Co-production of an oral health intervention: Enabling Service Users with Severe Mental Illness to Learn about and Engage (SMILE) with Good Oral Health

Background: People with severe mental illness (SMI) experience poorer oral health than the general population. They are less likely to visit the dentist or brush their teeth and face unique barriers to accessing oral health support. There is a limited number of oral health interventions for people with SMI, and there is no conclusive evidence on their effectiveness. An integrated oral health intervention delivered by mental health professionals in a community mental healthcare setting could offer a scalable option to oral health support for people with SMI. In this paper we report on the process of co-producing such an intervention in England. Methods: The intervention development process was informed by Hawkins co-production framework. In this paper we report on stages 2 (co-production) and 3 (prototyping). Two online and two face-to-face co-production workshops took place (N=22) involving service users with SMI (n=6), mental health professionals (n=8) and dental health professionals (n=8). Two online patient and public involvement consultations, and a professional stakeholder meeting were held during the co-production process to provide feedback on the co-production process. The workshops informed the core components, format and content of the intervention. Results: The co-production process resulted in five intervention components: 1) Initiating a conversation about oral health, 2) providing advice to people with SMI on keeping their teeth and mouth healthy, 3) weekly tooth brushing text reminders, and 4) mental health professionals updating the care record to document the administration of this intervention. To support intervention delivery, we co-produced an intervention flowchart, an intervention leaflet for people with SMI, and a training manual for mental health professionals delivering the intervention. Conclusion: We co-produced an integrated oral health intervention to be delivered to service users with SMI in community mental health settings. The next stage of the research is a single-arm feasibility study to assess whether the intervention is acceptable to people with SMI and feasible to deliver within the NHS.