Oral health and mental health: lived experiences of stigma and discrimination for Australians with mental health conditions

Oral health disparities persist among people with mental health conditions. They experience high rates of dental disease due to medication side effects, socioeconomic barriers, and stigma. Despite their high need for dental care, they face reduced access to care, exacerbated by structural inequities and provider biases. Stigma further deters care-seeking, with limited research centering lived experience perspectives. In Australia, where privatized dental care widens inequities, mental health guidelines rarely address oral health, and studies often adopt deficit-based frameworks. This study employed a co-designed, qualitative approach with Australians with lived experience of mental health conditions, exploring barriers, stigma, and systemic failures in oral healthcare. Findings aimed to inform person-centred interventions bridging oral and mental health systems. Informed by interpretive phenomenology, a secondary analysis of data collected by a lived experience-led national survey focused on responses by 198 mental health consumers to three survey questions that explored experiences related to stigma and discrimination. Latent content analysis was used to analyse the data. Each step was underpinned by a lived experience co-design group that met iteratively to design the original survey, provide critical feedback to the analyses and reporting on research outcomes. Findings reveal how intersectional stigma—linking mental health status, oral health, socioeconomic disadvantage, and marginalized identities (e.g., Indigenous background, refugee status, substance use, or history of transmissible diseases) perpetuates inequities in dental care, with lifelong health consequences. Stigma operated at multiple levels: experienced, internalized, and anticipated stigma, leading to avoidance of care; diagnostic overshadowing (oral health concerns dismissed as "behavioural"); dehumanizing attitudes (derogatory language, perceived delegitimization of pain); and ethical violations, including exploitation and inadequate consent processes in clinical interactions. Participants described systemic exclusion from preventive care, with compounding effects for multiple marginalized groups. This first Australian study on stigma in dentistry reveals how mental health, oral health, and intersectional stigma deter care-seeking and worsen outcomes for marginalized populations. Findings underscore the need for structural interventions, including stigma-informed training for dental practitioners and policy reforms to ensure equitable, trauma-informed care. Addressing these barriers is essential to breaking the cycle of oral health inequities.