Rory O’Connor is the problems solver’s problem solver. In his job, he helps a bunch of people who spend their working lives using their broad scientific knowledge and highly developed analytical skills to identify the cause of ill health in other, and offer suitable remedies.
He is kept very busy, as often the members of this group are not very good at recognising when it is they themselves who have a health problem. Ignoring an issue and hoping it will go away is rarely a sensible strategy and when the root cause of their difficulties is an addiction to alcohol or drugs, that approach can cause immense damage to the patient’s professional and personal life.
These people are, of course, members of the veterinary profession and Mr O’Connor is the person who took over in October as the national co-ordinator of the Veterinary Surgeon’s Health Support Programme.
Established in 1999, the programme is supported by the Veterinary Benevolent Fund and each of the main veterinary bodies. It provides guidance to members, their colleagues or family on dealing with a range of personal problems, not just addiction but also depression, stress and various forms of self-harming behaviour.
The co-ordinator’s role is to assess the clients’ needs, to offer advice and to help them access local or regional treatment services, either through self-help groups like Alcoholics/Narcotics Anonymous, or where necessary to more formal outpatient or residential treatment programmes.
On average the programme deals with about 35 cases a year with roughly equal numbers of males and females, of whom about 40% are under the age of 30.
During the early years of the programme, some clients were able to attend residential centres in Berkshire and Derbyshire set up by the Royal Pharmaceutical Society of Great Britain. Rory was clinical director for the scheme but the centres were closed down in 2003 and 2005 as a result of changes in the NHS funding system, when responsibility for supporting such initiatives switched from local health authorities to individual primary care trusts. Finding new ways to underwrite such costly but highly effective treatment options will be his biggest challenge in his new post.
Born in Limerick in the Irish Republic, Rory qualified as a psychiatric nurse at St Bernard’s Hospital in Ealing, west London, before undergoing further training in psychotherapy and counselling and then completing a masters’ degree in the treatment of addiction problems.
From the outset, he found that a disproportionate number of his patients were from the various medical professions and this caseload gradually increased as a result of the lack of enthusiasm among his colleagues in dealing with this particular group of patients.
“Doctors, dentists and vets tend to be viewed by my colleagues as a very difficult group of people to manage. It is a combination of factors and they usually feel they should be providing, not receiving, clinical services. But they can also be very demanding both of others and of themselves, and as scientists themselves they are very keen to understand what is going on.”
But at least in the early stages of their condition, medical professionals are guilty of making just the same excuses as any lay person with an addiction problem.
“There are three very common defence mechanisms – minimising, rationalisation and denial. These are the three basic things that people use before they accept that they have a problem which needs to be dealt with.”
Most of the evidence on the prevalence of addiction problems comes from the USA where the state licensing boards for the medical professions have well established and supported treatment programmes.
Another of Rory’s priorities in his new job is to improve the evidence base on both the scale of the problem and the effectiveness of the safety nets that have been put in place in different parts of the country. But the available data do suggest that the incidence of addiction problems to alcohol and other substances is significantly higher in doctors and vets than in the population as a whole.
But why should vets be more prone to developing addiction problems than any other group of people? Rory thinks that the nature of the work is a major factor.
“It can be quite an isolated life as a vet and, of course, it can also be quite pressurised. But I think that another factor is the sort of people who are attracted to a profession like this, high achievers who will have big expectations of themselves – and sometimes it just isn’t that easy.”
So is it possible to predict which people are likely to experience problems and be ready to offer help earlier? Despite pop-science claims about the existence of particular “addictive personalities”, he points out that the numbers of people who could potentially be at risk is huge.
“If you take alcohol, there is about 80% of the adult population who drink and perhaps 60% of those people could develop problems with alcohol dependency. Put another way, people will have a “drinking career” lasting maybe 40 years and at any time there may be 10 to 15% of that group with reasonably serious problems with alcohol.”
But there is good evidence to suggest that the seeds of later addiction problems can be sown early, before these people have joined the ranks of the veterinary profession. “Addiction is to some extent a learned behaviour. Both medical and veterinary schools are good training grounds for socialisation and part of that process is drinking.”
Rory points out that many young people in their teens and early 20s do drink to excess. The majority will settle down as they enter relationships and take on professional and financial responsibilities. But a minority are unable to make that change, just as there are some who are unable to resist the sort of recreational drugs like ketamine, benzodiazepines and opiates that may be obtainable, albeit at some risk, in any veterinary practice.
Touring the schools
Consequently, Rory will be continuing the work of his predecessor, Dr Virginia Richmond, in touring the UK veterinary schools to raise awareness among students and staff of the importance of mental health issues.
Clearly, any clinicians whose judgement is blurred by alcohol or drug misuse are a danger to their patients as well as themselves. As someone with experience in treating patients from all the medical professions, Rory knows that their problems are very similar and should be dealt with through a pan-professional support system.
He is a member of Clinicians Health Intervention, Treatment and Support Initiative which aims to attract Government funding to support addiction recovery programmes. He was much encouraged by the announcement on 17th November of Department of Health funding for a two-year pilot project providing specialist care and support for any doctor or dentist with a mental/physical health concern or addiction in the London area.
He is in the preliminary stages of negotiations for rolling out the scheme to the rest of the country and including other health professionals such as pharmacists and vets. He is optimistic that it will be possible to attract the funding needed for the veterinary profession to pay its way as a full partner in the scheme.
In the meantime, he is anxious to provide more support for those colleagues with health problems which may not need all the resources of this NHS Practitioner Support Programme, just guidance in helping the clinician deal with his or her own problems.
Another of his goals is to expand and develop the regional carers scheme, a network of vets around the country who will be available to offer counselling and practical help to colleagues in their area.
“I think this could be an extremely useful source of support for men and women in the profession who are trying to cope with addiction and mental health problems. But at the moment it is not very well known and it is certainly under-utilised.”