How to Manage our Clients’ Mental Health
A thread came up recently on the Vets:Stay, Go, Diversify FB group regarding questioning how to manage our clients’ mental health. With mental ill health on the rise in the general population, we increasingly find ourselves facing clients with overt mental health issues and reduced coping mechanisms when their animal is unwell. It can adversely affect communication, and result in concerns for the welfare of both the clients and their pets. Plus, it can leave us with a sense of responsibility and increased stress in our working life.
Rosie Allister, vet, researcher, Vetlife Helpline Manager and author of https://veterinarywellbeing.wordpress.com commented:
“A lot of people still believe the myth that if someone is talking about suicide they aren’t going to do it, which isn’t true. Talking about it indicates risk and is something to take seriously as you did.
My approach to try to listen as much as I can, empathise with how bad things are, then say that I’m worried about them, and I want them to be ok, and want to get them help. I actually say all that as when someone feels that bad it can be surprising to people that someone wants to help. I ask if they’re going to be safe leaving, and if they aren’t I ask their permission to call someone like a friend or family member. I stay with them while I do that and if they are in an unsafe environment I wait with them somewhere safer. If they can’t think of anyone to call I ask if they have anyone professional supporting them, or if they are registered with a GP and if I can call those. If all those fail it can be emergency services, but again I get consent for that. I’ve never found that someone won’t consent.
There is some really good training out there for lay people on supporting people who are suicidal. A key feature of all of it is getting support for yourself afterwards too. It’s a lot to process, and not something to carry alone. If there’s noone about to talk with you can always call Vetlife Helpline. The person answering will very likely have been there too, and will get how tough it is in a hectic clinic to find headspace to process supporting someone in that situation.”
Rosie will be taking part in a session on supporting clients at the StreetVet Conference in September, which will cover the following:
- How animals help mental health, and expectations of us in supporting that.
- What is our role as professionals when responding to clients who seem to be experiencing mental health problems – considerations like informed consent, mental capacity, safeguarding.
- How to access help services if you are really worried about someone.
- Some case studies looking at issues that might arise – depression and complex bereavement, safeguarding where you think a client is at immediate risk, perceptual disturbances where a client’s reality might be different to ours, and legal issues where we have concerns a client may not have capacity to make decisions.
“A lot of this is just about being human, non judgemental, and kind. It can take time, and trust, and lots of listening, and we need to have considered our own professional boundaries and legal responsibilities too. Listening, understanding and kindness are key. And support from our practices to make time and resource for that.
A number of organisations run general mental health based training like MHFA, or Samaritans training for businesses on supporting people who are distressed, or Mind do a lot of commercial training too.”
For bespoke training for practices please contact Rosie to discuss directly firstname.lastname@example.org
Other tips included Blue Cross Helpline when discussing bereavement following loss of a pet.
CPC also offer counselling.
I attended the MHFA course run by RCVS MindMatters / BSAVA, which was a great starting point. See here for 2018 dates
VDS training have a webinar entitled – ‘Helping Clients Deal with Their Emotions’ http://bit.ly/ClientEmotionVDS
Resilience and Compassion Fatigue
Our emotions are powerful assistants, but dangerous masters.
Compassion fatigue occurs when we become too involved in our cases that our emotions are affected beyond the consult room to the point where our own reserves are eaten away. The result is either switching off (becoming unemotional and disengaging), or emotional breakdown (where it all becomes too much), both of which are very damaging to ourselves, our relationships and our careers.
As a vet student, I was lucky enough to be taught by Peter Jackson, legend in the fields of reproduction and large animal medicine. I am now privileged to work alongside him at Wood Green the Animals Charity, where he is one of the veterinary trustees. His compassion towards patients always struck a cord amongst myself and fellow students. His subtle tones whispering “Cush, cush chicken”, to a stressed-out cow never failed to settle them… and the students observing him. I asked him to write a blog on how he maintained such gentle compassion after a lengthy career. The answer… professional resolve and peppermints!:
AVOIDING COMPASSION FATIGUE
“As a teenager I remember very clearly visiting the local doctor about a painful elbow. In those days doctors had open house surgery with no appointments. The doctor didn’t look at me as I went in but said ‘Sit down. Tell me your name, address and age. Now, as quickly as possible, tell me what’s wrong with you!’
Perhaps my doctor had compassion fatigue. It’s easy to develop it as you fight against the clock in a ten – minute consultation with a complicated case history. Your conscience reminds now or later that you have rushed your clinical examination and have been a bit impatient with your client.
If you feel compassion fatigue coming on think about why you became a vet. Most of us decided to be a vet whilst at primary school. We wanted to help sick animals and perhaps to be like that clever young vet on TV. We struggled to get a place at vet school, sat countless exams and eventually graduated. On admission to membership of the RCVS we said “I PROMISE AND SOLEMNLY DECLARE that I will pursue the work of my profession with integrity and accept my responsibilities to the public, my clients, and the RCVS, and that, ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care.’
We became members of the veterinary profession and as such we must behave at all times, whatever the pressure, in a professional manner. Our clients expect it and our patients deserve it. A quiet few words as you handle and examine your patient and a friendly word with the owner set the tone for a good consultation.
I worked for many years in general practice where pigs formed a high proportion of our farm livestock. Often arriving at a farm or smallholding there would be a note on the piggery door. “Peter – third sow on right, off her food and piglets hungry please leave note – please write clearly.’ You quickly learned to be stealthy with pigs doing as much as possible without disturbing them. Stroking the sow’s udder and speaking quietly to her you can perform your clinical examination including looking at the feet whilst the sow lies happily there. Far better than shouting ‘Come on get up let’s have a good look at you.’ Have a look at the piglets in their creep. Pick one up by a hind leg to reduce the chance of it squealing. The sow has diamond – shaped elevated lesions on her back and a very high temperature. You quietly give her a s/c penicillin injection as you rub her udder again and tell her she’s a good girl. She doesn’t notice the injection.
As you go out you write a little note ‘Bill, Sow has erysipelas, have injected her and will call again tomorrow. Can we discus vaccination? Peter.’ You write carefully as you remember Bill saying ‘You vets don’t half write badly Peter. I don’t expect to be able to read it ‘cos you vets and doctors always write in Latin don’t you?
You suddenly see another note on the inside of the door. ‘Peter while you’re here can you have a look at the old cat – it’s in the kitchen. She’s got a bad eye. Oh and we found a couple of dead chickens this morning can you do a PM please.’ Your planned timetable of visits is compromised but you dutifully look at the cat and the deceased chickens You radio the office asking them to tell your remaining calls you are going to be at least 30 minutes late. You have a peppermint, take a deep breath and remember to be professional.”
May you be happy as a pig in muck throughout you career!