Dr. Elizabeth Strand directs one of the only veterinary social work programs, and she’s determined to improve mental health among veterinarians.
- Veterinary Social Work program at the University of Tennessee-Knoxville: vetsocialwork.utk.edu
- Facebook: Veterinary Social Work at the University of Tennessee
- “Study: 1 in 6 veterinarians have considered suicide”. Summary of contemporary research on mental health among veterinarians, via the American Veterinary Medical Association.
- “For veterinary students, the hardest lesson of all is saying goodbye”. Profile of the mental, emotional, and moral challenges that veterinarians face, via the Washington Post.
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Monologue by Josh Morgan
This is The Plural of You, the podcast about people helping people. I’m Josh Morgan.
I’m a sociologist and a writer, and I use this podcast to share stories from people who are making a difference in the lives of others, people like you and me. You can read along with the transcript for this episode at pluralofyou.org/016.
Dr. Elizabeth Strand is a professor and a veterinary social worker from Knoxville, Tennessee. She directs one of the only programs in the world devoted to veterinary social work. This is an academic field covering topics at the intersection of veterinary medicine and social work, and includes how our relationships with our pets affect us. Overall, Dr. Strand’s focus is on strengthening mental health among veterinary students and social work students at the University of Tennessee in Knoxville. I talked with Dr. Strand recently about her work and about this surprisingly deep field, and I’ll play our conversation in a moment.
I’m not sure if you’ve heard, but there’s currently a mental health crisis among veterinarians in the United States. I wasn’t aware of it, either, until I came across a few articles about suicides in the field. Data on suicides is notoriously tough to collect, but there have been enough cases lately to suggest that mental illness is a growing concern among veterinarians.
A recent survey of veterinarians in the U.S. found that nearly one in ten have likely experienced serious psychological distress since graduating from college. About a quarter of male veterinarians and over a third of female veterinarians reported in the survey that they have experienced depression since graduation. It appears that more than one in six have contemplated suicide. I should note here that, according to the American Veterinary Medical Association, these rates are above the national averages for Americans and may be high compared with other medical professions, which are generally considered high-stress to begin with.
There’s this idea I picked up while studying sociology that has stuck with me, and I think it sort of applies in this situation. It comes from one of the most influential sociologists of the past fifty years or so, a French sociologist named Pierre Bourdieu. He mostly wrote about things like power and culture, but one of his most famous ideas was his notion of sociology as a martial art. In his early work, he encouraged sociologists to think of their field as a form of self-defense, which I like to think resembles something like social tai chi or social jiujitsu, which are all about controlling energy through movement. I realized while reading some of Bourdieu’s other work that social skills can be viewed in the same sense, not so much to inflict violence but to handle situations with better awareness of our intentions.
That said, I imagine people in our society have varying levels of “martial artistry” when it comes to social interactions, but we redirect and misdirect our emotions toward others all the time, and we do that to deal with our own stresses and anxieties. I think those in high-stress care professions like veterinary medicine take on emotional baggage from their clients without knowing it because they’re so compassionate. Dr. Strand will talk more about that later on.
I brought up Pierre Bourdieu and his martial arts metaphor because it’s helped me to better control my own emotions in social situations. In other words, it’s helped me to develop empathy. If I’m angry or upset about something, or if I’m having a tough day, I know not to unload my emotional energy on the nearest person because they often have nothing to do with my underlying issues. I also know not to turn these emotions on myself, and that took me a long time to appreciate, too. Emotional awareness is something we could all benefit from, and it’s part of what Dr. Strand is teaching veterinarians and social workers.
Professors are busy people, so I’m so grateful that Dr. Strand made time to talk with me on a quiet Sunday afternoon. She has an interesting story, and I’m glad to know she is doing so much to help those who help us care for our pets. Here’s Dr. Elizabeth Strand, Director of the Veterinary Social Work program at the University of Tennessee in Knoxville.
Interview with Dr. Elizabeth Strand
JM: Hi, Dr. Strand. How are you?
ES: I’m well, and you today?
JM: Doing very well. How’s your day been so far?
