a lot of very dangerous drugs. Once again, the very wonderful Dawn has put up the vet life phone number there, and you know, and I do it at the start of every one of our sessions.
Laura's come in with a wonderful questionnaire. What do you do if someone won't accept help but is showing signs of depression? Ideally what you do there is we can't sort of impose that, but what we can do, I think, is, is leave the door very much open, and we can say, you know, please, please, you know, do come and chat, do come and find me if, if, if you, you do need any support, .
If we if we do this well, and we do it warmly and comfortably, then quite often people will say, you know, I, no, I, I don't need any help. But the very fact that there's somebody in your practise that is willing to ask that question means that. Very, very often they will come back and say, you know, thanks for yesterday.
I am in a bit of a place of struggle at the moment. Emily's just come back to say that there's also a crisis team that are based at the A&E departments. If someone has attempted suicide or other avenues aren't available.
Again, you're right, most services these days is to access the crisis team, you would probably need to go via your GP. Emily, in most areas it's, you access the crisis team either from your GP or if you're really worried about somebody, you actually accompany them down to A&E, you're quite right there. So whenever I do this training, this first responder stuff, and we talk about suicide, I think it's so important that the way I share this with you that I don't overdramatize it because suicide remains a very, very rare occurrence within our professions.
But it is something that happens, and I think that too, it's very unlikely that you know, you will find yourself in a position where you're having to sit down with someone and do a Pippias. But it might occur, and if it ever did, how wonderful that there's somebody in the practise that feels competent and you've got your manual that I shared with you. You've got all the resources that are in our booklet to help us kind of feel a little bit more confident about supporting our colleagues.
So what we've really looked at tonight is being able to differentiate between low mood, worry. And when it becomes something a little bit more . Insidious something a little bit more .
Clinical pathological that the person might really need some expert help for. And so I'm hoping that that's really helped you have a strategy for what you might do to determine, you know, is this something that just requires me to do and would really benefit from some well-being work, or has this gone beyond that, remembering the three Ds and the screening questions there? A yes to either one of those would be saying, probably need to go and.
Speak to the that helpline or maybe to our GP and we're gonna do in session 4 we'll be looking at prices in a lot more detail, so I'm gonna leave that till then. So I hope people have found that interesting, not too scary tonight. I didn't mean it to be scary at all, but I felt it's very important that we don't shy away from it because this isn't something that should be shied away from, because, you know, mental health is, is, is universal and it's so important that we are comfortable and confident in talking about it.
Thanks very much. Those of you coming in, some people saying that really got a lot from the session. Thank you so much for that.
If you have questions for me that you felt unable to ask today because, you know, you just felt you didn't want to share those questions, anytime that you want to get a question to me, if you send it via the webinar that they will email it straight to me and I will always come back to you as quick as possible. So, Yeah, and there's Dawn's just put her email up again. I'm glad that was informative, useful, clear information on a really important topic.
Thank you. Yeah, some lovely comments coming in. I'm feeling that it feels like we're kind of getting kind of hitting this at the right level.
Please tell me if there's something I'm missing. If you just want to email me on that stuff, that would be fine as well. So, thanks guys, lovely as usual.
Thank you for being so interactive and helpful. Makes it so much a better course. Next week's session, I'm really looking forward to next week we start to look at some of the communication skills that we might need to actually begin to get into this, how we go on to support someone and how we kind of build on what we've done today.
So looking forward to next week already, but have a really great week and please start thinking about how you might want to use what we've learned in this course in your practises. So goodnight everybody, and thank you for being part of it. Thanks, Emily, thanks, Helen, Sophie, Georgia, all of you.
Thank you so much. Good night now.