A recent report that looked at the quality of life in US hospitalists (hospital workers) showed that while burnout and depression are major worries for the entire medical profession, they were a greater risk for workers treating patients full-time in a hospital environment (McKenna, 2024). The review questioned hospitalists regarding their efforts towards having a well-rounded life and how much their employers are helping to address burnout and depression risk.
We are not, of course, human medical hospitalists, nor are we in the US. However, being an experienced hospitalist in the veterinary sector in the UK and having listened to my therapy clients (vets, vet nurses and doctors), I see that the similarities are striking. We can learn from this review.
The good news is that there definitely is a greater awareness of the risks of poor mental health, depression and burnout in the UK veterinary world when compared to previous years. I have been working in London for 20 years, and we have gone a full 180 from burying our heads in the sand and “stiff upper lip” to talking about mental healthiness as something we are all allowed and encouraged to focus on.
However, the concern I have is that sometimes we don’t know how to “do it”. Often, we are given a load of phone numbers pasted to the back of the toilet door as though they are all the resources we need. But I know first-hand that this method doesn’t work with the majority of staff suffering with poor mental health.
Being a positive psychologist, I also believe we would all be much better off economically and emotionally if we addressed mental unhealthiness before it becomes a crisis. Tackling mental health after you meet the crisis point is a bit like brushing your teeth really well after you’ve been told you need root canal treatment. Have you ever examined a dog’s teeth only to see deep layers of rock-solid calculus present, and the owners then ask you whether they should start to brush their dog’s teeth? Have you shut the stable door after the horse has bolted? It’s just like that.
We should aim to have a life peppered with joyful moments instead of aiming to get through it intact in spite of our careers
Here’s another thought: do you ever look at your carefree, happy kids and hope they’ll keep their sense of joy with them forever despite the inevitable life hurdles they’ll face as they become older? It’s easier to hang onto that ability to enjoy life rather than desperately attempting to mould ourselves back to that childhood bliss after we’ve let it go in pursuit of greater achievements like status and tangible achievements.
We should aim to have a life peppered with joyful moments instead of aiming to get through it intact in spite of our careers. There will always be challenges for our entire workforce. It was COVID-19 for several years, now it’s the financial pressures and public judgement of our finances, and next year it may be something else. We cannot postpone our happiness until we “come out the other side” of these challenges.
So, how can I make the case for positive psychology in the face of the burnout and depression crisis? Here are a few more parallels with the UK veterinary sector that I found in that study.
What is the link between job stress and burnout?
The study showed that women experienced burnout more than men did (Figure 1). (I note that the study was, however, split into men and women in a binary fashion; a limiting factor, of course.) Ask yourself, “What’s my immediate reaction to hearing this?” When I put this question to my colleagues, the answers were mostly “shame and embarrassment” from the female workers, and “surprise” from the males.
I can’t measure the significance of this, and it’s not a double-blinded placebo-based study. Neither is it looking at the results of veterinary professionals in the UK. Nor is it asking other genders their opinions. However, shame is an emotion I often see in my clients: shame when they show vulnerability that they and many others see as a sign of weakness. Why my male colleagues were surprised is, again, open to interpretation. I wonder if it’s because women cover up their stress, depression and burnout more than males because of that shame we feel when we’re not seen as “strong enough for the job”.
What stressors at work contribute to burnout?
There are often numerous stressors that can contribute to hospitalists’ stress at work (Figure 2). So, if you are a line or practice manager or if you are in any way responsible for a clinician’s job description, please ask yourself the following questions:
- Am I giving my clinicians too much admin work? Is it really necessary to do that much e-learning? Am I sending out too many emails with too many action points in order to get to the actual information? Am I scheduling webinars during my clinicians’ work hours as though I don’t know they’ll be up to their eyes in clinical tasks during that webinar? This can make you look out of touch. Also, those tasks won’t be done and the webinars will be ignored, perpetuating the divide between “people on the shop floor” and “the powers above”
- Do I respect my clinical staff? Do I really understand the day-to-day workings of the clinic(s) I oversee? If I do understand, do my clinicians believe this?
- Do my staff feel adequately remunerated for the hours they work? Have I asked them? Would they prefer fewer hours with less pay? Do I know?
- When clients disrespect my staff, do I have their back? Do clinicians know where to turn to if something happens and how to make a complaint?
- Do I allow my clinical leads and experienced staff to make the decisions they are good at making? Have I decreased their autonomy in any way? If I have, do I know how this decision has affected them?
What is the duration of burnout?
The results of this study (Figure 3), showing that burnout is a long-term state, correlate with what I see in my counselling rooms.
