136 Chapter 5 information patients should have. It is well-known that salivation is a side-effect of anti-psychotic medication; the participants told patients that they must drink a lot of water. However, this also contributes to caries and dental erosion, which was not known, as reported by two participants, and therefore, not told to patients. One participant said that she had a patient with an oral health burden. Sometimes, due to the negative symptoms of psychosis, the patients are not motivated, are lethargic, and there is a lack of initiative. The participants saw that patients often felt insecure about their oral health (e.g., by talking with a hand in front of the mouth), but the participants did not know how to incorporate this into daily care. All participants indicated that there was too little knowledge and awareness about oral care within the teams and that this was the main reason they did not know what to do. One participant stated that she really did not know how to motivate and stimulate patients. Mental health staff downgraded these problems because oral health problems are physical, and their patients are admitted for psychological or psychiatric problems. The oral hygienist named the high costs for patients when there is no additional oral health insurance as the most important barrier. When patients contact an oral hygienist, there is often a lot of burden and treatment is only reactive; regular appointments and prevention were noted as important. “The cost of treatment of severe symptoms is too high for patients and a barrier to make an appointment. We see patients too late” (Participant 6). “In practice, at the time of intake, we know what medication patients are taking and we can respond accordingly. But if something changes in the meantime and we are not informed, it becomes difficult” (Participant 10). Needs of MHNs for Providing Oral Care Within the theme of needs, we found the subthemes of knowledge, which contained statements about the knowledge that the participants needed, and skills, which contained statements about the practical competencies the participants needed.
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