Dentists and their teams are in a unique position to observe patients regularly and can be the first to notice the signs of mental distress. It’s crucial for dental offices to prioritize awareness and training, establish robust assessment protocols, foster a supportive environment and know how to provide appropriate assistance.
According to the National Institute of Mental Health, major depression is one of the most common mental disorders, affecting an estimated 21 million adults in the United States with many of those undiagnosed. Even more people are undiagnosed. Too often patients hesitate to seek the health care they need, especially when it comes to mental health.
The Dentists Insurance Company’s Risk Management Advice Line has received calls from concerned practice owners who became aware of patients or employees who were suffering from depression or suicidal thoughts. In some cases, a patient mentioned feeling despondent or hopeless. In others, an employee threatened suicide or self-harm. While mental health diagnosis is out of dental professionals’ clinical scope of practice, there are both legal and ethical obligations for mandated reporters to help individuals who exhibit distress to access services or support.
A Case Study
Taiba Solaiman, TDIC senior risk analyst, recounts a sensitive Advice Line call she handled. “While confirming a re-care appointment, the patient stated that she would not be showing up and expressed an intention of self-harm to the staff,” Solaiman recommended that the practice contact local law enforcement for a wellness check and reach out to the national suicide hotline. Reminding the dentist of their role as a mandated reporter, Solaiman stressed the importance of promptly reporting such situations to the authorities.
Dentists and their teams are in a unique position to observe patients regularly and can be the first to notice the signs of mental distress. It’s crucial for dental offices to prioritize awareness and training, establish robust assessment protocols and foster a supportive work environment.
Awareness and Training
Practice staff can benefit significantly from training programs that teach how to recognize signs of depression or self-harm. Signs of depression can include lack of concentration, poor appetite, weight changes, fatigue, insomnia, mood swings and lack of energy.
Implementing regular training sessions ensures that staff members are equipped with the knowledge to identify and approach individuals who may be exhibiting signs of distress. Team members should also be trained in procedures for escalating concerns to appropriate professionals and maintaining confidentiality while showing empathy towards those in need.
Another means of gaining awareness is through the CDA Journal collection Dentistry and Mental Health. It contains articles that discuss the bi-directional relationship between oral and behavior health and offers resources to support integration of behavioral health in dental settings. The collection also includes an opportunity to earn C.E. credit.
Establishing Assessment Protocols
To ensure consistent and effective identification of at-risk individuals, practices should establish formal assessment protocols. Some of the protocols TDIC’s risk management analysts suggest are:
- Routine check-ins. Including standard questions about mental well-being in health history forms and during chairside patient assessments or employee 1:1s can be very effective. It opens the door for individuals to discuss any issues they might be experiencing. If a patient has indicated a history of depression or suicidal thoughts on their intake form or if their record shows the use of antidepressants or other medications for mental illness, be alert for comments that may suggest their condition is not under control.
- Screening tools. Use validated mental health screening tools as part of the assessment process. These tools can help in identifying early signs of mental health issues, facilitating timely intervention. Solaiman cautions, “Dentists should be wary of making comments that could be construed as making a diagnosis.” For example, rather than saying, “It sounds like you are suffering from depression. I’ll refer you to an outside provider,” dentists could say, “You may benefit from talking to someone who can help you.”
- Referral systems. Create a reliable and swift referral process to trusted mental health professionals for patients or employees needing further support.
Creating a Supportive Environment
Fostering an environment of openness and support is fundamental in promoting mental health awareness within the workplace. Dental practices can achieve this by:
- Encouraging open dialogue. Promote a team culture where discussing mental health concerns is normalized and stigma-free. This can be done through regular discussions, providing informational resources and inviting mental health professionals to speak with staff.
- Supporting work-life balance. Encourage employees to maintain a healthy work-life balance, which is critical for mental health. Consider implementing flexible work schedules or providing wellness programs.
- Providing access to resources. Ensure that both staff and patients have access to mental health resources, such as helplines, counseling services or support groups.
Appropriate Intervention
If a patient or team member is at risk for self-harm, it is appropriate to contact local law enforcement and/or the national suicide hotline. Not everyone who suffers from depression will have suicidal ideations, but they could benefit from additional support and treatment.
“If you are faced with a patient (or team member) who mentions depression, severe anxiety or any other conditions, ask if they will provide consent for you to reach out to their medical doctor or trusted family member on their behalf,” suggests Solaiman. “View these cases no differently than if a patient exhibits any other type of medical concern, such as high blood pressure, which would warrant a referral to an outside provider.”
Solaiman also reminds dentists, “Be sure the patient has signed a notice of privacy practices. If you provide a referral to a medical provider, it should be charted. If the patient is a minor, their parent or legal guardian must sign a notice of privacy practices and be informed of any referrals. When a patient declines consent, you can still offer information about community resources that they can access on their own.”
Here are some recommended resources that patients or employees can access on their own:
- The 988 Suicide & Crisis Lifeline provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week, across the United States. Simply dial “988.”
- The Suicide Prevention Resource Center provides a suicide prevention toolkit designed for primary care providers that can be used in the dental setting. The toolkit includes office protocols to define roles and responsibilities, a learning module on risk assessment and appropriate intervention approaches.
- The CDA Foundation’s Wellness Program is a source of support and assistance for California dental professionals and their family members who are dealing with physical and/or mental ailments, including substance use disorder, anxiety, depression and burnout.
By prioritizing mental health in your dental practice, you help ensure the well-being of staff and patients while cultivating a healthy, productive and compassionate environment. Dentists can play a vital role in changing perceptions and destigmatizing mental health disorders.
If you have questions about patient care or other practice challenges, consult TDIC’s Risk Management Advice Line.
TDIC’s Risk Management Advice Line is a benefit to TDIC policyholders. To schedule a consultation with an experienced risk management analyst, visit tdicinsurance.com/RMconsult or call 1.877.269.8844.