ES: The day has been pretty good. Nice Sunday. It’s my favorite day. [laughs]
JM: I know you have like a hundred other things you could be doing, so thank you.
ES: Sure. Thanks for inviting me to come and talk. I looked at your project and it seems very worthwhile, so I’m grateful to be asked.
JM: Oh, good. Thank you.
If you wouldn’t mind, could you just tell me a little bit about your project? What types of services do you provide?
ES: With veterinary social work, the short answer is we take care of all the human things that arise in the veterinary setting. If it’s a human problem, even though it might be related to an animal, we’re there to respond to it in whatever way we need to. Sometimes we get calls on our helpline—”We have a possum in the attic.” [laughs] We don’t take care of opossums in the attic, but we can get people to the right place.
We also in a more concrete way deal with some very specific problems that arise for people related to their animals. The first is grief and bereavement. Because the animals’ life spans are shorter than ours, most of us have to face the death of our companion animals. We address that.
We also provide counseling for people who have been perpetrators of animal abuse such as animal hoarding or domestic violence situations. We engage in animal assisted therapies. Lastly—this part is mostly human-species related—we provide help for animal-related professionals with their compassion fatigue and also with their communication skills.
JM: Do you find that you offer one service more than the others?
ES: I would say that our pet loss program, our grief and bereavement program, is very robust. I think that probably most of our scheduled appointments focus on that. I would say second would be the compassion fatigue work, then I would say the animal abuse work.
JM: I wasn’t aware that veterinary social work was a field that existed prior to me discovering you and your department. I’m curious: How widespread is the field? Are you aware of how many people are working in the field?
ES: There’s not any good numbers on it. What I would say is that having a mental health professional in the veterinary setting has been around since the early 1970s. It was the University of Tennessee who coined the term. We said, “Okay, this is a thing.” [laughs] People have been doing it, we don’t have to pretend as mental health professionals that we’re not doing it. It was happening.
How many are doing it now? I would say most veterinary colleges have some type of mental health professional within their college or they have a close relationship with the campus counseling center to provide care for veterinary students. Some of those veterinary colleges have pet loss programs. I would say there’s probably three or four programs within veterinary colleges.
JM: Would that be in the United States?
ES: There’s one in Canada that’s just started up, yeah.
JM: How did you find out about veterinary social work?
ES: I started my PhD and decided I would study the link between human and animal violence. During my research and through my contacts with professors in the College of Veterinary Medicine, it became clear there was a need for veterinary social work. In the middle of the night, I sat up in bed and I said, “Oh! It’s called veterinary social work! This is what it is!” I got in contact with some of the mental health professional that had been doing similar work since the 1970s. That’s how it all began.
JM: Did you practice more traditional social work before or have you always specialized?
ES: I would say my first love is family therapy. When I got out with my Master’s in Social Work, I went straight into a residential treatment facility for kids and was the family therapist. I apply a lot of what I learned about family systems and family therapy in what I do in my current job.
JM: What’s a typical week like for you?
ES: In the old days, the typical week would be that I would go down on the clinic floor, walk around in the clinics, see what cases were coming up, [and] support the veterinary teams. Sometimes I would have to be present for a euthanasia; sometimes I would get a call about an abused animal and how should we respond to this; working with a veterinarian maybe who’s feeling stressed because they’ve had eight or nine euthanasias in the week; and then I would teach on the side.
Our program has grown, so we have a clinical social worker now who takes care of the majority of our pet loss support. My typical day is coming in and doing some research about the current findings regarding compassion fatigue and suicide among veterinary medicine, teaching veterinary students as well as social work students, having a few counseling sessions here and there with veterinarians or students who want some extra support, running mindfulness classes to teach people to deal with their stress, exercising with the veterinary students, anything to build health, running surveys, completing surveys, doing data analysis, that sort of thing.
JM: That brings me to my next question. I discovered you and your work because I was reading about the topic of suicide among veterinarians, which surprised me. I wasn’t aware that was an issue. I know that you offer help with things like compassion fatigue, like you said. What exactly do you do to help?
