Podcast - Supporting suicide prevention in the veterinary professions

Introduction
 

Abi Judd-English (00:24)
Hi everyone and welcome to the RCVS podcast where we talk to you about everything going on at the College, explaining why we do what we do, how we do it and how we can all work together as we continue to support the advancement of the veterinary professions. I'm Abi Judd-English, a member of the RCVS communications team and today we're talking about an extremely important topic, suicide prevention in the veterinary professions. Before we get started, I would like to preface this conversation by saying that today's podcast will be centred around suicide.

Please remember that if you are impacted by anything discussed in this episode today, help is available to you. You can contact veterinary mental health charity, Vetlife, who have a confidential helpline available 24 hours a day, seven days a week, as well as an email service. You can also contact charities outside of the veterinary sector, such as Samaritans, details for all of which can be found in the show notes.

Since the 1st of April, 2026, the core standards of our practice standards scheme has required all accredited practices to implement a practice specific suicide prevention plan, assessing potential risks within the practice setting and putting in place measures to address and mitigate each identified risk.

Working with external suicide prevention experts, we've produced three initial resources that are aligned with the new British Standard on suicide prevention in the workplace to help practices meet the new requirements.

Today's chat is in two parts, both of which are presented by our Director for the Advancement of the Professions, Angharad Belcher, who, as part of her directorate, oversees our mental health project, the Mind Matters Initiative. In part one, Angharad speaks to veterinary surgeon and lead practice standards assessor, Alice Duvernois, and senior psychologist and leading suicide prevention expert, Peter Kelly. Together, along with the Mind Matters Initiative, they have helped to create the workplace suicide prevention resources designed to support all practices in meeting the new PSS standard. In part two, Angharad speaks with veterinary surgeons and suicide prevention researchers, Dr Rosie Alister and James Glass, who provide greater insight into suicide risk within the veterinary professions, drawing on research to understand what the evidence shows and the key factors impacting wellbeing. They also look at the role of standards, leadership and practical actions that can help practices better support their teams and reduce risk. But first up, we have our usual news roundup, keeping you up to date with the general goings on across the college.

News update

Abi Judd-English (02:52)
Kirsty Young RVN, the Acting Registrar at Scotland's Rural College, has been elected as the new Chair of our Veterinary Nurses Council. Kirsty has been an elected member of VN Council since 2024 and has worked in veterinary nursing education for over 20 years, including chairing RCVS Veterinary Nursing Accreditation Panels. She will take up her three year post from our annual general meeting on Friday, the 3rd of July, 2026. In related news, the guest speaker for Royal College Day, our annual general meeting and awards ceremony has been announced as Professor Sir David Spiegelholter, OBE, Emeritus Professor of Statistics at the University of Cambridge, and a well known communicator on risk and data.

Sir David's talk, entitled 'Communicating Evidence and Uncertainty in a Trustworthy Way', will take place in the afternoon during the awards ceremony after the annual general meeting in the morning. All veterinary surgeons and veterinary nurses are welcome to attend. The event will take place on Friday 3 July at one Great George Street, Westminster, and more information on how to register can be found on our website.

Please note registration for the event closes on Friday, 26 June.

Abi Judd-English (03:58)
At its June meeting, RCVS Council approved proposals for a future programme of specialty training for primary care veterinary surgeons. The development of the detailed curriculum stems from the work of the College's Veterinary Clinical Careers Pathways Project, launched in 2024 with the aim of expanding and diversifying the career options available to the profession.

We will begin consulting with the profession on the proposals in the coming weeks, starting with stakeholder groups, before progressing to a full consultation with the wider profession. New definitions to clarify the roles of advanced practitioner and specialist statuses were also approved, and work will now turn to developing a communications plan for the profession and the public.

In other news, the Veterinary AI Transparency Alliance, a group of stakeholder organisations and individuals from across the veterinary, technology, and regulatory worlds, is consulting members of the professions on a draft framework to support responsible artificial intelligence use. The alliance, led by the RCVS and digital veterinary communications platform, Digital Practice, has produced the framework to support safe, proportionate and informed adoption of AI tools in veterinary settings through best practice guidance for both AI providers and veterinary practices. The draft framework is available to access on our website, along with the survey.

Find out more about all these news stories and how to get involved, click on the News and Views link in the show notes.

Introducing the new PSS standard on suicide prevention

Angharad Belcher (05:28)
Hello everybody and welcome to the podcast. I'm Angharad Belcher and I am Director for Advancement of Professions and Director for the Mind Matters Initiative. And I'm really delighted to have two guests here with me today.

The first one is Alice and later on we'll be joined by Peter. So Alice, would you be kind enough to introduce yourself, please?

Alice Duvernois (05:45)
My name is Alice. I'm first and foremost a veterinary surgeon, but I'm also the lead assessor for the RCVS Practice Standard Scheme.

Angharad Belcher (05:53)
For those people who don't know, what is the practice standard scheme or PSS I think you shorten it to?

Alice Duvernois (05:58)
So PSS is a sort of a short acronym for it. So we're the RCVS's voluntary accreditation scheme for veterinary practices in the UK. And we effectively set out standards for practices to meet depending on the accreditation level that that they wish to aim for.

Angharad Belcher (06:14)
And standards cover all sorts of different areas, could you tell us a bit more about it?

Alice Duvernois (06:18)
So firstly we have various accreditation levels. So we have core level, which is the sort of baseline that most practices should meet. So we then have GP accreditation, hospital accreditation, emergency services. And we offer this accreditation level to various species. So farm animal, equine, and small animal. Moving beyond that, we also offer a variety of awards that practices can go for once they've achieved that accreditation.

Angharad Belcher (06:43)
Which is quite a nice thing for people to be able to aspire to, isn't it? And to sort of build their confidence and be able to sort of tell their pet owning or animal keeping public that this is the standard that we meet. So in terms of this new standard, can you tell us a little bit about why this has been brought in and when it started and why it's important?

Alice Duvernois (07:04)
Yeah, absolutely.

So the standard coming to came from a couple of directions. Firstly, the Mind Matters Initiative's ongoing work, which has been focused on tackling issues within the profession that can affect mental health. But the second was also from a more urgent matter, which was a direct response to recent coroners' inquiries. the reports highlighted cases where clear action needed to take place to make a real difference. And the reports made it clear that the profession needed to respond formally and meaningfully. So the standard reflects both that commitment to wellbeing, but our responsibility to act on those findings.

Angharad Belcher (07:42)
And in terms of when the suicide prevention standard started, from when have practices needed to have this implemented?

Alice Duvernois (07:49)
Yeah, that's a really good question. So the requirement formally came into play on 1 April 2026. Obviously the preparation came from before that and we've worked really hard to try and get our assessor team to be fully trained. We've tried to communicate with the profession as best we can to get everyone prepared. But 1 April is sort of when it was officially launched.

Angharad Belcher (08:09)
So in terms of thinking about is this going to be too much? If I'm a practice manager or somebody in charge of PSS within my practice or my hospital, I'm feeling perhaps a little bit unsure about this and there's so much that I need to do, what would you say to somebody about starting this process?

Alice Duvernois (08:26)
Yeah. So first of all, I think what I'd really like to do is sort of demystify the reputation perhaps that precedes PSS. The first thing to remember is this is not a pass fail exercise. But the assessment is a process whereby our team really try and provide as much support as possible. It's an assessment on the day, yes, but there's a pre-assessment process whereby we will meet you generally three to six months ahead of the day.

There's a process of uploading the evidence that helps, where the practice can make a connection with their assessor, ask as many questions as possible, and we will do what we can to support those practices. On the day, the assessors are very much trying to create an audit-style approach whereby we very much take into consideration the environment of the practice, the team and the work that they're delivering. And all of those elements really come into play with regards to how we assess and people that we need to speak with.

