14 Chapter 1 their participation in society, and patients show impairments in several challenging everyday activities (i.e., informal and formal relationships) [17]. Oral health might be related to societal recovery, and poor oral health can undermine self-esteem and confidence and discourage social engagement. It might also hinder speech and communication, complicating social interactions [18]. Given society’s emphasis on appearance, including oral aesthetics, visible oral health issues can expose individuals to stigma, discrimination, and social isolation and, in this way, obstruct social recovery. Personal recovery involves the development of new meaning and purpose in one’s life as one recovers beyond the catastrophic effects of a mental illness. Personal recovery has a focus beyond clinical and societal recovery, and it has been defined as ‘a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles’ and ‘a way of living a satisfying, hopeful, and contributing life even within the limitations caused by illness’ [19]. Oral health problems can significantly impact an individual’s self-image, self-esteem, and mental well-being. Concerns about dental appearance can lead to social withdrawal, hindering the process of personal recovery. With respect to social withdrawal, people do not make connections, which can affect an individual’s hope for the future and how they view themselves (identity); it may also impact an individual’s sense of meaning and empowerment [20]. Another movement strives to improve personal well-being rather than being focused on symptoms, and it comprises an altered perspective on (positive) health. The concept of health is defined as follows: “Health as the ability to adapt and self-manage, in light of the physical, emotional and social challenges of life“ [21]. In this concept, health is no longer seen as the absence or presence of disease (such as in the medical model) but as the ability of people to deal with (changing) physical, emotional, and social life challenges and manage their own lives. The increasing focus on recovery and positive health might enable mental MHNs to integrate oral health more effectively into mental healthcare as it provides a broader view of (mental) health. Holistic nursing Health promotion is not a new concept. Thousands of years ago, Hippocrates recognized the power of lifestyle and prevention as medicine when he said, “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health” [22]. Little
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