The dental industry is changing. Albeit, some may say very slowly when referencing insurance reimbursements or rapidly when referencing products and technology. We would agree that most dental professionals feel comfortable talking about products in which they believe and technology that aids in diagnosing treatment. Even the most introverted dentists eloquently communicate with patients when they feel confident about what they are saying, have evidence to back up their recommendations, and a cohesive team who understands their practice philosophy and vision to follow through with the next steps.
So what happens when change occurs, and we don’t feel confident or prepared? The change I am going to specifically focus on is the increase in mental illness in our society and the impact on patient care. Every day there are headlines about the rise of mental illness in the United States. A celebrity who has died by suicide, a new drug for depression, and the endless stories of suffering, hurt and hopelessness in our communities. These suffering people are our patients. They are moms, dads, school teachers, children, athletes, teenagers, co-workers, colleagues and possibly…you…the person reading this article or someone you love.
We can’t have a “one size fits all” attitude
The working environment of a dental office is unique because we see a variety of people of all ages. The age diversity, in and of itself, requires different communication techniques. When you add on the patients’ cultural, political, gender, socioeconomic, and educational differences, we can’t have a “one size fits all” attitude.
Simply put, dental offices have a diverse patient population. Developing an awareness of the prevalence of mental illness among your demographic area opens an opportunity to bridge the gap between dental health and mental health. Learning about practical strategies, available resources, and tools to intentionally communicate from a heart of compassion results in a systematic and proactive approach to help patients who suffer in silence.
In October 2018, a quick poll was done through the National Dental Practice-Based Research Network, of the 465 dental professionals who responded, 93% agreed that mental health and dental health have some degree of correlation. In addition, 66% said they were willing to be trained by a mental health professional to help screen, observe, or possibly intervene with potential mental health issues in the dental office. From this sample of responses, I concluded that dental professionals are interested in learning more about mental health in the dental office but not sure how or where to get appropriate training. To read the entire poll, go here. http://bit.ly/mental_healthDEW. Before I get into specific statistics on the prevalence of mental illness and sharing strategies I have learned, I want to give you a little bit of background on why I have become a dental/mental health advocate.
Imagine this…
It’s a Saturday night, and you are watching a Netflix movie, eating some popcorn and relaxing from a long work week when you get a call from your teenage son saying, “Mom, something is wrong with me!” Not understanding the context of the statement, you start to ask a barrage of questions without taking a breath. “What happened? Where are you? Who are you with? What’s going on? Do you need me to get you? What’s going on? Are you ok?”
He answers, “I don’t know what’s wrong with me!” He sounds distressed, confused, and panicked. You finally learn a few key details and discover he is hanging out with some friends, and he decided to try some substance that his friend said was “safe.” He took a hit from the JUUL, which typically has a high concentration of nicotine, and his life changed in that moment. Whatever was in the JUUL made him feel completely out of his mind and like he had been drugged. Now what? This is part of our story. (By the way, my son gave me permission to tell part of his story)
What happened next
My son and I have a relationship of honest communication, and he felt safe calling and telling me. For the next 7 months, he would not drive his car, drink out of a water bottle after he took the cover off, eat any food prepared by anyone except him or me; and he went to numerous specialty doctors to find out what was going on, and he became completely consumed by fear. Now you must understand that this is behavior from a teenager who, on occasion, would sneak out in the middle of the night and drive 30 miles with friends to ride their longboards in the parking garage…a teenager who was working and had many friends.
When your child changes, literally overnight, it is confusing. How do I protect my son from himself and the negative thoughts? We were aware of the predisposed genetic variables of an alcoholic father with mental health struggles, and me, a mom who struggled with eating disorders in her early years and had led an outward appearance that everything was fantastic!
Even though he had been diagnosed with ADHD and had typical childhood stresses over the years, circumstances can and did, change in an instant. Prior to that Saturday evening out with friends, he had been struggling with depression and grief from the passing of his grandpa and dad in the same year. We were seeking help, getting counseling, reading appropriate books, praying, and going through the motions of life. He was feeling numb to emotions on that Saturday night.
As a parent, I felt helpless.
What we discovered in that defining moment, the one choice he made that night, triggered a rollercoaster ride of panic disorder and obsessive-compulsive behaviors. As a parent, I felt helpless. We both knew that “logically” his fears didn’t make sense. The “what if’s” took over his thinking and elaborate scenarios of what could happen went to very dark places in an instant.
My son has a loving family who encourages him, listens, spends time with him, loves him, and supports him in all of his adventures. My “what if” to you is…what if you have a teenager in your chair tomorrow who doesn’t have the family support and they are struggling with mental illness? What is your role? How can you help? If you think that won’t happen in your office, I am here to tell you that it already is happening and you may not have the awareness yet.
