41 Oral health experiences and needs among young adults after a first episode psychosis The patients mentioned their financial situation as an important reason why they will not go to the dentist. They were often in debt; debts were incurred during FEP. The patients could not afford to pay for insurance for dental care. Because of their mental illness, almost all patients could not work for a period. Twelve patients incurred heavy debts at the time of their psychosis, and most patients had marginal incomes. The patients who were in this situation felt very uncomfortable. Their financial situation was directly affecting their ability to pay for dental health care. “I do not have insurance for the dentist because I am €15.000 in debt. I cannot pay the bill.” [part. 3] In the Netherlands, people with a diagnosis of psychosis are sometimes supervised by a financial administrator who manages their debts, and when the financial situation is stabilized, debt structuring is an option. The patients stated that this system is slow, and they became desperate. The distance to dental care is increased by not going to the dentist for many years. The patients stated that they entered a vicious circle and could not solve this problem themselves. After FEP, a period of recovery was experienced as complicated, and the patients reported insecurity about their appearance. Insecurity about themselves was linked to a decrease in overall wellbeing after FEP. For some patients, insecurity was a reason for using drugs and drinking alcohol. Experiences with dentists and dental hygienists The patients were questioned in regard to their experiences with dentists and dental hygienists. Early in life, almost everybody went to the dentist twice a year, the standard in the Netherlands. There were no negative experiences. One of the grew up without a dentist in Indonesia. The period no longer going to appointments started while using drugs and during the FEP. This aspect is linked to the period of overall neglect. In this stage, there was no ability for the patients to take care of themselves, nor did they pay attention to doing so. Going to a dentist or dental hygienist is linked to their financial situation. Having insurance indicates that the patients go to the dentist twice a year, but doing so is “conditional on remembering.” 2
RkJQdWJsaXNoZXIy MTk4NDMw