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Mental Health Information for Dental Workers

What is Mental Illness?

Mental illness is an illness with psychological or behavioural manifestations and/or impairment in functioning due to a social, psychological, genetic, physical/chemical or biological disturbance (Lemon & Reveal 1991). The illness or disorder may occur as an episodic or prolonged disturbance of mood or behaviour that significantly lessens an individual's ability to interact, work, or communicate with others effectively.
(Tesini & Fenton 1994)

A psychotic illness or, psychosis, refers to conditions such as schizophrenia and some types of depression.

Non-psychotic illnesses refer to illnesses such as phobias, anxiety disorders, eating disorders and some types of depression.

Identifying Signs of Mental Illness

Signs and behaviours which may be considered abnormal:

Deterioration in personal grooming and self-care skills.
Disinterest in oral hygiene and general grooming.
Withdrawal from family, friends and workmates.
Sleeping or eating poorly.
Extreme preoccupation with a particular theme e.g. death, politics or religion.
Uncharacteristic neglect of household, personal or parental responsibilities.
Deterioration in performance at school or work to the point of leaving.
Difficulty concentrating, following conversation or remembering things.
Talk about or write things which do not make sense.
Panic, extreme anxiety or marked depression or suicidal thoughts.
Loss of variation in mood e.g. flatness and lack of emotional expression.
Marked changes in mood, e.g. from quiet to excited or agitated.
Hearing voices that no one else can hear.
(Sane Australia 2000)

"An episodic or prolonged disturbance of mood or behaviour significantly lessens an individual's ability to interact, work, or communicate with others effectively"

Types of Mental Illness

Illness	Definition	Symptoms	Medications
Schizophrenia	- a chronic disorder characterised by thought disturbances and disordered behaviour (Friedlander et al 1993).	Positive: delusions, hallucinations and disordered thinking. Negative: flat mood, lack of motivation and socialisation.	Neuroleptics e.g. Clozapine (Clozaril). Commonly used as it treats both ‘negative’ and ‘positive’ symptoms (DHS 1999).
Bipolar Disorder	- when moods, thoughts and behaviours vary between depression and extreme elation. - previously known as manic depressive illness.	Manic: hyperactivity, reduced need for sleep, irritability, rapid thinking and speech, grandiose plans and beliefs and lack of inhibitions. Depressive: sadness, apathy, loss of interest or pleasure, loss of appetite and weight, lack of concentration, insomnia.	Lithium Carbonate is used to control abnormal mood changes.
Depression	- chronic or long term feelings of depression affecting daily life.	- Anxiety, poor sleep and loss of appetite. - Lack of concentration and energy. - Feelings of guilt and hopelessness. - Thoughts of suicide.	Anti-depressants
Anxiety Disorders	- persistent feelings of high anxiety, continual or extreme discomfort and tension, fear of panic attacks.	-Obsessive compulsive disorder (OCD): obsessive thoughts and/or compulsive actions causing the person distress.

(Dept Health & Aged Care 2000)

Dental Considerations & Treatment Issues

Schizophrenia	Greater oral disease and deterioration in personal grooming and self care skills. Hypochondriachal delusions and hallucinations centering on the mouth are common (Friedlander & Lieberman 1991). Impaired ability to think logically. Propensity for substance abuse. Possible adverse interactions between antipsychotic medications and those medications used in dentistry eg. adrenaline and atropine (Sreebny & Valdini 1987). Referral to a GP or mental health worker is suggested where bizarre behaviour may indicate an undiagnosed disorder.
Bipolar Disorder	Lithium treatment increases caries, stomatitis, xerostomia and oral cancers. Unique factors of the disorder cause advanced oral disease eg. disinterest in preventive oral hygiene and reduced saliva flow in the depressed state and lack of task oriented attention during the manic state e.g. toothbrushing (Friedlander & Birch 1990).
Depression	Disinterest in performing oral hygiene. Impaired taste perception, for sweet foods in particular, leading to consumption of a high sugar diet. Decreased salivary flow proportionate to the severity of depression. High prevalence of cigarette smoking in this group (Friedlander et al 1993).
Obsessive Compulsive Disorder	May show disinterest in oral hygiene self care. May have obsession with oral cleanliness, practicing excessive and often ritualised brushing, causing abrasion of the teeth and gums. Fear of body secretions eg saliva and HIV/AIDS. Reassurance in regard to denture work required – eg that no contamination is present. May have unrealistic treatment demands. Chronic motor tics are common with the orofacial region eg. spasmodic grimaces of facial muscles and involuntary eye blinking (Friedlander & Serafetinides 1991).

Communication

Communication approaches which may be useful for different client behaviours:

Client Behaviour	Approach
Withdrawn, apathetic	Active friendliness
Suspicious	Passive friendliness
Seductive, manipulative	Matter-of-fact
Out of control	No demands

(Freeman 1999)

Guidelines for dealing with a person with a mental illness

(Sane Australia 2000)

Be respectful to clients as adults.
Be calm, clear, and direct in communication.
Be as consistent and predictable as possible.
Set clear limits, rules and expectations.
Accept the illness of the client.
Attribute symptoms to the illness.
Maintain a positive attitude, even during failures or setbacks.
Allow the ill person to retain dignity when unable to do things.
Notice and praise any positive steps or behaviour.
Offer frequent praise and, separately, specific criticism.
Focus on current functioning and achievement of the best outcomes possible in the present.
Translate long-term goals into a series of short-term goals.
Help the ill person attain realistic short-term goals.

Guidelines when Someone is Severely Distressed

(Schizophrenia Fellowship of Victoria 1993)

Communicate ~ directly in an honest, understanding manner. Do not crowd or rush the person.

Calm ~ provide a calm, safe environment. Move to quieter, more open surroundings.
Remove any items, which might be a danger. Seek help.

Control ~ take control of the situation. Be firm and quietly assertive in manner.
Reassure the person that help is on the way.