Emotional Health Isn’t Extra: The Heath Model in Practice

In this special episode of Chattering With International Cat Care, sponsored by Orion Animal Health, iCatCare’s Yaiza Gómez Mejías and Laura Watson are joined by Dr Sarah Heath to explore the clinical relevance of emotional health in feline practice.

Drawing on decades of experience, Dr Heath outlines the principles of the Heath Model - a framework that integrates emotional, cognitive, and physical health as core components of veterinary care. Using accessible tools she offers practical ways to identify emotional bias and arousal in cats, even within time-limited consults. The conversation moves from subtle behavioural cues and their diagnostic value, to the role of veterinary nurses in emotional assessments and client communication.

Rather than treating behaviour as an afterthought, this episode challenges practitioners to recognise behavioural medicine as a veterinary discipline in its own right - essential not only for accurate diagnosis and treatment, but for improving clinical outcomes, reducing repeat visits, and supporting long-term feline welfare.

For further reading material please visit:

Environment and Feline Health: At Home and in the Clinic

Understanding Feline emotions... and their role in problem behaviours 

A new model and terminology for understanding feline emotions 

Letter to companies who use brachycephalic cats and other breeds with extreme conformation

Hosts:

Yaiza Gómez-Mejías, LdaVet MANZCVS (Medicine of Cats), RCVS CertAP (Feline Medicine), iCatCare Veterinary Community Co-ordinator

Laura Watson, RVN ISFM AdvCertFB & DipFN, iCatCare Cat Welfare Coordinator

Speaker:
Sarah Heath, BVSc PgCertVE DipECAWBM(BM) CCAB FHEA FRCVS, RCVS Veterinary Specialist in Behavioural Medicine & EBVS ® European Veterinary Specialist in Behavioural Medicine

Creators and Guests

Host

Yaiza Gomez-Mejias

Veterinary Community Co-ordinator @ International Cat Care

What is Chattering with iCatCare?

Welcome to Chattering With iCatCare, the official monthly podcast of International Cat Care, hosted by Yaiza Gomez-Mejias (Veterinary Community Co-ordinator). Each month, we chatter about cats and cat-friendly practices with industry experts and contributors to The Journal of Feline Medicine and Surgery. Each episode contains highlights from our longer discussions and interviews, which are accessible to iCatCare members at portal.icatcare.org. If you would like access to our full episodes, would like to become an iCatCare Veterinary Society Member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Welcome to this special
episode of Chattering with

iCatCare sponsored by Orion.

I'm Yaiza Gomes Mejias, iCatCares
Veterinary Community Coordinator and I'm

hosting this episode today with Laura
Watson, our Cat Welfare Coordinator.

Today we are joined by one of
the leading voices in veterinary

behavioural medicines, Dr Sarah Heath,
with decades of clinical experience,

Sarah has redefined how we understand
the emotional lives of our cats.

We will explore how behavioural medicine
is no longer a niche interest, but a

vital integrative discipline that touches
every corner of any veterinary practice.

So would you like to start
with the questions, Laura?

I can indeed.

So the Heath Model redefines how we
think about emotional health in animals.

Can you explain its core
principles and how they translate

into clinical decision making?

So the Heath Model, it's really about
comprehensive veterinary healthcare.

So the idea that healthcare has got
these three elements to it, one element

to that is emotional health, which I
guess the Heath Model started with the

sink analogy, thinking about how to
explain emotional health to caregivers.

The first part of your question was
about what are the core principles of

the emotional part of the Heath Model?

And certainly I think the thing that
differentiates it from other ways

of understanding is that it really
talks about that integration between

emotional capacity, emotional input, and
emotional drainage leading to arousal.

So not just thinking about emotions
as valence or whether they're

engaging positive or protective, but
also about that state of arousal.

How much emotional of whatever
type is this animal dealing with

at the time, and how is that
influencing behavioural output?

The core of the emotional part
of the Heath Model is the sink

analogy and the idea of this
interplay between those factors.

So knowing some history to know
a bit about their potential sink

size, their capacity for emotion,
thinking about their bias emotionally.

So are they more engaging
or more protective?

And thinking about their drainage
ability, how well do they cope?

How resilient are they from an emotional
health point of view, which results

in the residue in the sink as we
talk about it in the sink analogy,

but basically that state of arousal.

