Suicide in the dental profession

Estimated reading time: 5 minutes

It has long been suspected that the average rate of suicide and suicidal ideation for the 25,000-strong dental profession is higher than average. Now there is evidence to prove it. By Tracey Porter.

Almost all oral health specialists pride themselves on their ability to appear stoic in the face of challenging workplace conditions.

But new research has shown what many have long suspected—that Australia’s dental workforce is paying, in far too many tragic instances, a deadly price for their efforts to protect patients from witnessing their vulnerabilities.

A recent eviDent Foundation survey found many dental practitioners experience an array of mental health issues, including suicidal ideation, depression, anxiety disorder, burnout and psychological distress. 

Of the nearly 1500 respondents, one in six participants (17.6 per cent) reported thoughts of taking their own life in the preceding 12 months, 31.4 per cent reported thoughts of taking their own life in the year prior, and 5.6 per cent reported a suicide attempt.

Younger practitioners under 30 were more than twice as likely to have had thoughts of suicide in the previous 12 months than older practitioners (61+ years), and males were twice as likely as females to have had thoughts of suicide in the previous 12 months.

Associate Professor Matt Hopcraft, the report’s co-author, says dentistry is a stressful profession due to “highly demanding technical skills and the imperative of striving for perfection”. 

Hopcraft, who is also CEO of the Australian Dental Association Victorian Branch, says the high level of professional stress is due to a range of factors, including the demands of meeting patients’ expectations, anxious, challenging or dissatisfied patients, time and scheduling pressures, and professional isolation from colleagues.

“The stigma associated with mental health problems seems to be exacerbated with health care professionals. We often have the sense that we need to project invulnerability to our patients, and that mental health problems may be perceived by others as a sign of weakness.”

The profession is responding with some initiatives to address the problem. For example, in July 2020, the Dental Board of Australia (the Board) launched a new national health and wellbeing support initiative called Dental Practitioner Support (DPS). 

The service, which claims to be independent of the Board and the Australian Health Practitioner Regulation Agency (AHPRA) offers callers access to confidential advice and referral on a wide range of issues, including mental and physical health and general wellbeing.

The eviDent survey also incorporated several validated psychological measurement tools to assess psychological distress levels, including the Kessler Psychological Distress Scale (K10) which focuses on anxiety and depressive symptoms experienced in the preceding four-week period. 

A screening tool called General Health Questionnaire 12 (GHQ-12) was also used. This is designed to detect common non-psychotic psychiatric morbidity by individuals rating symptoms present over the previous two weeks.

The findings showed that one third of participants (31.7 per cent) were rated as having moderate or severe psychological distress on the K10 measure, and 59.2 per cent were classified as having a high likelihood of minor (or more severe) psychological distress on the GHQ-12 measure.

Nearly one in five (17.4 per cent) reported potentially hazardous or risky consumption of alcohol. Just over one-third (36 per cent) scored as having low resilience. One in four participants (24.8 per cent) was classified as likely to be experiencing burnout.

Hopcraft says fear of litigation, patient complaints, pressures associated with running a small business, and negative public perceptions of dentists, also feed into the elevated stress levels of many in this sector.

However, part of the problem may be that, apart from the DPS, there appears to be little regulatory or work-based support available for dental health practitioners experiencing poor mental health. Instead, the onus is placed on practitioners themselves to seek support when struggling.

Practitioners have an ethical obligation as part of their registration to maintain their own health and wellbeing. It is even included in their code of conduct, a spokesperson from the Board says. However, the Board is doing what it can to help at-risk practitioners by regularly reminding them of the importance of maintaining their health and wellbeing.

While it “strongly supports” those practitioners seeking help where needed, workloads were not something the Board could influence, the spokesperson says.

At a graduate level, under the competencies expected of new graduates published by the Australian Dental Council, those completing approved programs leading to registration are now expected to recognise the importance of maintaining their own health and wellbeing and support the health and wellbeing of colleagues and team members.

In response to whether the professional and institutional stigma associated with mental health in this sector has improved in recent years, the spokesperson says part of the role of the DPS is to normalise whatever proactive role practitioners take in maintaining their health, including their mental health. 

“It is encouraging that these conversations are happening more often and earlier. Seeking support when it’s needed is expected and encouraged. Health practitioners look for support and advice when faced with a clinical or administrative issue, and a practitioner taking steps to ensure their mental health is no different.”

The Board says from a regulatory perspective, no-one who seeks help for their mental health should fear losing their job.

Anyone can notify AHPRA or the Board if they’re concerned that a health practitioner may be putting a member of the public at risk. Moreover, some registered health practitioners, employers and education providers are legally obliged to make a mandatory notification in certain circumstances. That said, in March 2020, the rules around mandatory notifications changed to support health practitioners in seeking help for their health without fearing a mandatory notification.

“Healthy practitioners benefit everyone,” the Board spokesperson adds.

“If practitioners are seeking help and support so they can practise safely, this is encouraged and not a reason for a practitioner to face regulatory action. 

“We only intervene when the public is at risk of harm.”