Everyone in veterinary workplaces can have a role in suicide prevention.
Suicide is a global public health problem and a human tragedy. Suicide risk is elevated among veterinary professionals compared to the general population (Platt et al., 2010) and many in the veterinary professions want to know how they can best support and help people in crisis. This article summarises five practical, evidence-based steps for suicide prevention in veterinary workplaces. It particularly considers steps employers and leaders can take.
The interconnected nature of the veterinary professions means many veterinary professionals have been bereaved by suicide. Bereavement by suicide can leave some people with complex and profound feelings of guilt or responsibility. While this is a normal response to suicide bereavement it does not mean that those people were responsible or guilty of not doing enough. Although suicide prevention sometimes emphasises “spotting the signs”, in reality suicide is very difficult to predict at the individual level. What we know from the science of suicide prevention is that the most effective interventions act at population level, and it’s these that we are considering for veterinary workplaces.
We spend a significant proportion of our lives at work; workplaces, employers and co-workers have an important role in support and help for suicide prevention. There are actions we can all take.
Building a positive culture
Workplace culture and professional culture are important factors in veterinary mental health (Allister, 2020). Some aspects of veterinary identity and culture can act to undermine our well-being and mental health. These include expectations of self-reliance, seeing asking for help as weakness and expectations of prioritising work above other needs and supports (Allister, 2020).
Supporting good mental health is a key part of suicide prevention. Employers can promote positive cultures around mental health at work by having clear policies and leadership in place on issues that affect health at work. This might include preventing discrimination and bullying, tackling stigma about mental health and creating a workplace that feels psychologically safe and where employees feel able to talk about mental health (BITC, 2019).
Workplace cultures that are good for health place importance on valuing employees – and not just through incentivisation, which can sometimes add to stress and pressure. A positive workplace culture promotes a sense of belonging, respect, open communication and emotional well-being. Supportive workplaces enable people to seek help when they need it and to support each other.
Skills for care and support
You don’t need specialist skills to support another person who is in crisis but it can increase confidence for people to attend training to develop skills in supporting others. A variety of training is available for bystander support for people who may be suicidal, some of it free. Core principles are listening, non-judgement, empathy and creating a plan with someone to promote safety. More information on some of these can be found below listed under resources.
Sometimes practices assign mental health first-aider roles, with key identified individuals. That can help increase helper confidence; however, it is very important that those supporters themselves have a network of support, clear lines of communication within organisations, boundaries and expectations. Nobody should be left out of their depth or feeling they carry responsibility for others alone. HR staff and line managers may benefit from specialised suicide prevention training and support networks within an organisation.
Generally, some of the best evidence for effective support is through confidence and training in active listening, particularly for line managers. Many veterinary practice staff have these skills already through other roles. If you’re worried about someone, ask if they’re OK, listen to what they say and support them to get other help if they need it. Vetlife is happy to talk with people who are supporting others.
Supporters who have attended training need support themselves, including ongoing supervision and opportunities for reflection.
Resources for support and access to help
It’s important for suicide prevention that staff have access to mental health support and for this to be enabled and encouraged long before a time of crisis. Workplace resources might include access to employee assistance programmes (EAP), professional mental health care and positive use of occupational health to support people in work. EAPs should include support for such issues as mental health, physical health conditions, domestic violence, financial insecurity and others (BITC, 2019). Policies and procedures should enable people to access health care, including time for appointments in working hours.
Workplace safety and planning
Restricting access to locations and materials that may be used for suicide is an important and effective strategy in suicide prevention. This is known as means restriction and has been found to reduce deaths in many different studies across different suicide methods. The tension between means restriction and ease of access to medicines and other items needed in veterinary practice needs careful consideration and tailoring to the local context (Allister, 2020). This includes risk assessments about access to medicines and equipment in the practice building and in vehicles, in and out of hours. Responsible medicines practice includes regular review of the audit, ordering and storage of medicines. Where possible, two-step verification processes and controls beyond a medicine’s schedule may be appropriate including supervised disposal of unused medicines.
Another type of planning that is important but very challenging is thinking in advance about suicide postvention by consideration of the steps that would be taken to protect others after a suicide attempt or death by suicide. Suicide bereavement is a known risk factor for suicide in others; responses in suicide postvention can be an important step in protecting staff who may be vulnerable. Vetlife offers support to practices for suicide postvention and additional resources for postvention planning are linked in the resources section below.
Communication about support and resources available should start at induction and be accessible to all employees. This should cover workplace supports, other help and confidential sources of support for people in crisis such as crisis helplines. Vetlife Helpline produces stickers that can be placed on controlled drugs cupboards or other sites where people may be when they are at risk. There is evidence that helpline numbers and messages encouraging help-seeking at high-risk sites can play a role in reducing suicide. These stickers are available free on request from the Vetlife office or via the Vetlife website.
There is good evidence that asking someone in distress whether they are experiencing suicidal thoughts is not harmful and may contribute to supporting them to access help. However, careful communication is important. How we talk about suicide in veterinary public spaces and veterinary social media can influence suicide risk (Allister, 2021). Media portrayals and descriptions of suicide can lead to subsequent suicide attempts and deaths by suicide (WHO, 2008). This can include well-intentioned activity on social media. Guidance around talking responsibly about suicide in veterinary spaces is linked below. Suicide prevention is challenging. While we must acknowledge the risks within the veterinary professions, it is important that we do not resign ourselves to these risks being inevitable. Collectively we can work to support each other.
For confidential support 24 hours a day please contact Vetlife Helpline on 0303 040 2551 or email via the website.
Reducing the risk of suicide in the workplace: a toolkit for employers. Business in the Community and Public Health England
Crisis management in the event of a suicide: a postvention toolkit for employers. Business in the Community and Public Health England
Responsible communication about suicide for veterinary professionals: “It’s good to talk, but it matters how we do it” Rosie Allister
Free psychological first aid training to help people with different needs to cope with the emotional impact of COVID-19. FutureLearn and Public Health England