What lies beneath

Dentists are reporting worryingly high levels of stress in numbers far above the national average. There is evidence to suggest that this is leading to an increasing number of suicides within the profession. The stigma around suicide means it is not often discussed, but one charity is trying to change this

18 December, 2018 / indepth
 Andrew Collier  

The dental profession is often viewed with envy. Outsiders perceive it as an ideal career: interesting, socially worthwhile, well-paid and bringing huge personal satisfaction.

But they don’t see what lies beneath. For some practitioners, dentistry is delivering little but misery. High levels of stress, worry about negligence claims and even low pay are taking their toll, driving them into depression –  and worse.

A recent research paper commissioned by the British Dental Association highlights the issue of mental health well-being in dentistry. Covering Great Britain, the study looks at the causes of stress, burnout and mental illness.

Among the factors identified are pressure from regulators, patient expectations, self-employment, isolation, social pressures, work conditions, boredom and even the NHS itself. As a result, participants reported low morale, low patient care, a decline in professional standards, having to change career and early retirement as being among the outcomes.

Barriers to accessing support are seen as an important issue. “At what point do you just give up and realise that this – or perhaps any – career just isn’t suitable?” said
one dentist who took part. “As soon as you start looking at the cracks the whole thing falls down and you are left with nothing.”

“Being a dentist can actually be quite a solitary job, with patients coming through every few minutes. It can feel quite isolating”

Yvette Greenway, Silence of Suicide

The problem of stress is seen as particularly acute in Northern Ireland, which was not part of the recent GB survey. At least eight dentists in the province have committed suicide in recent years. Given that there are only just over 1,000 people working in the profession in the north, this is an alarmingly high level and reflects the serious pressure individuals are under.

The British Dental Association’s Branch President in Northern Ireland, Martin Curran, recently hosted an evening seminar on stress and suicide in Belfast along with Michael Mansfield QC and Yvette Greenway, co-founders and trustees of the charity SOS Silence of Suicide.

Both Michael and Yvette have experienced loss in this way, most recently Michael’s daughter Anna in 2015. The silence, stigma and shame surrounding suicide and mental health in general made them realise more talking, listening and understanding was needed and so Silence of Suicide SOS was formed.

Yvette explained that SOS started as a support group, travelling all over the country and inviting people with an interest or who had been affected by the issue to come along and share their thoughts, feelings and experiences. As well as dentists, the charity has held sessions with lawyers and in schools and prisons.

SOS is the only charity she is aware of that brings together anyone affected by this issue, including those bereaved by suicide or contemplating it and individuals who have attempted to take their own lives.

Yvette Greenway with Martin Curran, BDA Branch President in Northern Ireland, and Michael Mansfield QC, her co-founder of Silence of Suicide

“Discussing things can create quite upsetting situations, but people do like participating, especially when they realise they are not as isolated as they thought,” she added. “The people they meet may not be known to them, but those people understand the issues and what they are going through perfectly.”

“The BDA is very mental health-aware and has strong support mechanisms for members of the profession, which is fantastic.”

She continued: “We were asked to go over to Belfast to talk to dentists,  and the evening was really successful. It was a good turnout, though there were concerns about those who weren’t there and were under huge stress, trying to do their jobs and working long hours while attempting to look after their own mental health at the same time.

“Being a dentist can actually be quite a solitary job, with patients coming through every few minutes. It can feel quite isolating. Do you get out for lunch and if not, does someone go out and bring you a sandwich back?

“It’s about that kind of human factor – looking out for and caring for each other. The best thing anyone can do, whether it’s a dentist or anybody else, is to take an interest in somebody else – to ask if they’re OK and if there’s anything else they can do.”

Interacting with patients in the surgery as well as colleagues in dentistry can help both sides in identifying mental well-being issues, Yvette said. The important thing is to talk about it. “It can be like lighting a touch paper. It may create a two-way exchange that is beneficial to both sides. Once people realise they can speak freely, without being judged, open and honest discourse follows easily. Some people just want to listen, others simply wish to be heard.

“Communication is really important. We can only eradicate this problem by not feeling ashamed about it. Our message is not to be frightened. Don’t stop talking
and listening.”

The BDA survey has shown that some 40 per cent of dentists are affected by worryingly high levels of stress. In the general population, the figure is much lower at 15 per cent. Martin Curran, a Belfast-based specialist in oral surgery, said there is no evidence that this means a higher level of suicides, though he added: “We know that younger dentists are leaving the profession because of the pressure.”

“We need to be looking after our colleagues. Suicide is the ultimate in terms of stress. It can build until they just can’t see a way out”

Martin Curran, BDA NORthern Ireland

He cites figures from Queen’s University Belfast (QUB) showing that at least five students who qualified last year have left dentistry already. “They have gone into a job and found they can’t cope. It’s getting to the point where dentists won’t recommend any longer that people come into the profession.”

Why, though, are professionals literally under suicidal levels of stress? “One reason is fear of complaints or litigation. They are under time pressure requiring them to see more and more patients, and that’s particularly true of younger practitioners working for corporates.

“The demands of patients are also becoming more and more problematic. People believe they have a right to have treatment carried out to 100 per cent standards every time. There’s also the issue of difficult patients, long hours and the increase in paperwork. Everything has to be done sequentially, and people are finding it very difficult to
keep up.”

As if this were not enough, Martin added, regulatory costs are also increasing. Last year, a medical doctor paid a yearly retention fee of £425. This year it went down to £380. A dentist pays £890. This is partly, he said, because the General Dental Council is spending a fortune on investigations.

“It’s making dentists risk averse. They won’t do something in case they have a problem. A lot of younger practitioners are sending patients to hospitals even to get very simple work done.”

Income is another issue: it has fallen by more than a third in real times in the last decade, impacting on the ability of practice owners to fund the necessary equipment. “It has also dropped here because there’s no functioning assembly in Northern Ireland. That means a pay increase for the community dental service can’t
go through and it’s been sitting like that for the last three years.”

How can these issues be addressed? The Belfast seminar followed Michael and Yvette’s strategy, attempting to deal with the problems head on by discussing them openly. It discussed the language and stigma around suicide, stressing it was an illness and inviting the 70 people present to talk about their own experiences.    

A framework document is now being put together by a number of health-related organisations, including the BDA, examining how dentists might be able to train
to help share their stresses and mental pressures with each other.

“We need to be looking after our colleagues. Suicide is the ultimate in terms of stress,” Martin Curran said. “It can build on dentists until they just can’t see a way out. It’s very hard to get at those people, so we’re trying to offer the help before they get to that stage.

“I speak to a lot of dentists, and it may be that I meet one who has got a problem. Sometimes they’ll talk about it and I can then direct them to an organisation that can help. But people having suicidal thoughts are often very good at masking these things.

“The meeting we held was about that process of communication and stressing that it’s good to have a conversation about it.”

More details at www.sossilenceofsuicide.org

Tags: Mental Health / Stress / suicide

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