Making mental health resources available to a team—without stigma and with confidentiality—can go a long way to helping employees. Psychotherapy, also referred to as talk therapy, is among the most underrated, and, sadly, underutilized healthcare services on offer. Not only is it widely denigrated as a service intended for exclusive use by the feeble-brained, socially maladjusted, or mentally disturbed, it can be surprisingly tough to access through traditional healthcare channels. Too few plans cover it and, when they do, they tend to restrict sessions to a sub-therapeutic frequency or a paltry number of visits a year. What’s more, plans will almost inevitably limit your choices to the dwindling subset of therapists willing to suffer insulting reimbursement rates, delayed payments, and the convoluted machinations of a third-party payment system. Then there is the stigma. Despite a relatively steady growth in demand for these services over the past few decades, a large percentage of the population remains uneasy with the concept. While some demographic groups are more likely to view psychotherapy positively (as a responsible life choice, self-care indulgence, or rite of passage, for example), most Americans remain deeply disturbed by the prospect of seeking help for their emotional or psychological problems—as if to do so is to embrace weakness, defeat, or mental instability. To wit, only 9.5 percent of Americans received counseling or therapy from a mental health professional during 2019 (according to the Centers for Disease Control and Prevention). When compared to the 15.9 percent prescribed psychiatric drugs during the same time period, it is actually kind of shocking. More so when we consider these findings in a veterinary context. Indeed, this disparity between drug and talk therapy seems about as reasonable and ethical as prescribing Prozac to our own patients without the behavior counseling or training we would typically recommend. When viewed in this way—through the lens of our own veterinary experience—it seems clear psychotherapy is either insufficiently prescribed, underutilized, or both. After all, would you ever fail to recommend behavior modification to any of your separation anxiety patients? Your storm phobia sufferers? How about your feline inappropriate eliminators? Would you gloss over these cases with a thin layer of transdermal amitriptyline? Well, you could, but it would not meet our modern standards of care or decency. The vast majority of mental health experts, along with physicians in general, agree mental health treatment overall is appallingly lacking in this country—more so given the alarming incidence of mental illness in the general population. Beyond this subset of the diagnosed, however, is the wider cache of humanity who, finding itself increasingly isolated, anxious, or emotionally overtaxed, might benefit enormously from verbal communion with highly trained healthcare professionals. I mean, you do not need to have a mental health diagnosis to be mentally unhealthy, right? In no profession is this mental unhealthiness (arguably) more acute than in ours. The recent suicide statistics are no secret, after all. It seems we all know at least one colleague who has chosen this route. But it is not just the suicides. The high rates of burnout, early retirement, and professional migration speak just as loudly to our industry’s collective distress. Ours is a profession currently under siege by threats as diverse as extreme client behavior, rapid industry evolution, chronic understaffing, high debt burdens, and compassion fatigue. Our workplaces are emotional minefields. Increasingly so. How, then, can we be expected to soldier on without adequate armor or access to intelligence? Given this stressful state of affairs, it is time we openly acknowledged our entire profession is mentally unhealthy. We should admit the conditions we labor under are decidedly not conducive to a sound state of mind. It is also time we started taking responsibility not just for our own mental health, but for our colleagues, team-wide. To that end, practices need to take active steps to improve their working conditions by addressing both systemic and quotidian stressors, and mitigate the effects of our professional stress via proven solutions. Psychotherapy could be the linchpin in any practice’s plan to implement a stress-mitigation strategy. To succeed in this endeavor, practices need to make psychotherapy openly available, readily accessible, and—most of all, perhaps—socially acceptable. Here are some steps practices can take by way of achieving a higher rate of talk therapy utilization across their entire team: No. 1 Offer an insurance plan that actually covers mental health services. Read the fine print on this, and be sure your plan offers enough therapists in your area for an adequate number of sessions with a co-pay they can afford. If you do elect to offer a comprehensive mental health plan, be sure your employees know about these benefits! No. 2 Include a statement in the employee handbook explaining the practice’s philosophy, urging employees to consider routine psychotherapy, group counseling, or other mental health services. (“We understand veterinary medicine is an emotionally demanding profession and we urge you to consider availing yourself of routine mental health care services offered by a licensed mental health professional or community-based organization.”) No. 3 Consider making mental health services more accessible by flexibly allowing employees time off to make their appointments, perhaps even paying them for the time it might deduct from their work hours. (Though it is crucial everyone understand any information regarding counseling would be kept confidential.) No. 4 Discuss seeking mental health services during team meetings, being sure to address how these services might benefit them throughout their professional lives. Attempt to squash the stigma (potentially by volunteering personal information if you are able) and distribute materials on the benefits of these services. No. 5 Offer your teams information on community-based group counseling programs, as well. In fact, some team members might benefit even more from some of the local self-help groups in the area than from individual psychotherapy. These are typically free of charge and anonymous. Twelve-step programs like Alcoholics Anonymous, Narcotics Anonymous, Al-Anon (for families of alcoholics and addicts), Gamblers Anonymous, and Overeaters Anonymous are just a few examples of effective programs (available several times a day at multiple locations in most major metropolitan areas). No. 6 Be sensitive. Not everyone will accept this kind of information without feeling offended or otherwise put-upon. It’s important you not belabor the issue, but please know it is okay to let your teams know they have mental healthcare options and they can speak with management safely and confidentially on these issues if they choose to. No. 7 Above all, keep all individual information confidential! Nothing will ruin all your hard work in this department quite as effectively as betraying a colleague’s confidence. It is important your teams know mental health information is considered sacrosanct and private unless they explicitly state otherwise or self-disclose publicly. A 365-PROBLEM While mental health issues occur year-round, this is an excellent time to bring them up. Next month is National Suicide Prevention Awareness Month, as well as Suicide Prevention Week (Sept. 4-10) and World Suicide Prevention Day (Sept. 10). Resources include: 24-7 National Suicide Prevention Lifeline – call (800) 273-TALK (8255) Crisis Text Line – text HELLO to 741741 AVMA resource – visit https://www.avma.org/advocacy/state-local-issues/state-wellbeing-programs-veterinary-professionals Patty Khuly, VMD, MBA, owns a small animal practice in Miami and is a passionate blogger at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.
