What you need to know when working with mental health issues


A patient with mental health issues shares their experiences during a visit to a dental office. The goal is for the staff to be aware of these issues and to minimize any challenges these patients face.

Dear Dentist:
I have a problem with anxiety and depression. They have given me some other diagnoses, but I am only comfortable sharing these two. Why? Because I don’t want you to judge me. I have mental health issues. I also have a personality disorder. These illnesses impact everything I do every day.

When I walk into your office, I like your receptionist who smiles and greets me warmly. Laughing with me or making small talk helps take the edge off during my visit. You see, I am afraid that you are going to lecture me on how poorly I am flossing or tell me that I have cavities. I really do the best that I can, but I hate brushing. Let’s not talk about flossing. My mom gets on my back about it, and maybe that is one of the reasons I hate to do it. She also makes me come to see you. Sometimes I take Ativan beforehand to keep me calm. If you have little kids crying or doing annoying things in your waiting room, that can set me off. What is the answer for that? My suggestion would be to get me in and out as quickly as possible. When I am late for the appointment, it is usually because I am having trouble making myself leave home. But, when I get there, if you know my history, perhaps you can make some accommodations for me.

When I am brought back to have my teeth cleaned, I need your hygienist to just do the job quietly without conversation. I find it very frustrating being asked questions when things are in my mouth. Some people with my problems would prefer that you explain what is going to be done step-by-step before it happens. My suggestion is to ask the patient if they have a preference. If you know that I am on psychotropic medications or have a diagnosis for mental health disorders, you definitely should do this.

The goal is to get me in and out as quickly as possible. I want to be treated with respect and not overhear your staff talking about me. I get it-I do have some odd behaviors some might consider OCD-like. But I am still a person and one that should be treated with respect, not gossip.

When there is bad news such as needing a crown or some serious dental work, you should ask if I want a family member or friend to hear the plan, too. I know that I am a grown up, but let’s face it, sometimes I can’t help myself and make stupid decisions. It is really scary to be in a dental office and get bad news. One suggestion would be to take me into your office to share the bad news instead of keeping me in the chair. In the chair, I feel powerless. In your office, I feel more respected and in control.

It is very helpful for me to get something in writing before I leave that goes over what happened during my visit. This way, if I am overwhelmed, I can read it later when I am calmer. It is something I can share with a family member or caseworker if need be.

I know that your staff gets a little nervous when I am there. We have had some incidents where my anxiety was off the charts and they felt helpless to calm me down. I don’t have control over this. I am truly doing the best I can to stay calm. But your staff needs to understand that there is a stigma with mental health diagnoses. Would they treat me the same way if I was diabetic or a cardiac patient? They need to remember that I did not ask to have these problems. If they could substitute the idea of a physical illness with a mental illness, that may help all of us. I really want to be treated with respect and dignity. Please understand that if I don’t treat you that way, it isn’t because I am a bad person. Instead, it is because I have an illness that twists my thinking. I am just someone trying to live with the hand I was dealt.

I am working on controlling my anxiety and depression. I am trying to get to your appointments on time and not have any episodes in the chair. Please continue to give me the support and respect that you give all your patients. I am truly no different than them. I just have more challenges to overcome.

Thank you for being my dentist. I know that I am not easy to work with, but so appreciate how professional and compassionate you have always been to me.


The goal of this article is to generate conversations with your staff about how you are dealing with patients with mental health issues. Whether they are diagnosed or not, please remember to not stereotype or judge them. They are human just like you and me and are deserving of respect.

Please email me at diana2@discussdirectives.com and share stories of how your practice supports your patients with mental health issues.

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