Dentists in distress

Being a dentist has never been tougher. And it’s taking a serious toll. Burnout, anxiety, depression…worse. Scottish Dental doesn’t have the answers, only signposts to help. The journey starts here

09 August, 2018 / featured
David Cameron, Stewart McRobert, Tim Power

Mental Health

When the envelope arrived from the GDC outlining the complaint, anxiety instantly constricted her chest. She felt slightly faint. But, after the third read, she felt balance returning. Wasn’t she certain she had done nothing wrong? Wasn’t the complainant being as unreasonable now as he had been when he was in her practice?

Ten months later, an intense inquiry was under way. But not just into the original allegation. The GDC probes were delving deep into other unrelated case files that had been requested. And with it, she had morphed from a competent, confident clinician into a nervous wreck, frantic about her professional future and the security of her young family. Until the morning of the breakdown, her husband had thought she was “simply” stressed, going through the type of difficult time that so many professionals face at some point in their careers. But when he found her weeping in the bedroom, unable to get dressed to go to work, their world almost collapsed.

The story is true but the dentist for whom this was a reality doesn’t want the world to know her name. She fears that what she went through would even now, despite vindication before the GDC and a full health recovery, damage her professional reputation in the eyes of her contemporaries and her patients. Worse, it could still put an even greater strain on the viability of her small rural practice.

The reality is that this is not one isolated, extreme case. It is absolutely typical of the increasing numbers of dentists all over the UK who are suffering in silence, some of whom do not make the recovery that the practitioner in our study was able to make. Some are forced to quit the profession forever because they just cannot take the strain.

Suicide is a reality in our society, particularly in some areas of the UK such as Northern Ireland and parts of Scotland, and tragically, in recent years, several dentists who have felt overwhelmed have taken their own lives.

However, with wider recognition and public understanding of mental health issues, momentum is now growing within the dental profession for the radical change that is needed to tackle an insidious problem that is blighting the lives of so many professionals across the UK and the Republic of Ireland.

Scottish Dental magazine is committed to playing its part in supporting this work. Our aim is not to provide answers or solutions for individuals. Our key objective is to strive continuously to raise awareness of the issue and to provide, where possible, vital signposts for dentists to reach the professional support they need to help deal with the mental health issues they are facing.

We will be talking to the psychologists who are providing their expert help daily to professionals in difficulty, the organisations that are coming together to work towards a new way of helping those in trouble, and reporting on the stories that are impacting on this area of deep concern.

Roz McMullan, Chair of the BDA Northern Ireland Council

Passionate campaigner

Roz McMullan is currently chair of the BDA’s Northern Ireland Council and BDA President-Elect (2019/20), and she is a passionate campaigner on the issue of mental health among dentists. She has always been aware that stress was an issue for many of her colleagues, but the point at which she knew she had to act personally was when dentists and their families in Northern Ireland were struck by tragedy on a number of occasions. Not all of these were directly related to dental issues being faced by those who took their own lives but a number were. Enough was enough; something had to be done.

In Northern Ireland, Roz and her colleagues are now working within a framework that not only addresses the issue but also has an element through which outcomes can be measured. At its core is Probing Stress in Dentistry, a joint working group with representation from the BDA, the Deanery (Northern Ireland Medical and Dental Training Agency), the Northern Ireland Public Health Agency, the BDA Benevolent Fund and indemnity organisations. Recently, it has been powerful in producing guidelines on how to tackle the issue of mental health.

It has developed a range of access points through which dentists can get the help they need. It has created seminars and courses that they can attend to learn more about the problems and how to deal with them. It even has a small “roadshow” stand that is taken to events to raise awareness and offer guidance.

“We have to tap into the professional help that is out there and not try to be a panacea. We need to be signposts, guiding people to the proper help that they need. Access to occupational health services for dentists has been a great step forward in Northern Ireland,” said Roz.

“We see our role not in offering solutions for individuals. This is absolutely a job for the professionals. Our place is to offer to support and to raise awareness. We are bringing in the experts to help. And we are showing our colleagues where they can go to find the professional help they need,” she explained. “We are also continuing to work with other stakeholders to improve timely access to professional help when dentists need it.”

A measure of the success of this approach is the fact that the courses that are run by Probing Stress in Dentistry are always fully subscribed. “We see it all the time and that tells you just how big an issue this is and how important it is that we make this information available to all.”

