Episode 2: It's Your Mental Health

 *Opening Music*  

Listen up, animal care pros, compassion fatigue is real, and I'm here to help you address it. I'm Alissa Hebert-Wallace, an LCSW with over 20 years in the field, and this is Pawsitive Outlooks. On the show we'll take a look at various aspects of compassion fatigue and compassion satisfaction, including general information, mental health aspects, self-directed interventions, and a few guests along the way. 

I want to start by acknowledging that I live, practice, and learn in the traditional unceded homelands of the Acolapisa, Chakchiuma, Choctaw, Ofo, and Yazoo people, who continue to be stewards of this land. I also acknowledge the Houma people who were driven from this territory and on whose settled, unceded land I was raised. I mourn the loss of the individuals and tribes that did not survive the colonization, genocide, and warring of European countries. Finally, I acknowledge that this information regarding tribal lands was primarily taken from colonizers' records. 

*Musical Interlude* 

Welcome back!

 

As we talked about in the first episode, compassion fatigue can have a profound effect on one's mental health. The list of mental health symptoms that we will explore today is based on the works of Doctor Charles Figley. You may notice that as we go through it, I will say “you” sometimes, I will say "I" sometimes, I will say “we” sometimes, and that is because, like you, I am a helper and I also experience some compassion fatigue from time to time. 

So the first thing we want to talk about is we might experience a sense of powerlessness, helplessness, or that we are ineffectual as helpers. So this is the sense that you don't know what you're doing, you don't know how to do your job, other people are more experienced than you, and why do you have this position. A lot of times that comes on from some compassion fatigue. Sometimes we also call that "Impostor Syndrome." Let's talk about this right now. We all have imposter syndrome, so it's not even a thing. If we're all impostors, then none of us are, so we can get that out of our head right now. 

Alright, so the next thing, growing on that, we experience some anxiety or we experience some fear when we think about all of the things that our clients are going through. So, right, not just one client, but all of our clients have so much to deal with. All of the animals that we work with are sick, which is not true, right? Unless you're an emergency vet. Some of the animals that you are dealing with are just fine, and they're coming in for their annual check up, for their six month checkup, right? So, but we still think that all of our clients have something wrong. And this thinking can come with a sense of apprehension or uncertainty and it can grow to be even, like, a terrified feeling, right? And this is linked to the anticipation of what might be realistic, or it might be things that we're building up in our heads of events or situations that are facing our clients. 

So these can impair our physical health and our psychological functioning. Again, mental health is tied closely to physical health, so you may notice that you're experiencing some of these symptoms in your body--in your stomach, in your chest, in your head. So being mindful of those symptoms, too, you might notice that you're experiencing anger or rage to people responsible, so this might be in the case of animal neglect or animal welfare cases, right? You might experience some rage towards those folks who are responsible for putting that animal in that situation. 

As helpers we also might feel guilt. We might feel what our clients are feeling, or we might feel guilt because we might not be able to help. It might be a situation in which there's a financial reason that a human client can't help their animal, right? Or it might be a situation where, the animal is just so sick that it can't be helped and you know that maybe that animal is the only thing that that person has. That might be linked to some feelings of survivor's guilt. So it might be linked to a feeling of you might feel guilty because all of your animals at home are healthy, and you know that you were having to work with animals who are unhealthy, and why do you have all of the healthy animals, right? Why aren't your animals going through things like this? 

You might experience some shutdown or numbness, right? You might get to a point where you can no longer feel empathy towards your clients because all you feel is numb, and you just feel shut down. That can lead to a sense of exhaustion; like you just can't do it anymore. You can't get out of bed during the day, you... you just can't go on. You're exhausted in your profession. That might be a time where you start to think "Is this still right for me?” “Do I still want to be a vet?” “Is there something else that I might be able to do that I won't feel like this anymore?” That can grow into a depression, which can range from that sadness or those guilty feelings to more of a clinical depression and clinical depression is characterized by several things. It can be insomnia, loss of appetite, more extreme guilt and sadness, an inability to concentrate. So when you try to read a book, or you try to do your notes, or you try to file some charts, you just are distracted by everything around you, and you just can't focus on anything. 

