Healthy Head Space: Battling and Treating Mental Health Issues

I have been a dentist for 30 years but only practised for seven. I spent more than 20 years in the regulatory sector, and taught oral health professional students in six post-secondary institutions and medical students at two universities. I also have mental illness.

After I was interviewed recently for a feature article in another magazine about how I had been preparing to return to the practice of dentistry,¹ a dental school classmate who had moved away to the Yukon after graduation contacted me. In the intervening years I’d only spoken with her once, at our 25th reunion. She told me how “brave” I’d been by telling my story so openly. I knew I hadn’t been as brave then as I could have been.

For years I’ve said publicly, while teaching, that I left clinical practice in 1998 due to “stress.” In fact, I have an anxiety disorder for which I didn’t seek treatment until much later, so at the time I wasn’t yet able to manage my condition. I also have a mood disorder, and was experiencing depression again. I was in dental school when I first experienced depression.

When I worked as an associate in private practice and as a clinical dentist in public health, I believed it was the practice of dentistry that was “stressing me out.” I thought my depression was “reactive” and would go away if I had a different type of position, so I began to consider where else I could use my professional knowledge. What I didn’t understand then was that life is especially stressful during major transitions; every job can be stressful, and even more so if you lack autonomy and control over your work and working conditions. Unmanaged stress can exacerbate an underlying mental illness and make it much more difficult to manage.

The pandemic has created both the opportunity and the pressing need for a new, widespread conversation about mental health and mental illness. Well-known personalities and leaders in our profession have taken to online platforms and social media to spread the word that “it’s okay not to be okay.” I am not the first Canadian dentist to admit publicly that I have mental illness. I think it’s important to take a stand with my colleagues who have already come forward against the stigma of mental illness. After 30 years, I am confident enough in my professional reputation that I am no longer afraid to do so.

I have actually been fairly open about the fact that I have mental illness in some of the places where I’ve worked since leaving the operatory. Over the years I have found co-workers and dental colleagues who are supportive, and several have confided that they, or their partners or family members, have also struggled with mental health issues. In the context of trusting supervisory relationships, I have also felt comfortable disclosing my diagnoses, although this is not legally required in order for an employee to request accommodation.

Disclosure of your diagnosis isn’t always appropriate, necessary or safe. Your mental health information is private as is all other personal health information. The signs of a mental illness are often behavioural, which means that it can also be difficult to conceal if it is not managed and you are not well. I am certain, for example, that I first showed signs of anxiety while I was in dental school. Nonetheless, I’d counsel anyone with mental illness to be judicious about disclosure in the workplace, which can have unintended negative consequences, and to know their legal rights, whatever their professional situation. There is, unfortunately, still prejudice against people with mental illness.

If you are in distress, the most important thing is to seek mental healthcare so you can recover. Later you can make decisions about what your professional future will look like. I would caution my colleagues against leaving the practice of dentistry entirely, unless they have equity in a dental practice that they could continue to operate and profit from (or sell) or have another income stream. When you don’t practise dentistry for an extended period of time, you can lose both your clinical competence and your chairside confidence. From experience, I can tell you it can be challenging to regain those, so it is usually better to continue to practise as long as you are well enough to do so. There really aren’t many full-time administrative salaried positions for dentists, the remuneration for clinical teaching positions is relatively low, and consultant positions with dental insurance companies are few. You may need to pursue further education to gain the knowledge and skills you will need to move into another sector.

It is easy to imagine a dentist with a busy practice and a heavy debt load pushing themselves to physical and emotional exhaustion. In my view it is critically important that anyone with mental illness become experts in managing their own stress. They may also need to become experts in navigating the mental healthcare system to access the type of care they need when they need it. Practising dentists need to have the supports in place to be able to take mental health leaves and reschedule or refer their patients to other practitioners when necessary. Of course, there are costs to an employer for accommodating an employee with mental illness (for example to a dentist who employs dental office staff members who have mental illness), but they are generally well below the point of “undue hardship.” Principals and dental practice owners may not have a legal obligation to accommodate associates or partners with mental illness, but it’s to everyone’s benefit for them to do so. When dentists and their employees are well, they can all fulfill their professional responsibilities and take care of their patients and their families.

There are many good mental health and wellness resources that are available for free for all Canadians, and there are several programs that are specific to the needs of oral health professionals and dental office staff members (see sidebar). There is help available and you are not alone! We all need to attend to our mental health and wellness. The relationship between mental health and mental illness is explained on the We’re Here to Help website:

Just as someone who feels unwell may not have a serious illness, people may have poor mental health without a mental illness. We all have days where we feel a bit down, or stressed out, or overwhelmed by something that’s happening in our lives. An important part of good mental health is the ability to look at problems or concerns realistically. Good mental health isn’t about feeling happy and confident 100% of time and ignoring any problems. It’s about living and coping well despite problems.