So that's really the concept of
emotional health, but the Heath Model

in its entirety is far more than that.

So it's all also about
comprehensive veterinary healthcare.

The physical, emotional,
and cognitive together.

Cognitive health can be looked at as
the way we think, learn, and remember.

All the time when you're
having experiences, there is an

element of cognition, there's
an element of memory formation.

There's also an element of learning
to use a different, more applicable,

more successful behavioural response.

behaviour is just an
output, not a diagnosis.

These elements create a behaviour, which
is what we see the animal doing, but

that response also becomes learned.

How do they think about
what they're doing?

How do they remember what they're doing?

How do they decide a good
response in the future?

There's a term emotional intelligence
where cognition meets emotion and where

you make decisions about how you respond
to those emotional responses, and

that's really important when we think
about a cat in a clinic because they

will have certain emotional responses.

What they do about those has quite
an impact on their welfare, but also

on the welfare of the veterinary
staff, the perception of the

caregiver of how that visit has
gone, and therefore the potential to

have subsequent visits, et cetera.

So we are affecting the cognition of
the human animals involved as well.

But that cat will be learning something
and if we can teach them that they

can succeed in dealing with these
protective emotions by using things

like avoidance, by staying in their
carrier, being partially hidden by

a towel, and feeling that they are
successful in using avoidance, we lower

the potential for them to use repulsion
because repulsion is not needed.

But it doesn't mean if an animal's using
repulsion, it is more or less unhappy or

threatened that an animal using avoidance
or is inhibited and doing nothing.

They're just alternative
strategies to deal with emotion

and influence through cognition.

If they are successful, they're
more likely then to be put into

that behavioural repertoire for
that individual for the future

through cognitive processes.

Brilliant.

Fantastic.

I remember the first time I
heard you talking about the sink.

That was the moment where I really
understood emotional resilience.

In your experience, what are some
of the most overlooked behavioural

signs that actually point to
underlying physical health issues?

So we talk about flare up in cats in
relation to things like cystitis or things

like skin disease or the flu signs where
we have a pattern of a disease process

in a physical sense that sometimes is
quiescent, sometimes may appear to be

treated, but then raises its head again.

And that to me is a big sign that
says, let's consider what are

the other components of health?

Is emotion involved?

Is cognition involved?

They will always be involved, but
to what extent is it involved?

To what extent do we have to
address that in order to get a full

resolution of the physical signs?

I don't think it's one particular
disease process, but more the

pattern of how it presents in terms
of this quiescent flare up history.

That would be a big red flag for me.

The other is when your experienced
veterinary surgeon finds a case baffling.

I think that's another signal for me
that you need to also consider the other

dimensions of the health triad, because
that can be a complicating factor.

So you've got your physical health
condition, but if there's emotional

compromise involved, cognitive compromise
involved as well to a significant

level that may actually make that
physical disease much more difficult

to really pinpoint and get to the

bottom of.

So I would always see that as a red flag.

The third thing would be
response to treatment.

If I've made a good diagnosis as
a general practitioner, and I know

that this is a case I deal with
a lot and I know this condition

well, and I know how to treat it.

And yet I'm not getting the resolution
I expect or not in the speed of efficacy

or the retention of that efficacy,
which brings us back to flareups.

If something doesn't fit your normal
pattern, I would then go, have we looked

at the other parts of health enough?

Are they contributing
more than we thought?

Should we revisit that?

So those would be my flags.

Rather than looking at specific
conditions, a general practitioner

might think, hang on, maybe we need
to think comprehensive healthcare

approach here and look at the relative
contributions from all three domains.

How can general practitioners begin
incorporating behavioural assessments

into routine exams, considering our
limitations in time and training?

So this is where I hope the sink analogy
does help and also the tree analogy,

that's also part the Heath Model,
because what I'm hoping is that general

practitioners will realise that what
they can do in that very short time is

a very first point emotional assessment.

A bit like in your 10 minutes of
a consult, you don't investigate

physical health entirely.

You gather some basic information
about its physical health in that

10 minutes, and if you need more,
you're gonna have that animal in

and do other tests, but you don't
do a full write down to everything

clinical examination from a physical
health point of view in 10 minutes.

It's impossible.

We wouldn't expect you to do that from
an emotional point of view either.

So what is the equivalent of taking
a temperature and having a look in

its mouth and auscultating its heart?

