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Dentistry can be a stressful profession in which the importance of mental health is often overlooked, and the uncertainty about where to seek help can be overwhelming. Over time, this has led to high rates of depression and suicide among dental professionals in the UK. In order to improve the situation and work towards prevention, the helpline Confidental was founded, which offers emotional support for dentists provided by their peers. In an interview with Dental Tribune International, Dr John Lewis, who works as a dentist at Ghyllmount Dental in Penrith in the UK and who is part of the Confidental network, shared some insights into the important work the helpline is doing.
Dr Lewis, how did the idea for Confidental come about?
It was the individual experiences of Drs Jeremy Cooper, Lauren Harrhy, Jenny Pinder and Keith Hayes which led to the setting up of the helpline organisation Confidental. In particular, it was a colleague’s suicide which prompted Jeremy to moot the idea of Confidential on a dental forum in April 2018. This led to initial volunteer training meetings in early January 2019 and in April 2019. Confidental went live with a handful of volunteers in May 2019. Three volunteers are on duty at a time in shifts from 7 a.m. to 7 p.m. and from 7 p.m. to 7 a.m.
Our purpose is to provide emotional first aid around the clock for dentists in distress. The Confidental helpline is provided by trained volunteers who are all dentists and give their time freely in order to listen to colleagues. They are not judgemental and may often be able to trigger a cathartic point from which the caller can begin to think about the right solutions for him or her. Sometimes we can offer callers signposting to others who are best able to provide further assistance. Frequently, we are told by callers that merely having the time to talk about their concerns has been extremely helpful.
Research has shown that dental professionals are at high risk of stress-related mental and physical illnesses. Do you think that occupational health and safety is not taken seriously enough in dentistry?
We are all aware of how dentistry can be a stressful occupation. The psychological stress of caring for patients, combined with fears of litigation or investigation by the regulators and worries about running a small business, managing staff and fulfilling contractual obligations can all add to the everyday trauma of life, and this sometimes spills over into sleepless nights and even thoughts of suicide. In January 2019, researchers from the British Dental Association found high levels of stress and burn-out among more than 2,000 UK dentists, of whom almost a fifth (17.6%) admitted that they had seriously thought about suicide. As a profession, we pay lip service to occupational and mental health until circumstances force us to consider it.
A prime example of this is the risk assessment of staff from Black, Asian and minority ethnic (BAME) groups—or of those who have households or family members from BAME backgrounds—which suddenly became necessary as a result of a disproportionate death rate among these groups during the COVID-19 pandemic. The NHS had pledged to provide occupational health services for all dentists and their staff for many years, but this only became available locally in May 2020. Many dentists are professionally isolated and self-contained within their own practices, meeting very few fellow professionals. The emergence of Facebook groups—of which Mental Dental – A Group For Dentists in Crisis is a prime example—have highlighted the poor mental health and the anxiety experienced by a significant number of our colleagues in this country.
The COVID-19 pandemic has put additional stress and worries on oral healthcare workers. Have you received more calls in the past few months, compared with previously? What are the most pressing topics that callers have raised?
The calls to the helpline have changed as the pandemic has gone on. Initially, it was about lack of personal protective equipment (PPE) in practices. The emphasis soon changed to financial worries, as money became tight and associates and principals became concerned about their income. In the more recent stages of the pandemic, the calls have moved on to focus on advanced PPE, fit testing and anxiety about returning to work.
It has shown that, although the majority of the members of the profession behave decently towards their colleagues, this is not universal. Pre-COVID-19, general worries expressed on calls included bullying as a recurrent theme, whether in practice or by regulators. The callers quite often say that they feel like they cannot discuss such matters with anyone else and that they chose to contact us because our service is confidential.
“Dentistry can be a very insular profession and, unless we take care, it will become more so”
What is the feedback you receive from the dental professionals who are using your services?
Overall, the feedback we receive is very good and dental professionals often call back to express their thanks. Callers often comment that they had a “lovely call” and a “really positive experience”. Callers also sometimes explain in more detail how much Confidental helped them in resolving an issue, like in a particular case where someone reported: “I just called and spoke to a wonderful person at Confidental, regarding a minor dispute at the practice, which was a constant torture for past two to three weeks. I can’t thank that person enough who responded at 8:30 p.m. on a Friday night on my first call and guided me what to do straight away. Really, what a relief.”
What do you think needs to be done to create a healthier work environment? Do you have any advice for dentists who are struggling with their mental health, but do not seem to know where to start?
As I’ve said previously, dentistry can be a very insular profession and, unless we take care, it will become more so. Postgraduate education or study clubs used to be an easy way to meet colleagues, but with the increased provision of online education and webinars, this opportunity is lost. Discussing your problems with colleagues is always the best way, and when I was younger, this was often achieved by meeting in a pub at the end of the day. However, for many, social media has replaced personal contact, and this can often be impersonal with many online experts offering different opinions.
This is where Confidental comes into its own with a personal service 24/7 with experienced colleagues who are trained to listen and help seek solutions, not just offer opinions. Sometimes the best solution is to act as a sign-posting service to other providers, such as the Dentist Health Support Trust or the NHS Practitioner Support Service.
Some callers call a number of times before they actually feel confident enough to talk to a volunteer. This is entirely normal and is the case with many other helplines. We have no time pressures so are able to listen to colleagues for as long as it takes; some calls can last over an hour, and some callers call a number of times about the same issue.
Editorial note: The team at Confidental is available day and night and can be reached at +44 (0) 333 987 5158. More information can be found on the official website, which also includes an extensive list of additional resources.