Smoking and mental health - NCSCT

More documents

Recommendations

Info

Smoking and mental health are likely to include those with mental disorders, are twice as likely to buy illicit tobacco as the most affluent ones. 44 6.3.5 Minimum legal age of purchase Research exploring this issue with a special focus on young people with mental illness has to date not been conducted. However, as there is evidence that uptake of smoking occurs earlier among young people with emerging mental disorders compared with their peers without mental disorders, 87 this policy may be of particular relevance in mental health populations. 6.3.6 NHS stop smoking services It is difficult to evaluate the impact of NHS SSS on smokers with mental disorders because relevant data on service use or effectiveness are not routinely collected (see section 5.3). However, based on the evidence outlined in section 5.1, there are no grounds to suspect that SSS are ineffective in mental health populations, although further research into models of service provision is urgently needed. 6.3.7 Harm reduction strategies Harm reduction strategies for smokers with mental disorders, particularly serious mental illnesses (SMI), offer substantial potential for benefit. Given the typically high levels of tobacco dependence, the complexities involved in the association between smoking and mental illness (see Chapter 2), and resulting challenges in terms of motivation and confidence to undertake an abrupt quit attempt, often experienced by smokers in this group, offering harm reduction strategies could constitute an important step towards realising short-term gains such as reducing tobacco consumption (including its financial implications) and long-term gains such as increased likelihood to quit. Harm reduction could also contribute substantially to reducing tobacco-related health inequalities in one of the most vulnerable populations in society. To date, no research specifically exploring harm reduction strategies has been carried out, although a UK randomised controlled pilot trial involving tailored support including ‘cutting-down-to-quit’ strategies is currently being evaluated. 6.3.8 School-based interventions We are not aware of any studies that have assessed the effectiveness of schoolbased interventions with a focus on issues around mental illness. 120 © Royal College of Physicians 2013
Population strategies to prevent smoking in mental disorders 6 6.4 Factors perpetuating smoking in mental health settings 6.4.1 A smoking culture Despite the scope of the problems caused or exacerbated by tobacco smoking in mental health settings, smoking among patients in these settings has typically been neglected, particularly by clinicians. 88,89 Consequently, although a societal change towards the ‘de-normalisation’ of smoking and prevention of passive smoke exposure in public and work places has occurred in the UK over recent years, smoking is still widely, if covertly, condoned in mental health settings. Indeed, the complexity of social and systemic aspects involved in the perpetuation of smoking in these settings is well recognised, and has been described as a ‘culture of smoking’, created and perpetuated by the coming together of ‘various players, with various roles and rules for behaviour, interaction and communication, informed by beliefs and attitudes, set in the context of established rites, structures, artefacts and ideologies that together serve to perpetuate the culture’. 89 These conditions apply in relation to smoking in mental health settings. 90 Ethnographic and other work has demonstrated that smoking is a primary activity for mental health inpatients, forms a central part of the daily experience of both patients and staff, and has done so historically. 89 Smoking as a ‘multifaceted tool’ had become entrenched in the more complex set of social rules that apply in mental health settings and is used for purposes, such as the relief of boredom and stress associated with a ward environment, facilitating social interaction and the development of rapport between patients and staff, and controlling patient behaviour using cigarettes as a means of reward and punishment. Cigarettes have been described as the ‘currency by which economic, social and political exchange took place’, with patients and staff describing a complex enculturation process that involved strong reinforcement to smoke and rendered an escape from the culture in the studied settings extremely difficult. 89,91 Some important determinants that contribute to the perpetuation of the smoking culture are discussed in the following sections. 6.4.2 Staff beliefs and attitudes The potential importance of the role of clinicians and other healthcare staff in promoting healthy behaviour in general and smoking cessation in particular is well recognised, 92 and staff beliefs and attitudes to smoking are important determinants and perpetuators of a smoking culture. The role of mental health nurses has been described to encompass that of a ‘custodian, carer, cigarette source, counsellor, educator, behaviour modifier and gaoler’ 91 and, although staff in mental health settings generally recognise the importance of health promotion for people with mental disorders, they also often report that they perceive smoking to be a personal right and expression of self-determination that they are © Royal College of Physicians 2013 121
Page 1 and 2:
PDF not for circulation Smoking and
Page 3 and 4:
Contents Members of the Tobacco Adv
Page 5 and 6:
Contents 4.4.3 Attention deficit hy
Page 7 and 8:
Contents 6.4.3 Staff knowledge 122
Page 9 and 10:
Contents 10.5 Tobacco policy and me
Page 11 and 12:
Contributors Anthony Aclet - Specia
Page 13 and 14:
Contributors Jill Williams - Associ
Page 15 and 16:
1 Mental disorders 1.1 What is a me
Page 17 and 18:
Mental disorders 1 1.3 Common menta
Page 19 and 20:
Mental disorders 1 1.4.4 Somatisati
Page 21 and 22:
Mental disorders 1 In addition to s
Page 23 and 24:
Mental disorders 1 not diagnosed un
Page 25 and 26:
Mental disorders 1 Similar to many
Page 27 and 28:
Mental disorders 1 12 Chang CK, Hay
Page 29 and 30:
Mental disorders 1 52 Young S, Toon
Page 31 and 32:
Smoking among people with mental di
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Neurobiological and behavioural mec
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Epidemiology of the association bet
Page 79 and 80:
Page 81 and 82:
Page 83 and 84: Epidemiology of the association bet
Page 99 and 100: Smoking cessation interventions for
Page 125 and 126: 6 Population strategies to prevent
Page 127 and 128: Population strategies to prevent sm
Page 133: Population strategies to prevent sm
Page 145 and 146: Smoking and mental disorders: speci
Page 179 and 180: The economic cost of smoking in peo
Page 185 and 186:
The economic cost of smoking in peo
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Ethical and legal aspects 9 pose co
Page 199 and 200:
Ethical and legal aspects 9 less an
Page 201 and 202:
Ethical and legal aspects 9 patient
Page 203 and 204:
10 Summary and conclusions 10.1 Smo
Page 205 and 206:
Summary and conclusions 10 10.4 Smo
Page 207 and 208:
Summary and conclusions 10 although
Page 209 and 210:
11 Key conclusions and recommendati
Page 211 and 212:
Key conclusions and recommendations
Page 213 and 214:
Page 215:
show all

Smoking and mental health - NCSCT

Create successful ePaper yourself

Delete template?

Save as template?