Basically it's to look for signs of two
things, emotional bias and arousal level.

So arousal level talked about as
being synonymous in the sink with

the amount of water in the sink.

Look for signs of displacement behaviours.

Those displacement behaviours,
this sink is very full, this

animal's got a lot of emotion.

So are they yawning?

Cats also do yawn, not as
extensively as dogs do.

For cats, more thrashing
tails, they do lick their lips.

So those behaviours that
are grooming without intent.

So that's spontaneous, quick
grooming type behaviour that's

often displacement related.

So we are looking for those
signs that the sink is very full.

Now for cats, that could be because
they often get a lot of input

from coming in the car, being in a
carrier, being in a strange place.

Arousal may be contextual rather than
as inherent, but it's a guide that

this animal does have quite a lot of
emotion to deal with at the moment.

That means that it's unlikely
to make very rational decisions.

Think about yourself when you're
full of emotion and how bad

your decision making can be.

This animal is probably on the back
foot in terms of making good decisions,

and that's therefore a bit of a warning
sign that we're gonna have to be careful

handling this individual because it hasn't
got much capacity to deal with the next

input and do something sensible with it.

So that's a really useful thing to have
ascertained in your 30 seconds as it

walks through the door, or you see it
come out of the carrier, or you lift the

carrier lid and leave it in its carrier,
and you are looking for those signs.

The bias that's about is this animal
more pessimistic or optimistic?

We talk about the inflow from those
different emotions, so the engaging

emotion represented in the Heath
Model sink analogy by the cold tap

and then the hot tap representing the
protective emotions and what we are

looking for is which is predominant
because they are not in isolation.

Engaging in protective
emotions are not an either or.

It's like the health triad.

It's not, which is it?

It's what's the relative
contribution from each.

It's the same with emotion,
which is the predominant input

in this cat at the moment?

If engaging emotion is predominant,
the animal will show engaging

behavioural responses, they'll want to
interact, to explore or be interested.

Those behaviours will be
the predominant signs.

You know, you've got an animal getting
input from its engaging emotions.

As long as that's coupled with
low arousal, you've probably

got a good consult on your hands.

But remember, you could have
engagement, but a high level of

arousal and still have a problem.

Whenever you put into a full sink, you
still get a flood, so doesn't matter.

So look at the two together.

That's why arousal's so important.

The protective side, do I think this
animal's more protective in its responses?

Thinking about the four elements
of the tree analogy, the four

different responses from protection,
is this animal trying to repel me,

trying to avoid inhibiting itself?

The cat's appeasement behaviour
plays a role, and one of the

difficulties with cats is
differentiating between appeasement

interaction and engaging interaction.

But once you've looked at those responses,
you've got an idea of pessimistic

cat with a high state of arousal.

Now I want to know, is
that purely contextual?

Does that only happen here?

Or is that something caregivers
see in other contexts as well?

So I would have just maybe three
different contexts that you ask about.

Let's see, what, how does your cat
respond when visitors come to the house?

How does your cat respond
when you show it affection?

You've got a familiar
and an unfamiliar person.

And then other than coming to the vet
practice, do you ever take your cat

anywhere else, cattery, et cetera?

How do they react to that, for example?

So you just get some scenarios, though
you can test out that bias and that

arousal in another context and see, does
that sound like it's actually something

that's seen in other contexts as well?

Because if that's the case, I've
got a pessimistic, high arousal

cat who shows that in a lot of
various contexts, I've got more

likelihood it could be a significant
factor in this animal's health.

You've now queued it up.

You haven't got a diagnosis.

You don't know if there is emotional
illness or just emotional compromise,

and those two things are very different.

But you'd have some idea of, am
I gonna think about emotional

contribution for this individual, or
am I concentrating on physical health.

At the moment, I've done a
quick emotional assessment.

I'm reckoning this animal is
actually engagingly biased,

pretty low level of arousal.

I'm not seeing signs that emotional
compromise are likely to be a

big factor in this cat's life.

I'll concentrate on my
physical health diagnosis.

Or am I going, no, I think this could
be a major factor in this condition.

I'll treat the physical health
and then decide whether I ask a

veterinary nurse to take that further.

That might be the first step, not
referral, but get another member of the

team to spend a little bit longer asking
more questions and then make a decision.

