Smoking and mental health - NCSCT

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Smoking and mental health • NRT prescription through GP • Consultant, GP and care coordinator informed of quit attempt/relapse • Communication with clinical team (including consultants) in the context of a quit attempt • Documentation of support (care plan) If client is admitted to an inpatient ward, the client is referred to the inpatient adviser Inpatient adviser Individual support Group support Ready to quit promptly? Offer of referral to local NHS SSS Engages clients in smoking cessation conversation on the wards. All clients offered support to address smoking Initial appointment (provided at home and community locations) Wants to reduce or quit Not interested Community adviser • 1:1 support for as long as required • Liaison with prescribers to provide NRT from trust formulary • Communication with clinical team (including consultants) in the context of a quit attempt • Documentation of support (assessment sheet, care plan) Client given educational materials on nicotine and how to access support when on the ward and in the community Patient discharged to the community and referred for community tobacco dependence support City catchment area Self-referral County catchment area Mental health staff referral NHS SSS Fig 5.2 Structure of Nottingham tobacco dependence support service. NRT, nicotine replacement therapy; SSS, stop smoking services. 102 © Royal College of Physicians 2013
Smoking cessation interventions for individuals with mental disorders 5 carried out on two acute adult mental health wards and two rehabilitation wards (129 beds), and in a community recovery team caring for over 2000 patients, between October 2010 and June 2011. Two mental health professionals were trained in tobacco dependence and employed full time to support patient and staff smokers in the project settings, to deliver staff training and involve staff in service provision, and to develop instruments and materials central to the provision of comprehensive support in collaboration with the project team. Instruments for the integration of smoking treatment into care pathways, such as assessment sheets, tobacco dependence treatment plans and guidance related to potentially necessary adjustment of antipsychotic dosage, as well as comprehensive communication structures between all treatment providers (including GPs), were developed. A referral system to the local NHS SSS was also created. By the end of this project, 110 patients, comprising 53 inpatients (23% of all inpatient smokers) and 57 community patients (of an unknown number of community smokers, because recording of smoking status was not mandatory in this setting), had attended at least one support session with a specialist adviser. Of those, 34 (31%) had made a quit attempt and 17 (50% of those trying) had successfully quit by the final contact. A further 29 patients (26%) reduced cigarette consumption by up to 50% at the final contact. Barriers to service implementation were complex and mainly related to the following themes: (1) trust policy, systems and procedures, (2) staff knowledge and attitudes, and (3) illness-related factors. 5.6.3 Implications for practice These case studies indicate at best modest success of tailored tobacco dependence support services in terms of absolute numbers of successful quit attempts, but reflect a general interest in and demand for support. They also suggest the existence of a discrepancy between outcomes of efficacy studies conducted in controlled study settings (see section 5.1), and those following the translation of the evidence base into practice. To develop and deliver tailored, ‘workable’ support models in mental health settings successfully, complex systemic barriers remain to be addressed, even in a country with a strong anti-smoking climate such as the UK. These include addressing staff knowledge, attitudes and behaviour related to smoking (including staff smoking) and the developmentrelated information, and providing appropriate support. 5.7 Summary > Smoking cessation interventions that combine behavioural support with cessation pharmacotherapy, and are effective in the general population, are also likely to be effective in people with mental disorders. © Royal College of Physicians 2013 103
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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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Smoking and mental health - NCSCT

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