Access to planned dental care in people experiencing severe mental health difficulties.
Treatment as usual arm: Treatment as usual will include any treatments or services that the participant would normally have access to outside of the trial. For people with severe mental illness this may include support from a care coordinator, support worker, psychologist, occupational therapist, and/or psychiatrist for care around their mental health. Treatment as usual may include medication and case management. We will monitor, rather than withhold, assessment and treatment for oral health in the treatment as usual arm. Treatment as usual plus a link work intervention. Participants in this arm will receive treatment as usual plus the link work intervention. This will consist of six sessions with a link worker over nine-months who will offer practical and emotional support around accessing a routine dental appointment. A mental health link work intervention uses link workers to empower and assist people with severe mental illness currently supported by secondary care mental health services, but not dental services, to access planned dental appointments. Participants will be randomly allocated to one of the two groups with 1:1 ratio, stratified by site. We will follow-up both arms after nine-months.
1. Aged ≥18 years. 2. Receipt of care from community mental health or early intervention teams at the point of referral. 3. No routine dental appointment (e.g. high street dentist, special care dentist service) in the past three years. This would include any dental examination, diagnosis, advice or treatment (e.g. fillings, root canal, extractions, crowns, dentures, bridges) resulting from a routine (non-emergency) appointment at a dental service. We do not consider emergency dental care (e.g. emergency attendance at Accident & Emergency Department or a dental hospital) within this definition, although any follow-up routine and planned appointments with a dentist would exclude the person from taking part. 4. Able to provide informed consent as determined by trained researchers in consultation with the clinical team.
Current key exclusion criteria as of 27/07/2026: 1. Current inpatient status on psychiatric ward. This does not include people in rehabilitation homes or supported accommodation in the community. 2. Immediate risk to self or others operationalised as the presence of active intent or planning to harm oneself or others in the near future (e.g. next month), or a suicide attempt in the past month (e.g. life-threatening self-harm, overdose). Where individuals are excluded on this basis, with the person’s consent, the researcher will aim to re-contact them and/or the referrer in approximately one-months’ time to determine if risk has subsided to a point where they are now eligible. 3. Enrolled in another dental randomised controlled trial. Previous key exclusion criteria: 1. Current inpatient status on psychiatric ward. This does not include people in rehabilitation homes or supported accommodation in the community. 2. Immediate risk to self or others operationalised as the presence of active intent or planning to harm oneself or others in the near future (e.g. next month). Where individuals are excluded on this basis, with the person’s consent, the researcher will aim to re-contact them and/or the referrer in approximately one-months’ time to determine if risk has subsided to a point where they are now eligible. 3. Enrolled in another dental randomised controlled trial.