In terms of the standard itself, again, this sort of collaboration is really important. And we have trained our assessors to be very mindful of the fact that this is a very sensitive topic, which could be very triggering for many, many teams.

So we would encourage all practices that go through the process, if there are any concerns, to raise them ahead of time or as they see fit to make sure that we can, when we arrive and we send our teams out, you know, really discuss this and deal with this in the most appropriate way. And we do very much try and lean into that by making sure we can speak to the right people.

So I would say to reassure, first of all, start, one day at a time, one task at a time, delegate where you can. And more importantly, if you're not sure where to start or you need some help or advice on what can be a very overwhelming process at the very start is reach out to our PSS team. We're always here to answer questions, answer emails, take calls, and really lean on those resources because it isn't a test. And we are really trying for this to be a supportive process. We all have the same common goal to really try and achieve happy teams and practice teams that, you know, ideally the process should be about shedding light on the things that they do really well, but also really mentioning and finding those blind spots where perhaps practices aren't aware of some of the things that they should be doing. And it's a very collaborative process. So that's what I would say is first and foremost, if you're not sure, reach out to us, ask the questions and we're always there to help.

Angharad Belcher (10:45)
That sounds like a really good structured process, but also quite a lot to get through. For those people who haven't ever been part of the assessment or perhaps are new to the UK and new to how we do things, could you just tell us a little bit more about who the assessors are and how they understand how practices work?

Alice Duvernois (10:59)
Absolutely. So our assessor team are all either registered veterinary surgeons or registered veterinary nurses, all of whom have a minimum of five to ten years within clinical practice. Varying types of practice. We have subject matter experts in terms of equine and farm, but the majority of our team have been in general practice in the past. And all of them have been in some kind of management audit like position. They've essentially prepared for similar types of assessments themselves. So they are absolutely fully empathetic to what it's like to be, on the other side of that process. And as I say, there's a huge amount of training that goes into play in terms of ensuring that this is a supportive process.

Angharad Belcher (11:38)
I think that's really important to highlight there that it is that supportive collaborative approach and hopefully this will help people recognise that the assessors you know share that sense of pride in their professional duties, and that they want to see practices be successful and most importantly highlight the levels of work that goes into patient safety and making sure that that all of those duties are carried out. So that's a really good grounding there in terms of what PSS is and then how it works.

I'd like to bring in Peter now so that we can talk a bit more about the why. Peter, would you like to introduce yourself, please?

Peter Kelly (12:10)
Yes, it's Peter Kelly. I'm the founder and director of Being Real Workplace Mental Health Solutions, quite a long title, but Being Real was formed after I spent twenty five years in government as a mental health advisor and suicide prevention. And it was actually my dad said to me once, my dad passed four years ago, but he said to me, 'Why aren't people being real about their mental health, son?' And I thought, that's it.

If I ever have a company, it's gonna be called Being Real. So that's the point. Named after my dad. I was one of the authors of the British Standard, with the convener of the British Standard 30480, which was a drafting committee. For those of you in the standings world, you'll understand that that can be quite a process, but I'm very proud of what we've got now. We've got the first standard on suicide prevention and intervention in workplaces, anywhere in the world. And we've had thousands of downloads and eighty four different countries interested, including the Royal College of Veterinary Surgeons.

Angharad Belcher (13:09)
Similar to PSS, for those people who don't know what the British Standard Process is, could you just give us quick highlight as to how it works and why it's important?

Peter Kelly (13:17)
So yes, obviously it's very stimulating to do the standards. You spend about twelve months in committees and consultation, bringing together experts to formulate all the relevant information that you want in the standard.

So a British standard is collecting of information and guides that's given to businesses about how they should tackle or look at certain areas. Those standards can be what they're called defined, so they're in law, they're a requirement or they are voluntary. So in this instance, this standard is a voluntary standard.

The process took us a year and a bit, and I was the convener of the drafting committee. And I thought it was particularly impertinent and important that we got the language right. Because I particularly know that often when a when a suicide does occur in a workplace, it might be the HR person who's 23, 24, and never experienced anything like this, nor maybe experienced the death of a significant relative. So you want to make the guide, the British standard as simple as possible. And that's what we've tried to do. And that obviously led to you approaching us and saying we'd like you to do some work.

Angharad Belcher (14:22)
Indeed it did. So in terms of why the actual standard was created, how come this one was chosen over the myriad of other things that could be looked at in the workplace?

Peter Kelly (14:32)
Yeah, it's interesting isn't it, the reason was, there's been a rise in suicide. So there was always an upward projectory, but we were looking at three and a half thousand suicides. Last year we had seven thousand three hundred, I believe. So we saw an increase after lockdown because obviously coroners weren't reporting as much and as quickly, but what we have found is that there were an increase in suicide globally, according to the World Health Organization there's a fifteen percent increase in suicide which are significant numbers and there are identified professions where the suicide rate unfortunately is higher. And so we're seeing that on our global footprint as well.

Angharad Belcher (15:11)
Thank you for explaining that. And I think for people who might be interested the WHO has a really good mental health resource hub, doesn't it? Where you can find out more about the stats and how they explain them, what the denominators are and how they calculate these things and the change that's occurred over the last sort of 20, 30 years of them recording this data. So you can see certain things around preventable diseases, where those have perhaps dropped further down the list and sadly things like suicide, where that has come up the list. So if people are interested, please go and check it out. This is probably also a time to mention that we are going to dive into the veterinary side of things, but Peter, we will call on your expertise about the wider population because there is often this discussion of elevated risk, but I think it's important that we contextualise this within the wider UK society and globally if appropriate as well.

Suicide is multifactorial and it's very easy to stigmatise or perhaps spread myths if we don't talk about it correctly. So will try and make sure that this is as evidence-based as possible and not use inaccurate stats or facts that sadly do appear on social media.

Just thinking about suicide prevention, can you tell us, Peter, what is a suicide prevention plan? And what's the simplest explanation of what it is and what it does?

Peter Kelly (16:23)
Yeah, not always an easy question, but I'll give you an easy answer. Basically a suicide prevention plan is what you're putting in place once you're aware that you might have someone who's having suicidal thought or ideation. I think the important thing to realise is the best thing here is always to seek to prevent. So if you're aware that you might have somebody at risk, what do you do with them when they're at risk. You know, listening up actively, encouraging support, explaining limits of confidentiality, all of that is really, really important. So the plan gives you almost like a tick box of the things you need to consider and when you need to consider it.

And also what do you do once you have had someone who's indicated yes they have a plan to take their own lives what are the systems and how does the system impact on that? So in its simplest form, it's putting all the principles that you need for prevention, but also what you need to do once a suicide has actually occurred.

Angharad Belcher (17:17)
Thank you, Peter. And Alice, I'm just going to ask you from a veterinary lens, but before we do, for those people listening, you might hear us talking using different language to perhaps expected around people ending their lives and similar. If you are interested in learning more about how we talk about suicide, the Samaritans has a really good guide on talking about suicide and postvention on the VetLife website as well. So please do go and explore that if you if you want to learn a little bit more about the
context and why we don't use some terminology now.

Alice, just coming back to you then, if people are asking you from a PSS perspective, what is a prevention plan, is there anything you'd add to what Peter has said?

Alice Duvernois (17:53)
I think from a veterinary and PSS perspective, I think it's to not oversimplify it, but I just want to highlight that there are some pretty big combined risks that the veterinary profession does present, unfortunately. And these are really real risks. And it's to sort of start there, veterinary practices will be used to doing risk assessments for a myriad of other things. And I think it's not overthinking what this is and remembering that this is, to Peter's point, really something for practices to really think about and discuss and disseminate with their teams. And the power is really around identifying those risks and putting measures in place. And so looking at the really, perhaps obvious places you know, looking at storage of control drugs or schedule twos or drugs used for euthanasia or if practice has captive bolts or firearms, you know, some practices such as ambulatory, especially rural farm or equine practices where they will have a lot more loan workers where vets are effectively on their own for the majority of the time we're doing a you know vast amount of overnight loanworking. So it's really starting to look at the more common risks and then really sort of getting down to their actual teams and processes in the way that they work, and then being able to put into place any form of mitigation and I think it's really important that the expectation is not that a practice owner or director is their job to stop suicide entirely.

