Friday, January 27, 2017

How can we improve the mental health of veterinary patients? Interview with Dr Sarah Heath

Sarah Heath
Dr Sarah Heath with her non-human companions, including the late Timbit. Dr Heath is a well respected advocate for the mental health of companion animals.

How seriously do we take the mental health of our patients? What are the links between physical and mental health in animals?

Dr Sarah Heath is a veterinary specialist in the behavioural medicine of companion animals who is renowned for her advocacy in animal welfare, and shared some of her wisdom with us.

Dr Heath qualified from Bristol University and spent four years in mixed general practice before setting up Behavioural Referrals Veterinary Practice in 1992. She is an RCVS and European Veterinary Specialist in Behavioural Medicine, and an External Lecturer in small animal behavioural medicine at Liverpool University and a Certified Clinical Animal Behaviourist under the ASAB accreditation scheme.

She sees clinical cases across North West England. In 2002 she became a Founding Diplomate of the European College of Animal Welfare and Behavioural Medicine (formerly the ECVBM-CA) and served as President from 2002 to 2008.

She has a special interest in the interplay between behaviour and physical illness in dogs and cats and particularly in the role of pain. She lectures extensively at home and abroad on behavioural topics and is an author, co-author and editor of several books including Behavioural Medicine for Small Animals and Feline Behavioural Health and Welfare, both published by Elsevier. And she’s got some great advice for vets.

What’s your day job?

I am a veterinary surgeon in full time in behavioural medicine referral work. I run a private referral practice based in Chester in the North West of England where we have three vets and three rehabilitation trainers seeing clinical behavioural medicine cases. I also teach undergraduate vet students at Liverpool University and do a lot of lecturing to vets and nurses in CPD events. In addition, I write articles and books and book chapters on behavioural medicine in cats and dogs.

How are behaviour problems and poor welfare related?

There is a very strong link between welfare and behaviour and one of the five needs of companion animals in the UK’s Animal Welfare Act 2006 is the “need to be able to exhibit normal behaviour patterns”. In order for this need to be fulfilled owners need to be educated about species specific behaviours and behavioural needs in their pets.

Puppies and kittens also need to be prepared for life in a human environment through appropriate socialisation and habituation. Veterinary surgeons are the guardians of animal welfare and they therefore have a duty to ensure that owners and young pets have access to the education that they require.

One of the other needs in the Animal Welfare Act is the “need to be protected from pain, suffering, injury and disease”. This is highly relevant to behavioural medicine as suffering and disease can be mental or emotional as well physical. Mental health has traditionally been neglected in the human context and, sadly, the same is true for companion animals. It is the responsibility of the veterinary profession to protect animals from pain, suffering, injury and disease and emotional health is part of that responsibility.

In your upcoming lecture series, you focus a lot on what happens in the vet clinic – the vet visit from the dog’s point of view, or feline handling. Why is this so important?

Your next question asks about the challenge of behavioural issues within a veterinary context and the answer to this question is inextricably linked to that issue. In order to optimise the emotional health of our patients it is essential that handling techniques within veterinary practice are based on sound scientific principles and respect for species specific behaviour is vital. Visits to the veterinary practice can be challenging for pets and their owners and we need to do everything possible to minimise the stress through making the visits as positive as possible from a feline or canine perspective.

Why do many veterinarians find behavioural issues challenging?

A lack of appropriate education at undergraduate veterinary level is the problem for many vets. They often feel that they do not have the knowledge to deal with these cases and are concerned about the time consuming nature of fully investigating a behavioural case. The education situation is thankfully changing and in many countries behavioural medicine is being incorporated into the curriculum, but the time element is still a concern. The important thing to remember is that every veterinary surgeon is working in behavioural medicine every day because mental or emotional health cannot be divorced from physical health. Learning to acknowledge this link is a challenge that the veterinary profession needs to embrace. 

Veterinary practices can provide a preventative behavioural service by offering appropriate advice to new owners and can help to optimise the veterinary visit experience in terms of the emotional health of their patients. If animals have already developed emotional health issues then referral to a veterinary surgeon working in behavioural medicine may be needed. If the veterinary practice feels that they are able to deal with the emotional health element then there may still be the need to refer the case to a non-veterinary colleague who can offer support in the form of potentially time consuming behavioural and environmental modification.

What non-humans do you share your life with and how did you meet?

I share my life with a ten and half year old Flat Coated Retriever called Quaver, who has lived with me since she was 7 weeks of age. She was bred by a veterinary nurse at a local practice and I first met her when she was 3 weeks old. At the time I had another FCR called Cira but she sadly died from hepatic carcinoma in 2010, when she was ten years old. I also share my life with a fourteen year old ginger and white domestic shorthair cat called Muffin. She was diagnosed with chronic renal failure following an acute renal episode in January 2012. She has subsequently been diagnosed with hyperthyroidism but she is a very strong personality and is defying all predictions in terms of survival times. Sadly I had to put her litter brother Timbit to sleep in November 2016 due to pulmonary carcinoma. He was my best friend and I miss him terribly.

What are three things that veterinarians in general practice can do to improve their interactions with patients?

  1. Consider the emotional health of patients to be equally important as physical health
  2. Adjust protocols and procedures according to the emotional needs of the individual patient
  3. Act on behavioural concerns as soon as possible and refer to a colleague if necessary. Do not delay in the hope that the issue will resolve.

Thank you so much for your time, Dr Heath. Dr Heath is a keynote speaker at the Centre for Veterinary Education’s Small Animal Behavioural Medicine Conference from February 20 to 23.

For more information, visit

You can also visit Dr Heath's website or follow her on facebook here.