CDA Essentials 2018 • Volume 5 • Issue 8

I ssues and P eople The students do all the dental work throughout the week, with support from the CAMH dentists. When they leave after one week at CAMH, we want the students to feel more confident in treating people who have mental illness—ranging from mild to severe—and understand the context in which the dental clinic operates. When they graduate, they will have more confidence, more experience, and a better understanding of their essential role as a dental professional in providing services to people with mental illness. Do dentists need special skills to treat this patient group? JR: No, every dentist is capable of doing what I do. But I think one difficulty is maintaining a treatment and appointment schedule—maybe because the patients have a lot of appointments, or because their medications affect them, or maybe their lives are in turmoil at times. Dentists also need to be aware that many of the clients in the moderate to severe category of mental illness have been medicalized for a good portion of their adult lives and have spent many hours seeing practitioners, so they might be a bit wary of you; they might see you as just another doctor or dentist. How do you build trust with a guarded patient? JR: The first time I meet someone, I always make a point of sitting with them—not writing on my computer, not doing anything—just looking them in the eye, talking to them and trying to make a connection and build some trust. I probably give them more attention than I would to the average patient, but I want to show them that I’m there out of a genuine concern to help them. What kind of barriers do people with mental illness face when trying to see a dentist? JR: The foremost barrier to care is financial. There is a huge overlap between mental illness and poverty. Some dental offices perhaps can’t take on a significant proportion of patients on the Ontario Disability Support Program (ODSP). Another barrier could be an overall lack of trust in health care providers in general. Most of our clients at CAMH have had so many experiences with providers—good, bad, indifferent—that it’s easier to break that trust. So many of the CAMH patients have a high burden of treatment, a low amount of money, and a difficult time sticking to a treatment schedule. Putting that all together, it’s a challenge for a lot of general practitioners. How has the CAMH rotation influenced students? JR: I teach all four years of dental school and get to know many of the students; the feedback I’ve heard is extremely positive. Many of them go to CAMH feeling like they don’t know what they’re getting themselves into. They think, “Is it going to be scary?” but then they often find it to be a positive experience. A former student was so worried about going to CAMH that she wanted to pull out of the rotation; she didn’t know what to expect and her parents were worried for her safety. But by the end of her five days, she said it was her best experience in dental school. The patients were so different from what she expected; they were appreciative, gracious and happy that students were working with them. U of T has roughly two-thirds of graduating dentists in Ontario every year, and each one goes to CAMH for half a day, at least. They all graduate with some experience in a psychiatric hospital. For me, that’s a huge success. They’re just like the rest of us, people who have their own illnesses and struggles and challenges. They seek the same kind of treatment as any other patient; they want us to fix up their teeth and keep them healthy. – Dr. Joel Rosenbloom