Smoking and mental health - NCSCT

Population strategies to prevent smoking in mental disorders 6
form the largest group of healthcare professionals and are viewed as public health
role models, does not appear to be lower than that of the general population, 97
and in the case of psychiatric nurses may in fact be higher. 91 However, conclusive
evidence on smoking prevalence among psychiatric nurses is not currently
available. 98 British studies, some small, of smoking among mental health
staff 93–95,99–102 report prevalence figures ranging from 17% 94 to 40%, 100 although
the latter arises from a study conducted some 20 years ago when general
population smoking rates were much higher. Similarly heterogeneous figures are
found in other countries, often in the context of small sample sizes. 77,103–105 In
line with general population surveys, some studies describe a gradient of smoking
prevalence according to professional subgroup, with higher rates among nonqualified
nurses (healthcare assistants) than in registered nurses, and lowest rates
typically among doctors. 94,95,101 Despite the shortcomings of the available data,
therefore, 97 it appears that smoking prevalence among mental health staff is
broadly comparable to that in similar sociodemographic status groups.
6.4.5 Systems, targets and resources
Despite the growing recent emphasis on physical health in the context of
treatment for mental illness, which includes prevention of premature deaths
among those with mental illness and ensuring access to ‘high-quality support
services’, 82 treatment of smoking is rarely integrated into care pathways. As
discussed previously (see section 5.3), there is evidence that the structures and
processes that would be required to ensure this 72 sometimes do not exist in mental
health trusts, even if the smoke-free policy states otherwise. Recordings of patients’
smoking status, or any other smoking-related information such as motivation to
quit, support offered, referrals made or nicotine withdrawal experienced in
inpatient settings, appear to be rare, although bespoke instruments to document
smoking status and interventions, if available, are often not used. 83 The resources
necessary to provide adequate support for smokers attempting to quit or abstain
from smoking, such as a range of NRT products, behavioural support skills and
staff time, are often missing. Overall, addressing smoking appears to occupy a very
low priority in mental health settings 75,79,89 and, although this is in part a
reflection of local factors, it also reflects inadequate national policy.
Apart from strategies discussed earlier (see Chapter 5, section 5.3), referring
mainly to performance indicators, financial incentives and official guidelines to
ensure that smoking is acknowledged as an important issue, overcoming
prevailing misconceptions and negative or indifferent attitudes towards smoking
by mental health staff is clearly an important challenge and priority. Efforts to
integrate training and education on smoking and its specific links with mental
illness into professional curricula, and to challenge the idea that smoking is a
‘physical health issue’, the treatment of which lies outside the remit and
responsibility of mental healthcare, appear to be an urgent priority.
© Royal College of Physicians 2013 123