News and Views

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Dental providers are likely to encounter individuals who are living with serious mental illness

Wednesday, May 11, 2022 | Posted in GEHA Connection Dental Network News

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Dental providers are likely to encounter individuals who are living with serious mental illness, including people who may be at risk for suicide.1 Medical history and verbal disclosures shared with dental providers may include details about antipsychotic and antidepressant medications or symptoms and a history of mental illness and/or substance use, including tobacco.

Friends, family, and the healthcare team need the knowledge, skills, and ability to support and care for individuals impacted by mental health conditions. Many people experience mental health conditions, including psychosis, other emotional and mental health conditions, and substance use. One in five people in the United States experiences a mental health condition at some point in their lives.¹

Prevention Strategies

Figure 1. Levels of the social-ecological model – A framework for prevention. Adapted from Golden and the Social Ecological Model.² Courtesy Ashley Grill.

Societal level and community level resources - There are courses available to further your skills related to mental health and suicide prevention. A highly recommended program is Mental Health First Aid from the National Council for Mental Wellbeing. Mental Health First Aid teaches skills to help the people in your life get to care when and if they need mental health care.

Mental Health First Aid is available to everyone, and there is a teen version, too. Training is available throughout the United States; it would be great for dental providers to learn from this program. To find a training, visit www.MentalHealthFirstAid.org.³

Interpersonal Listening Skills for the Dental Team

Dental providers need skills to listen when mental health or substance use conditions are disclosed. If a dental provider can see an individual’s strengths, the provider can see their humanity. When providers or others lack social skills to accept the listener role, patients may feel stigma. Stigma happens when the listener receiving the information reacts with negative nonverbal and verbal cues. It may stem from listeners who rely on negative stereotypes, which may lead to discrimination.8

Try to stay in connection and try to avoid disconnection. Examples of positive nonverbal and verbal cues include maintaining distance, relaxed posture, and saying thoughtful replies.

Dental providers often have the skills necessary to support individuals in recovery from mental health and substance use. Listening skills and validating feelings may help patients. Being able to see the person’s characteristics such as strength, bravery, humor, and thoughtfulness. Other characteristics such as the ability to address their dental needs by attending the appointment may help reduce stigma.

Provider awareness and acknowledgment of the concept of resiliency and mental health recovery and/or substance use recovery is important.

If you are concerned about an individual’s mental health and substance use (including tobacco use), then recommend referral. Referrals include primary care and a behavioral health care provider. For mental health medication, patients will need a mental health prescriber, but also addressing any underlying health conditions is essential to overall health and wellness. Prescription and over-the-counter options help with quitting tobacco. Screening, brief intervention, and referral to treatment (SBIRT) are ideal for use in a dental practice, including pediatric patients.9

Dental providers’ Collaboration with the Medical and Mental Health Teams

Oral care is a health behavior and may be an early warning sign or indicator of a change in health status. If there is a drastic change in oral health status due to a change in an activity of daily living, this could indicate a change in mental health status. Tooth brushing and interdental cleaning are activities of daily living that may be considered part of self-care. Mental illness may be associated with a change in functional ability, especially when individuals experience psychiatric disability. Referral for assessment of underlying mental health conditions is an important issue, especially for youth.

In addition, brief motivational interviewing may be effective for oral health behavior change.12 Working with the therapist may be important as a part of whole-person health care, especially when patients have experienced trauma.

Collaboration with therapists can enhance the quality of patient care. Integrated oral and behavioral health care is well described in a 2020 presentation by the National Council for Mental Wellness, Center of Excellence for Integrated Health Solutions.13 If a patient has special dental needs, including anxiety or other mental health conditions, it may enhance care to reach out to licensed mental health providers (therapists and psychologists).

An informed approach is to ask patients on medical histories prior to office visits if they have any wishes for you to collaborate with their mental health care team to improve oral health care experiences (especially if dental anxiety is indicated on their health history). Outreaching to the therapist before the appointment is best.

If you have a procedure manual in your office, you can share your written protocols for patient care. This can help prepare patients for oral care interventions they may need. Therapists can help support patients coping with fears and trauma. Ask the mental health provider how best to support your patient during care, and if there are any particular “triggers” or stimulus to avoid that you should be aware of.

Person level - There are healthy activities that can benefit well-being. This list originates from Maslow’s hierarchy of needs, medical necessity, and avoiding substance use.19-21

• Self-care may include things that help restore your spirit. Activities such as taking a long bath, oral care, doing yoga, writing, your favorite exercise routine, or even performing standup comedy can be restorative.
• Coping skills are your ability to get your needs met, including communication skills and activities to keep you safe. Resources include mindfulness, meditation, phone apps, community resources, gratitude, journaling, mindful breathing, creating a self-care plan, identifying healthy supports, and a focus on hope for recovery.
• A stable living environment can contribute to mental wellness.
• Attending work, school, and activities may benefit wellness or indicate that you’re coping and well.
• Nutrition is one of the most important factors for well-being.
• Sleep is essential to mental health and well-being.
• Medication adherence (if needed) may be an essential factor for well-being.
• Avoiding tobacco use may make medication and overall health and well-being better.
• Avoiding substance use is essential to overall health and well-being.

If these items don’t help and you’re experiencing mental health symptoms, please recommend seeking professional mental and healthcare services.

For full sourcing and citations, please visit https://www.todaysrdh.com/mental-health-dental-hygienists-skills-can-help-patients/