I think there has been some perhaps misinterpretation of what prevention plan means. Really what we're asking is for a practice to identify the risk, to think about them, put into place mitigation and disseminate and discuss it with their teams in terms of the why.

Angharad Belcher (19:29)
Thank you. And I think from what you're saying there, it's around making sure that teams have got the tools, they've got the training and they've got the time to be able to look at this in a level of detail that perhaps hasn't been looked at before and that they can create that psychologically safe environment to encourage people to seek help either within the practice or out with the practice and start see some of those changes that come through around general wellbeing as well.

So in terms of what good looks like, you've mentioned that it's not pass or fail, you're not setting people up to get it wrong. But what would you like to be seeing from these practices?

Alice Duvernois (20:02)
Obviously there is the element of a document needing to be produced but it's really key that that's not the only focus. So an assessor will be looking for, as part of the pre-assessment process, for the plan to be provided so that the assessor has an understanding of the depth or knowledge of that practice. And we are meeting practices who haven't known where to start and have waited for the assessment for the assessor to be able to guide them and discuss it. And that's absolutely fine. So the document itself is what good looks like in some respects. But a policy or a document without the right communication, dissemination and understanding of the team is not of huge value. So what we really do look for is that the key people within the practice whose role it ought to be to have started that process, you know, understanding their journey, understanding the conversations they've had with the team, and equally asking team members how safe they feel to ask about that subject or to ask questions. And you know, again, you know, were you involved in that conversation of what risk potentially you've highlighted? And so these are all the things. So it's not just the what, it it's the how, and the why and every team is very different in their approach and what their experiences are.

Also based on what level of support a practice has available. So we very much appreciate that a lot of independent practices haven't got perhaps as much time or central support to provide templates and guidance on this. So we are very open and flexible to the product or the policy of the plan being something that the practice has created. So they might look and feel slightly different, but as long as the essence is there of have they identified the risks, have they put mitigation in place? And what does that look like? So what does that look like in terms of process change, SOPs, protocols, you know, learn workers having, measures in place to make sure that they feel as safe as possible.

Angharad Belcher (21:46)
Thank you, Alice. I think that's really reassuring to hear that you're not looking for perfection, you're not expecting everything to be done in the same way, but people will find something that works for them and ultimately that's the purpose of this.

So Peter, thinking about other sectors. Are you able to give us some examples of what you expect to see from other organisations and perhaps the different challenges that other sectors have faced?

Peter Kelly (22:08)
Yeah, there's a expectation that you should manage the risk, and that applies across any range of issues. Obviously, I'd say that because I used to work as a health and safety inspector, but you can manage the risk of suicide within the workplace, you can manage mental health in the workplace and a part of that is creating the right culture. It's also understanding how leaders set the tone, and that's a sort of powerful element to it as well.

What I've seen in other organisations is when there's a commitment from the person who's identified as being at the top the more likely people are going to be engaged with the process so i think it's really important and this is one of the reasons why we have in the various information in the guide that you have someone who's a responsible person who follows it through who's there to make sure things happen. I don't want it to become a tick box exercise. I want it to become a discussion point because that's where we formulate what we need to do. You work in an industry which has the possibility connect with the means for making suicide easier. Manage the risk. That's really what we're looking at. Unfortunately if you were to ask me across most industries, the ones that have the higher rates are those that had the means. So those industries we've dealt with, they've put in safety systems to support people. And also made it okay to talk and not to be panicked by the conversation that you're having with somebody.

Talking to somebody when they're at their moment of crisis may be the start of the first intervention that they need. It may also be the only intervention that they need because someone's listened and someone's had a conversation.

We need to look at prevention because terribly when a suicide does occur in the workplace, the implication is not just to the family, it's the entire workforce - it's utterly devastating. And what we're trying to do is, protect people through allowing people to have open conversations about things that might be bothering them.

Angharad Belcher (23:57)
I think it's really interesting to see how different organisations and sectors have tackled this challenge and hopefully this is something at a society level with this new standard that will help lift the lid of uncomfortableness on talking about this. And you've mentioned there, Peter, about the role of leadership and senior leaders being involved. I think it's not just senior leaders, but everybody who will perhaps feel a level of I'm really worried about saying the wrong thing or doing the wrong thing. I don't even know where to start with this. What would your advice be to somebody who is in that leadership or ownership of the PSS standard how to be comfortable with the uncomfortable?

Peter Kelly (24:30)
One of those things that you do to become comfortable is that you educate yourself. And I have to say, you've got multiple resources here, understanding and managing stress in the veterinary practice. Let's talk about obsessive compulsive disorder, let's talk about post-traumatic stress, let's talk about depression. There is a mountain of information that's there. And that's the first point. You educate yourself.

Start there by having a look at the messages. Read the guides that we've done. The reality and the truth is, talking to someone is way better than not. You simply have to be in that room or in that place or go for a walk with them and say, hey, you know, how are you going? You know, not are you okay? Because they'll say, I'm fine. Thinking about just having a conversation. People want to talk most of the time. They're just waiting for someone to give them that opportunity.

And then when if you have got someone who's in a in crisis, know what you need to do. So this is why we've got the suicide prevention plan there. This is what you need to do. And this is when you should do it. And these are the people you should contact. And there's a range of websites and information that are there. Don't be scared to have that conversation.

I've heard that the BS has been used, in an actual situation where someone was suicidal and they followed the information that's in it, which is in your guide, and that person's still here. And so for me, and I say this with absolute sincerity, if we make a difference to one person's life, then that for me is a success.

I've spent a quarter of a century trying to convince people to do this on a day-to-day basis, and it's refreshing that the Royal College has taking up that mantra. It will make a difference. And I know that 'cause I've seen the power of giving people information that can help them to guide them and direct them on what they need to do.

Angharad Belcher (26:16)
We'd wholeheartedly agree with that in terms of the impact and even if it's small numbers, those people are important and significant in all of our lives. And Alice, for you and the assessors going in, where people might be in that position of leadership or management who are worried about this.

Peter's highlighted the resources there, but in terms of the relationship with the assessor, how can you help with those people that are feeling as though it might not be up to muster or are really worried about sharing what they've written with you?

Alice Duvernois (26:43)
To Peter's point, it's being able to have that open conversation and not fearing that asking questions is in any way a failure or demonstrating. As veterinary professionals I think we are experts in what we do and we're very knowledgeable about what we do and sometimes we feel that if there's a subject that we're not as aware of or aren't sure where to start, that that's a failure in itself. I would encourage anyone to reach out to us and, yes, there are resources there and we've got the academy course and all the rest, but actually reach out to your assessor or myself. And if there's any fears or apprehension for us to hopefully be able to have a conversation about look, start here or start there, or if there are issues within that team that we can signpost those people to the right resources.

Angharad Belcher (27:28)
And just thinking about the actual on the day conversation, how would you like that to happen? Where would you like that to happen? What are you looking for with that?

