There's a growing public perception that dentistry is all about the money. Little do they know why they're being informed there are no NHS appointments available, but they can be treated privately if they wish - they just see pound signs rolling in the eyes of the dentist.

And while dentistry is a lucrative career, a sudden change of circumstances can alter everything you've ever built. We saw that when COVID-19 struck, but long before then financial pressures and the mental health toll associated with them existed. BDJ In Practice spoke to Laura Hannon, BDA Benevolent Fund General Manager, about how COVID-19, mental health and finances have become intertwined.

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How does the BDA Benevolent Fund see the current landscape of mental health within the dental profession?

LH Much of what we are currently seeing is still pandemic-related. 2020 was a stressful time for everyone, and a really busy year for us. We had three times the number of applications that we'd usually receive, and the majority came within two weeks of the first lockdown announced in March of that year. There was understandably a lot of panic when dental services were closed and dentists thought they weren't going to be able to work and earn, panic that eased slightly once the NHS and the government announced the variety of financial support packages available.

Ever since the resumption of dental services and the gradual reopening of dentistry, we've seen a steadier rise in applications rather than the large spike we saw in 2020, and the majority of those are from students. Is that a rise in the profession knowing more about the support we can offer given how busy we were throughout lockdown or as a result of the growing need due to increased financial pressures - or both?! The reality is the need to help dental professionals struggling has always been there.

When you look at the issues students have faced, in Scotland the need to repeat the year has had a knock-on effect. It's harder for final-year students to get part time jobs and self-fund, especially when they're under so much pressure as it is to complete the course. In Northern Ireland we know that the courses were extended by a few months, which doesn't sound that alarming, but the anxiety caused by the uncertainty meant students turned to us. If you have carefully budgeted for the year and suddenly you need to find two or three more month's rent because your course had been extended, that's stressful.

International students, for example, found support from their universities aren't covering basic living costs and their families weren't able to help put them through an additional term or year. Part time jobs, in hospitality or note taking - both jobs that ordinarily students may have been able to secure - were both massively impacted by COVID-19, which means fewer options for students to secure extra income.

How challenging with current inflation pressures, will it be for current dental students moving through university, to be able to cope, and could this turn more students looking for support to you?

LH If you're living with family, your circumstances may change but you are likely to be less impacted.

If you're only living off £2,000 in your final year which doesn't cover the cost of your rent, let alone food, travel and energy bills, stresses will clearly be heightened, potentially impacting on your in-clinic learning.

We see it more in travel costs with people doing clinics outside of their immediate localities and outside of university time. A dentist living on their own or with a family would face different pressures compared to a house-share of students, but as of now, the calls we've had relate to more general concerns, rather than specific requests for cost of living associated help.

How are these concerns affecting the mental health of those professionals you've spoken to?

LH Money and mental health are inextricably linked. If you have mental health problems your ability to manage money is more difficult from the outset. If you haven't got enough money to cover your monthly outgoings, or you can't manage your money because you haven't got enough, that's going to exacerbate any pressures and take a toll on your mental health.

We are having more conversations with people saying they don't know what to do about their finances and will struggle to manage their commitments. For students, something as basic as making their student loan last the semester is now a concern. For many fourth and fifth year dental students, the intensive nature of the course means they're in clinic 9-5, and that's before they have to work on the academic side of their course. The scenario of 'I can't pay my rent because I don't have enough, but there aren't enough hours in the day for me to find the time to do a job to make up the difference, and if I do find the time, there's a paucity of jobs' is real and of great concern to us. It is a very difficult thing to say 'sorry, I can't afford to do this', and we believe that may be worse in dentistry.

Is the support there for dentists - given the unique complexities of the profession - to access timely advice?

LH As you point out, dentists are in a unique position - many are self-employed but working within in a team, and the hierarchy that comes within that team. There isn't always that peer-to-peer support readily at hand and someone who can relate to the problems you're experiencing.

We've seen a huge shift to online learning, courses and support, but that doesn't replicate talking face-to-face with someone, or that coffee break when you can talk to someone on a more social level where you could mention your financial concerns. COVID-19 made that worse - it took that away - and if there's no avenue other than digital to access support, it could make it more difficult for someone to admit they need help. Often this means people can't talk to someone about it, don't have that relationship feeling comfortable to do so, so won't want to talk about it, which means they don't come to us when they need it. When they do, they're in a precarious position. If you're hugely overdrawn with no other option but to speak to us, that's great that you've reached out, but it's always easier for us to be able to turn things around when you first identify you might struggle with a shortfall.

You mention the need for support has always been there. What sort of support was needed pre-pandemic?

LH Our core work remains the same, and current day circumstances mean things have got worse for lots of dental professions since the pandemic began. For students, the problems are largely the same - namely inadequate funding. For dentists, any drastic change in their circumstance was often the trigger, of which COVID-19 was one.

Five years ago, the most common reason was being involved in a GDC Fitness to Practise hearing, which isn't now the most common reason - they do still come to us, but in fewer numbers. Fitness to Practise has undergone a transformation, resulting in fewer cases having that huge impact on people's lives, which impacts mental health.

To anyone reading this who can resonate with any of the warning signs or experiences you've spoken about, what would you say to them?

LH Speak to someone appropriate for you, whoever that may be. Look at the Wellbeing Support for Dental Teams - the UK Guide. It's a free resource to give you the tools to assess the signs. People who are unsure about whether they qualify for support can always contact us or fill in the application form online. If the question is 'do you have enough money to live off' and the answer is no, then we can help you. Knowledge is power, and throughout the process we work with those who come to us to run through a budget calculator so they can assess their income and outgoings. Sometimes that's all it takes - to show someone how to better manage their finances in the long haul. By doing so, we can help to put you on a more realistic path to enable you to be able to put money aside for the future, or have an insurance plan. Just do not leave it too late. â—†

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(England) NHS Practitioner Health: www.practitionerhealth.nhs.uk

(Scotland) NHS Occupational Health Advice and Guidance Service: www.sehd.scot.nhs.uk/pca/PCA2018(D)07.pdf