The survey and research protocol were developed by the Federation of Veterinarians of Europe (FVE) and approved by World Veterinary Association (WVA) and Zoetis in line with FVE privacy policy. Informal beta testing of the questionnaire was carried out within FVE. Targeted e-mails with an open link to the questionnaire on Google Forms were sent to all 51 FVE and WVA members, composed by national veterinary associations and several international organizations and corporations with a request to forward to their respective members, which resulted in additional responses from veterinary clinics, which included self-employed practitioners, practitioners working in corporate veterinary clinics (non-probability snowball sampling). Participants were given appropriate project information, including content, sponsorship, and purpose. Participation and each question were voluntary and not remunerated. Data were collected anonymously, unless participants wished to provide an email address of own accord and with informed consent. Any potential contact details or names mentioned by participants during the research were anonymized after transcription. A total of 10 questions in English covered demographics, the availability of support and importance of MWB and DEI, support implementation and design strategies, and impact of support programs on one single page (Supplementary Table S3). The impact was to be assessed based on the evaluation outcomes on institutional level with a numerical scale from 1 to 5 and reported as a median value for each category, where 1 implied no impact and 5 a very positive impact. Responses were editable by the participants until the survey was closed. Data were tabulated and visualized in Microsoft Excel. Incomplete or duplicate responses based on time stamps were removed and the first entry was kept for analysis. Responses were organized by submitting entities (veterinary organizations or veterinary clinics) and regions of origin (Asia, Africa, Europe, Middle East, North America, Oceania, and South America). The options of “yes” and “partially” were combined into a single category to create a binary system for data analysis for the question on importance of MWB and DEI.

Following survey completion, 14 targeted, virtual interviews were held with representatives of veterinary associations, companies, or global support programs in which three representatives each represented two organizations, resulting in feedback from 17 organizations (Figure 2). The interviewees were selected based on the online survey of all those who had support programs available on a voluntary basis. Using a structured approach, each participant was asked 3–5 questions (Supplementary Table S4), depending on the type of support program offered, with relevant follow-up questions asked when appropriate. Representatives rated their support program impact on a numerical scale from 1 to 5, where 1 implied no impact and 5 a very positive impact, based on institutional as well as personal evaluation, and reported on the current challenges and future goals of their organizations. Reports and quotes from the interviews were approved by the interviewees and collected to provide a broad overview of the MWB and DEI status in the represented countries and regions. Data from the interviews were analyzed using a thematic approach to identify recurrent themes from across participants.

One webinar each on MWB and DEI was organized by FVE in cooperation with Zoetis. The webinars gathered further information on the availability of veterinary support programs and their impact and allowed for an interactive session to exchange information between organizers of such programs. An interactive presentation tool (Mentimeter) was used to solicit anonymous and informal real-time feedback from the participants in both webinars. During the webinars, several programs related to MH and DEI were each presented by three subject matter experts and further discussed. A panel discussion each consisting of two members and audience participation took place to discuss selected statements and anonymized quotes were analyzed. Full programs and statements can be found in Supplementary Table S5.

A total of 146 survey responses were received of which 137 responses met the inclusion criteria. Most responses (81%, n = 112/137) were received from veterinary organizations and veterinary clinics based in Africa and Europe (Table 1).

In the 14 semi-structured interviews, the representatives of 17 organizations who gave an overview on their MWB and DEI support programs, including eight national and one regional veterinary associations, two private veterinary MWB organizations, two veterinary pharmaceutical companies, two universities, one helpline, and one veterinary student association were interviewed (three representatives presented support programs for two organizations), in which specific MWB and DEI support programs were available. However, DEI support programs were less often implemented by these 17 veterinary organizations. Most representatives interviewed struggled to rate the impact of their support programs as only participation data were available, especially for DEI support programs (Table 2).

Our study moved the focus from the identification of MH and DEI related issues in the veterinary profession to the action and intervention established through MWB and DEI support programs available for the three identified tiers (programs for the profession at large, for specific groups at risk, or for individual veterinarians). This was investigated on a national, regional, or global scale and explored information on the perceived impact of the existing programs.

