Smoking and mental health - NCSCT

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.
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