Smoking and mental health - NCSCT

Smoking cessation interventions for individuals with mental disorders 5
Although data from the USA suggest that, in the past, primary care physicians
(and indeed many other health professionals) have failed to address 85 or even
tacitly encourage smoking, for reasons related to common beliefs and
perceptions in terms of its therapeutic value and the risks of cessation for
patients’ mental health (‘first things first’; see also sections 5.1 and 6.3), the data
in Chapter 2 suggest that, in the UK at least, practice is changing. The revised
QOF is likely to have contributed substantially to this, at least in the patient
groups specified in the QOF (schizophrenia, bipolar disorder or other
psychoses). It is important, however, to ensure that this intervention is delivered
to maximum effect and that all smokers, irrespective of co-morbidity, are offered
and delivered the maximum level of intervention that they are willing to accept.
In line with new NICE guidance, 53 it is also important that smokers who decline
help to quit smoking are encouraged to adopt harm reduction strategies.
5.5.2 Specialist mental health settings (secondary care)
Specialist inpatient and community mental health services, provided by NHS
mental health trusts, should be able to play major roles in addressing smoking, at
several levels.
First, people with severe mental disorders, many of whom do not access
mainstream services (including primary care) regularly, will be in regular contact
with these services in the context of the care programme approach, which
stipulates the development of a care plan, the identification of a ‘care
coordinator’ and an annual review by a consultant psychiatrist. 86 Smoking
cessation should be a prominent part of this wider care delivery, in accordance
with mental health strategy objectives. 82
Second, there is now clear evidence that patients admitted to inpatient wards
tend to change their smoking behaviour by decreasing, increasing or even
starting to smoke, 87,88 possibly as a consequence of adapting to inpatient
routines and smoking breaks (see Chapter 6, section 6.2). Admission is,
however, an opportunity to intervene to reduce smoking, 89 particularly in the
context of strong smoke-free policies in British settings. Motivation to stop
smoking is similarly high in hospitalised patients with and without a mental
disorder, 90 and a Cochrane review of smoking cessation interventions for
hospitalised patients found that intensive counselling interventions started
during admission and continued for at least 1 month after discharge increased
cessation rates (OR = 1.65, 95% CI 1.44–1.90; 17 trials) regardless of admission
diagnosis. 15
Third, specialist mental health services are particularly suitable settings in
which to provide tailored support through experienced mental health staff, in
environments and contexts familiar to service users and with appropriate
attention to treatment interactions, and with recognition and appropriate
attribution of withdrawal symptoms.
© Royal College of Physicians 2013 97