The availability of studies on MWB support programs became more prominent in English-speaking countries over the last decade. In these countries, results from multiple studies and reviews detailing work-related stressors (3, 4, 6, 7, 10, 15, 16, 50–54), particularly during the COVID-19 pandemic (20–22, 24) emphasized MWB concerns within the veterinary profession. This was mirrored in our survey, with more responses on implemented strategies received from English-speaking countries. As our survey was solely distributed in English, this could have given a geographical disbalance. Research from larger veterinary organizations in English-speaking countries (11–13, 37, 55, 56) revealed increased psychological distress among veterinarians. This led to many organizations regardless their size establishing MWB support programs for veterinarians on an individual and/or workplace level, as well as the growth of large private organizations focusing on the MWB of veterinarians (MMI; Vetlife; and Not One More Vet). Though it is recognized that veterinary clinics face MWB challenges, the possibility to implement intervention measures is most likely hampered due to workforce shortages. However, larger veterinary corporate companies on a central level made major efforts in the recent years to tackle these issues (IVC Evidensia; AniCura).

Reports on the lack of DEI within the veterinary profession are as well more frequent from English-speaking countries, mostly coming from veterinary schools (26, 29, 57–63), but also from veterinary workplaces (27, 43, 64). Our study shows that in Europe, less organizations perform research on DEI and/or have support programs, though the results could have been biased due to the questionnaire being available solely in English. The identified DEI support programs were mostly targeting the inclusion of the LGBTQI+ community and different ethnicities (PrideVMC, DVMC, BVLGBT+; BVEDS, LGBT Ireland). No programs were identified tackling discrimination of other specific groups (e.g., veterinarians working in the city vs. rural areas, young vs. old, full-time vs. part-time, and specialists vs. generalists). In the EU, the Charter of Fundamental Rights lays down that any discrimination based on any ground shall be prohibited, obliging the EU MS to enact legislation including all grounds of discrimination envisaged in this fundamental right (65). This supranational Charter explains partly why there are less specific DEI support programs in the EU on national level. Legal obligations are present as well in other parts of the world but not always (fully) implied in practice due to different reasons, DEI support programs of the 1st tier were still in their infancy in some regions of the world, most likely as dialogs about gender, sexuality, and ethnicity are considered taboo. In addition, the cultural acceptability of extreme positive or negative opinions of assessment scales, cross-cultural equivalence of the categories “high” and “low” based on a scale from 1 to 5, and whether respondents could be biased toward answering questions in ways that are socially acceptable, particularly in the interviews, could have influenced the responses. One interviewee indicated:

Whereas, DEI implementation strategies of all three tiers, including “part of the mission, vision or internal rules,” “dedicated working groups or committees” as well as “description of rules and regular investigation of non-discrimination of employees” were perceived as having a high impact, they were primarily implemented by veterinary organizations, possibly due to their complexity and time intensive maintenance.

Few studies (47–49) exist on the impact and effectiveness of different support programs for MWB and DEI, which was confirmed by our study. Program organizers found it challenging to measure the impact of their own programs as it is difficult to implement meaningful scoring metrics (what to measure: reduced suicide rates, improved veterinary resilience, perceived happiness?). Primarily, respondents could only evaluate the frequency with which their programs were used (e.g., how many participants certain webinars had, how many calls to a helpline, etc.).

First tier activities such as “description of internal rules/sanctions” were often implemented by veterinary organizations and were perceived as having a high impact. Veterinary clinics also frequently implemented them, but they perceived the impact of those internal rules to be much lower, probably due to the smaller work structure and more direct contact between the colleagues. The MMI Kite App is accessible for every veterinarian and a helpful tool to monitor MWB individually and guide to tailored assistance if needed. Tools intended for veterinary clinics such as the SafeVet Smartbooklet were also perceived as beneficial. For example, one participant indicated:

