Co-Producing an Intervention Involving Dental Professionals Providing Oral Health Support in a Mental Healthcare...

People with severe mental illness (SMI) are nearly three times more likely to lose all their natural teeth and five times more likely to have tooth decay compared to the general population, negatively impacting their physical and mental health and well-being. There is a need for greater focus on this area in research, policy and practice to reverse this unacceptable inequality. To address this health inequality, we aimed to co-produce a system-level intervention to improve oral health in people with SMI.

Building on our initial work, seven online stakeholder consultations and one in-person co-production workshop were conducted to co-produce a system-level intervention. Consultations were conducted with a total of 23 stakeholders to discuss different intervention components. The stakeholders included people with lived experience of SMI, their family members and carers, mental and dental healthcare professionals and dental public health consultants. Notes were taken and summarised for each consultation session, and an in-person workshop plan was drafted based on the online consultations. The final workshop was conducted with 13 participants (10 of whom had participated in the earlier consultation and 3 of whom were new to the study) to determine which intervention components would be feasible and acceptable through discussing the practical requirements and constraints of implementing a system-level intervention. Detailed notes were taken and analysed using the Acceptability, Practicability, Effectiveness, Affordability, Side-Effects and Efficacy (APEASE) framework.

Six intervention delivery steps - including suggested intervention components for an integrated model of dental supportwere identified and agreed in the workshop: (1) having dental health professionals visit the mental health setting, (2) initiating conversation around dental health in a mental healthcare setting, (3) providing a brief dental check-up using a dental mirror, (4) tailoring oral health maintenance-related advice, (5) providing positive reinforcement and (6) providing continuous engagement and support accessing dental visits. These components were believed to be potentially acceptable to service providers and service users, and feasible to deliver.

We co-produced a system-level integrated model of dental support to improve oral health in individuals with SMI. The insights from the co-production process and resulting recommendations will inform future intervention development.

People with lived experience of SMI, their carers/family members, and mental and dental healthcare professionals were involved in every stage of developing the intervention. We conducted a series of consultations with these aforementioned stakeholders prior to the intervention co-production workshop. Stakeholders provided their perspectives on the intervention components. The stakeholders also joined and contributed to the co-production workshop and helped design the intervention.