Is psychiatric hospitalization an opportunity to deal with oral health issues in France?

Abstract

Abstract Background People with severe mental health diseases appear to suffer from poor oral health compared with the general population. Specific strategies, including prevention tools and improved access to oral care, should be implemented to tackle this issue. The aim of this study was to investigate whether or not psychiatric hospitalization may constitute a favorable environment to develop such strategies. Methods Data were collected from an ethnographic study conducted over 3 months in two different wards in a French psychiatric hospital: an admissions unit for acute cases and a unit for long-term hospitalization. In addition, 16 semi-structured interviews were conducted with different professionals (psychiatrist, general practitioners, nurses and auxiliaries). Results Most professionals described their goal as making patients more autonomous in order to go back to the community. Oral health issues were acknowledged by the professionals and increased oral health literacy was perceived as a part of this autonomy improvement objective. However, especially in the admission unit, shortened length of hospitalization in the deinstitutionalization context was seen as a major barrier to both implementation of oral health education programs and oral care treatments (related to the on-site dental clinic waiting list). In the long-term unit, direct assistance for oral hygiene and oral treatments request was perceived as potentially contrary to patients' intimacy and autonomy. In addition, professionals from both units pointed out the lack of oral health practices formalization and the weakness of the relationships with the dental team. Conclusions Oral health issue in psychiatry seemed to be well identified by the professionals, but its management remains challenging. Systemic (deinstitutionalization), ethical (intimacy and autonomy) and organizational aspects have to be considered in the implementation of oral health improvement strategies in psychiatric hospitals. Key messages Ethnographic study in a French psychiatric hospital identified systemic, ethical and organizational barriers to oral health care for in-patients. Oral care needs in psychiatric hospitals are acknowledged by the professionals but strategies to satisfy these needs are still to be implemented.