Depressed And Lonely Dental Patients

Dentists can Also Help Depressed And Lonely Dental Patients

Very few private dental practices offer to address specific mental anxieties of their patients who also happen to be their dental patients. Dental offices often address dental anxiety, but not many dentists respond to the particular psychological issues a patient may be dealing during a dental visit.

However, when they do—like Dr. Huong Le in Asian Health Services, Oakland, California—a dentist creates a far more enabling and healing environment for patients who sometimes are managing twin stresses: dental anxiety and severe mental restlessness.

In somewhat of a rarity in the dental industry, Dr. Huong Le, a dental practitioner of more than 30 years, often spends 45 minutes with each dental patient during their consultation, taking an interest in their well-being, especially the older ones who visit more often in a year. Patients share information about their families, experiences in home countries, and routinely, their feelings of loneliness. Dr. Le and her staff have also heard their patients express suicidal thoughts.

After taking stock of such experiences, Dr. Le decided to take concrete action, and in 2017 began offering depression screening for patients 65 and older. In 2018, seeing the response, she widened the scope of her initiative by hiring a full-time mental health counselor and gave her an office at her dental clinic. The counselor was made available to patients immediately following a dental session if needed. In the second half of 2019, Asian Health Services’ counseling and depression screenings are scheduled to be offered to patients who are 12 and older.

“When you have someone who is telling you they’re going to go home and kill themselves, and you think, ‘I’m a dental provider; what can I do?’—that was one of the moments when I knew, wow, we need someone, a professional who is trained in this here,” said Le, the chief dental officer at Asian Health Services, reported Kaiser Health News.

Since dental visits are mostly planned, it is useful to offer such services at a dental office considering the perceptions about receiving psychological help.

Asian Health Services is a community health clinic and operates at multiple sites in Alameda County, with most patients being Asian immigrants, a community that usually avoids availing behavioral health services due to the attached stigma associated with mental illness.

The health clinic was responding to real trends. According to the Centers for Disease Control and Prevention, in 2016, Asian and Pacific Islanders had a suicide rate of 7 deaths per 100,000 people; 6.4 deaths per 100,000 among Hispanics and non-Hispanic blacks; and 18.1 for non-Hispanic whites.

How A Dentist Responds To Patients’ Mental Health Issues

Dental patients visiting Asian Health Services receive forms during check in, and one of them is a survey that records the level of anxiety and negative or sad thoughts. If a patient expresses mental anguish, they are encouraged to interact with mental health counselor and social worker Zona Keo who is always on-call during working hours or can be spoken with later after an appointment.

Such a service is even more important as people from low-income and diverse communities while visiting community health centers usually don’t pursue mental health services willingly due to issues related to language, culture barriers, and transportation.

Patients, too, have to overcome stereotypical thinking about mental health. Many older immigrants seen by Asian Health Services have misconceptions, and some younger patients are not willing to explore taking professional help. “We have patients whose parents were refugees, and they feel guilty to talk about mental health because they think, ‘Well, my parents went through an actual struggle — they went on a boat, swam across a river, walked through bombs, and here I am complaining about mental stress,’” says Keo. “So they keep quiet.”

Keo often takes recourse to a cautious approach—by not using words like “therapy” and “emotions”—so as not to alarm patients from pursuing mental health services. “I have to feel out the patient and say what I think is appropriate for each individual,” says Keo, who can speak the Cambodian language Khmer.

Presence of a mental health provider within the premises of Asian Health Services enables patients not to reveal they are receiving therapy, says Donna Jung, a social worker who has worked long at Asian Health Services. “Some patients don’t even tell their families,” due to being stigmatized or they don’t want their children to worry, reported Kaiser Health News.

So far, Keo doesn’t have too many patients from the dental clinic, and patients often cancel mental health appointments or state that they feel improved after one visit. However, once the clinic begins screening younger patients, and they familiarize themselves with her role, the number of patients seeing her is likely to grow. “I want patients to know we’re here for them,” says Keo, “and that this is a dental office but also a safe space for mental health.”

Innovative Model: Mental Health Services At Dental Office

Asian Health Services’ in-house model for immediate mental health help is also offered at several medical clinics. However, it’s rare in private dental practices and is a relatively new idea at community dental clinics.

Some experts appreciate the worth of the inventive model: it enables mental health services to be made accessible to communities that are difficult to reach.

According to Dr. Irene Hilton, a dental consultant at the National Network for Oral Health Access, she does not know of any other community dental clinic that provides services of mental health in their dental office. It “totally makes sense,” says Hilton. “You can’t really engage in self-management of a chronic disease, including gum disease, or cavities, if you’re not in the right frame of mind.”

Dental offices are a sort of catchment area to address mental health issues, agrees Dr. Lorna Flamer-Caldera, a former president of the New York State Academy of General Dentistry. “Depression affects such a large segment of the population that all avenues that can be used to steer patients,” should be used, says Flamer-Caldera, who does not offer screening for depression at her dental clinic but is trained to observe signs of it, and encourages patients to seek specialist help, if she finds they require professional care.