Am I going to need to refer out for
that behavioural medicine approach, the

emotional and cognitive health input or
am I gonna be able to do that in-house?

That's fascinating and it's so important.

We usually tend to make notes about
the barriers we find to approach the

animal, but we don't add many words
that refer to the actual animal's

perspective of the situation.

So I think words there are very useful.

Thank you for that.

Yeah.

Love a word.

I loved something that I heard you say
in one of your lectures, Sarah, once a

few years back, listen with your eyes.

It was profound.

You don't have to do much with the actual
cat, just watch the cat in front of you

and it really shaped my nurse consults
going forward because I was like,

actually, I don't need to touch the cat.

I don't need to do anything.

Just have a little conversation with
the owner, watch the cat, does it come

out of its carrier and yeah, I'm ready,
I love this environment and allorubbing

on everything, or are they hiding in
their carrier underneath the blanket?

Because it just instantly gives you
that idea of what emotional bias,

like you say, that cat is sitting
at, which can then help shape your

consult because what's priority to
actually get done in that consult?

Interesting what you just said, Laura.

We'll just pick up on
something you just said then.

So that is, absolutely, that this
emotional assessment in its barest

sense, if you like, in getting it
right back down to the minimal,

can actually be done in seconds.

The more you do them, the more easier and
the quicker you will do those, the quicker

you'll get a feeling for that emotional
bias and that arousal level in that

individual as they come into the practice.

With cats, I mentioned earlier
about appeasement and said that

one of the difficulties with cats
and appeasement I think is our

understanding isn't quite there yet.

We are still grappling with this concept
of how it works in cats, but I personally

believe, this is a personal belief and
not saying I've done any studies yet

to really determine where this fits.

But I see that allogrooming and
allorubbing, yes, there's affiliative

behaviours in a feline sense, but
because I believe them to be appeasement

to behaviours, I think they actually
come from a point of uncertainty.

The difference being appeasement
is gathering information through

engagement, finding out about
it and telling it about you.

And the reason, therefore, I believe
we see that in cats who are considering

themselves to be part of a social
group, the only individual they exchange

information with, rather than just take
it from, would be an individual that

they trusted to some extent because
otherwise it's too dangerous as a prey

animal and as a solitary survivor,
you put yourself in too much danger.

Whereas if you're a dog, horse or a
person, it makes perfect sense because

you're socially obligate, that the value
of social contact is always going to be

there and therefore it might be better to
engage with this thing I'm worried about.

It shows more input from engagement, but
the protective emotion is still there.

Appeasement comes from protection.

Engagement comes from engaging emotions.

When cats go up to another cat or a person
and rub and and do that, my belief on that

is that it tells me that I've got both
engaging and protective emotion present.

Not that they are 100% engaging, is
that protective emotion of a worrying

degree is a different question because
appeasement inhibition repulsion

avoidance are absolutely normal
when justified, absolutely normal.

Nothing abnormal about using any of
those responses if justified by the

emotion and the context that you are in.

So that animal who shows engagement is a
cat, isn't a cat who lives in this context

and then shows some appeasing behaviour.

Yes, I would believe there is an
element there of protective emotion,

but probably within normality and not
something to worry about, but there is

a bit of a, or there has been a little
bit of a tendency to create this image

of some emotions as being negative and
bad, and we should get rid of them.

That worries me because these
are very important emotions.

The fear anxiety system is hugely
important and in our animals in a

consulting room should be present
because it is not a normal place to be.

If we see that animal showing that
sort of behaviour that I would say is

okay, yes, that animal has got levels
of fear, anxiety, but they are normal.

They are things that are protecting
it from making a mistake and doing

something stupid and letting itself
be too open because it's a cat and

it has to protect itself, but it's
actually got enough engagement

that it is going to use appeasement
rather than inhibition or avoidance.

It's going to want to find
out more proactively from you.

Amazing.

And it helps us learn, doesn't it?

Because it helps us gauge what's
normal for that individual

in front of us, isn't it?

And react accordingly.

If it didn't have that fear and
anxiety there, then we wouldn't

know when not to go too far.

It's their way of communicating with
us, 'No, I've had enough, this needs to

stop here', so it's really interesting.

Fantastic.

So many of the cat caregivers
views on behaviour can be seen as

training issues rather than medical
concerns or normal species typical

behaviours as problem behaviours.

How can veterinary teams
reshape that narrative?