You might be hypersensitive, and you might react emotionally with very little provocation. So you might cry easily, or you might find yourself laughing, like at inappropriate times or with nervous laughter, things like that. You might also find yourself on an emotional roller coaster. One minute you're happy, the next minute you're sad, you are hypersensitive to things that are happening. Then you might get angry over things that used to not make you very angry, things that might just irritate you. You might just feel extreme anger for so that emotional roller coaster and that hypersensitivity can just make us almost do somersaults. We're so we don't know what to do at times. 

You might feel overwhelmed. You might feel that you are going from, like, zero to 60 in less time than it used to take you. Or you might be reaching your limits with your patients and your sensitivity and your empathy that you are giving to other people, especially with your clients. So it'll happen with your colleagues, right? You'll find yourself being short with them, but you will find that some of this shortness is especially directed towards your clients. And if that's the case, then you can be pretty sure that you're experiencing some compassion fatigue. 

Finally, you might feel yourself just severely depleted by being a helper and by the work of helping others, and you might blame this either on the quantity of your workload, like you are being forced to see such a high number of patients, or you are having more difficult patients than anybody else, or you are having to severely cut down the amount of time you spend with your patients because you've got so many of them to see in a day. So the quantity of your work might be depleting your ability to help others. You might also find that it's the quality of your work, so not your work quality—Your work quality probably is not suffering in all of this; it is probably just as good it's as it's always been—but the quality meaning like the intensity or the difficulty of your patients. You might find that what you're sensing, what you're feeling, is that you are the one that gets all of the difficult clients and you are the one that gets all of the most intense cases because that's what you're seeing. That might be a sign that you are experiencing some compassion fatigue. 

Now that we've gone through that, you might be thinking, well, everybody experiences these things at one time or another, which is true. We do, and it is just, it is kind of something that we go through as helpers. These things are things we experience from time to time, but as they develop and they build and you notice that you're experiencing more and more symptoms, it is important to address these things and not let them go on. 

One reason is because you're ethically bound to. We talked about it in the last episode, right? The AVMA requires that, as a veterinarian, you don't practice impaired, and that includes with mental health impairments and it includes some of those things we talked about, maybe some negative coping skills like substance abuse. So that is an important reason that we that you address it, but otherwise you can't think about two things at one time. So if you are preoccupied with some of these feelings you're feeling, maybe some guilt, some survivors guilt, if you're on an emotional roller coaster, if you are hypersensitive, if you are having insomnia at night, or if you are feeling extreme sadness or helplessness, or all of those things can affect the way you practice. You cannot concentrate on those things and have the same amount of thought processes and reactions that you would if you were clear headed. 

So if you don't address your mental health symptoms that are coming from compassion fatigue, then your work with your patients will suffer, and so it is important that you go through and maybe just do a mental note every day of how you're feeling. And if not, luckily you will have some of these great self-directed interventions coming up and you can maybe include some of those in your routines so that you aren't so preoccupied with some of these mental health symptoms. 

*Musical Interlude* 

This next section of the episode discusses suicide. While it is an important topic for us to talk about, especially in relation to compassion fatigue, I understand that for some people this may bring up certain distressing feelings and emotions. If this is the case, please jump to 24 minutes and 28 seconds for our discussions on safety planning and resiliency. I do encourage you to take time to listen to this when you feel you are able. 

I'd like to take a minute now to address something that we briefly discussed and alluded to in the first episode, and that is suicidality in veterinarians. The reason that we discuss it, along with compassion fatigue is because globally veterinarians have been shown to have two to four times the suicidality rate as the general public. Additionally, one study showed that veterinarians have approximately six times the risk of suicidal ideations and suicidal behaviors as the general public. 

Now, we discuss this with compassion fatigue because research has indicated that the high suicide rate among veterinary professionals is directly related to compassion fatigue. Other studies show that veterinarian suicidality is related to specific factors, but those factors include the factors that we have addressed in contributing to compassion fatigue, including euthanasia related stress, ethical conflicts and moral distress, lack of DEI in the workplace and work related stress. 

In addition to factors directly related to compassion fatigue, veterinarians also face unique risk factors that the general population may not face. First, veterinarians have certain personality factors that may contribute to suicidal ideations. These include the tendency to be high achievers and to want perfectionism, and also a preference for working with animals rather than people. 

Next, many veterinarians work in professional isolation, where there is often little supervision or access to assistance. This increases the potential for professional mistakes, which might contribute to the development of suicidal thoughts. 