Alice Duvernois (27:38)
Yeah, so the assessor will always communicate with the practice with regards to a bit of a plan of what the day might look like. And the reason for that is that we often do need to meet and discuss particular individuals in the practice, whether that might be a head nurse, a practice manager, an RPS, or you know, the responsible vet for controlled drugs or whatnot. So we'll always put a bit of a plan into place. And what we're trying to do, especially around any conversations around mental health, is to have that initial plan and speak to that more responsible person, which can often be a practice manager, and to warn them that those conversations will happen. We are very sensitive to the fact that our presence within a practice can be very off putting for the team. It can be often quite disruptive. So we are very self-aware to not start talking about really sensitive subjects such as suicide prevention or mental health in the middle of a prep room or, whilst you've got a younger and more junior member of staff performing surgery. So the idea is, any concerns to flag to us ahead. And on the day the assessor will temperature check what that looks like and what the situation is. And we appreciate that every team has different experiences. So we will take all of that into consideration as to how we approach the subject, but we will always ensure that this is done in a private way and in a sensitive way as to not make anyone feel uncomfortable or triggering in any way.

Angharad Belcher (28:53)
And I think that will help people plan for how they're going to approach this. And as you say, communicating with the assessor early about where you're up to. So this process should be similar to other parts of PSS, not to minimise the impact of it, it's very much a structure that can be followed.

Alice Duvernois (29:08)
And something else to mention, sorry Angharad, which I think I forgot earlier, even if on the day a practice unprepared, there is a report that is issued after the assessment day. We do a debrief meeting with the practice so that they have an understanding of, again, of you know where compliance was met and where a little bit more work needs to be done. And there's then an opportunity for any evidence that is required to be submitted after the assessment. Now, yes, we do have various deadlines after that, but it's a very long process. So I would urge anyone who's not feeling prepared, you know, to reach out because this isn't just something that you must provide on the day. Obviously, ideally, you know, you get it done in in one foul swoop, but ultimately there is that opportunity post assessment to keep working on policies and plans to provide the assessor the evidence that they are compliant within the standard. So, hopefully there's enough time there for everyone to feel like they're able to prepare.

Angharad Belcher (29:57)
Absolutely. And it's more important to do it right than to do something and then it sits on the shelf and gathers dust. So just a final few thoughts really from you both in terms of what you would like people to take away from this. Peter, if you're able to share any wisdom from other sectors who've also gone through this change curve of implementing and looking at more active prevention perhaps. If we could start there, and then Alice if you've got any other final thoughts for the veterinary specific advice.

Peter Kelly (30:25)
Yeah. Well, one of the models that is as often used with these areas is called peer. So it's plan, implement, review and evidence, what's going on. And I need to know what you've done, what you did with what you're doing, and how you're gonna review the success of it. So that's in the context of your PSS but you know, I think it's interesting. BTA ran a campaign about 30 years ago saying it's good to talk. And that for me is one of the key elements. We need to talk about this. We need to talk amongst ourselves and have conversations and demystify some of the myths out there. And with organisations that I've worked with where it's working is they're having those conversations. They're building it into team meetings and they're training their managers about how to look out for potential risks. So it can be done, and it you know what it just seems like the right thing to do. To look after your colleagues.

And there are a number of examples in the guide which I think are really important that apply is when people are working in isolation, check in. When they've got access to means, put some measures in to reduce the access or a check-in on how often you're accessing them. And where possible, make sure that when someone tells you something, you're acting on it, yeah.

And there's so many resources. There's so many people working in this field to prevent suicide and to prevent mental health issues in the workplace. So please access those.

Angharad Belcher (31:44)
That's a very very good point to end on there, Peter. Alice from your perspective.

Alice Duvernois (31:48)
Yeah, so I think my last sort of little pearls of wisdom would be first of all, if you're feeling overwhelmed about the process or this standard specifically, please do reach out. We are there for you as PSS members. Please look at the resources that we've got and they are extremely useful and very practical, which is key because we very much appreciate, practice teams are really time poor and that this could be perceived as yet something else that they need to do. Thirdly, involve the team and delegate what you can, but with this specific one, do involve the team and have conversations and talk about it. Don't be afraid.

Angharad Belcher (32:18)
Thank you both very much for sharing that wisdom. Peter, we are going to be having a webinar on the more practical elements of the plan, so please look out for that if you're interested in in learning more.

The resources are currently available, the webinar is coming, and there will be more coming at later dates as well. But just to are the academy courses for managers and how to support people, but there's a broad variety on there as well looking at things like informed consent and confidentiality, unconscious bias. So do think broadly when you approach some of these topics and the different challenges that your team might be facing.

Peter also mentioned the Mind Matters Let's Talk documents. Those are all free to download and again very much written with the aim of if you need information quickly and you need the signposting, then those are all there There's also the reasonable adjustments guide as well.

And it might give you an insight into some of the topics to tackle within your team.

Also Vetlife have some incredible resources, especially the postvention work that they've got that is being updated later this so please take a look at what they have as well. we will also be joined by Euthasafe in July to talk about the research that they've conducted into controlled drugs and how they can be stored. So there's lots more coming up, but I would just like to say a huge thank you to Peter and to Alice for spending the time with us, demystifying it and making people realise they can have a huge role in supporting people to stay safe within their workplace and within the wider community. So thank you very much. And Peter will see you soon. And Alice, you will be out and about with PSS. So people will hopefully see you at one of the many events and activities that you attend. So thank you.

What the evidence tells us

Angharad Belcher (34:12)
Now we are joined by two other experts who are going to share their insights and pass on some different ways in which we can think about some of the evidence that sits behind this topic. So I'm delighted to welcome Rosie and James to join us for this section of the podcast. Would you like to introduce yourselves and tell us a little bit about the work that you do in suicide research within the veterinary community, please.

Rosie Allister (34:33)
Yeah, sure. I'll go first. So hi everybody. I'm Rosie Allister. I'm a vet, mental health and suicide researcher, and I'm the consultant manager of Vet Life helpline which is the charity that supports the veterinary community. I'm also a trustee of Samaritans, the suicide prevention charity in the UK and Ireland, and I've volunteered there as a listening volunteer for 21 years.

And as well as that, I do some advisory work in suicide prevention, including being on an academic advisory group for the Scottish Government around suicide and self-harm. The work that I'm doing in veterinary suicide prevention has been something that's run through a large proportion of my career. I was drawn to it very early in my veterinary career because of experiences of suicide loss. And it led me to retrain in public health research and to conduct a PhD looking at transition to practice.

And now to work specifically on suicide prevention research in veterinary settings. So the study I'm currently doing looks at experiences of people who were affected by suicidal thoughts and behaviour in veterinary workplaces. So veterinary professionals who have lived experience of suicidal thoughts, suicidal behaviour, but also of suicide loss. And we're looking at experiences of suicide loss in the study as well. Through the study, we're looking at things that affected the methods that people chose. Methods research is a really important part of suicide prevention. And we're also looking for other opportunities that might influence veterinary suicide prevention. So we've just started publishing from that study, first paper will be out soon, that looks at restriction of access. And what we mean by restriction of access is where we try and make workplaces safer for people by thinking about people's access to things like medicines and firearms.

We're also going to be publishing on how and why people chose the methods that they chose when they were feeling suicidal or planning or attempting suicide. Going to be publishing a study looking at the role of animal euthanasia in veterinary suicidal thoughts and behaviour, and on people's experiences of the suicide loss of a veterinary professional and what help and support might be effective for them, as well as hopefully a strategic overview of all of that.

I'm also really delighted that I'm able to co supervise a PhD at the University of Glasgow that hopefully James will tell you more about just now.

James Glass (36:45)
Yeah, so hello everybody. I'm James Glass. I'm a postdoctoral research student at Glasgow, as Rosie said. I'm based in the suicidal behaviour research lab and I'm just coming to the end of four years of research and it's been focused on looking at risk and protective factors for suicide and spread across not just vets but veterinary nurses and students as well.

