A decade of changes

Close your eyes…cast your mind back ten years or so. What do you remember from around then? Smartphones were still only gaining traction as the world moved further online, the days of CD sales were numbered, sportswear started to be worn as fashion by more than teenagers and we hosted the Olympics. Also, the Queen celebrated her Diamond Jubilee, same sex couples were able to marry for the first time and after 26 years, Sir Alex Ferguson stepped down as Manchester United manager and after 168 years, The News of the World closed due to a phone hacking scandal.

From a dental perspective, digital imagery was in its infancy, many practices still had rudimentary websites and limited social media use, minimal intervention dentistry was a new term and amalgam was still the restorative material of choice.

What did the wider world look like?

With those memories surrounding you, ponder what’s happened to the world in a wider sense; the political, economic and environmental factors that affect our lives and work. Some aspects of the world feel the same - another recession, royals still having children, people still breaking records - then a skydiver jumping from 24 miles up and now a 100-year-old WWII veteran raises nearly £30 million for the NHS by walking laps around his garden.

But with the benefit of hindsight, there are also events that we can look back on and only now realise their impact. We were aware of environmental damage but perhaps not the real significance of ‘natural’ disasters, and only now are many governments and individuals truly realising the extent of the problems global warming has caused; from the icecaps melting to increased localised flooding to ever more devastating wildfires. Similarly, although we had experienced avian flu, and before that mad cow disease and Ebola, even these widely reported health scares tended to be distant or localised events that had little direct impact on many of our lives and work.

Human experiences

Thinking back to the world we experienced then, compared to now, from a personal and professional point of view, it may feel like some things were very different and distant, and others as though they only happened yesterday. But what hasn’t fundamentally changed of course is us, and a global pandemic highlights the very essence of humanity in its simplest form.

The current global pandemic has restricted us with what we can do; not being able to go about our daily life, seeing friends and family, living in perhaps isolated or unnatural conditions and feeling like we’ve had our personal liberties taken away from us. This can all have a direct impact on our mental health. Additionally, working dressed head to foot in PPE reduces your personal contact with patients, as does having to communicate over video and that can also exacerbate the feelings of restriction. 

Talking about mental health issues is more commonplace now than it was ten years ago, but we as individuals haven’t changed. We are still put in stressful situations and feel and react to them in personal and individual ways. And just because the world has changed from a more ‘stiff upper lip’, pick yourself up and get on with it approach, we as humans still have the same basic instincts, impulses and needs.

Things will continue to change in the world around us, we can’t control that, but we can control how we react to these changes. The global pandemic has highlighted mental health issues, and we talk more openly about them than even just before the pandemic. Recently there has also been an independent review of the Mental Health Act to overhaul outdated legislation which allows people with mental health problems to be held against their will (sectioned) in certain circumstances.

Mental health issues

Mind, the UK national mental health charity, acknowledges the negative impact the pandemic has had on many people’s mental health. They define poor mental health as a period where you are frequently thinking, feeling or reacting in a way where your life feels hard and you feel unable to cope. So, it is no surprise that figures show one in four people experience this pain in any given year. And they have also recently revealed the potential for a worrying trend, that men have indicated they feel worried or low more regularly than they did ten years ago and are twice as likely to feel suicidal, although this may of course be related to the increased acceptance in talking about these issues.

The factors that contributed to poor mental health 10 years ago are no different than today, although recent events mean some of these factors may now be more obvious. Unemployment or the risk of losing your job have always been prominent factors, as have social isolation and loneliness, both which have undoubtedly increased over the past year.

The dental profession

Dentistry is widely considered to be a stressful profession and psychiatric disorders remain a significant reason for sickness and early retirement. This has been the case for more than ten years. In 2015 the BDA began collecting qualitative data from dentists to understand more about stress, burnout and mental health issues. They published a paper in 2017 with new insight and recommendations, triggered by previously undertaken research on the work pressures on dentists working in primary salaried care, suggesting they were twice as likely as other workers to experience high levels of job-related stress.

In 2012, 15% of Dentists’ Provident claims paid to men and 16% to women were for psychiatric disorders and in 2020 this had increased to just over 20% in men and 25% in woman. In 2012 our claims ranged from a member in their 20s who was off work for over seven months with anxiety, another in their 30s who was off work for over a year with depression and a third who had already been off with work-related stress for four years. These stories are no different to the claims we still have now, such as a dentist in their 30s who recently went through a family trauma and had to take a few months off work to undergo treatment for anxiety.

The stress in dentistry has been increasing for years, with more regulations and a demanding, increasingly litigious public. Online consultations, the health concerns of your team, maintaining social distancing measures and keeping an efficient practice running with your required level of service in full PPE can be extremely stressful. In a recent Dental Defence Union (DDU) survey 68% of dental professionals reported that their stress and anxiety has worsened since the pandemic began, with around half feeling that they can’t do their job properly.

Getting help  

The BDA’s recent past president, Roz McMullan, has been working to support the mental wellbeing of frontline staff during the crisis, and in a blog in June 2020 discussed the level of stress dentists are under. In it, she suggested three strategies for coping: not ignoring the signs of stress, empowerment through supporting colleagues and considering what information you consume. She also presented during an online event in November last year, with a comprehensive and detailed look at the impact of the pandemic on all aspect of a dentist’s life and work. The slides from this presentation are still available on the BDA’s website.

Currently, BDA members can access counselling services and a 24-hour confidential helpline, but all dental professionals can access the Dental Health Support Trust. There are also a number of closed social media groups where dental professionals can support each other. Many Local Dental Council’s (LDCs) also offer Practitioner Advice and Support Schemes (PASS) in certain areas. There is also the Dental Health Support Programme (DHSP) providing mental health and addictive disorder support. In England, dentists have access to the NHS Practitioner Health Programme (PHP) and in Northern Ireland similar support is available through Inspire. Many indemnity organisations also provide counselling services and courses, so there is support if you look for it at every turn.

The stress of our professional and personal lives will always be there whatever the world throws at us. How we respond to that will make a huge difference to our happiness and our positive mental health going forward.

References available on request.

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