Smoking and mental health - NCSCT

Smoking and mental health
guidelines. Young people in this study also reported that staff in residential care
did not always take incidents of smoking seriously. Up to two-thirds of foster
carers reported smoking in front of the children in their care, indicating that
passive smoke exposure is also a significant risk for looked-after children. Other
potential contributors include the reported low expectations of children in
care, 181 particularly concerning education but perhaps extending to smoking as
well. In crisis situations, and where placement moves are frequent, health matters
may also take a lower priority. 182 Young people may miss out on health
promotion messages and healthy lifestyle discussion due to school changes, or
even due to being excluded from school. 183 These vulnerable children and young
people, in terms of their mental health and smoking behaviour, are thus subject
to a ‘double disadvantage’. They have already experienced considerable adversity
before coming into care and can be further disadvantaged by the care system
itself. Time for change, the 2007 White Paper, with the key theme being the
importance of good corporate parenting, states that ‘the aspiration that the state
has for these children should be no less than each parent would have for their
own child’. 184
7.6.5 Smoking prevention and cessation in children and adolescents with
mental disorders and in looked-after children
In addition to the wider efforts to prevent smoking uptake in young people
generally, there is a clear need for services to address the high rates of smoking in
these groups. The Royal College of Psychiatrists recommends ‘targeted
approaches for children and adolescents with emotional and behavioural
disorder, who are at a much higher risk of taking up smoking’. 185 This may take
place within child and adolescent mental health services (CAMHS), but means
that staff working with young people with mental health problems need
appropriate training and resources to offer brief intervention or signposting. 186
British studies are lacking, but one US study of child and adolescent psychiatrists
found that the majority did not give consistent messages about smoking, and
highlighted the need for more formal training. 187 Some mental health problems
may be open to specific approaches, eg it has been suggested that
‘pharmacological treatment of ADHD before children are exposed to cigarettes
may protect against smoking’. 171 NICE has produced guidance on smoking
cessation services in general 186 and is due to publish guidance in 2013 on
smoking cessation in secondary care mental health services; however, further
research into what works is still needed.
There have been efforts to address the mental health needs of looked-after
children through dedicated CAMHS teams and mental health screening.
Similarly, there has been a movement to target smoking in this group in
particular, eg by employing a looked-after children’s smoking cessation adviser to
work with young people, foster carers, social workers and residential staff. 188 In
152 © Royal College of Physicians 2013