It's been sort of mixture of things that I've looked at. So we've tried to update the global research so just coming to the end of a systematic review on that. we had a really well-received study where we had over 1800 vets and vet nurses and students take part, looking at risk factors and protective factors and looking at their psychological health and we've got some really good data coming forward on that. And at the moment just starting an interview study talking to vets and RVNs in the UK who have planned or made a suicide attempt. And slightly different to Rosie's research. So what I'm looking at is the factors which bring people towards suicidal thinking. And then for someone who is struggling with suicidal thinking, the factors which are often different, which then lead on to perhaps a suicide attempt. I came to mental health research much later. My background is 25 years as a veterinary clinician, most of it in small animal. And my entry into anything like this was initially starting to volunteer for vet life on helpline but then a significant period of my own lived experience major depression and suicidality and that led me in a very different direction but really a really important field and when you talk to people and when you're interviewing people for the studies and so on, it's a real privilege to be involved. The profession is incredibly generous with their time and openness and honesty and it's much appreciated.

Angharad Belcher (38:41)
It's a really good point to highlight there that with all the work that we fund through MMI and all of the great research that you're doing, we are hugely grateful, aren't we, to people sharing their stories and their experiences with us because that's the foundation of how we can learn and go forward.

I think one of the key things that it would be good to start on, and it was touched upon earlier when we were talking with Peter and Alice, is the suicide risk being higher in the veterinary professions. And I was wondering if you could tell us a little bit more about what evidence there is and equally how people should contextualize this evidence.

James Glass (39:14)
I think all of us will have heard this sort of figure that gets tossed around of perhaps four times increased risk for someone within veterinary. Looking at the most recent data that's been published globally, and I've looked at almost the last 20 years of papers right up until maybe six months ago. And what we find is that the work is very variable. It's done in different ways. The data that's available in different countries is sometimes unclear or difficult to extract. And probably maybe more importantly for this conversation is that we have no recent UK data at all. The most recent figures that we could look at for suicide deaths in the profession would go back to the early 2000s. And that's something which I think both Rosie and I would be keen to see being brought forward as a piece of research. It's not that it we absolutely need that figure, but I think it's useful as a foundation for other research. Looking at the global papers, you could perhaps say that the risk across about 14, 15 papers that looked at deaths in various parts of the world, the risk is perhaps two to three times above what it would be for a member of the general population. But it is very unclear and the methods are very variable. And probably maybe what's more important to say is what's not there. We have virtually no information on veterinary nurses, veterinary technicians in other countries. Virtually no information on veterinary students. And no information on all the other people who are working in really busy and pressured areas of practice, whether that's front of house or management or whatever.

So is the risk increased? Yes probably but it's not delivered in a way that we can put it as a headline figure. I think the other thing which I've become increasingly aware of as I've done this research is that I think we need to be really careful about pathologizing the profession. If you talk to students in the early years of the course, sometimes even A-level students who are thinking about going into veterinary, if you talk to young graduates, it's not uncommon to hear people talking about mental ill health and suicide risk as a sort of inevitable part of being in the profession. And I think Rosie and I would agree that is absolutely not the case. And there are lots of things which we are working on and lots of things that can be done. And I think we want to be careful that, we don't hold up this black flag over the profession.

Rosie Allister (41:32)
Yeah, thanks, James. And I think James's review of the literature about rates of suicide worldwide is going to be really helpful here in clarifying some of the data, but also clarifying some of the really big gaps in what we know. And I think, you know, James's point about, the way that we talk about this is really important. I'm very frequently contacted by mainstream media journalists who've seen veterinary discourse in different places or been contacted by vets who have said things about veterinary suicide that they absolutely believe to be true, but for which there is no evidence. So things like the suicide rate is increasing or the suicide rate is the highest of any occupational. And this comes from this place of incredible care, often from lived experience of suicide loss, and the absolutely devastating effect that can have, and wanting to change and make a difference.

And suicide is such an important area to think really carefully about how we communicate. So the point that James makes about the discourse that we have, so the way we talk about suicide as a profession, sometimes making it seem inevitable, is something that I've sort of theorised and talked about potentially actually being one of the risk factors for suicide for veterinary professionals, because if we talk about it as though suicide rates are very high and it could just be something that happens in somebody's career, that potentially makes it harder for people or less likely for people to get help, or to know that there's effective help or that things can get better for people. And we need to be careful that we don't sensationalise suicide so we don't exaggerate rates and we stick to facts when we talk about rates of suicide, but also that we don't talk about it as though it's inevitable.

Yes, there is elevated risk and it's super important we do everything we can to combat that. But it's also the case that with the right help and support, things can get better for people and people can decide to stay. something I always want to say is that, you know, we're researchers, we need to talk about things like rates and numbers, but actually every single number is a real person, who was known and loved and cared about and their loss has had a devastating impact. And suicide is this immense human tragedy as well as a public health issue. And it is vital our profession acts on this.

And part of us acting is having this responsible discourse where we deal in facts and we deal in evidence and we respond compassionately and supportively. James's point about the at least 20-year gap in UK data is really important. I have to say to journalists all the time that actually there isn't good data at all in the UK for vets or for veterinary nurses in the last 20 years. In fact, there's almost no data on veterinary nurses in the UK. My own sense when I'm asked, is that the rate probably is still elevated, but often not fitting necessarily, we don't think, with some of the sort of exaggerated things that get said about veterinary rates. And I want to emphasize I know that they're said with absolutely the best intentions, but we do worry about sort of harmful impact of that. There is more recent data from some countries in the world, but it's quite patchy.

There are also countries in the world where the rate doesn't appear elevated. That's really important for us to look at. And just more broadly, when we're thinking about suicide, deaths by suicide are obviously a really important measure, but there's other measures that are important too. So we know that rates of suicidal thoughts may be elevated among veterinary professionals. There's been some work that's looked at veterinary students and veterinary professionals. Again, older data now, but relevant. Also when you look at things like the number of contacts to Vetlife Helpline. Last year, 2025, 14% of contacts to Vat Life Helpline were from people who were feeling suicidal or had attempted suicide. And that's over 800 contacts over the course of a year. So we know absolutely there is need out there. We need to work on this, but we just always urge caution and thoughtfulness and responsible discourse around rates and around risk.

Angharad Belcher (45:22)
You've raised some really good points there and I think the one that perhaps will resonate mostly with people who are listening to this that it's always done with the most positive intent isn't it that people want to do anything that they can to support their colleagues or to raise awareness amongst owners, but sometimes that can sway into the blame side or the negative connotations that come with veterinary work and perhaps dissuading young people from choosing a career that they would actually flourish in.

And we would absolutely agree the number of contacts we get from various publications who want to sensationalise it sadly and we are often referring them to, the Samaritan's Guide for Best Practice and those sorts of documents so that we can try and educate in that way. Because as you say, these are individuals and they have families and they have friends and they have work colleagues and It should be something where we go actually how can we be part of the solution.

I think that brings us on quite nicely then to key risk factors, not just from a suicide perspective, but thinking earlier in the process around poor mental health. And you've mentioned a few, but I wonder if you might be able to break those down a little bit so that we could have some basic definitions perhaps when we say access to means and access to knowledge. And then we can perhaps progress risk factors that then will impact suicidality as well. I don't know who wants to start. Rosie, are you happy to jump in?

Rosie Allister (46:34)
Sure, yeah, absolutely. And I think the point you raise about definitions, first of all, is really important. Just like veterinary medicine, suicide prevention as a science and as an area kind of has jargon and things that we say. And it is really important that we explain what we mean so that it's accessible and understandable to people, like people running businesses in veterinary, people supporting students, people in all the different roles. Suicide prevention, is everybody's business. So to be effective, it can't just be people in support organisations or in research who make the difference. It has to be everybody. And when I'm talking about suicide loss in this podcast, I'm talking about people affected by the death by suicide of a veterinary professional. When I'm talking about access to means, what we mean by that is one of the big factors that's implicated in elevated suicide rates worldwide when you look at specific groups, is does that group have particular access to a method of suicide that they might use? And in veterinary, obviously there are aspects of our job that do expose us to particular things that might be considered potential means. So that's what we mean by access to means.

