Tailored tobacco dependence support for mental health patients: A model for inpatient and community services

Addiction (Impact Factor: 4.74). 12/2012; 107(S2). DOI: 10.1111/j.1360-0443.2012.04082.x


AimsAlthough smoking prevalence among people with severe mental illness is high, it remains largely unaddressed. This pragmatic pilot project aimed to develop and implement a tailored tobacco dependence service in mental health settings and to assess its impact, as well as barriers and facilitators to implementation. DesignAn integrative service model, spanning acute, rehabilitation and community services, including the design of tailored instruments and referral pathways, delivered by two mental health professionals. Setting and participantsFour adult acute and two rehabilitation wards (129 beds), and the community recovery team (2038 cases) of the United Kingdom's largest Mental Health Trust. MeasurementsAudit of smoking information in patient notes; service uptake; quit attempts; smoking cessation and reduction; qualitative data on implementation barriers/facilitators. FindingsA total of 110 patients attended at least one support session: 53 inpatients (23% of inpatient smokers) and 57 community (of unknown number of community smokers, as recording of smoking status is not mandatory). Thirty-four of these (31%) made a quit attempt; 17 (15%) stopped smoking and 29 (26%) reduced cigarette consumption by up to 50% at the final contact. Barriers to service implementation related to: (i) trust policy, systems and procedures, (ii) staff knowledge and attitudes and (iii) illness-related factors. Conclusions
Despite the strong anti-smoking climate in the United Kingdom, including a law requiring smoke-free policies in mental health settings, establishing a smoking cessation treatment service for people with mental illness proved difficult, due to complex systemic barriers. However, there is clearly a demand, by patients, for such a service.

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    • "Pilot research on in-patient units has demonstrated that the mantra of offering NRT and specialist smoking cessation advice in everyday practice results in modest success rates in terms of service uptake and smoking cessation or abstinence.14 Nicotine replacement therapy products, although generally effective and doubling success rates for smoking cessation compared with no use of pharmacotherapy,19 are undoubtedly products of limited popularity - whereas it should be noted that mental health professionals’ often sceptical stance, probably based on misconceptions with regard to their use in the context of mental disorder,20 do a disservice to the products and needs to be addressed. "
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    ABSTRACT: Electronic cigarettes (e-cigarettes), have recently been the focus of much attention and debate. This article attempts to highlight their relevance and potential importance for mental health settings, with a focus on in-patient units. To do so, the complexities involved in smoking among people with mental disorder, the debate surrounding e-cigarettes, and their potential to be utilised as a smoking cessation or temporary abstinence aid in the context of smoke-free policies and new National Institute for Health and Care Excellence guidance for smoking cessation in mental health settings, will be discussed and synthesised below.
    Full-text · Article · Oct 2014
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    • "The reported lack of encouragement or indeed active discouragement to address smoking mirrors findings from other vulnerable populations, such as people with mental illness, where numerous barriers, including staff attitudes and beliefs related to the ‘therapeutic’ effects of smoking on some symptoms of mental illness, potential harms of doing so, and a general ‘first things first’ attitude, marginalising smoking, have been described as part of a complex and intricate smoking culture [26-28]. Similar concerns appear to be of relevance for homeless smokers, who often experience comorbid substance abuse and mental disorder. "
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    ABSTRACT: The prevalence of tobacco smoking among homeless people can reach more than 90%, with related morbidity and mortality being high. However, research in this area is scarce. This study aims to explore smoking and quitting related behaviours, experiences and knowledge in homeless smokers in the context of other substance abuse. Face-to-face interviews were conducted with homeless smokers accessing a harm reduction service in Nottingham, UK. Data on smoking history, nicotine dependence, motivation and confidence to quit were collected using structured instruments; a semi-structured interview guide was used to elicit responses to predefined subject areas, and to encourage the emergence of unprecedented themes. Data were analysed using framework analysis and basic descriptive statistics. Participants were generally highly dependent smokers who did not display good knowledge/awareness of smoking related harms and reported to engage in high risk smoking behaviours. The majority reported notable motivation and confidence to quit in the future, despite or indeed for the benefit of addressing other dependencies. Of the many who had tried to quit in the past, all had done so on their own initiative, and several described a lack of support or active discouragement by practitioners to address smoking. High levels of tobacco dependence and engagement in unique smoking related risk behaviours and social interplays appear to add to the vulnerability of homeless smokers. Given reported motivation, confidence, previous attempts and lack of support to quit, opportunities to address smoking in one of the most disadvantaged groups are currently missed.
    Full-text · Article · Oct 2013 · BMC Public Health
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    • "Staff knowledge and attitudes to smoke-free policy have been identified as barriers to the provision of dependence support for mental health inpatients. Staff report concerns relating to the effects and costs of NRT, the loss of smoking as a patient coping strategy and the perception that patients are too unwell to quit while hospitalised [13]. The smoking status of staff has also been shown to impact on support for smoke-free policies, presenting additional obstacles to policy implementation [22-24]. "
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    ABSTRACT: Background In 2008, a new forensic hospital was opened as a totally smoke-free facility. This study describes the attitudes and experience of mental health professionals working in the high secure mental health facility three years after it was opened. It is part of a larger evaluation describing the experience of current and discharged hospital patients. Methods Quantitative data was collected using a survey of hospital staff (N = 111) with a 50% response rate. The survey collected demographic and smoking data to describe staff responses to statements relating to hospital smoking policy, patient care and staff support. Results Among staff surveyed, 13% were current smokers and 41% were ex-smokers (10% quit after commencing employment in the smoke-free hospital). Most (88%) preferred to work in a smoke-free environment, although this was significantly lower in smokers compared to non-smokers (39% vs. 95%). While most staff felt that the smoke-free environment had a positive impact on the health of patients (86%) and on themselves (79%), smokers were significantly less likely to agree. Just over half (57%) of staff surveyed agreed that patient care was easier in a totally smoke-free environment, although less smokers agreed compared to non-smokers. Staff who smoked were also significantly less likely to indicate they had sufficient support working in a smoke-free environment, compared to non-smokers (15% vs. 38%). Conclusions The staff surveyed supported the smoke-free workplace policy; most agreed that patient care was easier and that the policy did not lead to an increase in patient aggression. Implementation of a total smoking ban can result in positive health outcomes for patients and staff, and may influence some staff to quit. Staff who smoke have a less positive experience of the policy and require additional support.
    Full-text · Article · Apr 2013 · BMC Public Health
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