Yeah.

So we're back to this
differentiation between behaviour

and behavioural medicine.

And so you are absolutely right that
many of the behaviour outputs that

caregivers find difficult are things that
are incompatible with living as a human.

That's a problem when you take any
species into a domestic environment,

these animals are not humans.

This ideal existence that we perceive from
a human perspective is not necessarily

going to be the ideal perceived existence
for them, and that is automatically

going to cause some miscommunication.

And it's all about education.

It's all about understanding what
the species is that you take on.

I share concerns with many people
about the horrors of images on

YouTube and TikTok skewing
perception of what these animals are.

And then we have inappropriate breeding,
which is leading to morphologies,

which are not compatible with being a
cat in the normal sense of the word, a

species specific normal, if you like.

Dan O'Neill at the RVC, he talks about
innate health and talks about health

being something that is needed to allow
you to be what you are meant to be.

Whether you're a cow, cat, or a human.

We need innate health.

We need a health that allows us
to be what we are supposed to be.

One of the problems with any
domestic animal, and then we could

get into a ethical debate on pet
caregiving, but we won't but that's

another topic for another day.

But we need to remember that as human
animals, we are making a decision to

take another species, whatever that
species is, we are talking about cats,

but whatever species into an environment
which is not their chosen environment.

If we're gonna do that, we have
to be willing to compromise.

We have to be willing to
understand what is absolutely

essential for that individual to
be a cat and what is optional.

The essential stuff must be provided.

In the Heath Model we
talk about environmental

optimisation, not enrichment.

Environmental enrichment is different.

It is a thing, but it's the
addition of things that are not

necessary, but nice to have.

The five pillars from iCatCare and from
the guidelines are fundamental needs.

They are not enrichment.

When we were doing those guidelines
a long time ago now, we sat and had

that debate about what they would
be called, and they are called

environmental needs for a reason that
they are a need, they're not an option.

So I think getting that across, that if
you want to live with another species,

I think this is an education piece
across the board for the veterinary

profession, not just in the cat world,
but if you want to live with another

species, and I would highly advocate that
we do, we benefit enormously from it.

But we can only do that
if they benefit too.

If it's only for our benefit, then I
don't believe we should be doing it.

It has to be beneficial and I feel
that about assistance animals and

animals doing anything to further
and increase the quality of life

of human animals, I'm all for it.

As long as the individual
involved is also benefiting.

If it's at the detriment of
their health and welfare, then

I don't think it's acceptable.

No, I completely agree.

A veterinary team could
do so much to help.

The big part of my job in practice as
well was supporting cat caregivers,

and how many times did I email those
environmental needs to caregivers and

discuss them with them and put them in the
kitten packs and put them on social media

and little nuggets of information used.

Like you said, social media can be
used for such a negative, so let's,

in practice use it as a positive tool
that we can actually educate with our

caregivers so that they know what they
need to provide their cats with as well.

And be very careful about the
images we use on veterinary

practice social media sites.

I see terrible imagery used and used
on cat social media platforms by

individuals who are very experienced
in physical health treatment for feline

patients, but the imagery that's shown
and used on their platforms is really

detrimental because it's showing
protective emotional bias without

that being talked about, recognised,
even spoken about, and even sometimes

talked about in the opposite way.

Look at how lovely and happy this cat is,
when actually the signs that we're seeing

on that is of a cat that's clearly in
protective emotional bias and struggling.

We have to be really careful
as a profession about imagery.

Yes, inappropriate breeding and
morphologies, but also emotionally.

It is really important that we get that
message out there, that they show these

behaviours because they're unhappy.

How do you envision veterinary nurses
contributing more actively to behavioural

medicine in everyday practice?

What makes them particularly well
suited to supporting the emotional

health of their feline patients?

Love veterinary nurses, advocate
the use of the word the veterinary

team, veterinary professionals.

We are a team.

One can't operate without the other
and as far as caregivers are concerned,

nurses are traditionally thought
of as potentially more approachable

people that they can talk to.

I think nurses sadly do not have any
more time than vets have, but they do

have some communication skill differences
with, compared with a lot of veterinary

surgeons, although they are now better,
much better trained vets in communication

skills at undergraduate levels.

But caregivers often perceive that the
vet doesn't have time to talk about it.

As I say the vet nurse is just as time
pressured, but their perception is very

different from the caregivers themselves.