A really important thing to say in this though, which often gets missed, I think, in veterinary spaces, is it's not just physical access to means. There's also psychological access to means, which is how people think about that particular method. And that's something is really coming out in some research that I'm publishing quite soon.

So you asked about factors affecting mental health at work and factors affecting suicide risk at work. Now some of those are shared. But there are things in suicide prevention that are quite specific to suicide prevention. A general wellbeing programme won't actually catch all the interventions that you could do for suicide prevention. You do need specific suicide prevention activity as well. And one of the things we'd really highlight there is the importance of access to means as a risk in veterinary suicide.

But more generally thinking about work and mental health. Something I often point people to is the World Health Organization did a really excellent report within the last few years about mental health and work. And they highlighted factors that globally affect people's mental health at work, many of which absolutely are the things we see coming through in research in veterinary context. So they highlight discrimination, inequality, excessive workloads, low job control and job insecurity, as well as organisational culture and other factors in affecting people's mental health at work.

And it's a really great report, really accessible. I'd recommend it to people working in this area wanting to read more about it. When we look specifically at veterinary, there are veterinary-specific things that go on in terms of risks to mental health at work, but actually some of those really big ones highlighted by the World Health Organization, like workload, like control over work, like culture at work. Do people feel that they belong? Do people feel that they're responded to compassionately?

Super important and a really great place to start. When we think about factors driving suicide risk in the veterinary profession, something that's always really important to say is that suicide is complex and it isn't caused by a single factor. And I very much understand why sometimes people can feel that they want it to be a specific single thing because it's this horrible thing that often has personal impacts on us, has affected so many of us through our lives. You want it to be explainable. And it is explainable, but it a very complicated issue. So it's caused by a complex interplay of biology, psychology, environment and culture. And it's a really helpful model for understanding suicide that's actually co-developed by Professor Rory O'Connor, one of James's other PhD supervisors, and by Olivia Kirtley called the IMV model of suicide. So it's the intentional, motivational, volitional model of suicidal behaviour. And what this highlights is that there are different factors that operate in different ways at different points in somebody's experience of suicidal thinking and suicidal behaviour. So there might be background factors, and these would include vulnerability factors, like socially prescribed perfectionism People do theorise about that, but also life events. Like a relationship breakup or the loss of a pet. So serious life events that have perhaps increased somebody's background vulnerability. Then there's a stage of motivation, and this is around the development of suicidal thoughts and things we know are really important here, is feeling defeated, feeling humiliated, and a sense of entrapment. A sense of not having other options. And that's something that's very much come up in my previous research, looking at the transition to practice, where people early in their career developed suicidal thoughts, there was often a sense that it was vet or nothing, that there was no escape. Entrapment can be internal, it could be how you feel, and to do with things that are going on inside, or it can be external.

It can be a situation. Sometimes people say to me what's the one thing I could do to help? And I say help people feel less trapped. Help people to have options. Look out for situations where people are feeling trapped because that will raise people's risk.

The final phase is volition. So actually moving from thinking about something to doing. To performing a suicide attempt. And things that are important here are some of the things I'm looking at in the current research I'm doing. So access to means. So there we're thinking largely about medicines and firearms in veterinary settings, but also things like exposure to suicidal behaviour - potentially a massive issue that isn't talked about enough in the veterinary sector.

So many of us have had exposures to loss of colleagues, loss of friends, loss of family members to suicide. And we don't always have scope to talk about the impact that's had on us and to have that support. Also, a reduced fearlessness about death is an important factor in this phase. And that's again something that's come up in my current research. So just to highlight finally some of the veterinary-specific factors And Helene Dalum's work on the NORVET study in Norway is really excellent on this. So she's looked at a range of factors including euthanasia of animals, work stress, moral strain, lack of training, some gender differences, and independent factors, life factors. So people who are single, people who've experienced negative life events.

In my own recent research, got a couple of papers coming soon, which will have a lot more on this, but just very briefly, access to means is a big issue. It's not the only issue. But it is a big issue and it is an issue where we can do things that are helpful. Also this physical and psychological proximity to means. So not just about physically can people access these things, but also how do we think about them, how do we talk about them, how do people feel about them? And can you intervene with those things as well? And you can. got another paper, hopefully coming soon, about the role of animal euthanasia, which very much builds on Helene and other people's work.

And also experiences of suicide loss, which very much fits with the IMV model that we've discussed. It's a big picture and there's a lot going on. But that means there are a lot of opportunities for intervention. And I think we can be really hopeful when we talk about suicide research, because there are things that we can do and there is a lot more that we could do in veterinary spaces to prevent suicide loss. James, do you want to add?

James Glass (53:33)
Yeah, I mean I think that forward looking approach that Rosie commends is what we need. And it sounds maybe as a researcher you're sort of banging your own drum, but as I've looked at the work that's been done over the last 20 years, one of my biggest concerns is that you see really well meaning, quite well developed research that collects a lot of data, but there has been a temptation sometimes to then shortcut to what I would call the usual suspects of this is responsible, that's responsible, we need to do this. And some of those are I'm sure absolutely spot on, but I think it's quite an indictment on us. We're still in a position where we don't really have the clear evidence for a lot of this.

And it's not about knowing the answers so that we academically know what's going on. It's about having evidence-based answers so that the interventions that we can put in place. I think that's something that Rosie and I have both found where, you know, one of the great positives out of the practice standards change is we've had lots of practices and organisations approaching us at Vetlife saying, can you help us?

But the most encouraging part has not been that they're saying, can you help us work out how to fill in a suicide prevention plan? They're coming with a desire to say, okay, we need to take care of this bit for practice standards. But can we talk to you about how we look after our staff, how we run our practices, how we induct people into work, how we train people, how we deal with people who are struggling?

I think it's been really helpful to set off a conversation and it's encouraging to hear practices that they want to make a difference by dealing with organisational and cultural factors that Rosie was just talking about.

Angharad Belcher (55:09)
I would absolutely agree that it has had a really positive response. However, when we first started talking about this, there were quite a few places that came to us and said, but if we talk about it and if we use the word suicide, then are we just making it feel inevitable? Or should we just not talk about it? And for those of us who've been through mental health best aid and those sorts of training courses and looked at the research, we know that that's not the case, but would either of you be able to explain exactly why talking about it doesn't make it more likely?

Rosie Allister (55:38)
Yeah, sure. And there's kind of two types of evidence here that exist together and are both true. And that's why sometimes people hear conflicting messages and understandably get a bit confused here if it's not their specific field. So it is absolutely the case, and there is very strong repeated evidence for this, that it is safe to talk with somebody who is distressed about suicide in terms of asking if they're having thoughts of ending their life, helping them to find support.

You will not put the idea in somebody's mind by introducing suicide to that kind of supportive mental health-informed conversation. So that's why on training courses like Mental Health First Aid and many others, it's this real encouragement to help people to feel equipped and if you're concerned about somebody, to ask if they're having thoughts of ending their life, so that you have that opportunity to help them. And that is a vital thing to be able to do. And I'd love to see it as a skill that all veterinary professionals had.

Some of the resources that Vetlife are producing over the next few years about suicide prevention will absolutely be talking people through how to do this as a skill and to support people with that, both for colleagues but also for clients. So, first point, safe to ask individuals about suicidal thoughts in a context of help and support. Absolutely safe. Research with children, with all kinds of different groups of people to show that this is a safe thing to do. Where we need more caution in talking about suicide is when we're doing in other ways. So think here perhaps about media portrayals of suicide. There's a big body of evidence globally that the way that we report suicide can have an influence on future deaths and sometimes can be associated with deaths that we think might not have occurred otherwise.

