Smoking and mental health - NCSCT

Smoking and mental health
Fourth, active promotion of a smoke-free lifestyle should also be an integral
part of any health service, including those for mental disorders.
Finally, nicotine substitution as a harm reduction strategy and/or to enable
compliance with smoke-free environments in secondary care settings should be a
default support for smokers unwilling or otherwise unable to engage in cessation
activities but obliged by admission to a smoke-free setting to abstain from
smoking.
However, there is little available information on the extent to which stop
smoking support is (or is not) delivered within specialist mental health settings
in England. Although all NHS mental health trusts in England have now
implemented smoke-free policies, most of which are likely to include a statement
on the importance of addressing smoking and providing appropriate support or
referrals to NHS SSS, in the absence of minimum standards, reporting
requirements or monitoring in this area makes it difficult to evaluate the
effectiveness of these policies. Overall, there is evidence that resources allocated
to enforcing smoke-free policies, including those that would ensure the provision
of adequate behavioural and pharmacological support (such as staff training and
provision of NRT), are often lacking and that complex barriers to the
implementation of effective tobacco dependence treatment in mental healthcare
settings exist. 21,22,91 Perhaps most fundamentally, studies have highlighted how
the ‘culture’ within mental healthcare settings tends to facilitate smoking 19 (see
Chapter 6, section 6.2 for details).
A possible vehicle for implementation of more systematic delivery of stop
smoking support in mental health settings is the Commissioning for Quality and
Innovation (CQUIN) payment framework, 83 which was introduced in 2009 as a
national framework for locally agreed priorities; it was intended for use by
commissioners to reward excellence by linking a proportion of providers’ income
to the achievement of local quality improvement goals. The focus of the
framework on innovation and directly measurable indicators that are aligned
with national priorities would seem to suggest stop smoking support
programmes within mental health settings as an ideal application for CQUIN
schemes. However, as the schemes are negotiated locally, there is no currently
agreed standard for this.
5.5.3 Child and adolescent mental health services
As most smoking starts before adulthood, prevention of uptake among
adolescent non-smokers and intervention to promote cessation in young people
who smoke are especially important. A recent meta-analysis has demonstrated
that smoking prevalence among young people at the time of presentation for
treatment of first-episode psychosis is around 60%, and six times higher than in
age- and gender-matched controls, 92 demonstrating that more attention needs to
be paid to the reasons for starting tobacco use before diagnosis, as well as
98 © Royal College of Physicians 2013