Smoking and mental health - NCSCT

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Smoking and mental health require more resource-intensive support. 99 SSS also need to be equally available to patients in secondary care or other health settings in which access to community-based services is limited or impractical. 5.5.5 Enhancing service provision for smokers with mental disorders It is evident that much could be done to improve smoking cessation service provision for people with mental disorders in the future. Recent government strategies and service guidance reflect this; the mental health strategy highlights that closer working between primary and mental health secondary care staff would facilitate integration of tobacco dependence support across treatment settings, and help support the confidence of mental health staff to identify and intervene in smoking and other adverse health behaviours. Revised service and monitoring guidance for NHS SSS also emphasises the importance of targeting and supporting people with mental disorders, and recommends improved coordination between NHS SSS and primary care, community and acute mental health services. It specifically states that health inequalities experienced by people with mental disorders will widen if investment in smoking cessation for this group is not greater than for the general population. Thus, the development of suitable incentives for service providers (such as smoking-related QOF outcomes for GPs and potentially CQUIN targets for mental health trusts) and the development of guidance for the delivery of adequately tailored treatment for certain groups of people with mental disorders (notably those with severe and enduring illness) are likely to support the enhancement of service provision in the future. 5.6 Experience of attempts to introduce comprehensive smoking cessation support in mental health settings: UK case studies 5.6.1 London, UK A 3-year project (2008–11), funded jointly by Merton Borough Local Authority and South-West London and St George’s Mental Health Trust, aimed to develop a defined pathway of smoking treatment for mental health service users by training all frontline staff to identify all smokers and deliver brief advice to quit, and to refer smokers to a specialist adviser based in inpatient or community clinics and employed to deliver stop smoking support 100 (Fig 5.1). The adviser provided a structured behavioural support programme and combination NRT in accordance with NICE guidance. 12 Face-to-face behavioural support was provided for at least 12 weeks, whereas smokers were encouraged to cut down their smoking in advance of a chosen quit date, and received continued support 100 © Royal College of Physicians 2013
Smoking cessation interventions for individuals with mental disorders 5 To address patient smoking: • one-to-one sessions provided on Merton wards • every user of Merton services given a physical health screen that addresses smoking and considers healthier alternatives • six inpatient/ward-based clinics established (running twice weekly) • six community-based clinics established (running twice weekly) • personalised diaries for smoking cessation designed • local promotional material designed • carers involved through information session at carers meeting. Stop smoking and physical health lead recruited To address staff attitudes: • care coordinators and registered nurses given a one-hour, level one smoking cessation training • workshops on smoking cessation conducted quarterly to provide staff with opportunities to further develop skills • roadshow conducted in staff canteen to raise awareness • regular meeting with community outreach team to provide information, support and treatment services. To address procedural and policy barriers: • service policy guidelines and pathways towards treatment in line with gold standard service structures created • commitment of all consultants pledged for new policy guidelines • up-to-date records of smoking status on the trust electronic system maintained to enable clear referral pathways. Fig 5.1 Steps along the smoking treatment pathway. for up to 4 weeks thereafter. Over 400 healthcare professionals (95% of frontline staff) were trained to deliver interventions, and 180 patients accessed the service, most of whom achieved assisted reduction. The number of patients successfully quitting per quarter totalled 38 after 18 months of the specialist adviser being in post. The greatest challenges were perceived to be related to staff attitudes reflecting reluctant engagement with smoking cessation interventions for patients with SMI, and to the development of adequate pathways including prescriptions and management of pharmacotherapy. 5.6.2 Nottingham, UK This project, part of a series of pilot projects funded by the Department of Health to address tobacco-related inequalities, aimed to develop, implement and appraise a tailored tobacco dependence service in mental health settings 101 (Fig 5.2). It also aimed to address barriers to sustainable implementation by addressing knowledge gaps, common misconceptions and more complex systemic issues relating to the ‘smoking culture’ in mental health settings, to develop instruments and materials suitable to be integrated in care pathways, and to improve collaboration with the local NHS SSS in the context of an integrative service model. The project was © Royal College of Physicians 2013 101
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PDF not for circulation Smoking and
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Contents Members of the Tobacco Adv
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Contents 4.4.3 Attention deficit hy
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Contents 6.4.3 Staff knowledge 122
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Contents 10.5 Tobacco policy and me
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Contributors Anthony Aclet - Specia
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Contributors Jill Williams - Associ
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1 Mental disorders 1.1 What is a me
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Mental disorders 1 1.3 Common menta
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Mental disorders 1 1.4.4 Somatisati
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Mental disorders 1 In addition to s
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Mental disorders 1 not diagnosed un
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Mental disorders 1 Similar to many
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Mental disorders 1 12 Chang CK, Hay
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Mental disorders 1 52 Young S, Toon
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Smoking among people with mental di
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Neurobiological and behavioural mec
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The economic cost of smoking in peo
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Ethical and legal aspects 9 pose co
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Ethical and legal aspects 9 less an
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Ethical and legal aspects 9 patient
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10 Summary and conclusions 10.1 Smo
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Summary and conclusions 10 10.4 Smo
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Summary and conclusions 10 although
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11 Key conclusions and recommendati
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Key conclusions and recommendations
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