The Samaritans and others produce really great media guidelines to help people with this. Now, one of the really emerging spaces here where there isn't enough evidence yet, but there's a lot of concern is how we talk about suicide online. Particularly when we're doing perhaps campaigns to raise awareness. And taking a pragmatic approach, in the absence of the right level of specific evidence on this is very sensible. Generally try and follow what we know is important when talking in the media about suicide, because that's another public space and that media research looks at cultural and other portrayals as well.

So follow that guidance. don't sensationalise, don't exaggerate, don't make it seem inevitable, point to help and support, have help and support details there. Don't use images, don't use things that's going to make people overly associate with a death. All kinds of helpful guidance that you could apply in those contexts. Something else helpful when thinking about this is do I need to talk about suicide here? Am I doing this for suicide prevention? So one of the sort of phenomena that I quite often see in veterinary spaces is people who obviously really care about veterinary suicide and want to do the right thing in suicide prevention, bringing it in to other spaces and other stories that aren't about suicide. So maybe it's like something that's going on in the veterinary profession and someone says, well, we have a really high suicide rate. Or, I've even seen it in adverts.

And I think bringing it into those spaces raises questions around is this helpful and is there a risk associated with it? And that's something we do need more research on. But for now, I would just say, is what you're talking about about suicide? If so, do it responsibly, follow the media guidelines and remember you're safe to ask individuals about suicide. If what you're talking about isn't suicide and you're bringing suicide in for a political - small p - reason to make a point. So you're doing it to try and leverage sympathy for the profession or something like that. Please don't do it, because we don't know that that's safe.

Angharad Belcher (59:08)
Really clear. Thank you, Rosie, for helping people understand that. Both of you have reflected upon the multifactorial nature and mentioned the different roles that people can play. So, just in terms of the new practice standard I'd like to move into the role of leadership. And that could be sort of capital L leadership of us as a regulator, but that can also mean sort of everyday leadership. So starting at the regulatory level, how important do you think it is to have something like this in practice standards to show people what could be done and the difference that it could make in practice?

James Glass (59:38)
I think it's about highlighting the right things, isn't it? And I think what's fantastic is in the timing, because obviously there's quite a lot in the practice standards approach around access to means and we're basing it on what we know up to this point.

And I think timing-wise the work that Rosie and others have been doing into the space is going to be really important. And that's why I've been encouraged by the contacts we've had. It's so important that people don't kind of treat this as a tick box. We've got, you know, we've got an inspection coming next month, next year, whenever we need to make sure this is up to scratch. Because in a sense it's almost worse because then they're thinking, yeah, we've done that bit, we don't need to worry about it, which makes them less likely to step into situations.

Rosie Allister (1:00:21)
Yeah, thanks, James. And somewhere I always start when I'm talking to practices or businesses about this is highlighting the role of leadership and actually the role of strategy in suicide prevention because there's evidence and it's well published in the field that isolated interventions that are not part of a multi-level prevention strategy have a low probability of effect at population level in suicide prevention.

So just doing one thing on its own, there is a point doing it, but you're not going to have a significant effect at a population level. So suicide prevention needs to be strategic, to be joined up and to go through every level of organisational leadership and management. And for me, it's a board level thing for organisations to really be thinking about what is our strategy on suicide prevention and to be providing that governance, that support, that leadership and that understanding of risk.

When we think about different levels of leadership, something I really want to highlight is the incredibly important role that leaders in the veterinary profession play every day in supporting staff. The VetLife helpline volunteers took almost 6,500 contacts last year, so around 18 a day.

One of the things that often causes them to speak to me after a call when we're kind of chatting about and debriefing it, we never talk outside helpline about calls, but we do support each other with them, is how struck they are by how supportive many leaders in the veterinary profession are. How much they care about their staff, how much they carry in terms of worry and concern for staff, and how much they genuinely want to help them. And I think this is this incredible resource that we have, but it's also something that it's really important we're thoughtful about.

what we put on leaders because leaders do feel often this huge responsibility. They sometimes feel an excessive burden of responsibility around suicide prevention without the right organisational support to help them to be effective in achieving what they need to achieve. So I would actually say, yes, leadership important, start with support for leaders. Because if your leaders are not well supported and equipped and prepared to do this kind of activity, you cannot expect them to do it well.

Are you just expecting them to do this with no resource or with no preparation or training? Or actually, is there a strategic thought behind how the kinds of things that they're maybe hearing from staff could affect change and could be helpful?

The World Health Organization actually did a framework around thinking about suicide prevention 2014? And what they talked about were three levels of intervention. And I find these quite helpful for veterinary context. These were universal, selective, and indicated interventions. So universal are things you might do for suicide prevention at a population level. So maybe your whole business or the whole profession or your whole student body or whoever it is.

Selective interventions are for groups that, based on particular characteristics, might be at elevated risk. So, for example, this might be groups of staff who have a known mental health issue, indicated interventions are for people who are experiencing suicidal thoughts or suicide-related behaviour. So, this is actually what help is there for people who are suicidal. I think this can sometimes be a really helpful stratification for people thinking about.

How am I going to start this? What am I going to do? And across the profession, there are lots of things we could be doing taking that public health approach. So thinking about universal interventions, really addressing stigma, discrimination, some of the other factors that we think might be affecting suicide risk at population level, and in that you would include things like accessibility of certain types of medicines, so perhaps medicine scheduling, interventions like PSS would potentially be at universal level in terms of some of what people are thinking about. Selective would be things that you were doing for at-risk groups. So you might be thinking about what kinds of support are available. Do staff know about it? Other things that you might be wanting to do in your business as well. So doing things like training for leaders so that they felt really confident and able to have mental health informed conversations at work.

And indicated would be thinking about how confident are you that people who experience suicidal thoughts and behaviour are able to access effective help and that they don't experience barriers to accessing that. So that's sometimes a really helpful place to start from a leadership point of view. There's also other specific actions that I recommend leaders could take. So access to means is an issue in the veterinary professions, and safe medicines practice can help with that.

Another thing I think is important is support for people bereaved by suicide. This is something that affects many people across our professions and is really, really important in future suicide prevention as well as in support for those individuals and what they're going through. And then thinking about the way that we talk about this.

That is a really important part of suicide prevention too. Responsibly talking about suicide and making sure that whenever we do speak about it, we have a message of hope so that people who are vulnerable, who are listening know that there's help and support available and know that things can get better. So there's lots of different levels of leadership intervention and things that could be done, but it absolutely does need resourcing and it needs really effective high level leadership as well as expecting people in very frontline leadership to be able to do things as well.

Angharad Belcher (1:05:26)
That's a really easy framework, I think, for people to understand and to look at the different levels and as an individual, whether you are a first line manager, responsible for a group, a practice, or at the top, to consider where you fit into that and which actions at every level you could participate in or support or raise awareness, et cetera. And equally look at where the gaps are, perhaps that you don't know where somebody is responsible for sharing that type of information or signing that off, those sorts of things. And I suspect also that framing will help people think of this more of a risk management approach rather than something that's really scary or difficult or I don't know how to do this and I'm going to get it wrong. That by following that type of thinking, it makes it easier and more accessible.

So sort of moving on to what you've actually seen within practices. Are there any top tips that you'd like to share with people of things to consider or different approaches that you've seen that have had some positive response or perhaps have been a slower burn but have been worth the effort?

James Glass (1:06:29)
I think it sort of links back to stuff that we've already talked about. You know, we were talking about the fact that the research is really clear that it's fine to ask someone if they're feeling suicidal. But if the culture within your practice is that it's not safe to disclose stuff and that's not just suicidal issues, that has a massive impact. And I think in terms for people who are in vulnerable situations with their mental health, with suicide, and making a difference in suicide prevention, having a practice culture that makes it safe to disclose either that you can go and ask for help, although if you are struggling with suicidal thinking, it's one of the hardest things to actually put your hands up and ask for help. But if you feel that you are going to be judged, side-lined, discriminated in the workplace because of that, then you quite simply you absolutely won't do it. It needs to feel safe. People need to be able to know that they can seek help without having any detriment to them.

