Authors: Nicole Brigg, Archana Pradhan, Susan Patterson
Event: 2019 TheMHS Conference
Subject: Facilitating Inclusion: Inter-service partnership, clinician engagement and consumer resilience enabling oral health access for people experiencing severe mental illness.
Type of resource: Conference Presentations and Papers
Nicole Brigg has over 18 years of clinical experience working as an Occupational Therapist. This includes advanced clinician roles in interstate and overseas acute and community mental health settings. In her current role, Nicole has overseen the implementation and evaluation of clinical programs including the UQ Dental Screening Clinic.
Within the context of a facilitated clinical pathway, established in university-mental health service partnership, we examined factors enabling engagement with dental services. This work was novel in moving the focus from multiple barriers to access, by highlighting the strengths, resourcefulness and resilience within people with Severe Mental Illness (SMI) and establishing the importance of collaboration between services and consumers in overcoming oral health disparity. Qualitative methodology, utilising a pragmatic approach enabled development of information of value in the ‘real’ world in which services are provided and accessed. Interviews were completed with 15 consumers who attended no-cost treatment at a university clinic. Analysis employed a framework approach with a theoretical lens (COM-B) to support generalisation of findings. Findings demonstrated that; individual’s motivation was complex, focussed on either function or self or social appraisal; required resilience to overcome ‘messy’ life circumstances and the importance of social and instrumental support. The importance of inter-service partnerships to establish facilitated pathways underpins the vital role of support provided by others to enable access. Ultimately, to enhance social inclusion and health service access for SMI populations, services may need to prioritise both; identified support needs and sustainable service partnerships based on mutual goals of social justice.
Learning Objective 1: An understanding of the meaning and importance of individual social support and inter-service partnerships in addressing oral health inequality for the SMI population. The role of facilitated pathways is supported by the complex interaction of a range of enabling factors for individuals to access services such as oral health, most effectively described by application of the COM-B framework, which identifies themes of capability, motivation and opportunity within the facilitated pathway and collaborative partnership context.
Learning Objective 2: Mental Health services globally are challenged by and therefore continuing to explore and evaluate methods to address an alarming disparity in physical health outcomes for people experiencing SMI. Oral health disparity is equallly confronting with significantly higher rates of total premature tooth loss compared to the general population, the personal, economic and social costs of this disparity are considerable. Broader Implications for the generalisation of these findings include applications for facilitating access to a range of health services with an overarching aim to reduce the gap in mortality and morbidity for the SMI population.
Kisely, S., Lalloo, R., Ford, P., (2018). Perspective: Oral disease contributes to illness burden and disparities. MJA, 208(4),155-156.
Michie, S., Van Stralen, M., & West, R. (2011) . The behaviour change wheel: A new method for characterising and designing behavioural change interventions. Implementation Science, 6(42) 1-11.