Dr Janine Brooks MBE (FFGDP(UK)), dental coach and mentor, was one of the speakers at our recent webinar on health and wellbeing in the profession, part of the joint webinar series from the dental faculties of the surgical Royal Colleges of the UK and Ireland that discusses the consequences of COVID-19 for oral health professionals. In this blog, Janine considers the impact of the pandemic on the health and wellbeing of dental professionals and offers advice for those affected.
Dentistry and dental professionals are an important part of health services within the United Kingdom. Our primary mission is to care for the health and well-being of our patients, we serve their requirements. The COVID-19 pandemic gave dental professionals and dental students an opportunity to show how versatile they are as many stepped into front line medical services working with seriously ill patients. Many are currently involved in the vaccination programme. We should be proud of our contribution to the health of our nation.
Health is a relatively easy concept to define, the major aspects being physical health and mental health. Well-being overall is more complex and there is no single definition of what it is. It is fair to say that it’s broad and encompasses a number of domains. Chapter 1 of the Care Act (2014) notes well-being as including the following:
- personal dignity (including treatment of the individual with respect)
- physical and mental health and emotional wellbeing
- protection from abuse and neglect
- control by the individual over their day-to-day life (including over care and support provided and the way they are provided)
- participation in work, education, training or recreation
- social and economic wellbeing
- domestic, family and personal domains
- suitability of the individual’s living accommodation
- the individual’s contribution to society.
There is no hierarchy in the areas of well-being listed above – all are equally important and are likely to depend on the individual and what their priorities are at any one time. Today some of these areas might be at 100% whilst others might be only 50% or even lower, but if overall most areas are more positive than negative then we are likely to consider our well-being to be good. How ‘topped up’ or depleted each area feels will be subjective and individual. It may be that we ourselves weight specific components as being more important to our overall well-being. For some it might be that the domestic, family and personal domain gives them the greatest level of satisfaction and contentment. When this is positive it gives that person the ability to weather dips in the other areas, for example a loss in control of their day to day dental practice. Each of us is likely to know which of the domains are the absolute key to our over- arching well-being and resilience.
Being healthy is important for everyone in society, but even more so for those who provide care and treatment for others. A flying analogy tells us to ensure our own oxygen mask is fitted before we help anyone else with theirs. We, as health professionals, need to look after our own health and well- being before we can properly care for others.
Until early 2020 it would probably have been said that dental professionals scored highly on most of the areas of well-being most of the time. Then the Covid-19 pandemic hit. Clearly before the pandemic dental professionals were subject to health problems, both physical and mental health. Experiencing the pandemic has been the most disturbing and unsettling of times for us all and will have had a negative impact on most people’s mental health, both in the short and longer term. In addition, the pandemic has affected the well-being of dental professionals in all the domains that constitute the wholeness of our wellness. In an incredibly short amount of time dental professionals saw their control over their work and personal lives disappear; their participation in education, training and recreation truncated; their social and economic wellbeing seriously dented; their family (and themselves) under attack from the virus; their contribution to society turned on its’ head. Many in the profession found themselves re-evaluating their professional lives, some decided the time had come to retire or move out of dentistry.
There has been much discussion on the impact of the pandemic on our mental health and that is as it should be. However, for more complete well-being the other domains also need to be addressed. They are linked and come together holistically, impacting upon one another. Many practices struggled to make financial ends meet, some Associates found their contracts were not honoured. Dental professionals were struggling with home schooling, worried about the health of their parents and older relatives. Some became ill themselves. Control was gone, when would it return? Many practices were unable to provide care to their patients and felt abandoned by those they looked to for support. For compassionate individuals the risk of moral distress and injury was considerable.
As the pandemic progressed, practices began to rise to the challenge of delivering dentistry in a completely new way with modifications to the physical space, added protection for themselves and patients and different ways of working. During this phase, professionals may have experienced a sense of rising to a challenge and increased camaraderie as the team came together. Teams may have worked longer hours under the difficult circumstances and focused on getting things done, individuals neglecting their own needs. In the short term that approach can be motivating. However, the pandemic created sustained pressure lasting months. This continued pressure is likely to have led to professionals experiencing exhaustion and disillusionment.
We are slowly returning to something that might eventually approach ‘normal’, albeit a new normal. As we do we can begin to assess all aspects of our well-being and work on getting back to a more positive balance. However, in this period of recovery and reflection some individuals may experience a sense of regret over what they ‘should’ have done differently and shame or guilt. Our well-being could be at its most vulnerable during this time when it seems the worst is over.
What can we do to help ourselves and those we work with?
- Allow time and space for ourselves, staff and colleagues to take stock and seek help if needed. A practice may consider using trained practitioner psychologists to facilitate reflection and processing of the Covid-19 experiences (both professional and personal). It’s okay to feel stress and anxiety.
- Seeking feedback from staff and colleagues about what their mental well-being needs are and how they can be best supported.
- Providing spaces for ongoing peer support to continue. Dentistry can be an isolated profession, by encouraging conversation it helps to let others in as we rebuild our well-being.
- Involving staff/colleagues at all levels to reflect together and share learning which can be fed into future preparedness plans.
- How practices can recognise and reward the contribution of everyone for going above and beyond during this unprecedented time. It is important that we value each other.
I’ve included a list of resources and other organisations that anyone grappling with health and well-being issues may find helpful.
Resources to help:
The NHS Employers, Emotional wellbeing toolkit can be used to support staff to maintain good mental wellbeing.
NHS Employers, Health and well-being framework sets out clear action steps and provides guidance for organisations to develop and deliver a staff health and wellbeing plan.
NHS England and NHS Improvement has developed a comprehensive package of practical support which is freely available to all NHS staff and can be used to compliment local approaches.
How are you feeling NHS? Toolkit. This has been developed to help understand emotional health and assess the impact emotional wellbeing has on ourselves, our colleagues and on our patients
For a list of organisations that offer support to dental professionals, click here.
Department of Health and Social Care (2020). Statutory guidance, care and support statutory guidance (updated) 24 June 2020. www.gov.uk
Care Act 2014. www.legislation.gov.uk
24/7 Confidential Support and Advice Service - 020 7869 6221, (state your organisation as the Royal College of Surgeons of England).
FGDP(UK) Members who are based in the UK or Ireland can access mental health and wellbeing support from a trained counsellor at Health Assured, accredited by the British Association for Counselling and Psychotherapy.
A free recording of the Health, Wellbeing and Support for the Profession webinar is available here.
You may also be interested in our 'Lunch and Learn' webinar series, held in conjunction with the College of General Dentistry (CGDent) and ProDental CPD, which examines some of the explanations about why we experience stress and explores psychological techniques for overcoming it, with speakers Dr Heather Buchanan and Dr Koula Asimakopoulou.
- What is stress and why am I experiencing it? - recording available here
- Dealing with stressors using CBT techniques, 13 May at 1pm
- Dealing with stressors using ACT techniques, 10 June at 1pm
Drs Buchanan and Asimakopoulou are psychologists from the British Psychological Society (BPS) Division of Health Psychology, and the co-authors of Dentistry during COVID-19: Psychological advice for dental teams, policy makers and communicators, which was recently co-published by the FGDP, CGDent and BPS.
Read more posts at www.fgdp.org.uk/deans-blog.