Wales: Mental health in a time of crisis

A personal perspective and research insights into the mental health of dentists in Wales during the COVID-19 pandemic. 

If you've found this past year challenging, know that you're not alone. A recent BDA Wales survey of dentists reveals that an incredible percentage of us have struggled with our mental health over this period of 15 months.

We all know that pressures on dentists and dentistry in Wales long pre-date the pandemic. But I find it particularly worrying that 75% of practitioners in Wales attended work when they didn't feel mentally well enough during the pandemic. What's more, 43% of respondents now feel they cannot cope with the level of stress in their job. The sources of stress vary, but financial pressures, practicalities of clinical practice and the impact of sleep deprivation are common concerns.

Urgent Dental Care Centres came to the rescue just over one year ago, but 62% of respondents have found working in UDCs very stressful. Almost two thirds of dentists describe their sleep quality as 'bad' or 'very bad'. And more than half of dentists say they are extremely stressed about their finances.

These findings make for stark reading, but are sadly unsurprising.

Coping mechanisms can only do so much

For me, the main source of stress has been the responsibility towards my patients as we haven't been able to deliver the care we are duty bound to provide. I tried to take a positive problem-solving approach to my worries - for example, by securing capital in the form of loan repayment holidays on both business loans and my mortgage. This allowed me a little breathing space from a looming crisis until support measures were agreed.

I've suffered with anxiety and depression since late childhood, but I've actually been relatively lucky in terms of the impact of the pandemic on my mental health. I've no doubt that being an NHS GDP, and therefore receiving financial support, was an essential part of this. This ensured that the coping mechanisms I'd developed following my past mental health struggles served me well throughout lockdown.

For colleagues in private practice I know the situation has been much more difficult. It is little wonder therefore that we're seeing such high numbers of dentists reporting financial stress and pressure, and record numbers are reaching out to the BDA Benevolent Fund and Health Assured for support.

Getting out of toxic spaces

While at the start of the pandemic I found social media a positive space, where I could reach out to colleagues and friends to share information and encouragement, I've found it more and more negative as the pandemic has gone on. Social media has brought out the worst in some people and I found myself becoming increasingly angry and upset by some of the misinformation that was being shared both inside and outside of dentistry.

So, I decided to prioritise my mental health and take a break from social media. This itself caused worry and a sense of shame, as I felt a hypocrite after using these platforms to promote my own views and aspirations. I realised that it was better to remove myself from these spaces, and now Facebook and Twitter groups are no longer lighting up my phone and inviting me to 'doom scroll'. 

What will the new normal bring?

One of the few positives of the last year for NHS dentistry has been a temporary respite from the pressure of care targets and penalties. In my pre-pandemic practice, our single biggest source of stress was patients missing appointments. This frequently resulted in us facing the unenviable choice of having to effectively work the time back for free, or face financial penalties of £25-300 per patient, depending on the treatment needed. The worst part of this is that the only legal way we can prevent that from happening more than once is by removing patients who repeatedly miss appointments from our care. This goes against the very ethos of NHS practice, but otherwise we risk not being able to afford the penalties.

“I worry about the impact [targets] will have on a profession already exhausted by the last year.”

As the prospect of returning targets begins to loom, I worry about the impact it will have on a profession already exhausted by the last year, particularly given the unprecedented backlog of patients needing care. Targets may also make it extremely difficult for NHS practitioners to take time off to recuperate, so it is no wonder that so many choose to work when they do not feel mentally well enough.

It can be difficult to not feel worn down by the public and media perception of dentists as being unwilling to take on new NHS patients when we want to help more patients, but are financially dis-incentivised from doing so.

Right now, I am concerned about how we will address the needs of our existing patient group who have, on the whole, been very supportive and understanding. I feel unable to look after them in the way I would like at the moment.

Looking ahead

One of the things that has helped me through this time is the support and camaraderie of my colleagues. I hope that will continue as we move into the next phase of increasing clinical activities and renewed pressures.

It's important that policymakers understand the impact of pandemic working conditions on practitioners' mental health and wellbeing. BDA Wales will continue to make the case for dentists and dentistry in Cardiff and in Westminster on your behalf.

In the meantime, I hope that the public and our patients can appreciate what we have been trying to do and have patience with us. We've not been on the frontline in the hospitals, but we have had our fair share of the pressure. We remain, as ever, committed to doing the best we can for our patients.

Dan Cook

General Dental Practitioner