The Mouth Matters in Mental Health Study

Severe mental ill health (SMI) including depression, psychosis, and bipolar disorder affects around 1% of the population. People with SMI often have problems with their teeth and gums. They are more likely to have missing, filled, and decayed teeth than people without SMI. Having poor oral health impacts a lot of everyday activities like eating, speaking and smiling. It can affect how patients see themselves and their mental health.

Dentists can treat many early teeth and gum problems. However, very few people with SMI attend regular dental appointments. Instead, they are more likely to seek help when in crisis and invasive treatments are the only option. Accessing a dentist for people with SMI can be difficult for lots of reasons. People can feel helpless, fearful, or demotivated about attending. They can have difficulty booking, planning, and getting to appointments. They may struggle to pay for or access free dental care. Unfortunately, existing dental initiatives have not addressed the barriers facing this group and do not help people with SMI to attend the dentist.
We want to help people with SMI to access dental care. We will use mental health support workers who are already working in the NHS. They will link people receiving care from mental health teams with dental services. The support workers will help people to book, plan, and attend regular dental appointments. They will support patients to apply for financial support. People call this type of support link work. Research has indicated that link work can increase dental visits in people who might not normally attend. Mental health support workers already do link work for other appointments. Link work has been used to help other vulnerable groups of people (e.g. children) around dental care. However, this will be the first use of link work to help people with SMI to attend the dentist.
There are four work packages;

1. We will complete some patient and public involvement workshops with patients, staff, and carers to refine the link work intervention and design training materials for use by support workers.
2. We will conduct a review of how link work has been used in the past and explore what might make it more or less effective.
3. We will test whether the intervention is feasible. We will do this in a clinical study with 84 people recruited from Lancashire, Manchester, and the Pennines. Half will get the link work intervention. The other half will receive their usual NHS services. This will be decided by chance. We will measure how often people in both groups visit the dentist. We will also assess the state of their teeth and gums. We will collect this data when people come into the study and after nine months.
4. We will interview patients and staff. We will also listen to recordings of appointments and read field notes. This will tell us whether or not patients and staff find the link work intervention is acceptable to people. It will tell us whether or not we should test this further in a larger trial. It will also help us to make changes to its design.

If you're interested in learning more about the study or taking part please contact:

Jasper Palmer-Claus, Faculty of Health and Medicine, Lancaster University
Email: J.Palmier-Claus@lancaster.ac.uk

Download Mouth Matters protocol