According to the National Alliance on Mental Illness,
1 in 5 adults has some sort of mental illness, 1 in 5 youth ages 13-18 have a severe mental illness, and suicide is the 3rd cause of death in ages 10-24 in the United States. How many active patients do you have? Let’s say your patient base is 1,500 patients. If we use the statistic that 1 in 5 people have a mental illness, that is 300 patients in your practice right now. Also, take into consideration your team. Do you have at least 5 employees? Statistically speaking, one would be struggling with some form of mental illness, and you may have no idea. Many times the strongest people on the outside are the ones who are hurting the most on the inside.
The statistics mentioned are only a few of the societal trends affecting the increase in mental illness in the US. These stats represent people. One goal of a dental mental health advocate is to increase awareness of mental wellness and create a community concern. When a community loses a child to suicide, the teachers, parents, healthcare workers, friends, and family members struggle to make sense of it. If we can have a proactive approach and help with prevention tools, we can contribute to the community in a big way. It’s not just about teeth!! What do you want to be known for?
So what?
One reason dental professionals should get involved is: whether we like it or not, we are affected by the increase in mental illness.
Here are 3 considerations:
Mental Illness Could Impact Your Patient’s Ability to Make & Keep Appointments
If your patient or a family member is diagnosed with a mental illness such as depression or anxiety disorder, the next appointment may be on a “bad” day when they are unable to get out of bed. Understand that the person may feel guilt or shame, and they want to keep their appointment and not disappoint you. However, the debilitating nature of depression or anxiety disorder consumes their emotional, physical, and cognitive strength.
Case Acceptance
A person’s current mental health state can potentially affect our patient’s ability to decide to accept treatment. Deciding to receive treatment may be more about the “what if’s” your patient is saying inside their head. Possibly, financial concerns with the many doctor appointments and medications they take to get through the day are a higher priority than their mouth. In my situation with my son, we were going to so many appointments that the increase in co-pays and day-to-day unknown stresses affected financial decisions for my own health. Another reason is they may feel worthless and that they don’t deserve to have their teeth fixed. Or they may be contemplating suicide and think, “I won’t be here next time, so there is no point in fixing my teeth.” Some people have a chronic suicidal thought process, and it is always an option. http://bit.ly/suicide-article-dew
All Age Groups Are Affected
Here’s another article to discuss: http://bit.ly/suicide2-dew. This article discusses 31 suicides in a 15-month time frame in children ages 10-18 years. Since this article was written in October 2018, the number has increased. This is where I live. These kids are my son’s age and younger. A 10-year-old died by suicide in my community. My heart hurts. The struggle is real and could be your patient. Would you know what to look for, or what to say?
HOW DO WE HELP?
1. Review your medical history: What questions are you asking? When someone states they have or have had a mental illness, what do you do? Look up PHQ-9 for a reference on questions to ask regarding depression.
2. Get training on QPR: This stands for Question, Persuade, and Refer and is 3 simple steps anyone can learn to help with suicide prevention. People who learn CPR save lives each year, and we must have that to renew our license, correct? QPR provides training on signs and symptoms and gives communication techniques and resources to help save lives.
3. Create a network of local resources you can use as resources for help. For example, a psychologist, guidance counselor at the high school, suicide hotline number, etc. I have created a template for this and call it my “Proactive Crisis Plan.” Feel free to reach out to me, and I’ll send it to you.
4. Self-Care: Prioritize your health. Dental professionals have physical, emotional, and financial stress that contribute to the level of their mental health. Examples are: eat healthy, exercise, meditate, get massages, and get an accountability partner, counselor, or support group to work through the stresses.
We can still do more. . .
5. Patient Comfort Menu: Even patients who have high mental health and stability may have anxiety during their dental appointment. To enhance the patient experience, offer items such as a blanket, noise-canceling headphones, warm towels, squeeze ball, soothing music, essential oils, etc.
6. Team: Communicate with your team on a relational level. Create a safe environment where your team feels comfortable talking about difficult topics. Does your office feel like your work family?
7. Community Involvement: Become an advocate, go to state meetings, learn about your demographic area, and what needs you can fill.
8. Listen: Be quick to listen and slow to speak. More studies are coming out to support the idea that technology and social media are contributing to the increase in mental illness. http://bit.ly/ suicide-SM-Dew The human connection has decreased, and it affects how we communicate.
Change is inevitable.
Some people may embrace change while others fear the unknown circumstances of change. Regardless of with which category you resonate, change will happen whether we like it or not. What if dental professionals had a community involvement mindset to increase mental wellness, and took a proactive approach to develop awareness, confidence, and networks of resources? Wouldn’t it be nice to be prepared before something happens?
On average, 129 people die every day by suicide in the US. Don’t let the fear of not knowing what to say keep you from potentially saving a patient’s life. My challenge to you is to take one intentional step to understand the impact of mental illness in your community. Then, determine what your purpose will be in the community effort to increase mental wellness and take action.
This is an emotional topic, and I am very passionate about helping people build confidence in their skills to communicate with patients who suffer in silence. Please reach out to me if you would like to know more or would like me to speak with your team, study club, or dental association.