Veterinarians have a different attitude towards death, euthanasia, active participation in the ending of animal life may change their views on death, and maybe the on the sanctity of human life, and this also reduces inhibitions towards suicide. 

Veterinarians have access and knowledge about means of suicide. They have access and knowledge to prescription medication, which has the potential for misuse. Like we've talked about before, sometimes we might use substance abuse to deal with some of the symptoms of compassion fatigue, so this access and knowledge just increases their risk of a death by suicide or an accidental overdose. 

Also, there is a risk of the suicide contagion, which means that knowledge and indirect exposure to others’ death by suicide might increase suicidal ideations in an individual. 

Finally, veterinarians have a stigma around mental illness because their identity, much like other helpers, is firmly rooted in being a helper. And so veterinarians, like other helpers, may have a stigma around seeking mental health, or they feel that they are the ones to help so they don't need the help. And so this contributes to a lack of seeking out formal mental health assistance, which could also increase suicidal ideations. 

 

I'd like to take a minute to note that not all self-injurious behavior is suicidal behavior. Some reasons that people engage in self-interest behavior include managing painful feelings of current or past trauma, punishing themselves, exerting influence over others, avoiding feelings of being detached from themselves, to avoid or combat suicidal thoughts, to feel pain and relief, and to exert some control over their own body. 

Just as we discussed before, that there are outside influences on compassion fatigue. So it's not always the things that you're dealing with as you're working, but there are outside influences. There are also outside influences on one's suicidal ideations or suicidal thoughts and suicidal behaviors, and some of these you might notice overlap with what we were talking about when we talked about compassion fatigue. These risk factors include stressful events or a history of abuse and trauma and substance misuse and sensitivity. Some seasonal changes--some people notice that they have what we call seasonal affective disorder, which is when the season changes, especially from summer to winter and there is less light and they're outside less. They are extremely affected. So this isn't just like “Oh, I'm kind of blue because it's winter.” This is feelings of extreme depression due to seasonal changes. 

Some other things include maybe a previous episode of mental illness or a presence of another mental illness that might be being treated. Some other risk factors include ongoing stress and anxiety, maybe medical conditions, illnesses that are life threatening or chronic, or associated with chronic pain, and also some medications can cause a side effect of increased suicidal ideations. 

I would now like to go over some statements and thoughts that are common about self injury and suicidal behavior. These facts and myths are based on an exercise developed by Mental Health First Aid USA. 

Statement #1: “Self-harm is a mental illness.” That is a myth. It's actually a behavior and often is symptom of mental illnesses such as depression, borderline personality disorder, or psychosis, and self-harm can become addictive.  

Statement #2: “Self-harm is more than just cutting, burning, and things we can see.” This is a fact. Excessive exercise, pinching oneself, increased drinking, overdoses with non-fatal intentions, sabotaging relationships, and staying in toxic relationships can all be forms of self-injury. 

Statement#3: “Self-harm is a failed suicide attempt.” This is fiction. As we discussed before, some self-harm can just be in fact intention to harm oneself and not kill oneself.  

Statement #4: “Self-harm can be a good thing.” While this sounds counterintuitive, this is actually a fact, because it might stop suicide. It may also be a way to get some relief until new and healthier coping skills can be developed. 

Statement #5: “If you ask someone about their intent to suicide, you will encourage the person to kill themselves.” That is fiction. Actually the opposite is true. Asking someone directly about their suicidal feelings will often lower their anxiety levels. Your openness and concern in asking will allow the person to talk about their problems. 

Statement #6: “A person who attempts suicide will always be, quote, 'suicidal'.” This is a myth. Many people who are at risk feel suicidal for only a brief period. With assistance and support, they might never be suicidal again.  

Statement #7: “Suicide happens without warning.” This is a myth. Studies show that people who are suicidal generally provide many clues and warnings regarding their intentions.  

And, Statement #8: “Suicide occurs across all classes of people.” And this is a fact. Suicide shows no class prejudice and is represented throughout society. 

While it is important to be able to recognize some of these signs and symptoms in yourself, it is also important to be able to recognize some of these signs and symptoms in friends and colleagues. One veterinarian who spoke with me told me that she did not know a fellow veterinarian who was not touched by suicide, whether it was from their graduating class or their schoolmates in vet school, or whether it was a colleague, someone that they had known while they were working. 

