It's not unusual for dentists experiencing mental health problems or addiction to feel they are alone in their struggle. And yet, nothing could be further from the truth. Mental health is a universal concern, especially in these troubled times - but might dentists be more susceptible to mental health issues and addiction?

High levels of stress and anxiety are common within the dental profession. A survey of DDU members last year showed that 78% of respondents had these feelings on a weekly basis. This echoed BDA research from 2019, which found 54.9% of dentists experienced high job stress and that consumption of alcohol and suicidal thoughts were higher than in the general population.

The Dentists' Health Support Trust (DHST) ensures that dental professionals do not have to face these challenges on their own. It has been providing advice, assessments and co-ordinating treatment for more than 2,000 practitioners since 2008, when Rory O'Connor took over as national co-ordinator with colleague, Kevin Collins. Previously, the charity had focused on those with addiction problems, but with his background in psychiatric care and counselling - working almost exclusively with dentists and doctors - Rory extended its remit to cover mental health issues as well.

Running the DHST is a major commitment for Rory. "There are a number of components to the service," he says. "One is the confidential helpline itself, which is funded by the BDA and staffed from 7.30am until 10.30pm every day of the year. Sometimes it is just a matter of giving advice, but if there is a mental health or addictive disorder or GDC issue, I will take a history and carry out an assessment. And based on that assessment, we'll help the person find the right treatment pathway."

Rory explains that practitioners can be wary of using local primary care services because of the risk that the GP will be a patient. However, having been involved in establishing Practitioner Health 14 years ago, Rory is able to point them towards an independent NHS-funded service, which can put them on the fast track to recovery. "I encourage them to self-refer and within a couple of weeks they will have had their first assessment, followed by treatment. It just works really well."

The DHST represents a lifeline for dental professionals, particularly in the current climate. By its nature, dentistry has always been a high-pressure job where practitioners have felt the weight of expectation to provide high standards of care amid a growing complaints culture.

But practice has inevitably become more challenging due to the backlog created by the pandemic and changes in working practices. "We are beginning to get more Covid-related calls, with dentists saying they feel like they are firefighting because the book is full for the next six months and they can't see a break," Rory observes.

At the same time, many dental professionals have personality traits that can make them more vulnerable to mental health problems. "The classic presentation is of a high achiever who is defined by their job and usually has a huge fear of making a mistake," says Rory. "No matter how good they are, it's never enough. They have no sense of reward from their work, which means there is an elevated risk of exhaustion and burnout. Dentists with anxiety also have a tendency to catastrophise. For example, they might say, 'I have made an error, the patient is going to complain, it will go the GDC and I'll get struck off. My career is finished.'"

The fear of losing their career and livelihood can be a significant barrier to dentists seeking help with mental health or addiction, particularly the misapprehension that they will be reported to the GDC and struck off.

In Rory's experience, where someone engages with treatment, the GDC is unlikely to take action to stop them practising, unless there are concerns that they pose a risk to patients. By contrast, the DHST is more likely to advise practitioners not to work if they are unable or unwilling to engage and - in some cases - to support them in self-referring to the GDC.

Rory believes this approach is beneficial because it gives practitioners a sense of ownership and responsibility, which is often the first step towards recovery. For its part, the GDC lists the DHST as one of the support organisations available to registrants facing a fitness to practise investigation. And despite some reservations about the time that cases can take to resolve, Rory gives the regulator credit for taking practitioner health into account and recognising that sick dentists deserve the same confidentiality as any other patient.

Another potential barrier for dentists in crisis is the need to make the psychological transition from healthcare professional to patient. Rory often tells patients to, "Leave your 'white coat' at the door, because it's you who has the problem and you're more than a dentist. No one is immune from mental ill health or addictive disorders, so come as yourself and I promise you will be treated with respect."

Sadly, many dental professionals have been struggling in their practice for some time before reaching breaking point, sometimes by resorting to unhelpful coping mechanisms. "Many high-functioning professionals will appear to be doing well and work is often the last aspect of their life to go," Rory explains. "But looking back after treatment they say, 'My standards had dropped and I can see things were slowly going wrong over a number of years. I'm just grateful I didn't harm anybody.'"

But while early intervention is the ideal, how can dentists themselves and their colleagues recognise that something is amiss? "There could be all sorts of subtle - and sometimes not so subtle - changes," says Rory. "It might be a change in eating or sleeping patterns, difficulties in concentration, negative thoughts, a loss of interest and perhaps a bit of moodiness. Someone with an anxiety disorder might experience low mood, tension headaches, chest palpitations and perhaps over-checking. With alcohol or drugs, there might be more incidences of lateness and agitation at the end of the day, as well as missing days, especially Mondays.

"The bottom line is you don't need to be an expert, but what you do need to be is a concerned person who considers their own wellbeing and the wellbeing of others. For example, rather than thinking that someone has seemed a bit off today, the single most important thing you can do is to express concern; ask them if they are OK, and really mean it. You might be the first person they are willing to open up to. You can then tell them about support services such as the DHST or the BDA Benevolent Fund website, which will guide you on the next steps."

Seeing dentists who have committed to treatment, got well and stayed well is hugely rewarding, reflects Rory. "After we have had that initial assessment and identified the problem, I am able to say to them there is a solution and we are in this together. In most cases, they commit and engage with therapy (medication is less commonly indicated), and in four or five sessions they see a massive improvement."

Depending on the nature of the problem, the DHST will continue to work with practitioners in the long term, as well as talking to families and liaising with organisations like the DDU if there is a dento-legal aspect to their case. "Sometimes, people get well after a single episode. Others can experience recurring episodes of mental ill health or have an addiction that means they need support for the rest of their lives to maintain abstinence. Some will call to let me know that all is well, so they don't lose the familiarity of contact if there is a problem. Our door is always open," he says.

Of course, the best outcome for Rory and his colleagues is for a dental professional to be well enough to return to safe practice, but it is important that this is managed carefully to avoid sacrificing hard-won gains. As Rory advises: "Go back gently. Have a supporter at work so there is someone to talk to - we can talk to the practice on your behalf - and visit the practice first to break the ice and refamiliarize yourself.

"Simple things like walking into your room and using relaxation techniques work really well. Most importantly, recognise what it took to get to that point, practice the coping mechanisms that are working for you and don't give up practising. If you keep doing that, you're in grave danger of staying well!"

Interview by Susan Field.

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