As one of the trustees of the ConfiDental helpline, John Lewis is well placed to explain why professional isolation is a barrier to good mental health in dentistry, as well as the value of an anonymous listening service where dental professionals can open up to their peers.

"When I first qualified, if I'd had a bad day, I went to the pub with a friend and we talked it through," John Lewis remembers. "But no one does that now. Instead, they'll go home and look at social media, where it's easy to get imposter syndrome because very few people publish their failures. But even if they have 100 Facebook friends, how many could they call up if they had a problem?"

A lack of real interaction, even with colleagues in neighbouring practices, means that dental professionals feel they are on their own when things aren't going well. John, a practice owner and CQC adviser, believes that isolation is one factor behind the higher rate of suicide among dentists compared with other professions.

It was the suicide of a dentist in the northwest that proved the final straw for fellow dentist, Jeremy Cooper. Jeremy had first mooted setting up a support organisation for dentists after a patient died at John's practice in 2011 after an anaphylactic reaction to mouthwash. "The police investigated and it got a bit messy,' he recalls, "but apart from superb representation by the DDU [John is a member himself], I dealt with it on my own."

Nothing came of the idea then, but the tragic death of their colleague in 2019 pushed Jeremy to set up ConfiDental, a registered charity that runs an anonymous listening service for dental professionals.

"The first objective for our volunteers is simply to listen to callers when they are in crisis or simply had a bad day,' John explains. "We all have a list of resources that we can signpost them to, such as lawyers who do pro bono work, but it's really about actively listening and giving people the time and space to reach their own solutions."

The importance of confidentiality

ConfiDental is different from other support services in several respects. It's available 24/7, operated by dental professionals for dental professionals, and is completely confidential.

"Confidentiality is immensely important," John says. "Callers are directed to volunteers by a call handling service, so there's no way of finding out who that person is. That guarantee means they can be open and honest and tell you things they may not have told their friends or families. The only boundary we have is where there's a safeguarding issue, but that's not come up yet."

The service currently receives about four to five calls a week, although numbers rose dramatically during the first few weeks of the pandemic when many dental professionals were at home on furlough, or worried about PPE and whether they were going to get paid.

Types of concerns

According to John's most recent analysis, callers are predominantly younger female dental professionals, and he reports a worrying trend that over a third of calls have come from dentists who qualified in the last five years and are now thinking of leaving the profession. He believes this is also COVID-related.

"I speak to dentists who didn't do any dentistry in their fourth year of training, who only had six months as an FD or missed out on their FD year entirely. It's not been a nice introduction to professional life," he reflects.

Callers contact ConfiDental with specific problems like patient complaints or contractual disputes [something also dealt with by the DDU's contract checking service], but in many cases it's an accumulation of things building up to a tipping point that finally drives callers to seek help. There are also repeat callers who often just want to talk.

Helpline calls also shine a light on the pressures currently facing the dental profession, such as the NHS contract and workload. "Many younger dentists become very stressed if they can't establish a work-life balance that works for them," John says, "and because so much post-graduate study is online, they've also missed out on opportunities to build a network of contacts they can call on for advice."

A lot of dental professionals feel weighed down by unreasonable expectations from patients, he adds. "Like a lot of essential workers, we could do no wrong for patients at the time of the pandemic, but things have swung the other way since then.

"Along with this, there's a lot of concern about litigation, which is often fuelled by social media. One thing I find a lot is that people worry that their subscription will go up if they contact their dental defence organisation for dento-legal advice, and I always reassure them this simply won't happen - and it's important to spread the word about that.

John goes on to mention dental professionals' fears surrounding the GDC. "It's irrational if you look at the statistics, which show the number of cases that go to a case handler, then to the IOC and then to FTP, is minimal compared to numbers in profession. But of course people worry it will happen to them.

"That said, one area that is a massive problem is the time it takes between IOC and FTP, which can be up to two years. If a dental professional is suspended or working under conditions for that length of time, it's effectively taking away their livelihood, even though they haven't been found guilty - and I know some who have been released from their jobs.

"Of course, if there's a perceived patient safety issue that has to be addressed, but the timeline needs to be shorter. And as a practice principal, I think we should be there to support them, along with their defence organisation."

Spotting the signs

More generally, John would like dental professionals, especially those in a managerial role, to notice warning signs and act if they are concerned about the mental wellbeing of a colleague. "It might be someone has become quieter than usual, or they suddenly go over the top about something, or they look tired because they aren't sleeping," he says.

"You could see a depreciation in the quality of their work, such as not getting referrals and other paperwork done on time, which might easily lead to complaints, and the final stage might be alcohol or substance misuse."

He also advises that if you're concerned about a colleague, "ask them if they are OK. Then ask them twice: 'are you really OK?' - because we all tend to give an automatic response to that question the first time. Encourage them to talk to a friend, manager or someone like ConfiDental if they are worried about something, because a lot of the time, when you share a problem, the weight just lifts."

John also points to the fact that in most areas, there's also the option of referral (or self-referral) to the Practitioner Advice and Support Scheme (PASS), which can help those in difficulty before things escalate and come to the attention of the NHS or GDC.

While PASS is open to dentists only, John is pleased that ConfiDental is available to all GDC registrants, and all volunteer call handlers are dental professionals. "Until you've experienced the problem yourself, it's really difficult to understand. If a caller had to explain what a UDA is, for example, you've probably lost them. At ConfiDental, we've all been there and most of us have had some issue that's affected us, so we can empathise."

Making a difference

Anyone wanting to support the work of ConfiDental can donate or contact the charity via the website to volunteer. "It's important to get the right ratio of volunteer call handlers to calls," says John. "There are currently 30 of us and we work one week in four, which is a good balance."

"We run a training day in Manchester for volunteers with organisations like the Samaritans and MIND and we provide ongoing training and support." All call handlers complete a call log that goes to the trustees, and mentors are available if someone has been on a difficult call.

"I find it incredibly rewarding and it feeds into everything I do; my practice, the LDC and as a CQC adviser," John says of his volunteer work. "For instance, there've been times when I've been out with CQC inspectors where we can see someone is struggling, and we've stopped the inspection to have a chat.

"We obviously don't collect feedback on the helpline because calls are anonymous, but I see things on social media from people who have called ConfiDental and recommended us, which is brilliant. It's interesting, rewarding and I get a buzz from being involved."

The organisation has just had a recruitment drive and plans to broaden the volunteer base to include DCPs. "If you want to help," offers John, "send us your details and we'll get in touch to explain what's involved, and see if we're a good match."

Interview by Susan Field.