Monday, 10 July 2017

The Management of Mental Health and Homelessness in Dentistry

Managing these vulnerable patients has been a devotion of mine since I worked in an acute dental setting in secondary care last year. I thought I'd share with you the reasons why...



Why are mental health and homelessness relevant to dentistry?


  • We often encounter forms of mental illnesses in dentistry e.g. anxiety and depression. This can commonly be in the form of dental phobias. One study reports 78% of general dental practitioners encountered patients with diagnosed mental health issues.
  • Patients who suffer from mental illnesses or who are homeless suffer a greater burden of disease. In a community-based psychiatric clinic for example, 52% of patients were suffering from dental pain and of the homeless patients attending a dental clinic in East London; 40% presented in pain.
  • There is a high prevalence of mental health issues in the homeless population: 25-30% according to Crisis.
  • Depending on the dental setting, some settings will see high levels of these patients attending e.g. community dental services, acute services.
  • Mental health issues are still stigmatised and can go undiagnosed and untreated. Not only in patients but also within the profession.

What problems can arise when seeing these patients?

  • Their general management and interactions can be difficult
  • Attendance can be sporadic
  • Consent can be an issue e.g. capacity with mental health issues or if they are under the influence of drugs or alcohol
  • Communication can be difficult in those with severe mental health issues or indeed in patients where English is not their first language
  • There can be extensive dental neglect in these patients e.g. I see a lot of homeless patients who are on methadone
  • Patients medical histories can be unclear or complex e.g. clotting issues in alcoholics
  • Motivating patients to stabilise their oral health can be difficult or even impossible. Often their priority is not their teeth!
  • Access to care is a huge issue
  • An issue many of the staff encountered at the acute dental setting I worked at last year was patients threatening suicide. I am planning a post in the near future about this so keep an eye out!

How can we improve the care we provide for these patients?

  • Educate the profession in the management of patients with mental illnesses so we learnt not to stigmatise them
  • Forge close links within the dental profession and other health professionals in order to liaise easily and link up care e.g. CDS, GDPs, GP, homeless charities, psychiatrists
  • Make access to care as easy as possible e.g. self-referrals, free care for those who are homeless
  • Further research is needed to help us understand how many of these patients access dental care and what barriers they encounter


To read a talk I presented at a local meeting regarding some research into how many of these patients access care, click here



Do you see these patients in practice? Let me know in the comments below. 

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