With respect to second tier activities, tailored programs should be offered to higher-risk groups to deliver more targeted interventions. Webinars were identified as successful group programs with a very high potential impact (median of 4) to raise awareness and promote destigmatization. Surprisingly, this was the 2nd tier activity less frequently implemented by both veterinary organizations and clinics. Specific advantages of webinars are that they are cost-effective, can have a large outreach, and are universally available regardless of the geographical location of the veterinarian or speaker. More seasoned members of the profession can easily share their expertise on coping mechanisms with stressors and well-being optimization strategies. A before-after evaluation of outcomes and effects is imperative to monitor the developments over time (66). By way of support is the following quote from one student organization:

The AVMA Workplace Well-being Certificate, a program to create a culture of well-being in the workplace, was also perceived as having a high impact. For example, one participant indicated:

Different studies report peer-to-peer coaching as being effective in tackling mental health problems in students (36, 67, 68), in general practitioners, especially in teaming up with mental health support research (69, 70) and for other healthcare professionals (71–74). Training students in specific group session format were identified as a useful teaching method especially when concrete skills were emphasized, such as self-care and well-being (68, 75). Platt et al. interviewed 21 British veterinarians with mental health problems about coping mechanisms, and they indicated that peer support was beneficial (76). In a recent study, 889 US veterinarians indicated that they would cope with a distressing situation by talking with a partner or friend (72% of respondents), and/or by discussing with a colleague (9). In the US, it was recommended that veterinary practitioners should connect with others to minimize the development of compassion fatigue, and this should include debriefing after critical incidents and having supportive conversations at team meetings (77). The potential impact of peer-to-peer exchange was highlighted in a recent study (78), in which it was found that final year veterinary students improved their communication skills significantly after peer-to-peer learning with role-play simulations with other students about breaking bad news. However, students commonly choose to speak to a peer or a family member for MWB issues instead of a health professional because of concerns over perceived lack of confidentiality, fears of documentation of their MWB status, or concerns that disclosure will affect their academic prowess or their career (79, 80). This perceived stigma, whether real or imagined, hampers help-seeking behavior.

Third tier activities such as helplines were perceived as having the highest impact for DEI and MWB. However, individual support programs were infrequently implemented, probably either due to the cost involved to train, staff, and maintain the service or the existence of alternatives (e.g., general suicide helplines) (Figure 7).

In our first webinar, the most important factors related to unfavorable MWB were “low pay,” “long hours.” Work-related factors such as “long hours,” “heavy workload,” and “imbalance work-life/private life” have been previously reported to contribute to unfavorable MWB (4, 50, 81–84). Therefore, programs should be provided for all veterinarians beginning with undergraduate training, reinforced at annual conferences, and/or by offering continuing professional development on the subject for veterinary clinics and practitioners. There is good reason to focus on the formative years of the veterinary career, as MWB interventions in this period seem to lead to the longest beneficial effects and are the easiest to implement (85). It is an imperative for professional organizations as well as for veterinary clinics to set and defend minimum standards for employments and encourage early career professionals to value themselves and vouch for fair working conditions. However, veterinary students should be prepared for challenging situations that come inevitably with their future work and embrace lifelong learning, including soft skills. Undergraduate courses on MWB including topics on coping styles, early identification of signs of stress in self and others, and enhancing help-seeking behaviors were suggested for all students as a part of the core curriculum (7). Resilience training has been stated as successful (86) and is considered as a part of selection procedures for students of many health programs (87). While avoiding discrimination of applicants based on their psychological health profile, resilience is considered to be an imperative for veterinary studies (88). The next generation of veterinarians grows up in a society with certain expectations about values, team spirit, a work schedule that also allows time spent with family and friends, fair remuneration, and possibilities to change to other veterinary work fields or professions. This demands a culture change within veterinary medicine and veterinary practice [also earlier stated by (15, 89)], in which a compensation model that incentivizes long hours and promotes heroism should not be used. Several authors (36, 48, 90) have reported on the “Job Demands Resources Model” (91) and its successful use in “Job crafting” within (early career) veterinary professionals, which was reported as a promising and positive intervention within other professions (92).

