Providing Dental Care for Adults with Mental Health Disorders: Can Increased Interaction with Therapists Help?

An interesting article titled “Providing oral care for adults with mental health disorders: Dental professionals’ perceptions and experiences in Perth, Western Australia” written by Clair Scrine, Angela Durey, and Linda Slack-Smith, appears in Community Dentistry and Oral Epidemiology (pp. 1–7, 2018). The article sought out to explore dental professionals’ perceptions and experiences of providing oral health care for adults with mild to moderate mental health disorders in Perth, Western Australia. The article suggests that people with mental health disorders have poorer oral health outcomes and are even less likely to receive dental care. In Australia those with several mental health disorders are more likely to have decayed, missing or filled teeth than the general population. It is believed that access to care and affordability in Australia limit those with mental health disorders from receiving dental care. Most of the dental care (~85%) in Australia is through the private sector.

The authors performed a series of interviews that lasted up to 60 minutes of dentists, oral health therapists, dental specialists and dental assistants in both the public and private sector to gauge their experiences of treating those with mental health disorders. The interviewers were semi-structured and topics included problems encountered in the consultation, context delivering dental care and any concerns or challenges at the structural and organizational level including resources to support care, including professional development and inter‐professional practice such as liaising with mental health professionals or therapists. The interviews were digitally recorded and coded independently by two researchers. There were a total of 16 interviews conducted.

The study identified several barriers to providing oral health care to those with mental health disorders. One barrier included a siloed, one‐size‐fits‐all model of care attitude towards oral health care where other health professionals involved with the patients are reluctant to be involved in the patients oral health treatment. In addition there is little discussion amongst dentists and other health care professionals who treat the same patient. Another barrier identified included limitation of the public dental care system that is often plaqued with waiting lists and delays that did not facilitate regular check‐ups to prevent oral disease nor provide adequate time to undertake preventative care for patients. Many of these patients had to constantly prove their eligibility for the public health care system with forms that may be difficult for someone to fill out when English is not their first language. Another barrier identified was due to the nature of the business aspect of private practice dentistry. Those interviewed said that patients with mental health disorders often need additional time with a dentist in order to trust them to proceed with treatment. However, dentists have a financial incentive to get work done efficiently so if they are slowed down to treat such patients this is not financially beneficial.  The last barrier that was identified was that those with mental health disorders are often perceived as disadvantaged socioeconomically which negatively impacts their ability to adhere to treatment and preventative regimens. Furthermore these patients were seen as non compliant and less motivated to look after their health.

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The study also identified several enablers to providing oral health care to those with mental health disorders. One enabler included receiving special training and developing for dealing with patients with mental health disorders. A recurring theme identified by the interviewees was the need for specific training from undergraduate level to continuing professional development. This included strategies for responding to emotional distress, anxiety, aggression, anger and fear and also included effective communication and establishing trust. Another enabler included establishing closer collaboration and coordination among other relevant medical professionals. For example, educating mental health professionals about oral health and preventing oral disease was seen as a potential strategy to enhance understanding of the significance of oral health among people with mental health disorders in the hopes of having them establish oral health as an important part of their care. The final enabler identified was involving any carers or family members for the patient.

The authors state

“Research shows that dentists, the majority of whom enter private practice in Australia, graduate with the highest level of debt and often assume financial risk for start‐up costs, capital development and service provision. As such, dentists are acutely sensitive to the financial imperatives underlying their approach to providing care… The reality…is…extra time needed to build rapport or obtain professional development to better meet the needs of patients with mental health disorders … impacts…overall business profit margins.”

The authors believe their findings suggest that some dental professionals feel neither public nor private models of care adequately support their professions to respond to treating those with mental health disorders. As such a review of current policies and practices aimed at reducing disparities and improving oral health care of these individuals is needed. The results suggest that strategies are needed to encourage and support dental professionals to provide oral health care that is inclusive, inter‐professional, and has a focus on prevention while being sensitive to the needs of those with mental health disorders in order to improve their oral health.

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