Turning to the nature of the problem, Roz highlights a number of key issues facing dentists around the country. Stigma is a big one.

“There is an issue of people not being prepared to put their hands up. They fear the real and perceived consequences of doing so. They are frightened of the increased risk of complaints, possible loss of income, loss of face, impact on their families and their colleagues. There are a lot of pressure points,” she said.

Another is money. Making a decent living in dentistry can be a very tough challenge. The reality is so different from much of the public’s perception. And so, regardless of how difficult or stressful the job has become, many, many practitioners are self-employed and simply cannot afford to take time off. The result can be perceived as devastatingly simple: No work, no income. No income, no future. No future, no life.

“I’m not certain what the answer is, but I feel that we have to be working towards some form of practical help for people running practices who are feeling overwhelmed and are needing to take time off. Health boards need to be taking more responsibility here and helping to find answers. The NHS needs to value its workforce.”

And for many, the trigger is the ever-increasing burden of regulation and governance.

“It’s incumbent on everyone in leadership not to burden healthcare workers with more issues that provide more stress. There needs to be right-touch regulation. We can’t keep increasing pressure on people with more and more regulation.

“Recently I was talking to a very experienced dentist who had a complaint against him through a solicitor. When the reports were gathered, the solicitor said he felt that there were potentially no grounds for legal action. But, he suggested, the patient could, if they wished to continue to seek redress, pursue the matter through the GDC. And indeed this is what the complainant has done. The onus is on the GDC to make sure their responses are proportionate,” she said.

Roz McMullan believes that we are moving forward in tackling the problem, just perhaps not fast enough. She hopes that when the results of a major new study by the BDA and the University of Cardiff – about 2,000 dentists have been surveyed on the trigger points for their stress levels – are published, this important piece of work could be the springboard for greater action.

“We now know how many people are suffering so we know this is a very real problem and not just people talking. Soon, through the work that is being done, we will have the data that we need to identify the key triggers. This is crucial in taking us forward.

“Will we ever be able to prevent these issues? No. But could we help people to manage things better, I am absolutely certain that we could.”

Breathing Space

In Scotland, a considerable amount of work is under way and once again, the advice from within the dental profession is to seek professional help at all times.

North of the border there are numerous bodies and organisations that specialise in helping deal with specific problems and issues. But it can often be hard to work out which one would be best to help deal with a particular issue.

The Scottish Government became so concerned about the mental health of the population, including that of the medical and dental professions, that in 2002 they set up the Breathing Space telephone service as a ‘first port of call’ for people in distress. Today, this confidential call service, staffed by a range of experienced professionals, handles 8,000 calls a month. It is an excellent, highly professional start point for anyone needing help.

Lisa-Jane Aitken is Breathing Space’s National Development Officer and has a background in developing suicide-prevention initiatives. She said: “We handle calls from people that are just having a stressful day, maybe because they have had an argument with a family member, right through to those in real distress.

“We have a wide range of expertise available and our job is to listen to the caller and, through open-ended conversations, allow people to work through whatever it is that they are experiencing at that moment.

“Our other role is to signpost them to local organisations or national resources that can support them with their particular issues.”

The largest number of issues that Breathing Space deals with are the consequences of relationship breakdowns. However, loneliness and isolation are also highly significant. For dental professionals, particularly those working in single-handed or rural practices, this sense of isolation, accentuated in times of stress, can be particularly damaging.

According to the latest statistics on suicide in Scotland, of the 680 people that took their lives in 2017, 552 were men. Research shows that men are more at risk of mental health problems as a result of relationship breakdowns because they are often the ones that will lose their home, become estranged from their families and not be able to see their children. This, ultimately, has an impact on their performance at work, and as they can’t often talk about their personal situation at work they can enter a spiral of despair, which can lead to them considering suicide.

The growing trend in people calling Breathing Space with loneliness and isolation issues is also alarming, as Lisa-Jane explained: “You would think this only applies to an older generation that might not have any family to support them, but what we are actually hearing is that a lot of people are feeling very alone despite having a lot of people around about them.

“For me, it’s so important that people in crisis talk to someone about what’s going on in their life. By doing this they will soon realise that they are not alone and by opening up and talking about how they feel will ultimately make them feel better, even if it is just in that moment. After that they can look for support and learn strategies to make them more resilient and improve their mental health.”

If you are feeling overwhelmed and unable to cope, for more information: