In the veterinary field, mental health has become a large topic of conversation in light of data that shows high levels of stress and high rates of suicide among veterinary professionals. While experts agree these numbers should be taken seriously, some say there are a host of factors that need to be considered in order to fully understand the issue.
Kerry Karaffa, a licensed psychologist and mental health and wellbeing coordinator at the University of Missouri College of Veterinary Medicine, is one of those experts. He’s something of an animal lover himself - in addition to his dog and two cats, he is a proud pet parent to 25 different species of reptiles and amphibians, as well as four species of fish.
Karaffa is the first psychologist with the MU Counseling Center to be embedded in the College of Veterinary Medicine, and works alongside colleague Tiffany Sanford-Martens. In addition to providing individual counseling for vet students, the pair offers consultations for students and staff members, conducts research and engages in mental health outreach and education. Some of this education focuses on mental health literacy and the realities of mental health in veterinary professions.
Misconceptions surrounding mental health in the veterinary field
Mental health concerns among veterinary professionals are a complex, but serious issue. A study published in 2019 showed veterinarians are between two to four times more likely to die by suicidethan the general population. Karaffa said this is an important and pressing statistic, but there are some misconceptions that exist when it comes to potential driving factors behind high suicide rates.
“People have a tendency to get rather reductionistic,” Karaffa said. “We want answers, we want to know ‘A plus B equals C.' But the truth is, I mean, there's a host of factors that can play into it.”
According to Karaffa, there is somewhat of a cultural narrative that suggests there is a high rate of suicide among veterinarians because of job requirements like performing euthanasia. However, he said this correlation is not supported by evidence.
Although performing and witnessing euthanasia can have a psychological impact on a person, Karaffa said it cannot be directly attributed to high rates of suicide among veterinarians. However, having access to lethal means, in this case euthanasia solution, is known to be a contributing factor to suicide rates.
“One thing that we do know is: access to lethal means is a variable that definitely underlies any suicide, whether it is in samples of vet students, veterinarians or not,” Karaffa said.
According to another study published in 2019, poisoning was the most common mechanism of death among veterinary professionals who died by suicide or in a manner undetermined. A drug called pentobarbital, which is a medication routinely used for euthanasia in veterinary practice, was the most common drug used for poisoning among veterinarians. Most of these poisoning deaths occurred at home.
The data was consistent with other reports that show higher rates of suicide among veterinarians as compared to the general population.However, the researchers who conducted the study found something interesting: once they removed poisoning deaths from the data, the rates of suicide among veterinarians were not significantly different to the suicide rate of the general population.
This suggests access to drugs that can be used for self-poisoning can impact the likelihood for suicide, and other studies have identified this as a potential contributor to veterinary suicide rates.Karaffa said this is an important factor to consider, and it opens up the possibility for discussions around changing access.
“Whenever I talk about these issues, I always want to emphasize that they're very, very serious, and we have to be doing something. And I feel like we also have to be focusing on tangible kinds of solutions,” Karaffa said.
Conversations around mental health are important for increasing awareness and working toward solutions. And when it comes to mental health in the veterinary professions, it’s important to consider all of the factors before making assumptions.
Karaffa said presenting the issues without context can create a cultural script that normalizes mental health struggles as an unavoidable aspect of working as a veterinary professional.
And while it’s important to be aware of these struggles, they should not be seen as a defining factor in the field of veterinary medicine.
“If you hear a news story, and you hear like, ‘Oh, wow, these are elevated rates of all these mental health problems,’ or, suicide, and it's not presented in context, it gives the message that every veterinarian is struggling,” Karaffa said. “Or if you go into vet med, you will be unhappy. And that's not the case at all.”
Stigma and culture as contributors
There are a host of reasons why a vet or a vet student may seek out mental health services, including academic stress, financial stress, relationship problems and trouble managing perfectionism. Working with pets and their owners in a medical setting can also mean vets and vet students are put in emotionally intense situations. This is just one factor that can contribute to compassion fatigue, which is often characterized by a decrease in feelings of empathy and sympathy. Compassion fatigue is commonly experienced by people in high-care professions, such as veterinarians. And sometimes, it’s not very easy to leave work at the door.
“It's really hard to turn it on and off. You know, it's like even when you're home, you're still a veterinarian,” Karaffa said.
When it comes to seeking out mental health resources, there are several barriers that can exist for vet students. In a recent study co-authored by Karaffa, the main barrier themes identified were stigma, veterinary medical culture and identities, services and personal factors. In an earlier study, Karaffa researched stigma as a barrier to accessing mental health services for vet students and found students had “overwhelmingly positive” responses to seeing a therapist, but “consistently underestimated their peers’ willingness to ask for help.”
“If you ask them: ‘What do you think other vet students would do?’ For every issue in the study, except for academic problems - study skills, essentially - they thought that their peers were less positive than they actually were,” Karaffa said.
This concept, known as pluralistic ignorance, is one cultural factor Karaffa said can intersect with stigma to create a barrier. He added there are several cultural factors that can contribute to mental health in the veterinary field, such as perfectionism and the stress of making moral decisions. Sometimes, veterinarians have to make these decisions on their own.
“In Missouri, especially when we have tons of rural communities - that is a thing. I mean, the truth is, you may actually be the only veterinarian within a 20 mile radius,” Karaffa said.
Embedded mental health providers can make a difference
Many studies, including one co-authored by Karaffa, have shown veterinary students are at increased risk for depression and anxiety. Additionally, embedded provider programs within colleges of veterinary medicine are becoming increasingly common.
According to Karaffa, embedded provider programs give students easier access to mental health services and can address barriers to access such as scheduling, time and cost. This can be especially beneficial within vet schools, which are not usually centrally located on college campuses. At MU, the vet med campus is located on the outskirts of main campus: over half a mile away from the university counseling center.
“When you have an embedded therapist, they're able to schedule appointments between classes, between labs. It's as simple as just coming downstairs or walking down the hallway,” Karaffa said.
In addition to supporting the overall wellbeing of students, Karaffa said addressing mental health concerns is especially important for vet students who are working in clinical practice. For veterinarians and health professionals, poor mental health can lead to burnout, high turnover, decreased empathy and even medical errors.
“If we're able to improve mental health and well-being among students, and hopefully establish skills and insights and things like that, that they're able to kind of take with them into practice,” Karaffa said. “It doesn't just impact the individual, it impacts the work that they do, the animals, the humans and ultimately the systems in which they exist and work in.”
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