Breaking down the barriers

Posted on 4th July 2019

As a society, we’re talking about mental health and self-care more than ever before – but are dentists? Or are we bottling up our stressors until we’re burnt out and breaking down? Brooke Evans-Butler and Lisa Shearon tackle the issue of mental health in the dental profession – discovering what needs to change and what help is out there.

Dental Protection Limited recently held a lecture around the subject of burnout, ultimately not knowing whether or not there would be a great deal of interest in the topic. As it turns out, there was: more than a thousand dentists across Australia have seen the “Under Pressure” lecture, presented by Dr Annalene Weston and Dr Sam King.

Interestingly, the World Health Organization recently included “burnout” in the 11th Revision of the International Classification of Diseases. It’s defined as follows:

Burn-out is a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:

  1. feelings of energy depletion or exhaustion;
  2. increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
  3. reduced professional efficacy.

“Studies show that dental practitioners experience burnout at twice the rate of the general population,” Annalene says. “We’re proud to have started the conversation on stress and burnout, as brushing it under the carpet does not address the issues. Burnout can affect anyone, as pressure does not discriminate.”

The large attendance and amount of discussion at DPL’s lecture prompted ADAWA CEO Dr David Hallett to ask the question of how and why dentists are reaching the point of burnout.

“It wasn’t just the attendance numbers at the lecture that hit me, but also the number of attendees who spoke with me after the lecture, both on the night and in the days after, talking of their own circumstances and seeking potential avenues for assistance,” David says. “There seemed to be a universal appreciation to DPL and ADAWA for facilitating the presentation and for putting the subsequent webinar together, which is still available to members through the DPL website.”

It was a subject, David realised, that was relevant to each and every dental practitioner. He found himself asking the following questions: are dentists, as a profession, more prone to suicide and mental-health issues than those in other professions? What preventative measures can dental practitioners implement to avoid getting to crisis point?

Lorna MacGregor, CEO of Lifeline WA, says suicide is a low-prevalence condition, thereby making it difficult to establish statistically reliable data on discrete populations.

“It is generally considered that dentists, vets and other health professionals have higher suicide rates than the general population, but this is subject of some debate,” she says.

“Further confounding things is that different studies in different countries seem to find different professions at risk,” Lorna adds. “A study in the US in 2014 listed dentists as the profession with the highest suicide risk, followed by pharmacists, physicians, lawyers and engineers.

“However, a study in the UK found that while this was the case in the 1980s, in 2013 the top five professions were coal miners, merchant seafarers, labourers on building sites, window cleaners and artists.”

In September 2016, The Medical Journal of Australia undertook a retrospective mortality study of health professionals in Queensland. The study found that, in general, health professionals are healthier and live longer than the general population.

“However, research found an elevated risk of suicidal ideation and death by suicide among certain groups of health professionals, including doctors, nurses and dentists,” she says.

The research found two distinguishing features of suicides by health professionals:

  1. They are more likely to involve poisoning than the general population
  2. Women working in health professions appear to be at particular risk. In the general population, the male suicide rate is 3 to 4 times higher. In health professions, the female suicide rate is the same as the male suicide rate
  3. The rate of suicide for health professionals with access to prescription medicine is higher than for health professionals without ready access to these means

Regardless of the statistics, the fact remains that mental health and wellbeing needs to be a priority for those in the dental profession. It’s important to reach out for support, advice and simple conversation, whether online, on the phone or in person. Don’t wait for burnout or crisis point to hit before you start talking.

Talk it through

Lifeline WA’s mission is to prevent suicide, support people in crisis and create opportunities for emotional wellbeing. Drs Christine Pears, Don Rechichi and Clive Moody are all retired ADAWA member dentists who now volunteer their time as Lifeline Telephone Crisis Supporters.

“Like all dentists, I spent my life looking after people,” Clive says. “When I retired, I wanted to find something to help others. I was also concerned with the high rate of male suicide. For me, this has been the most rewarding thing I have ever done.”

“We spent our whole professional lives solving problems,” Christine adds. “After necessary introductions, we would ask a new patient ‘How may we help you?’. We would then carry out the necessary examination and aim to come up with a solution or range of possible solutions. With Lifeline, we have had to un-train, in a way. We are no longer problem solvers. Our main role is to actively listen non-judgementally and with empathy and to try to help the caller find their own solution.”

According to Christine, there is a misconception that Lifeline calls are mainly from people who are having thoughts of suicide. The fact is, however, that only 1 in 10 calls to Lifeline are of this nature.

“One of the most common reasons for calling is social disconnection,” she says. “Loneliness in our society is massive and a lot of people often just need to talk to someone. Simplistically, a problem shared is a problem halved.”

As former dentists, Christine, Don and Clive understand the unique pressures of the profession, as well as the reluctance many dentists may feel in opening up and admitting their struggles.

“Professional pride can force people to hide things from their peers,” Don says. “However, to me, talking to other dentists who you can trust about what is worrying you in your life and in your practice is important.

“And if you can’t talk to your peers, then talking to a support service such as Lifeline can also be helpful.”

“Of course, you can be lonely in a crowd,” Christine adds. “You could be a dentist who has a family, fabulous staff and amazing patients and still be lonely.”

Services such as Lifeline exist to offer anonymous support to those who need it, regardless of their “level” of crisis.

“What would be a crisis for me may not be a crisis for you,” Don says.