So I think there's a window there of
opportunity and that also, I think this

is an area where we can really, as a
profession, give this message to the

world that it is a veterinary team.

That a vet nurse and a vet have equal
contribution to make to a veterinary

practice by doing dual consults, having
a nurse in the room with you, but having

the nurse in there at the beginning
because they may actually be using their

eyes to do that emotional assessment.

And then the vet saying, I'm going to
leave you now with my colleagues capable

hands, who will just take some of those
little things we've talked about a

little bit further and decide whether
or not to arrange another appointment.

And then they go into another consulting
room and start another consultation.

But the nurse has been introduced
as a co-professional, as someone

who's on a equally important for
this cat's welfare, and therefore

the caregiver sees it as a team.

So it's important the vet is talking
about behavioural medicine, emotions,

et cetera, but it may be the vet nurse
who then takes that step further and

does more than that initial assessment.

But I'm also a massive advocate of
vet consults, but I know that time

pressures and other pressures have
meant that isn't always the case.

But I do believe that is how we should
be seen by the client that we're a team.

There's two people involved in this.

There's the vet and nurse contributing
different but equally important things.

We did that in our practice
and it worked really well.

So just as an example, like with
our diabetic patients, the vet would

do the spiel on the, this is what
you medically need to treat the cat

with, but then they'd do the same.

We're gonna leave you
with Laura, for example.

She's gonna go through everything else,
how to teach the owner to actually inject

the cat and that's just as stressful.

And then how they might need to
adapt the home environment as well.

It's such a big change for them, isn't it?

And what to spot for.

And I used to really love that.

And like you say, it comes a lot
when that veterinary professional,

when that vet does speak highly
of you and they do see you because

then the owner sees you as an equal.

There's not that kind of hierarchy there.

It's then you are seen as just as
valuable to that cat's journey.

So one of the things that Ilona Rodan, who
many of you will know, very dear friend

and colleague, and I remember talking to
her about cat friendly practice, right

way back over a decade ago now, isn't it?

When we started talking
about these things.

Her saying that one of the things
she'd found in her cat only practice

in the States was that not moving
the cats from one place to another

is hugely beneficial for them.

So she got her nurses to come into
the consult room to take bloods and

do that with the caregiver present.

And that not only was that very
beneficial for the cat because the cat

didn't transition, and that's, we know
that to be very important for them.

But also she said the value caregivers
placed on nurses shot up and their respect

for them as professionals changed because
they saw vet nurses taking blood samples.

They saw vet nurses doing what
vet nurses do all the time,

but often behind closed doors.

The caregiver only sees the vet in
the consult room, they never meet the

vet nurse apart from one discharge
maybe where they're just handing them

over, they don't see those skills.

Bringing the nurse into the room,
taking samples and doing blood pressure

measurements, doing things like
without moving the cat, beneficial for

the cat, but also hugely beneficial
for increasing the recognition of

veterinary nurses.

So I think that's also an important
part of cat friendly approaches.

Do you have a standout case where
you remember a nurse's positive

impact in the clinical outcome or
communication with a caregiver?

I think that's probably difficult for me
at specialist level because that, it's

not the same scenario, but I do know from
teaching veterinary nurses a lot about

the fact that they often have input,
particularly in observational skills,

and pick up on things that through no
fault their own the vets are, have got

their head thinking about something else.

Maybe they're doing an otoscope
examination and don't notice the cat

shows a behavioural change or is finding
it hard to maintain a sit posture to get

that look down the ear, and therefore
the vet nurse brings in that extra bit

listening with their eyes and giving
that information and feeding it back.

So I think there are countless examples
of where that has been the case, where

vet nurses notice something, maybe
heard something a caregiver said, that

has led that individual to actually
have their behaviour investigated

because the caregiver hasn't actually
come out and said it outright.

It's just something that has come in a
much more subtle way through a comment

or through a, an action, comment from
the caregiver or an action of the pet.

For clinics looking to utilise their
registered veterinary nurse, what

first steps would you recommend for
building behavioural responsibilities

into their daily routines?

I think we have this idea that
emotional assessment is something

we should be doing on a daily basis.

We are getting better,
aren't we, at pain scoring.

That's really good.

But we are still not very good emotional
scoring or emotional assessment of

an animal in the veterinary context.

