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Dental professionals treat patients with a range of mental illnesses. This article focuses on severe mental illness (SMI) and highlights the challenges that people with a severe mental illness may experience when accessing dental care. Additionally, it looks at the oral implications of SMI and the management strategies that dental professionals can employ to support patients in the dental setting. This article will not cover all mental illnesses and readers can also consult the recent series on mental health covered by Dental Update.
CPD/Clinical Relevance: Severe mental illness is a condition that may frequently present in patients treated in primary dental care. Therefore, it is essential dental professionals have an understanding of how this can affect dental care.
Article
Severe mental illness (SMI) is a term used to describe a mental health condition that has a significant, debilitating impact on quality of life.1 Functional impairment and/or limitation are key features of a spectrum of conditions that include schizophrenia and bipolar affective disorder.1 Schizophrenia and bipolar affective disorder are the main conditions referred to under the umbrella of SMI and are the focus of this review.
According to the Impact Mental Health Report produced by NICE, around 0.9% of the UK population have been diagnosed with an SMI.2 Over 550,000 people registered with a general medical practitioner (GP) were diagnosed with schizophrenia, bipolar affective disorder, or other psychoses in 2017–2018.2
People with SMI have been reported to be at a higher risk of dying 15–20 years earlier than those without an SMI.3 While causation is not clear cut, there are a number of comorbidities that are more common in this demographic and are likely to contribute. In 2018, a Public Health England analysis conducted on patients registered with a GP, found 10 comorbidities present at a higher rate in people with SMI compared to those without SMI (Figure 1).3 Additionally, the data showed that those diagnosed with SMI were twice as likely to have four or more of the above-mentioned comorbidities.3
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