So let's talk about how to talk about suicide with someone else. The first thing to remember, and I know it's hard, but the first thing to remember is that when you're having this discussion use the word “suicide” or “kill yourself”, because if you ask someone if they want to harm themselves and they are really thinking that they want to kill themselves, they might tell you no because no, they don't want to harm themselves. They actually have an intention to kill themselves. 

When you have this conversation, it's also important to appear confident, and I know that's hard too, because this is probably a discussion you don't really want to have. But the more confident that you appear in the discussion, the more reassuring it will be to your friend or colleague that you are about to discuss suicide with. You want to tell them about your observations, the things that you've seen. You want to reassure them that thoughts of suicide are common and that many people have them. You want to talk to them about receiving help, about professional mental health help, because once we're at the point of suicidality, these interventions that we're about to go through in this podcast will probably not be enough. 

If you are ever in a situation where you do have to have this conversation with a friend, remember, it is important to show empathy for what they're feeling and what their beliefs might be about their experiences and their symptoms. Also understand that the symptoms are just that, symptoms of something else that they're feeling. 

It's also important that you do not confront them, criticize them, or blame them, or use sarcasm or patronizing statements, even if that is your typical relationship, and you want to not judge them. It is also important to remember that you are not the mental health professional and it is not your job to treat them or fix them or save them. It is your job to get them through the moment into a place where they might be able to receive some professional help, too.  

In this segment I would like for you to think about your own mental health. If you have had suicidal ideations or have engaged in suicidal behaviors, I urge you to reach out to someone you trust, a friend, a family member, or someone you can talk to. Or I urge you to call the national crisis line. In the US, you can dial 988. Outside of the US, please visit nomv.org/crisis-numbers. Also, if you feel like you are in an emergency or you are not safe, please call 911 or your local emergency number. 

*Musical Interlude* 

So we've talked about the mental health aspects of compassion fatigue, and we've also talked about suicidality. So now I'd like to move into what can we do. How can we help ourselves to face some of these symptoms and improve our mental health? 

Well, the first thing I'd like to talk about is a safety plan. So what is the safety plan? Safety plans are tools that enable us to de-escalate in a moment of crisis. It is a written list. It is a list that you keep somewhere safe, that you keep somewhere that you know you can find it, and maybe you share with your partner or a trusted friend or relative. Safety plans are not “no suicide contracts”, okay? These are things that you can do to help yourself de-escalate in a crisis situation. 

Safety planning is useful because these feelings of intense distress, these feelings that we talked about in the first portion of the show today, they can fluctuate over time. They don't...They aren't the same. They go up and down and sometimes they go high enough that they reach what we call a crisis. So a safety plan is designed to break that cycle. It is designed to help you from entering that crisis state. 

So let's talk about how we're going to build our safety plan. So I'm going to go through some things with you and this will be a lot of pausing and writing and stuff, but before we do that, guess what? It's time to gather some materials. So take a minute, grab a pen and a paper. Now, this might not be the final thing. You might want to type it up. You might want to print it out, but for now just grab a great pen--maybe your favorite pen--and some paper that you can write on, and when you come back we'll get started with our safety plan. 

*Action Music* 

All right, now we're ready to roll. It's important when you're writing out this safety plan that you don't just write things like "read a book" or "listen to music." It's important that you write things out. Like "I will read a book" or "I will listen to music" or "I will call my friend Bob." 

OK, so the first part of a safety plan is triggers and risk factors and maybe some warning signs. So these are going to be things that you notice that happen before you get to that crisis state. So it might be that you feel your chest getting heavy, or it might be that you notice that you're feeling flush, or it might be that you notice your teeth are clinched, or you have your hands in a fist. So those are some warning signs and then the triggers, obviously, are anything that will make you get to that state. 

The next part of the safety plan are internal coping strategies or self-coping strategies, so these are things that you do on your own, such as reading a book or listening to music, right? Things that you can do by yourself without another person. 

The next part is social contacts, so these are people who can distract you. These are not people you're going to call for help. These are people who you can call, and they will take your mind off of your problems. They will distract you. They will help you to feel better. 

