When a dentist in a neighbouring county took their own life, the shock affected everyone in the community, as Malcolm Prideaux remembers. 'Friends and colleagues rallied round but the tragedy really brought home what can happen when someone is unable to cope and doesn't feel they have any options left.'

Suicide is thankfully rare but, as an active member of his local Practitioner Advice and Support Scheme as well as a practice owner who is involved in local occupational health provision, Malcolm understands the pressures that can drive dental professionals to breaking point.

'Business stress and money worries are at the bottom of a lot of problems,' he says. 'Practitioners might be under pressure because of the constraints of their NHS contract; they might have over-borrowed or be drowning in the paperwork involved in buying or selling their practice; or they could be struggling with the demands of regulation and compliance. And this is on top of the demands of treating patients and meeting their commitments outside work.'

According to Malcolm, health breakdowns usually have multiple causes but there are some common warning signs. 'If you are preoccupied, it can easily lead to a drop in your clinical performance,' he explains. 'Receiving a complaint from a patient was a real eye-opener for me and I was fortunate that the DDU helped me resolve the complaint amicably. But talking to the dento-legal adviser helped me realise that I had not been focused on the job at the time because a close family member was receiving cancer treatment.

'In the absence of a complaint, slips might be unnoticed by the dentist concerned but it can be picked up by colleagues, especially in larger practices, where patients might see different dentists. At the same time, other members of the dental practice will often notice if a colleague is uncharacteristically withdrawn, irritable, starts taking sick leave at short notice or having trouble with time-keeping. There might also be signs of heavy drinking or substance abuse which in my experience tends to be a symptom, rather than the root cause of the problem.'

Early intervention is the best chance for dentists experiencing difficulties but Malcolm is concerned that this doesn't always happen. 'It's partly a cultural problem,' he suggests. 'Team leaders and decision makers need to be in charge so they just get on with things but this can lead them to put their head in the sand about problems, especially mental health issues. They also worry about their obligations to staff and not being able to pay their bills if they take a break.'

For practitioners who recognise that they have a problem, a local Practitioner Advice and Support Scheme (PASS) is a valuable source of free and confidential support. Malcolm is one of six experienced dentists on the Devon Local Dental Committee who are involved in running the county-wide scheme which was set up in 2006. Dentists can self-refer through the LDC but PASS can also be alerted by concerned colleagues or someone from the Local Area Team.

'Our goal is to help professionals with performance or health problems and avoid the need for a GDC investigation,' he says. 'This might range from simple telephone advice and practice visits through to coordinating mentoring, further training or counselling, although we have to refer drink and drug problems for specialist support. It's quite informal which I think works best because we want dentists to be positive about involvement, rather than see it as a punishment. In many cases, just talking with someone who understands the dentist's point of view and circumstances can be invaluable.'

And there is a pressing need for help and support for dental professionals. Following research which highlighted 'a wellbeing gap' between dentists and the rest of the UK population, the BDA is conducting a more detailed study of burnout within the profession which is due for publication later this year. It hopes the research will raise awareness and help it develop strategies for promoting emotional and mental well-being at work.

Meanwhile, the GDC has recently acknowledged the immense stress caused by fitness to practise proceedings and now includes information about organisations that can help on its website, including the Dentists' Health Support Programme, the NHS Practitioner Support Programme and the BDA Benevolent Fund. 

Malcolm thinks that reform of the dental contract in England along with changes to the GDC's approach to regulation would help to address some of the pressures on the profession, but he also suggests that some practitioners can get into a rut in their practice. 'There is a tendency to think that once qualified, they have made it, which means they don't explore other options. However it's not necessarily the end point and I think there needs to be better career guidance for dentists after they have completed their foundation training.'

But whether they are unhappy in their career or under pressure at work, Malcolm wants struggling dental professionals to talk to open up and seek help. 'It might be a trusted friend, colleague, someone you trained with, or someone from a PASS team but there are always people around who care about you and you can trust,' he says.

'At the same time, everyone in the dental community - including organisations that represent dental professionals and regulators - has a part to play in recognising situations where a practitioner may be vulnerable and in need of support.'

Contact your LDC to find out if you have a local Practitioner Advice and Support Scheme.

Interview by Susan Field.