Smoking and mental health - NCSCT

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Smoking and mental health Successfuly smoke-free (n = 39) Clear leadership: 38 (97%) reported clear leadership Cohesive teamwork: 36 (96%) reported cohesive teamwork Education and training: 36 (92%) reported standard or extensive education and training for staff Strong policy enforcement: 35 (96%) reported to obey the policy consistently NRT available: 39 (100%) reported capacity to offer NRT to patients 60 staff interviewed for information on 99 adult inpatient mental health units (n = 56 open, n = 43 secure) Tried and failed to go smoke-free (n = 14) Poor leadership: 14 (100%) reported detached, inconsistent or poor leadership Fragmented teamwork: 12 (86%) reported fragmented teamwork Education and training: 8 (57%) reported minimal education and training related to smoking for staff High rates of staff smoking: 12 (86%) reported smoking levels of 30% or more, despite 100% (n = 14) offering free or subsidised NRT to staff Poor policy enforcement: no units reported to consistently obey policy Not available: 14 (100%) reported capacity to offer NRT to patients Fig 6.1 Determinants of successfully or unsuccessfully implemented smokefree policies. 79 NRT, nicotine replacement therapy. light and moderate smokers tend to increase, and those who are heavy smokers to decrease, cigarette consumption during admission to a smoke-free ward, consistent with an effect of imposed smoking pattern arising from restricted access to smoking areas. 77,78 Figure 6.1 displays factors that have been identified as essential for the successful implementation of smoke-free policies across Australian mental health trusts, and include clear leadership, cohesive team work, consistent policy enforcement, staff training and appropriate use of nicotine replacement therapy (NRT). 79 Studies of the clinical impact of smoke-free policies on symptom control among patients in smoke-free mental health settings suggest that there is no appreciable effect on the severity or improvement of symptoms in people who smoke relative to those who don’t, 80 but can result in weight gain (an average of almost 5 kg in one study 81 – see Chapter 5, section 5.4.3). A systematic review on these effects, commissioned by NICE, is due to be published in 2013. 118 © Royal College of Physicians 2013
Population strategies to prevent smoking in mental disorders 6 Follow-up studies of English mental health trusts 4 years after implementation of smoke-free policy suggest that the opportunity to use the policies as a driver of health promotion is being widely missed. Policy enforcement in mental health trusts is often deficient, with blanket exemptions being granted frequently to all smokers, and inadequate support from staff to address tobacco dependence among patients. 75,78 A recent assessment in a large mental health trust in England revealed that, despite a newly acquired focus on physical health, 82 addressing smoking was still a marginalised issue and not integrated into care pathways or standard procedures and documentation. 83 6.3.2 Media campaigns Evidence on the effect of mass media campaigns on smokers with mental illness is limited. One Australian study of 89 patients with schizophrenia 84 found that mass media campaigns did not appear to impact on smoking behaviour or intentions to quit in this group, and the authors suggested that tailored approaches taking into consideration specific barriers experienced to quitting may be more appropriate. The study also suggested that antismoking media campaigns may be less effective in marginalised populations in general, such as those of lower educational status and socioeconomic status, and those who are unemployed. 84 These findings are in line with suggestions indicating that public health campaigns to raise awareness of and prevent sudden infant death syndrome had less effect in people with mental disorders than in the general population, and implying that targeted approaches may be needed. 85 6.3.3 Health warnings, advertising and sponsorship We are not aware of any studies that have explored the effectiveness of health warnings, or relative impact of prohibition of advertising and sponsorship, in subpopulations of people with mental disorders. 6.3.4 Price and illicit supply A US empirical modelling study suggests that mental disorders increase participation in the consumption of addictive goods but does not have substantive effects on price elasticity, and therefore that increasing the price of tobacco through tax is likely to be an effective means of influencing behaviour among mental health populations. 86 We are not aware of any British studies of this effect. Prevention of illicit supply of tobacco, which undermines tax measures, is likely to be effective because the most disadvantaged smokers, who © Royal College of Physicians 2013 119
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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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Epidemiology of the association bet
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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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