When burnout is primarily due to our job stresses and work environment, it’s not going to change just by going on a nice holiday or having a weekend off. When we return, the same stressors are likely to still be in place. Burnout isn’t an acute state; it is the result of an accumulation of concerns, many of them embedded in the makeup of the workplace.
I’m not saying this to make you throw your hands up in the air and give up. My hope is that we will learn to face the plethora of varying stressors, observe the emotions they bring up in us and still manage to concurrently enjoy other factors in the workplace, life outside of work and those holidays. Adversity can co-exist with happiness.
Does burnout impact personal relationships?
I suppose this statistic (Figure 4) isn’t a shock. What is surprising is how many people, when struggling with poor mental health, simply cannot see how it is affecting their relationships with their partners, children, parents and friends.
When we become practised at noticing the small things around us that are “OK” or even “good”, then our workplace stressors take up less of our headspace. This takes effort because we are used to only focusing on problem lists, tasks that need to be completed and things that need to be fixed because they’re broken. It’s the tiny, “good” things that don’t need our attention that can bring us robust joy in the long run.
If we break the habit of a lifetime and make the effort to focus on what’s going well (eg a game of hide and seek with your kid or a well-made shape on the foam of your cappuccino), then, and only then, are we giving ourselves a chance to balance the weighing scales: the scales where burnout, depression and exhaustion are on one end and joy is on the other.
How involved is your employer?
I do feel very hopeful about this one as regards the UK veterinary sector (Figure 5). All the large veterinary conferences are hosting well-being streams now. As these are growing in popularity and size, I have moved from speaking on positive psychology in a lecture area separated from the loud PA system by a crimson curtain to pop-up lecture pods and now to decently sized lecture theatres. I’m also seeing most corporates looking for new and effective ways to promote positive psychology throughout their workforces, focusing on new graduate vets and nurses to managers and everyone in between.
There’s an increasing awareness among healthcare executives that well-being is a leading quality indicator, if not the indicator of favourable outcomes in patient care, staff turnover and more. I’m very optimistic that someday the veterinary world may lead the way.
But remember, “your employer” is human too. Many people along the chain of management and command are also struggling with their own issues, including job stress, depression and burnout. Many people are having the time of their lives, and there are many others in between.
At any given moment there are numerous reasons to be sad and numerous reasons to be happy. When we each take a moment to see where our focus is and try to shift it slightly towards the tiny reasons to feel happy, we are not only helping ourselves but also helping those below and above us in the chain of command.
What are your coping mechanisms?
As a therapist, I see us do many things to combat or attempt to combat the effects of negative influences on our well-being. (Coping methods used by hospitalists are listed by the percentage of users in Figure 6.)
When it comes to these coping methods, what’s important is to try to remain non-judgemental. For example, if you go for a run in the fresh air to help with your well-being and then have a few beers that evening – also to help with your well-being – neither has to be judged as “good” or “bad”. I can meditate for an hour before dawn and still have a takeaway that evening – the pad thai does not undo the loving-kindness meditation. I can choose to be completely alone, and then spend the night at a crowded gig. Both can be good for my mental well-being in different ways. Even though it may seem more extreme and, therefore, prone to be classed as “bad”, some intravenous drug users meditate effectively and some alcoholics do amazing voluntary work.
So, listening to yourself actively and being “responsibly selfish” by making the effort to balance your work with your well-being in whatever ways are genuinely effective for you are essential life skills. Regularly checking in with yourself after partaking in activities you expect will improve your well-being and trying to honestly and accurately assess their beneficial and detrimental effects takes time and effort.
Do you talk about it?
Here’s an interesting one: why might someone not tell anyone about their depression or poor mental well-being (Figure 7)? Well, we still see poor mental health as a weakness. We are terrified of shame. I know for sure that, sadly, many people do judge those who say they have mental health struggles as unfit for the job.
Can we change this common misperception? I think it’s happening, albeit at a very slow rate. Maybe those of us who currently feel content and happy can be advocates for those who don’t. Speaking out loud about positive psychology methodology is the easiest way to do this. The narrative around burnout and depression is nothing new (here I am, writing about it again), but the narrative around positive psychology is current and exciting. Yet, I believe we don’t shout about it enough.
What’s out there to help?
The book Mental Wellbeing and Positive Psychology for Veterinary Professionals (Figure 8) has been available since September 2023. It contains chapters on stress, depression and burnout, of course. It also has a large section of chapters on positive psychology and is written specifically for our veterinary professions.
Sprinkling three or more copies in the practice break room for staff to flip open takes such little effort, yet it immediately opens up conversations around positive psychology. It also benefits Vetlife and veterinary nurses in crisis, who receive all the royalties from its sale.