The second webinar revealed that factors related to DEI were positively connotated (“respect” and “belonging”). Strengthened networks between underrepresented minorities within the veterinary profession could be alleviated by mentor–mentee programs, in which fostering a sense of belonging can improve well-being (93). The support programs should focus both on the current generation and on the future generations as it is important to create role models within the profession, as well as recruiting a more diverse pool of veterinary students who will later represent the veterinary profession. An explicit offer of 2nd tier resources and strategies to implement pipeline programs increasing diversity according to evidence-based practices will foster a welcoming and inclusive environment. Third tier strategies such as individual consequences for not adhering to expected policies are imperative to establish this standard. In other (medical) professions, different support programs on all tiers were used and stated as effective. This includes recruiting a large group of minorities (94, 95), creating a safe and antiracist work environment (96), training staff to recognize unconscious bias and exclude discriminatory behavior (97–99), and using DEI to create workplace targets as well as embracing it as a part of organizational strategy (100). Improving diversity starts with the selection and admission to veterinary schools to change gradually the demographics of the profession. This 1st tier implementation strategies are also used and recommended in other medical professions (101). Willbur et al. (102) stated that increasing the diversity within the healthcare workforces would require social, academic, and financial support, which was recommended earlier by Elmor et al. (27) to improve diversity within the US veterinary schools and profession. This is supported by Witte et al. (64) who concluded that LGBTQI+ support programs were more available within the US universities compared to the professional environment. The improvement of diversity must tackle this inclusion of a wide group of minorities, including the LGBTQI+ community but also underrepresented ethnicities, people with disabilities, people originating from less favorable socioeconomic backgrounds, etc.

In general, interventions should be undertaken by veterinarians as individuals and by veterinary organizations to be most effective as this will best incorporate interventions that address all three strategic tiers (103).

Webinars and group trainings are very useful tools to raise awareness of MWB and DEI and for reducing stigma, which is important to create a culture of sharing, belonging, and talking. In addition, when delivered as dedicated Continuing Professional Development (CPD) courses providing credit points, the approaches and techniques can incentivize and help veterinarians throughout their professional life to develop coping styles, early identification of signs of stress in themselves and others and enhance the likelihood of help-seeking behaviors.

More 2nd tier activities such as tailor-made awareness campaigns for specific groups at risk, peer-to-peer groups (ideally with dedicated professional support, e.g., psychologists), but as well the promotion of 1st tier activities such mobile application and initiative such as the SafeVet Smartbooklet, are recommended to specifically address the needs of the veterinary profession and provide MWB and DEI support. These should be practical and tailored to the needs of the individual and easy to find and use in practice.

As a profession, MWB should be prioritized during initial veterinary training and throughout the professional career. In addition, veterinary organizations, and, in particular, veterinary faculties, should work collaboratively with practitioners to exchange, support, and ensure that evidence-based methods are implemented to increase DEI in the veterinary profession. DEI support programs should focus on incentivizing 1st tier activities targeting the current generation as well as the future generation.

The non-probability snow-ball sampling of the survey made it difficult to determine the sampling error or generalize inferences about the studied entities based solely on the questionnaire responses obtained. The overall picture of MWB and DEI support programs presented in the survey and in the additional in-depth interviews was warranted, although we acknowledge that the responses may reflect the views of those veterinary organizations and veterinary clinics that are more proactive in promoting MWB and DEI. In the survey as well as in the interviews, there was a subjective measurement bias in the results since respondents were asked to rate the impact of their own support programs. In fairness, it is very difficult to quantify the impact of such support programs, especially over the short term. The impact may only be visible by repeating surveys and viewing the results after several years have passed to evaluate changing trends. The accessibility and geographical coverage of the survey could possibly be improved by providing the questionnaires in different languages. However, even well-translated surveys can be biased by cultural issues. The main considerations were the acceptability of extreme positive or negative opinions of assessment scales in various cultures, cross-cultural equivalence, and whether respondents could be biased toward answering questions in ways that are socially acceptable in the interviews. By design, the interviews did not allow for quantifiable differences between participants, but they provided the richness and depth necessary to inform and motivate future studies to explore the impact of MWB and DEI disparities.