ES: I think the first thing that I do to help is that, when I receive a call from somebody saying “I have a friend who’s a veterinarian that took their life” or I find myself giving a talk about it, we always take a moment of silence to recognize the feelings that veterinarians have about the loss of their colleagues.
Veterinarians are very hard working people. Sometimes they don’t necessarily stop because there’s always an animal in need. They don’t necessarily stop and recognize, “Oh, I’m feeling sad about this” or “Wow, I miss that person.” The first thing I would say is to create space about recognizing that a loss has occurred. I provide talks on helping veterinarians learn about suicide prevention, teaching them that they can ask the question to each other “Are you feeling like killing yourself?” and that’s not going to cause somebody to kill themselves.
Reducing the stigma of talking about mental illness I think is a big thrust of what we do to help with this problem. We’re also conducting some research to find out more about what might be the reasons for this increased risk of suicide.
JM: I was about to ask: could you talk about why that risk—would you say it’s more pronounced among veterinarians than maybe other medical fields?
ES: One study from the United Kingdom found that veterinarians were four times as likely to experience suicidal ideation than the general population and twice as likely as other medical professions. I think all medical professions are a little bit elevated. That’s the main finding we have that compares veterinarians’ rate of suicide to the general population.
That one study does seem to indicate there’s a higher rate. The reason why has been hypothesized a lot, and there’s been a few studies that have come out recently. I think the findings of this one seem to be the most congruent with my clinical experience, which is that veterinarians are—they take an oath to prevent animal suffering. When it comes time for euthanasia, many veterinarians feel relieved that they can end the suffering of an animal. That itself is not necessarily what contributes to suicide, although that had been hypothesized.
What does seem to be associated with it is there is an enormous amount of counseling—I don’t know if you’ve ever gone through this yourself. As clients, those of us that have pets, there’s a lot of emotional counseling that veterinarians have to do about when is the right time. That is a set of skills that, in the older days, veterinarians did not get any training in. Nowadays, we give them quite a bit of training in how to handle that well, but not in the older days some time ago. It might be that the counseling role that they haven’t been educated on how to do properly in the end provides more difficulty with feelings of depression.
JM: It also sounds like you work with members of the local community. How do you help those people?
ES: Anybody in the country can call our helpline and receive four free pet loss sessions. That also goes for animal-related professionals. If there’s an animal-related professional that is facing issues of compassion fatigue, they can give us a call. We’re not a hotline. If you call us at 9:00 at night, you’ll get a voicemail. You have to call, schedule an appointment, and keep your appointment. It’s a service that you make appointments to take advantage of.
Many times, our alumni call to refer their clients or they themselves call because they’re facing compassion fatigue. Sometimes we get calls from animal control officers in different parts of the country because their job is hard, too. We provide that care for them and help them get connected to resources that can be of support to them in their communities.
JM: Was this a service you were instrumental in setting up?
ES: Yes! We’ve always had a phone service. We’ve done most of our work via the telephone. Our phone counseling program has become more structured and more streamlined. We’ve always had that model, but it’s much more robust now.
JM: I know the primary purpose of your department is to support the College of Veterinary Medicine at UT. What do you offer to help them, too?
ES: For the people in our college, all veterinary students get five free counseling sessions per year at times that are convenient for them that are confidential. We provide care for all of the human beings that come into the clinic with their animals, if they need our support. We provide compassion fatigue support and consultation for all of the faculty and staff, should they have a question, need a referral, or just need to chat for a little bit.
JM: Do you offer courses? Did I hear you say you offer courses? I know you said you offer counseling sessions.
ES: Yeah. That’s the clinical services. We’ve got a clinical service, then we have classes that we teach. I teach in the curriculum for our veterinary students. We teach all communcations skills training for our veterinary students. We also teach a course called Grief Recovery. It’s an eight-week course to teach people how to navigate the grieving process. I teach a class called Mindfullness-Based Stress Reduction, which we’ve been doing since 2004. [That] teaches the skills of being in the present moment for our well-being and health. Then we teach in the College of Social Work, too, because our program is a joint program between two colleges.