Next, we want to look at places that you can go, public places, social events, that can help distract you and make you feel better. So again, these things are not that you're going to ask for help or you're going to tell somebody that you're necessarily in a crisis, but these are things that will help you to distract yourself. Your own coping skills or places that you can go. Or people that you can call. 

Next, I want you to write down some people that you can call for help so different than the first list of people. These are people that you can call for help. You can say, “hey, I'm really distressed right now. I need you to help me. I need you to come over and be with me,” or “I'm having a real problem. Can you come sit with me? Can I come to your house and sit with you?” So again, when we look at people that we're putting on our crisis plan, the first list of people you might not even tell you're in a crisis. You might just call them to come hang out, and you know that they're going to be able to distract you. The second list of people are people that you can tell that you're in a crisis, a trusted friend, a partner, a relative. People that you can say, "hey, I need some help.” 

Now the next set of numbers, you might not have these numbers right now. You might have to go search for them. There are going to be some at the end of the podcast. The next list of numbers are professionals and agencies and mental health services that you can call in a crisis. For example, in the United States, you can dial simply 988 and it will direct you to a crisis line. 

The next part is making sure that your environment is safe, so ways that you can protect yourself from either lethal or non-lethal self-harm. So we want to be able to, if you have firearms, lock them away, maybe get some gun locks, if you have large amounts of medication you want to be able to lock that away, but in the same time you also want to have a number right here of a person...that one person that will always be there that can help you make your environment safe. 

And that's the end of your safety plan. 

So I'll go over it quickly again. The 1st part is triggers and warning signs. The next one is things you can do yourself, places you can go by yourself to distract you. A list of people that you can call to distract you, not for help. But just to distract. So next, you want a list of people that you can call and ask for help. You also want a list of professionals that you can call to let them know that you're in a crisis and get help from the professionals. And finally, you want a list of ways to make your environment safe, and one last phone number of someone that you can call to help you make your environment safe. 

Now you're all set. You've got your safety plan written. 

What I would suggest is that you go back over it and you write it out in a way that you want to keep, because if you are like me or some of our friends, if it's written messy it's not going to be something that's going to help you in a crisis, right?  So you might want to write it neatly, or you might want to type it out. Some people will put it in the place where they know that's where they go. So if you're somebody who turns to alcohol, you could put a copy of your crisis plan wherever you keep your alcohol. If you're somebody who might turn to other substances so you could put a copy in where you would go for that. Also, some people like to have a trusted friend or a partner have a copy of their safety plan so that when they call them in the crisis, and when they call them asking for help, their friend or partner will have the safety plan and they'll be able to go through it with them and say, "well, did you try reading a book? Did you try listening to music? Did you try some of these other things at the start of your safety plan?” 

So just a few more things to remember before we finish the safety plan segment. So the first thing is we all have these magical wonderful cell phones that have every number we've ever known listed in them. I still want you to write the phone number of the people on your safety plan, even if it's programmed into your phone. Because in that crisis moment, you may not go to your cell phone. You may not feel like fumbling with it. It's important that you have that number right in front of you now. 

Second, this safety plan that you just wrote is not your safety plan forever and ever, amen, right? Some things change, some people change. We get closer to some people. We get farther away from some people. We used to like to read a lot, and now we like to listen to music. So periodically it's a good thing to go over your safety plan and make sure nothing has changed and make sure that it needs to stay the same, OK? 

So hopefully you have walked with me through this and you have completed your safety plan. And now before we talk about resilience, go put it in a good spot. 

*Musical Interlude* 

Resilience is the ability to grow and even thrive in the face of hardships. These hardships can be personal trauma, environmental disasters or emergencies, and even work-related stressors such as providing medical care in euthanasia, difficult client relations, financial stress, or a lack of DEI in the workplace, just to name a few. Hmm...I wonder where I got those from? 

A typical reaction to any of those scenarios may be anger or grief, which are natural ways to react to things not going our way. With resilience, we not only are able to work through negative experiences, but we can bounce back and move forward, having grown from those experiences. 

While emotions such as anger, sadness, anxiety and embarrassment are common and expected reactions to negative situations, folks with greater resilience are able to move through these emotions and take new lessons with them. People who lack or have very little resilience often find themselves either overreacting or sitting in those negative emotions for long periods of time. 

