For many, 2020 has been a stressful year so far. Covid-19 has had a significant impact on many around the world. For doctors, this has meant an increase in workload – or loss of employment all together. It means social distancing, missing friends and family, longer hours and more responsibility.

The pandemic and its impact on our emotional wellbeing is a key topic of discussion as part of this year’s World Suicide Prevention Day. Held annually on 10th September, it’s the brainchild of Italian doctor and psychiatrist Professor Diego De Leo. He was director of the Australian Institute for Suicide Research and Prevention at Griffith University in Brisbane and is a recognised expert on suicide prevention.

In 2017, Medworld’s Dr Sam Hazledine interviewed Prof. Diego about his life and career. He became interested in suicide prevention after a young resident he was supervising took his own life. Prof. Diego was shocked because the young man had not shown any signs of suffering or uneasiness.

“[H]e was a fantastic fellow, he was a very alive, young, sporty, intelligent guy…” explains Prof. Diego (listen to the full podcast here).

Unfortunately, research shows that the suicide rate of doctors is higher than many other professions. One US-based study recorded a suicide rate of 28 – 40 individuals per 100,000 – a rate twice that of the rest of the population.

The reasons are complex and there’s still not enough known about suicide and suicide prevention. In the medical industry, suggested reasons for this higher rate range from substance abuse to fear of stigma around mental health and not prioritising personal health (which probably has something to do with the long hours and high-stakes responsibilities).

What is clear is that more needs to be done to prevent another tragedy. Every year, 800,000 people die by suicide and 20 million attempt suicide.

In a home YouTube video filmed in Italy, Prof Diego says that this year, World Suicide Prevention Day is more important than ever.

“Suicide is a stronger enemy than ever before because the circumstances are so difficult […] World Suicide Prevention Day is another opportunity to be more together, exchanging information, giving each other solidarity and giving each other care and love.”

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R U Okay Day, an Australian initiative, shares four simple tips to start a conversation with a colleague or friend you may be concerned about:

1. Ask R U OK?

2. Listen

3. Encourage action

4. Check in

But we also need to remember to take care of ourselves first. You need to be in a good headspace to be prepared for these conversations and to practice medicine effectively. That’s why Medworld petitioned the World Medical Association to change the Declaration of Geneva (the modern-day Hippocratic Oath) to include:  

I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard.

So how should we tackle suicide prevention in the medical industry?

1. Destigmatise suicide

We need to look at suicide differently. As Prof. Diego stresses in his conversation with Dr Sam; “suicide is not a disease; suicide is a behaviour.”

You cannot be ‘infected’ by suicide, and mental health issues are not always a factor in suicide and attempted suicide.

“I’m talking about maybe 30, 40 percent of suicide cases in which there was a detected or detectable mental disorder [in some cultures]. And the rest are what? The rest are difficulties in life. The rest are litigations with family members, or neglect from family members, or loss of face and reputation, or separation, divorces, or financial failure; all these issues that may make your life very, very difficult.”

2. Take time for yourself

You can’t help others if you’re not well. Doctor and mental health advocate Dr Amanda Thompson reminds us that doctors often prioritise others over themselves.  

“Doctors by nature are generally very caring people,” she says. “It is very easy to over commit, particularly when working in under resourced areas. I think one of the main things I have learnt throughout my years of working in mental health, is to make a conscious effort to create time for self-care and to learn how to set boundaries at work in regards to work load, so as to maintain my own mental fitness and to ensure every patient receives the time that is required to provide optimum care.”

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3. Remember that showing weakness is not a weakness

The medical industry has an ingrained culture which expects doctors to be resilient. Patients and colleagues rely on us to be strong and resilient. Talking about the alarming levels of burnout in the medical profession and Dr Juviraj suggests it’s time to change the paradigm.

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“It's perceived to be weak to ask for help […] and that's drilled in from medical school or even before – that you have to be able to cope, you are supposed to be resilient.” 

If you need help, don’t be afraid to ask a colleague, visit your GP or seek other help. It’s okay to not feel okay!

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