All the course work we teach in the College of Social Work is to teach social workers to do veterinary social work.
JM: You just said something that I thought was interesting: being present in the moment being related to health. Could you expand on that?
ES: Yeah. The research is very clear that, when we are able to train ourselves to be present in this moment, that it has positive effects on our brain and also in our biochemistry. That in turn affects our sense of well-being.
Over the past fifteen years, the amount of research that has been done is mounting to support that being present is something we have to learn to do. We are not naturally that way—at least when we start growing up, our species is not naturally that way. Babies are that way. [laughs] Animals are that way, which is one of the reasons why we love them so much. We just train ourselves through paying attention to our current, present moment and environment through our senses.
Particularly paying attention to our body as the focus of our present-moment attention seems to help with negative, anxiety-provoking thinking that is focused in the past or the future. All of that negative, anxiety-provoking thinking in the past and the future is what turns on our stress response, turns on the stress hormones like cortisol that cause a great deal of inflammation, problems in the body, make us anxious and miserable, and unhealthy.
JM: Is this something that you discovered in your own life and incorporated into the program, or is this something that other researchers in the field have found? Does that make sense?
ES: Yes, it does make sense. I was the youngest of four kids. My brother became a Buddhist monk when I was seventeen, or when he was seventeen and I was five. He taught me to meditate when I was very young, so I grew up with that as an acceptable way of dealing with myself and with life.
When I got to my job at the veterinary college, I wanted to learn how to bring that skill to the veterinary students. I started training in mindfulness-based stress reduction, which is that eight-week protocol that most people would safely say is responsible for the beginning and the flourishing of research regarding mindfulness in this country.
Also, in line with that is wanting to bring a way for us as a species to cultivate what we love about animals as a species—or I guess that’s not a species. A kingdom, maybe? [laughs]
JM: [laughs] I understand.
ES: —Of not thinking too much, being the present moment mostly. We can do it, too, as a species, but we have to learn how to do it. I get to be around all of these veterinarians, and I want to teach them and myself how we can be the best part of what we love about the animals that we’re around.
JM: That’s so interesting.
Now I’m wondering: how much of what you do overlaps with veterinary medicine?
ES: We work side by side with veterinarians on the clinic floor. We’re part of an interdisciplinary team. Veterinarians are walking down the hall with dogs and saying, “This is the cutest dog!” and we’re saying, “Oh my gosh, this is the cutest dog!” and we’re petting, or “This dog is so sick and I’m so sad.” “We’re so sad, too.” We are right there alongside of them with all of the human emotions that occur. The difference is the veterinarians’ main target is the animal and our main target is the people. It can be the client or the owner of the animal or the guardian of that animal, however you want to talk about it—the pet parent.
JM: I see.
ES: Yeah, or the other people in that room or in that system is the team: the veterinary nurse, the veterinarian, the animal care assistant, the front desk staff. Our clients, our patients are the people, and the veterinarians’ patients are the animals.
JM: Gotcha. Makes perfect sense.
What types of research do you and your team engage in?
ES: The research that I’m engaging in right now is mostly focused on veterinary wellness, so looking at the prevalence of issues of depression, anxiety, and stress among veterinary students as well as the prevalence of the resilience skills like grit and feeling happy. We’re also looking at the early childhood experiences of veterinarians to see if something called ACES—Adverse Childhood Events—can be associated with poor mental health outcomes for veterinarians.
JM: Like traumatic events.
ES: Exactly. There’s quite a bit of research being done for ACES among the general population. We definitely know that, the more ACES a person has, the shorter their lifespan is and the more ill health they have. We’re just now looking at that for veterinary students.
JM: What I’m hearing is ACES among children related to loss of pets and that sort of thing. Is that what you’re studying at the moment?
ES: Yeah. Losses, family disruption, parents with depression, substance abuse issues, things that happen in childhood that are hard for kids.
JM: Okay, I see.
I know your department offers graduate certificates. What have some of your student gone on to do with these certificates?