While negative examples are typically the easiest to envision, it is important to be resilient in the face of positive changes as well. Significant positive events like promotions, moving, or undertaking educational and business ventures can create a need for adaptation and the time for recovering after the change.  Greater resilience can also help to manage secondary traumatic stress and burnout, the components of compassion fatigue. Greater resilience is needed to manage stress and setbacks. It also assists in building authentic relationships and continuing to act in line with one's values. Resilience can also help to build compassion satisfaction by helping us to remain inspired in our profession. 

So now let's take a look at how you've been resilient in the past. This resilience exercise is called the 4 S's, and it comes to us from the good people at PositivePsychology.com who state “this tool helps people unpack their personal resources for resilience by giving them a framework to bring out what specifically works for them.”  To do this, you'll need a pen and paper, and if you're like me, you might need a ruler and a highlighter, and multiple colors of pens. Oh, and you'll also need to open up that brain of yours. Now, since we have a bit of writing to do I'll save our action jingle for then, but run and grab your supplies before moving on. 

OK. Are we ready? 

First, divide your paper into 4 quadrants.  In the upper left, write “Supports that kept me upright.” In the upper right, write “Strategies that kept me moving.” Next, in the lower left, write “Sagacity that gives me comfort and hope.” (This is the 4S's. So the Positive Psychology folks couldn't just say ‘wisdom’.) Finally, in the lower right, you'll put “Solution-seeking behaviors I showed.” 

Now we'll take some time to fill in our squares. Once you've done that, I want you to mark any of the items that you think would still apply to you, because some of them might not, and I'll meet you back here in a bit. 

*Action Music* 

Well, how was it? 

I know that when I did it, it was hard work for me to get started, but then it came easier to fill in all the squares. I am confident that you have at least one strategy marked in each quadrant for moving forward, right?  That's what the start of building your resilience plan looks like. To give you an extra boost I've dropped a link in the description with some more ideas for building resilience. 

The great thing about resilience is that it's not an all or nothing trait, and it can be developed over time. In addition to the responses you've recorded during your 4 S’s exercise and the additional ones that I've dropped in the description, here are some other ways that you can build resilience at home. 

The first step is to recognize your signs of stress. Where do you feel stress in your body? Do you get headaches? Stomach symptoms? Maybe you feel tightness in your shoulders or get short of breath? And what are some of the not-so-healthy habits that you engage in when you feel stressed? 

Next, focus on building physical heartiness. So what kind of changes can you make to improve your health physically? Can you get better sleep? Can you eat better? Or drink more water? What is one small change you can make now? 

Next, strengthen your relaxation response, calm your body and calm your mind. You can list some activities at home that could help you relax. Try out some new relaxation skills such as mindfulness or deep breathing. We'll look at those in the next episode. Try out some self-soothing activities such as holding something comforting using a scented candle, or a wax melt. Watch some puppy or kitten videos. Listen to music or sounds of nature. Or drink some tea or mindfully eat something that you think tastes really, really good.  You can identify and use your own strengths. That's what we just did in the 4S's.  You can try to increase your positive emotions on a daily basis by expressing gratitude or identifying sources that you find humorous or joyful. You can engage in meaningful activities and notice what happened in your day that was meaningful on a regular basis and identify more enjoyable things you would like to do. You can counter unhelpful thinking by writing down what you're thinking when you get stressed, and we'll look at that in the next episode too.  And finally you can create a caring community by connecting with friends and family who offer you great support on a regular basis. 

I know that we covered some heavy stuff in this episode, but I also know that we've added the first tools to your compassion fatigue toolbox, and there's more to come in the next episode. 

*Musical Interlude*  

Compassion fatigue can have a detrimental effect on our mental health. If you need mental health assistance, please contact Not One More Vet at nomv.org. If you need to speak with someone right now or feel you are having a mental health crisis, please call the US National Crisis Line at 988 or visit nomv.org/crisis-numbers outside of the US. Please seek immediate assistance by calling 911 or your local emergency number if you feel unsafe. 

This has been Alissa Hebert-Wallace with Pawsitive Outlooks. If you enjoyed the show, hit that follow or subscribe button, tell a friend, and leave a review wherever you access podcasts. Also, your feedback is always welcome, just click that link in the description. 

Thanks for listening, and we'll see you next time. 

*Closing Music*