Promoting a collaborative approach to research is at the heart of the Mental Health Research Matters campaign, with the eight research networks bringing together people from the technology, health, medicine, humanities and environmental science fields.
We spoke to Masuma Mishu, who is a researcher and lecturer in public health and previously worked as a clinical dentist, about her role in the Closing the Gap network research.
We know that those living with severe mental health issues live significantly shorter lives, by 15 to 20 years. Closing the Gap aims to understand this profound health inequality and to close the unacceptable mortality gap.
The network also runs a special interest group in oral health in those with severe mental illness, which Masuma heads up.
Closing the gap between physical and mental health
Masuma’s involvement in Closing the Gap was spurred on by her interest in dental public health and how oral health can impact an individual’s overall quality of life. Her introduction to mental health research in the UK was as a post-doctoral researcher at the University of York where she worked closely with the mental health and addiction research team.
During her work with Closing the Gap, Masuma was interrogating why people with severe mental illness have some of the worst physical health issues of any section of the population.
She noticed that, along with co-morbidity of severe mental illness and other non-communicable diseases, this group of people have poorer oral health. They are nearly three times as likely to lose all their teeth and higher caries rates (mean difference of 5), compared with people without severe mental illness.
Unfortunately, there is comparatively little research on how to improve their oral health and reduce these inequalities.
Reviewing existing evidence
To address this huge disparity in oral health, Masuma and her team conducted a systematic review to gather evidence on the effectiveness of interventions that had already been tested.
The review highlighted that most of these interventions focused on behaviour change at an individual level. Masuma believes there is not enough evidence to demonstrate that these interventions, focussed solely on the individual, are actually effective.
There is a need for system-level intervention by effective integration of mental and dental health care services to provide better support for people with severe mental illness with their oral health care. By bringing together mental health service providers, dental health professionals and researchers, Closing the Gap wanted to delve into a comprehensive approach to support.
Recommendations for future interventions
Their exploratory study, ‘Interventions to improve oral health for people with severe mental illness: mechanisms, barriers and facilitators’ identifies the barriers and facilitators of different aspects of oral health care and service use in people with severe mental illness.
The study took in the perspectives of both service users and service providers. The recommendations were gathered for the future oral health interventions. Masuma stresses that their ultimate aim is working towards the co-production and testing of a suitable system level intervention. This preliminary study is a first step towards achieving this goal.
Under the support and funding from Closing the Gap network, Masuma and her team interviewed seven service users (people diagnosed with severe mental illness) and ten service providers (mental health nurses, dentists working in community dental services, high street dentists, dental hygienists, clinical psychologists occupational therapists and informal carer consultations), to get a view from all sides.
They were all shown videos of tested interventions and were then asked what the barriers and facilitators to access these interventions might be, and what suggestions they had for improvements. They also conducted eleven stakeholders’ consultations to discuss the findings and recommendations.
The feedback from service users said that they would like tailored support with a focus on overcoming any challenges and problem solving together. There was also a preference for the use of softer communication skills by the service providers.
Service users stressed the importance of system-level interventions. For example, the incorporation of an oral health checklist at the same time as other regular physical and mental health check-ups.
Multiple barriers, including a long waiting list to visit a dentist, were identified. Service users described the provision of dental care under the same roof as mental health care as the best-case scenario.
They felt this was the way they could get the best possible care. Multiple visits to different institutions were cited as difficult and stressful. Through these conversations, it was identified that an integrated healthcare model, the inclusion of support from dental professionals in their mental health care unit, would be beneficial
“We need to stop thinking about oral health as separate”
Masuma says: “Oral health has a significant impact on general health and quality of life. We need to stop thinking about oral health as separate from the rest of a person’s health.”
Masuma and her team want to co-produce a system-level intervention with service users and different stakeholders to improve oral health in people with severe mental illness.
A multidisciplinary approach to mental health research, as exemplified by Closing the Gap’s work, can improve quality of life for service users.
By drawing on lived experience, as well as the expertise of mental healthcare providers and dental professionals, this study champions a more integrated approach to both mental health research and services.