Just as it’s possible to have poor mental health but no mental illness, it’s entirely possible to have good mental health even with a diagnosis of a mental illness. That’s because mental illnesses (like other health problems) are often episodic, meaning there are times (‘episodes’) of ill health and times of better or good health.³

I believe that every registered dentist who wants to work as a clinician can be productive, effective, and successful in practice. As dentists we have more control than most professionals over our individual scopes of practice, our business arrangements, and our work schedules. Whether we are solo practitioners or practise in groups, we can create communities of mutual support. Mental illness doesn’t need to be disabling, but it does need to be managed responsibly when we are in the position of public trust that we are fortunate enough to hold as professionals.

Acknowledgements: Thank you to Katrina Burch, Akil Chawla, and Dr. Bruce Freeman for their thoughtful feedback on earlier drafts of this article, and for suggesting additional resources.

References

About the Author

Lesia Waschuk holds a Doctor of Dental Surgery and Master of Education degrees from the University of Toronto. She is currently working as the Compliance and Education Specialist at Prep Doctors. The views expressed in this article are her own.

Selected Resources
The Members’ Assistance Program (MAP) that is sponsored by CDSPI (originally known as Canadian Dental Service Plans Inc.) provides confidential, no-cost support for all dentists, dental staff, and their immediate family members, including short-term counselling, professional guidance, wellness resources, and referrals (cdspi.com/members-assistance-program).

CDSPI offers extended health coverage for retirees and their families (dspi.com/wp-content/uploads/ins_plansheet_retiree.pdf). CDSPI also offers financial planning advice, which may be helpful for dentists with mental illness who may be considering making changes to their work schedules or adjusting their planned retirement date.

At this year’s Ontario Dental Association’s Annual Spring Meeting there was a special focus on mental health. Not only was the keynote address on the speaker’s experience of trauma, PTSD, depression, and resilience, but the educational core committee also invited speakers from a local branch of the Canadian Mental Health Association to speak on a variety of other topics. CMHA resources are available to anyone, and there are virtual educational opportunities available at all branches. To find your local branch, visit the CMHA website (cmha.ca/find-your-cmha).

The CMHA has developed resources on workplace mental health that may be helpful to dentists who are practice owners and employers (cmha.ca/programs-services/workplace-mental-health). Ontario dentists who are employers can also find information about accommodating employees with mental health issues in Employment Guidelines for the Dental Office on the member side of the ODA website.

BounceBack® is a free skill-building program of the Canadian Mental Health Association British Columbia that is available nationally (bouncebackbc.ca) to help adults and youth 15+ manage low mood, mild to moderate depression, anxiety, stress, or worry. It is delivered online or over the phone with a coach and provides access to tools that will support you on your path to mental wellness.

The pandemic has seen an explosion in the availability of virtual healthcare. MindBeacon is an online platform funded by the Government of Ontario that offers free mental health support for Ontario residents. MindBeacon’s Therapist Guided Program offers customized support for frontline healthcare workers (mindbeacon.com).

Ontario dentists who are members of the ODA can purchase extended healthcare (EHC) benefits through the ODA; EHC members have access to a mental health navigator to locate mental health services and a virtual medical app. The British Columbia Dental Association offers a Dentist Wellness Program (bcdental.org/membership-benefits/dental-office-wellness/dentist-wellness-program/) to its members in partnership with Doctors of BC’s Physician Health Program. During the pandemic the Dentist Wellness Program has offered regular drop-in online sessions for BCDA members. Dentists in other provinces should check with their provincial dental associations regarding the extended health resources and wellness programs available to them.

Mindfulness Based Stress Reduction and Mindfulness Based Cognitive Therapy group programs for people with anxiety or depression are now running online and may be covered under provincial medical coverage (camh.ca/-/media/files/community-resource-sheets/mindfulness-resources-pdf.pdf).

Those who are living with addictions and require more comprehensive assessment and rehabilitation services can find a range of services for health-care providers, including dentists, at the following three rehabilitation centres:

The Farley Centre in Williamsburg, Virginia – 1-877-389-4968
The Talbott Recovery Campus in Atlanta, Georgia – 1-800-445-4232
The Homewood Health Centre in Guelph, Ontario – 519-824-1010

Physical health is important. While gyms are still closed in many parts of the country, members of participating YMCAs have FREE access to Y@HOME, and non-members can join Y@HOME for a very reasonable price (ymcahome.ca/purchase-a-membership). ParticipACTION offers a free app (participaction.com/en-ca/programs/app). During the pandemic, Dr. Bruce Freeman, dentalcorp’s Director for Patient Experience, has been offering free online yoga classes on Wednesdays (participaction.com/en-ca/programs/app).

Throughout the pandemic the Canadian Dental Association has highlighted wellness topics in video interviews that are available online at OASIS Discussions. Three of the dentists featured, Dr. Uche Odiatu (druche.com), Dr. Sally Safa (mindfuldentist.ca), and Dr. Jessica Metcalfe (drjessicametcalfe.com), offer personal coaching. There are also other retired or “recovering” dentists who offer career coaching, which may be helpful for dentists who want to review all the professional options available to them.