What is the problem that needs to be addressed? Please describe how it is related to mental health.
Dental Care. People experiencing mental illness have specific oral health needs that are described at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841282/ https://www.integration.samhsa.gov/health-wellness/oral-care https://www.integration.samhsa.gov/health-wellness/Clinical_Concerns_in_Dental_Care_for_Persons_With_Mental_Illness.pdf. The submitter of this Innovations Idea has not observed dental care tailored to the needs of a person experiencing mental illness.
Why is this a concern for Orange County? What can Orange County and other counties learn from this project?
For this discussion, Orange County has two general settings for dental care: Psych Inpatient and Outpatient. In the Psych inpatient setting, patients are provided a toothbrush and sodium floride toothpaste. They are not provided dental floss nor a toothpaste that addresses gingivitis/tartar or plaque control/sensitivity (Stannous Flouride). One of the major dental issues for the mental health population is periodontal disease. Access to interdental cleaners, such as dental floss, and a toothpaste that addresses issues in periodontal disease, such as a Stannous Flouride toothpaste, are basic self care interventions but not available to people in Psychiatric Wards. When a patient has dental sensitivity, the liklihood they will use a sodium flouride toothpaste is quite low because the continued pain associated with toothbrushing is not addressed by sodium flouride. In the outpatient setting, a single dental provider is marketed as the place to go or, alternatively, the patient can find a provider on their own from a list of hundreds of providers. The dental provider that is marketed as the place to go has preditory practices that includes requiring a credit application to balance bill the patient for questionable services that are quite expensive. The preditory practices are not disclosed prior to the visit and the patient is not provided informed consent prior to being exposed to the preditory practices. These financial practices are an unnecessary additional barrier to dental care. This reality is part of the “training” provided to mental health patients to erode their self-care. A previous OC Innovations Idea submission described the refusal of Sanitation services as another “training” that erodes self care. People that are trained to erode their self care are not going to be reintegrating into society or the workforce easily. At some point a retraining in self-care will be required. Common sense suggests it would be easier to not erode self care in the first place. Poor dental health is associated with dementia, cardiac disease, respiratory infections, diabetic complecations and possibly other serious medical issues.
What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?
The above referenced academic source is from Australia. The above referenced SAMHSA sources, which are essentially public policy documents intended to guide future investment, were not found to identify any model programs for dental care in the mental health population. They may exists, but they are not prominently described in the sources reviewed.
What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.
As has been previously noted by the Orange County Healthcare Agency Behavioral Health (OCHCABH) Innovations team, the innovation suggested is not the innovation. Dental floss, stannous flouride toothpaste, etc are not innovative. Developing a dental program that addresses the needs of a mental health population is the innovative part of this idea. How are you going to get Psych wards to start providing stannous flouride toothpaste and dental floss? How are you going to get dental providers billing on Denti-Cal to show interest in the needs of a person with mental illness. That’s the innovative part.
What is the project idea? Please describe how this project will operate.
The project idea is to do whatever can be funded via the Prop 63 Innovations process to create a dental care program – both inpatient and outpatient – that addresses the population experiencing mental illness. Addressing patients with lengthy inpatient stays (>6 months) and without dental floss/dentist access should be included in this plan. Training on navigating the Denti-Cal system – with the significant risk of preditory dental financing of dental services of questionable quality – should be part of this plan.
Respondent skipped this question