Vet nurses can be really good at doing,
so again, in a consult room if the

vets are not feeling overly confident
about doing emotional assessments try

having your vet nurse in with you for
a while, into a series of consults, and

see what did they pick up using those
emotional values of arousal and bias

and what have they seen in that consult.

See how much additional information
you get from nurses standing,

watching, and taking in information.

Progress that into emotional assessment
of our hospitalised patients and also

thinking about that recurrence, I talked
about the flags at the beginning of

what about a physical health case makes
me think that the contribution from

emotional dimensions may be significant.

If that happens, and as a vet, you
go, 'God, this is the third time

I've seen this cat with cystitis.

I'm gonna make an appointment for
you to see the nurse because that is

a red flag that tells us that other
domains of health may be involved.

I want to investigate that further.' I
hope we talk about it in those terms.

We don't say it could be stress
because caregivers become

defensive, upset, worried.

Talking about it in a way that could be
perceived as being negative because of

some of the misunderstandings about what
stress actually is, which we probably

haven't got time to go into today.

But if we talk in terms of health domains
and the vet says, 'I've noticed this

is the third time we've seen fluffy for
cystitis, a little concerned because

there are other dimensions to health.

I've talked to you about what's
happening with the bladder.

Sometimes there can be an interplay with
emotions and with the way the animal

thinks or what their memories they've
got, and those things can impact as well

and it's all about their health and so
really the best person for me to pass

you to now is the vet nurse because
I want her to expand on our clinical

examination as a clinical assessment.'

It's a clinical exam.

It's health.

That's what you are looking at, rather
than talking about it as a behaviour

problem or stress, that word is so
difficult because it's rarely defined.

It has two aspects to it.

There's physiological and psychological
stress, and we very rarely define

which one we're talking about.

We talk about it as if it's
an emotion, which it isn't.

It gets lumped in with fear
and anxiety, which it's not.

It's given bad press, which it's not.

So stress, none of us would be alive
if there wasn't such a thing as

psychological and physiological stress.

It keeps you alive.

There's a lot of misperception and
caregiver defence around that word,

they're worried about that word
because it makes them feel like

they must have done something wrong.

If their cat is stressed, 'oh
my God, that must be my fault.

That must be something wrong with, I must
have done something' instead of thinking

about it as having some compromise
in its emotional health systems.

Which is, could be an illness as well.

It isn't always, often it's not, often
it's a reactive emotional compromise

that's, that is related to environments
and needs, but it can be an illness.

I see nurses as helping to keep
it as behavioural medicine.

And yes, if it's just a behavioural
change which is purely cognitive,

then what you need then is training.

We think more of that in the dog
world because with cats we have a

different perception of training.

In the behavioural world, we prefer
the word education to training because

training is literally about a response
being put into a particular context and

that can be important and is important
for dogs in a challenging domestic world.

Education is relevant to any species to
live in a world that's not their own.

So they need to learn and be
educated to be able to do that.

But getting that differentiation between
education and behavioural medicine, I

think nurses are fundamental to that.

And talking about education, if you had
to choose a few changes in veterinary

education and practice to better integrate
behavioural medicine into mainstream

care, which ones would you choose?

I really want to see behavioural
medicine as a day one skill.

That's been my sort of professional life
ambition, to get to the point where it's

recognised that it's not a, an added
extra, and that behavioural medicine

is a veterinary discipline, different
from behaviour counselling, behavioural

medicine is something different,
and it's a veterinary discipline.

So it should be fundamentally central
to veterinary undergraduate education,

veterinary nursing education.

Not an optional extra, not something
that's added on, but something that's

absolutely fundamental from first year,
when we teach them in first year as

veterinary students about husbandry and
about ethology, that we actually talk

about it in terms of behavioural medicine,
not just in terms of pure ethology or

et cetera, but actually talking about
it as part of what creates health.

And that's actually, go back to the
oath, that issue of the health and

welfare of the animals committed to
my care shall be my prime concern.

I didn't say the physical health, I said
the health and that to me is absolutely

fundamental to what we need to change in
the veterinary profession, that health

is seen as a comprehensive thing, which
is why in the Heath Model we talk about

comprehensive veterinary healthcare.

Thank you for your valuable insight on
the behavioural medicine in, in modern

veterinary care and for reminding
us that health isn't just physical,

but has a lot of other components.