ES: One student went and took the job of an executive director for an animal assistive therapy program that served the seriously and persistently mentally ill.
Most of our students that complete the certificate take regular social work jobs; it’s just that they have more knowledge about the other family members that are in the home of their clients. Most social work agencies don’t pay attention or even ask questions about if there are pets in the home. Social workers that are trained in veterinary social work go into these organization and start to raise awareness as well as include animals as members of the family as a part of their application of what they’ve learned in the Veterinary Social Work certificate program.
That being said, you found out about our program because of an increased awareness regarding suicide among veterinarians. I think that the veterinary profession is starting to look at collaborating with mental health to address the human needs that arise in veterinary settings. I anticipate that there’s going to be more positions for mental health professionals that are particularly trained in being useful to veterinarians. That’s what we do.
JM: I don’t know if you’d say you specifically advocate for animals being recognized as family members, but I was going to ask if you’ve had any successes where you’ve made the case where animals should be treated or thought of more highly than maybe they are in our culture.
ES: That’s a really, really important question. It’s a huge question. The role of the veterinary social worker is to be knowledgeable about human-animal issues, including how animals are conceived of in the law and in society, but not necessarily take a position because our client is a human species, not an animal species. If there’s someone that wants to raise awareness or raise the status of animals in this country, then their identity might be better as an animal welfare advocate.
Social workers in the veterinary setting work to let go of biases about how animals should be treated and rather increase the human-to-human connections between people that may have very different views about how animals should be treated. Does that make sense at all?
JM: Yeah, that’s a great answer.
ES: That’s a really sticky wicket. A lot of times students will come to me and I’ll say, “Why are you interested in veterinary social work?” and they’ll say, “Because I love animals!” That’s not necessarily a good candidate for my program.
If you love animals that much, are you going to be able to deal with it when you lose your own animal? Are you going to be able to deal with it when you have to help a client let go of an animal, or deal with somebody who has abused animals? Can you treat that human being with the dignity and respect that you need to treat all of your social work clients, if they’ve abused an animal? If you love animals that much, this might not be the right job for you. [laughs]
We have to deal with the human side of it, which is not always pretty. Sometimes it’s beautiful and sometimes it’s really not at all.
JM: What makes you the most excited about going into work every day?
ES: Oh, what a great question.
I do not know why this is, but I have a heart for veterinarians. They’re the most hard-working people I have ever been around.
JM: Did you have any exposure to veterinarians growing up?
ES: No, not really! I remember one time going to the veterinarian. He was trying to take a fecal sample from my kitty. I was putting my face up next to the kitty, and the veterinarian scolded me because the cat of course could have scratched my eyes out—I was a kid.
I never had much interactions with veterinarians. When I got the opportunity to start the program, I just found them to be so wholesome, good-hearted, and caring. They taught me more about compassion, even though I’m a social worker and we’re all supposed to be about caring for people and being compassionate. A lot of times it just gets burned out of you as a social worker. I think in some ways because veterinarians get to be around animals all the time, there’s a way in which their compassion is highly active.
I feel I’ve come to be protective of veterinarians. My colleagues all know that I have a bias to protect veterinarians. I’m a little bit like a mama bear. [laughs]
ES: One of the stressors I wanted to mention—you asked me what I look forward to the most—I love working with veterinarians. I just like to learn from them, I like to talk with them about their patients, I like to help young veterinarians start to learn about self-care so that passion that brought them into veterinary medicine can stay with them throughout their entire career. It’s all very rewarding.
JM: That’s so great.
ES: One of the things I do get protective of is that clients many times are faced with difficult, sad moments with their pets, when their pet is sick and they haven’t saved up money or maybe they never had the money to care for their pet. Many of those clients deal with that stress by saying to the veterinarian, “If you really cared, you would take care of my pet.”
ES: For a veterinarian who took the oath to end animal suffering, that really goes to their heart. It’s unlike human medicine because in human medicine there’s health insurance and governmental processes in place to make sure that everybody can get health care, but not so for pets.
JM: I never thought of it that way.
ES: It’s very hard.