And I think that obviously comes in lots of different ways. It's not just about suicide, it's how community life and management and approach is handled day to day. But it's very much part of how leaders lead in a way that creates that environment because otherwise people are slipping through the gaps because they don't feel it's safe to speak up.

Angharad Belcher (1:07:49)
And just picking up on that, James, I know that when we talk a lot about reasonable adjustments and disclosure in the workplace for chronic health conditions or other challenges that people might be facing, often we get the, oh I've sort of opened the floodgates and now everybody is telling me about everything that's going wrong. Are you able to reassure people about why that might be a good thing?

James Glass (1:08:11)
I think if you think about it in terms of we're going to focus in on this area. So we're going to make sure that people feel safe to disclose about suicide or disclose about mental health challenges that they're facing, then I can see why people do as leaders come away with that concern. I think what I'm talking about and wanting to see is that it's a broader thing.

In some ways the same sort of attitudes about what happens if there's a mistake, what happens if there's a complaint, what happens if a colleague is obviously struggling. How are they treated? And that might have nothing to do with their mental health. They might not be suicidal. So it's a broader picture. It's not just about saying, we're going to make it easier for people who have mental health challenges or are struggling with suicidal thinking to come and ask for help.

It's about how does your practice culture and approach and leadership deal with things at any level which are going to be challenging, where people might feel a reluctance to be honest and open.

Angharad Belcher (1:09:09)
Rosie, is there anything you'd like to add to that?

Rosie Allister (1:09:10)
Sure. So as James was talking there, I was thinking about how it really highlights a big myth in suicide prevention that I come across a lot in veterinary spaces, which is this idea that people who talk about suicidal thoughts don't do it. So they aren't at risk of suicide. And that is not true. the best hope we have in much of suicide prevention, in terms of actually preventing individual suicides, is if somebody feels able to disclose those suicidal thoughts so that we have an opportunity to help them, that is one of our best hopes in suicide prevention. It is always something we would want to create conditions where that is as likely as possible to happen. So to reiterate absolutely it is not the case that people who talk about suicide don't go on to act on those thoughts. There are a group of people who appear to experience suicidal thoughts and not speak to anybody.

They're actually a relatively small group among people who die by suicide. Most people who die by suicide have tried to talk to somebody about those thoughts. So something that I've seen practices do really, great work on is, and we supported them in this, is thinking about what do we do if we have a disclosure of suicidal thoughts at work. So this relates a bit to your point, you know, some of the worries and fears of overwhelm that managers might have because it should never be the case that a manager is on their own with that kind of information or has a sense that they're responsible for that risk. Yes, there are duties that we have in the workplace, but there need to be really clear policies and procedures to support managers. And managers need to be properly prepared and where necessary trained to know how to respond compassionately, to know how to respond supportively, and crucially to know where their role stops, and where somebody else's role starts. One of the things I see quite a lot in the veterinary community is people trying to be a mental health crisis team for a member of staff, for example. And I know there's all kinds of reasons why, you know, people end up in those situations, but that isn't safe for anybody in a workplace. And that isn't the role of a line manager. And so line managers feeling really clear about what their role is, what their role isn't, and prepared and trained to help with that.

And I warn people not to be too distracted by training, because training as an intervention is massively over-suggested within mental health and suicide, the answer to absolutely everything. And often it isn't training that's needed, it's something else. There are a few bits of training that definitely are, indicated. And one of the ones, particularly, is managers feeling able to have mental health-informed conversations and to be able to listen.

And another one is people feeling able to ask about suicidal thoughts and to know how to respond. And there's some brilliant resources that might support managers with this. So Scottish Government's got a whole set of resources called Time Space Compassion, which has some really lovely stuff. And they're doing some sort of organisational work as well around time space compassion and really building that into organisational change and ideas around support. And I'd love to see more of my workplaces exploring whether those kinds of resources are a fit.

Other things I've seen workplaces do really well are work around return to work conversations, maybe where a member of staff has been off sick or perhaps has attempted suicide. So supported transitions back into work. Because as James was saying, one of the big barriers and big issues we come up against a lot in this is people not disclosing suicidal thoughts or not disclosing crisis, mental health difficulties, extreme distress, because of fear of what will happen if they do. And one of the main fears we come across is risk to career. So they either fear regulatory action or they fear losing their job. They fear essentially I won't be able to be a nurse anymore or I won't be able to be a vet anymore. And that is sometimes enough to make people not disclose suicidal thoughts up until the point where they attempt suicide. So one of the things I say to managers that you can really do to potentially help is think about actually how confident am I that people would feel able to disclose to suicidal thoughts that we would know what to do in response and that there is effective help for them. So do people really know about the help? And I think often it's the case that, you know, there can be great help available, but staff aren't aware of it. You know, it was in an induction pack a long time ago, those kinds of things. So really making aware that there's help available, being very clear about the limits of confidentiality of that help.

And also role modelling, help seeking, because it's not enough to say that it's there, you need to use it. Actually, as leaders, one of the things that you know we need to be able to do is both to be somewhere people can come with their distress and we can potentially offer somewhere that can contain that. So people aren't worried about disclosing to us because of what will happen. Either to us, or to them in terms of career. But also we need to be able to role model that it's okay to get help and it's okay to need help. And that doesn't mean, me necessarily talking about help that I might have received, but it might be something like leaders, saying we all need help sometimes and these are the resources available and really encouraging people to use them and making sure it is safe and that there's no detriment.

One of the things I would say is be really aware that if any member of staff experiences career detriment because of disclosure, other people will see it and it will have a profound and lasting impact on them. So really don't underestimate that as an area for intervention. Make sure it is safe for people to ask for help. And as soon as they ask, there's effective help available. That is an incredibly important thing in suicide

Angharad Belcher (1:14:20)
Thank you, I think that sums it up nicely in terms of what we can be thinking about. So I would love to keep talking about this. And I think we might have to come back and revisit this conversation once your publications are out so that we can get into the detail a bit more. But thank you both hugely for sharing your insight and your expertise on this. It's been a fascinating conversation and hopefully people will take away some of the top tips, be encouraged to delve into some of the reports a little bit more. I would absolutely agree, the WHO resources on mental health, but disability, chronic illness, et cetera, are a hugely, hugely useful read and lay things out very clearly and help you contextualise things for the UK versus the global level so that we can all have a ponder about what we can do. So thank you both very much and we will see you again very shortly.

Rosie Allister (1:15:02)
No problem. And just to finish, if I could just say that really would encourage people who are listening to this, who may be thinking that they need some support to reach out to Vetlife Helpline. It's available twenty four hours a day, every day of the year. And it's a really confidential service. So do give us a call or an email if you would like to talk to somebody. It's what it's there for. Thanks. Thank you.

Outro

Abi Judd-English (1:15:38)
A massive thank you to Angharad, Alice, Peter, Rosie and James for sharing their expertise with us today on such an important topic. The message coming through from all the conversations was loud and clear. It's always better to talk to someone about how they're feeling than not. As mentioned earlier, please remember that if you've been impacted by anything discussed today, help is available to you via Vetlife and other charities such as Samaritans and Papyrus, the links to which are in the show notes.

The webinar, mentioned in Angharad's chat with Peter earlier in the podcast, is now available to access via the RCVS website. This includes lots of useful information on how to use the resources to create a suicide prevention plan for your practice.

We've also provided a range of other resources in the notes, including the links to our Suicide Prevention Plan resources and our Suicide Awareness Fundamentals and Managing Mental Health at Work courses available to access for free via the RCVS Academy. Don't forget, listening to this episode counts towards your CPD, so be sure to record and reflect on the 1CPD app. Thanks for listening.