Maxfacts

There clearly is a subgroup of people with a range of maxillofacial conditions who, in addition to clinical oral & maxillofacial treatments, are in need of mental health support. As defined by the National Health Service, NHS, in the UK and more widely used, need is the ‘ability to benefit from health care’. Need is influenced by knowledge of what is available and what may (or may not) work, what is possible and accessible. Need has an element of ongoing learning, and the ability to benefit essentially mirrors the ability to express that need. This amounts to a rather strong statement confirming the old wisdom that knowledge is power – and even more empowering are any actions to look well after oneself.

How needs are best met with regard to mental health in specific circumstances, and with changing needs over time, is a highly individual matter. Accordingly, all we can do here is to give an overview of some options – there is little hard evidence about the efficacy of many of these interventions, but it may be worthwhile to give some such intervention a try.

Specifically, with many maxillofacial patients, there are long-standing ‘working relationships’ with the various clinicians looking after their physical condition, part of which often extends naturally to include support, or sign-posting and referring to helpful resources, for their other needs as well. The clinical team are important in this role because needs strongly depend on treatment modalities (different dysfunctions and difficulties) and do change over time. However, this role needs to be carried out with sensitivity as some people may experience flashbacks of their recent traumatic health experiences in this clinical setting.

Self-help – cannot be placed high enough on the agenda. This statement assumes honest soul-searching (where required…), accepting that low mood and grieving are completely normal and even helpful in coming to terms with difficult circumstances, and the willingness to reach out and ask for help when that is needed (whatever the need). Social / emotional support is an important component in this concept, with communication a key priority.

Counselling – different forms of ‘talking therapies’ exist, group events are typically not in favour with most maxillofacial patients (except some patient support groups which seem to have some social support role for those not too poorly, but do not reach those most in need of support). This can be a useful way to share concerns away from family and friends. Counselling by a therapist specialising in post-traumatic stress disorders (PTSD) may be helpful for some as an adjunct in establishing a new normal. PTSD following the traumatic experiences of serious disease and treatment often is overlooked by all stakeholders.

CBT, cognitive behavioural therapy – a particular variant of talking therapy, broadly aiming to divert negative thoughts and behaviour patterns by ‘unlearning’. It has been repeatedly reported that CBT and CBT-like approaches can be counterproductive as, for example, many head & neck cancer patients feel that their misery is belittled by these approaches and they have good and rational reasons to be concerned and worried. There are times and circumstances when a low mood is the perfectly adequate response to one’s situation. Alternative and individual psychological support appears more appropriate for people who have to deal with significant symptom burden of disease and treatment(s).

Antidepressant agents – may help to overcome some temporary crisis but should be used with caution. Some of these agents may interfere with other medications and can even worsen some disease symptoms. Antidepressant agents should only be considered if depression is clinically manifest.

Support for alcohol/nicotine cessation is generally as much needed after treatment as it is before treatment. However, in practical terms cessation before and/or during treatment may be all that is achievable. This is still useful and can be effectively done outside hospital, although in-patient ‘detox’ is still widely practised.

Physical activity – when possible, has a proven record of being beneficial in several regards. It does not matter what exactly is the preferred activity.

Specific rehabilitation activities – such as speech and swallowing therapy or restorative dentistry tend to have a strong impact on mental well-being in addition to their physical role, highlighting the need for integrated care.

Relaxation techniques – such as ‘mindfulness’ approaches or yoga, may be seen as a support to self-help and self-management. Reducing stress levels is important for reasons of subjective well-being as well as for physiological reasons (for example, reducing hypertension (high blood pressure) or inflammatory markers).

Learning and adopting positive coping strategies – mainly to avoid maladaptive strategies that may develop over time. Avoidant strategies (such as behavioural disengagement) or negative strategies such as excessive drinking have been shown to underly poor quality of life and poor outcomes.