Background
People with severe mental illness (e.g. bipolar disorder, psychosis) experience poor oral health compared to the general population. They are more likely to have decayed, missing or filled teeth, and periodontal disease, which can affect quality of life and functioning. It can add to the burden of living with severe mental illness. Dentists can prevent and treat oral health problems. However, people with severe mental illness experience profound and multifaceted barriers to attendance, including practical issues, financial difficulties and dental anxiety. Unfortunately, existing dental interventions have not addressed these issues. They have not helped people with severe mental illness to attend the dentist.
This project aimed to develop and evaluate a link work intervention, delivered by mental health support workers, to enable dental access in people with severe mental illness. The intervention attempted to help people to navigate dental systems and bridge the gap between services. There were four work packages:
Work package 1 involved 4 co-production workshops with patients, staff, and carers (7, 6, 8 and 12 attendees, respectively). We used this information to co-develop and refine the link work intervention and associated training materials. This step ensured that the intervention was relevant and helpful to people with mental health difficulties.
Work package 2 was a realist review to understand the contexts and resultant mechanisms by which link work interventions affect access to community healthcare services. A search of empirical and grey literature identified 31 reports. The analysis resulted in nine context, mechanism, and outcome configurations within three theory areas, providing useful information on how and why link work interventions might be helpful.
Work package 3 was a feasibility randomised controlled trial of a link work intervention to support dental access in people with severe mental illness who had not attended a routine dental appointment in the past 3 years. Seventy-nine out of the target 84 participants were randomised to receiving either treatment as usual or treatment as usual plus the link work intervention. The majority of the feasibility criteria were met and there was high engagement with the intervention. Uptake of an optional dental examination was low at follow-up (12.7%; 95% CI: 7.0% to 21.8%). There were no serious adverse events attributable to the intervention or trial procedures. Overall, the findings supported progression to a full trial.
Work package 4 was an embedded qualitative evaluation of the link work intervention and trial. Narrative-informed interviews were carried out with 18 participants in the trial (13 in the intervention arm, 5 in the treatment as usual arm) and 3 link workers. The qualitative data suggested high levels of interest and engagement from stakeholders, and need for dental intervention. The link work intervention offered practical and emotional support at different stages of access to address barriers to dental visiting at the individual, relational and organisational level. Overall, the project successfully developed and evaluated a link work intervention to enable dental access in people with severe mental illness.
Limitations
The authors followed participants up after 9 months and the feasibility of longer-term retention is unknown.
Future work
The next step is to explore the effectiveness and cost-effectiveness of the link work intervention through a full trial.
Funding
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132853.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)