JM: What opportunities do you see in your field to contribute in the future? What are you excited to be working on at the moment?
ES: The thing I’m the most excited about is teaching how efficiently veterinarians, social workers, and other health professionals can maintain resiliency by using their resources right: being able to stay positive; being able to have short bursts of energy, which we know is really good for keeping stress at bay; learning to meditate; having great conflict resolution and communication skills so that people can feel great about their work instead of feeling overwhelmed, stressed, and sad. That gives me a lot of juice. [laughs]
JM: Every episode, whenever I talk to someone, I try to ask a question that gives listeners something to think about, ways that they can help. I’m having trouble nailing down a question to ask like that for you, so I was wondering if there was something listeners could do, from your perspective, to help out their animals or maybe their veterinarians. Would you have any suggestions to make the lives of others easier?
ES: Yeah! I really do. I think this last topic we talked about creates moral stress for veterinarians, when they can’t save every animal because of money. I think that one of the things everybody could do is A. start saving up for their own pet’s health so that you can pay for it if your animal gets sick. Save up the money so you can provide the care that your animal needs. That’s good for you and good for the veterinarian who doesn’t have to be faced with that moral dilemma of saving an animal at maybe the detriment to their own well-being.
Another thing a person could do is go to their local veterinarian and say, “I want to make a donation to the Good Samaritan fund at this clinic.” If there’s a person that comes in and can’t pay, you have some money that you can use to save a well-deserving pet.
JM: That’s a good idea.
ES: Those are two things I would say somebody could do right away that I think would enhance the quality of life for both pet owners and also veterinarians.
JM: Is there a network that you’re aware of where people might could access the types of services that you offer? For example, grief and bereavement support groups. Are you aware of anything like that?
ES: We keep a resources page and we have some websites on there that are clearinghouses for pet loss support lines across the country. I can give you my website address in a moment. We also have a listserv that we keep for the Veterinary Social Work program, and we try to post information about jobs that might be applicable to this area, workshops that are coming up, trainings, and then discussion board kinds of stuff.
JM: Okay. That leads me to my next question: Where could we follow you and your project online?
ES: You would go to vetsocialwork.utk.edu. We’re also on Facebook.
JM: How many pets do you have?
ES: [laughs] I have two right now. I have two poodly types: one, a big poodly type, and one, a little poodly type. I have had four dogs before. That’s a lot of dogs.
JM: So you’re more of a dog person than a cat person?
ES: Yeah. I’m allergic to cats and horses, if you can believe it.
JM: Oh, okay.
ES: Some day I’ll get a bird.
ES: How about you?
JM: I have two cats.
ES: Oh, that’s right. Two cats.
JM: I love cats.
ES: Yes. Cats are great.
JM: Is there anything I haven’t asked that you would like to talk about?
ES: No. I think that the thing I really wanted to make sure got mentioned was the issue of moral stress in veterinarians, and having resources to care for pets in need and their owners. Thanks for letting me mention that.
JM: Yeah, I’m glad to do it.
I think that was everything I wanted to cover.
ES: Okay, great. Thanks, Josh.
JM: Alright. Thanks, Dr. Strand.
ES: Okay, take care.
Conclusion by Josh Morgan
This episode of The Plural of You was produced by me, Josh Morgan, in chilly Edinboro, Pennsylvania. Mike Martinez created the music.
You can find show notes, past episodes, and other resources at PluralofYou.org. Please follow me on Facebook and Twitter at PluralofYou; I’m building a community of people who care, and I’d like for you to be a part of it. You can subscribe by searching for The Plural of You wherever you get your podcasts. If you’re listening through iTunes, please leave a review for The Plural of You because it’ll help others find it, too.
In closing, here’s a homework assignment.
Check with your local veterinary clinic to see if they have a Good Samaritan fund. Even if you don’t have pets or can’t afford to contribute, you’ll be able to recommend the service to others. If they don’t have a fund set up, offer what you can spare to get it started. This will not only help the pet owners in your community but, like Dr. Strand said, it will help the staff working there, too.
That’s all for now. Thanks for helping.