“If it is a problem for you, then call us,” Clive adds.

Online support

As all dentists will know, peer support is vital. For those who aren’t surrounded by likeminded colleagues in a busy practice, it can be difficult finding peers to debrief with. That’s where social media can be of assistance.

Last year, Dr Julee Birch created a peer-support Facebook Group for dentists called The Mental Block, after a conversation about mental health for dentists. “A colleague found an article about a group in the UK called Mental Dental. It was a Facebook group that offered peer support and I thought it was fantastic idea,” she recalls.

After contacting the founder of Mental Dental, Julee set up an equivalent group of dentists in Australia and New Zealand. She, along with Annalene Weston and Moira McQueen, moderate the group, which now has around 880 members across Australia and New Zealand, with 51 dentists from Perth.

Julee says 62% of all members are in the 25- to 34-year-old demographic, with a combination of concerns being raised.

“It’s varied; there are dentists who need to talk and others who want to provide support. The topics are usually what we would expect – patients stressing dentists out, the environment at the dental practice, not having anyone in the practice to talk to. There are a lot of posts that are uplifting. There was one today saying: ‘Look at yourself in the mirror, and you are enough’; it is a very supportive group.

“There are a lot of good-hearted dentists out there who are very willing to help their peers,” Julee adds. “It really is a good news story and if it helps one person then I will be happy.”

To request to join, search The Mental Block on Facebook. Requesting members are asked to provide their AHPRAor DCNZ registration number to join.

Your self-care tool box

The Samaritans is a telephone support service, offering a safe, anonymous and caring environment to help you explore your feelings, and uncover your options for a pathway forward. Executive director Zrinka Highfield believes that dentists – just like other members of the community – should prioritise self-care, building resilience and seeking help when you’re struggling.

Be kind to yourself. Practice self-compassion. In life there are things we can’t change but many things we can change. Beating yourself up over things, especially those you can’t change, will just make you feel worse. It is not your fault you are feeling this way.

Be mindful. Being present in the moment can help you become aware and manage overwhelming thoughts and feelings.

Do something you enjoy. Have some “me” time.  It can be as simple as listening to your favourite music, going for a walk or seeing a movie. We live in a world that seems to value long working hours and everything else that comes with it. We hardly have time to enjoy life, connect with friends/family and do things that bring us joy. Put aside some time every week to do something you enjoy. Rebalance the scales in favour of your own wellbeing.

Try not to judge your emotions. There is no right or wrong in emotions – it’s ok to feel what you are feeling in this moment. Aim to move toward accepting the presence of your emotions.

Avoid unhealthy habits. Try not to rely on smoking, drinking and caffeine to help you cope. Men are more prone to this behaviour than women. It’s only a temporary crutch that can make you feel worse long-term and won’t solve your problem.

Remember that you are never alone. You don’t have to suffer in silence. Talking to a friend/family member can help you feel listened and supported. By acknowledging your feelings out loud can help. Maybe you would rather talk to someone anonymously and in that case, you can reach out to a helpline.

Seek help. Sometimes you may need that extra bit of help and that is ok. Your GP can be a great source of further help.

The Samaritans has a 24/7 support line – 13 52 47.

 “No matter what you are going through you can talk it through with us,” Zrinka says. “We will accept you for who you are, without a label or diagnosis. You don’t have to be suicidal to call us.”

Get a good GP
Dr David Oldham, medical director of the Doctors’ Health Advisory Service WA, says the most common mental health problems for medical practitioners are anxiety and depression.

“The workplace is probably overall the main contributor to the burden of burnout, anxiety and depression,” he says. “There is a culture of practitioners being expected to work hard and not complain and if anyone does complain, then it’s seen as a sign of weakness. As a result, there is a very high rate of burnout particularly for doctors under the age of 30, with a 50% burn-out rate.

“When you are talking dentists’ health, the number one message would be for them to have a GP,” David says. “GPs provide about 80% of mental health care in the country, with the remainder being provided by psychologists and psychiatrists.”

He has the following wellbeing advice for health practitioners, including dentists:

  1. Have a GP and see them regularly
  2. Getting anxious and depressed, especially with an obsessive and conscientious personality, is very common and people shouldn’t feel embarrassed about it. It is certainly something they can talk about with their GP. It is the most common condition GPs deal with
  3. Discuss with the GP who to tell in the workplace, or whether to tell anyone at all
  4. Occasionally medication will be required. If needed then it usually works well


Mandatory reporting

Western Australia is the only State that doesn’t enforce a mandatory report of a health practitioner’s impairment by their treating practitioner.

“Dentists may resist seeking treatment, fearing the stigma of personal humiliation and the potential impact on their professional reputation and registration,” says ADAWA CEO Dr David Hallett.

“WA is the only Australian State where a treating doctor or practitioner is not required to notify AHPRA of a dentist’s health condition if there is a reasonable belief formed in the course of provision of treatment without having to defer for regulatory advice or action.

“A situation could arise whereby a dentist may be encouraged to take the brave action of undertaking a voluntary AHPRA notification or perhaps consider modifying their practice or cease practice for a period. These decisions can be difficult.

“Members can be assured that any counselling or assistance provided by the Dental Cases Panel consultants or by me in this regard will be conducted in the strictest confidence.”

For 24-7 support, call Samaritans: 13 52 47 or Lifeline: 13 11 14