Smoking and mental health - NCSCT

More documents

Recommendations

Info

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
Smoking and mental disorders: special circumstances 7 Glasgow, a specific looked-after children’s smoking cessation project was set up, involving health promotion advice, one-to-one support, and training of care staff around raising awareness and the importance of positive role models. 179 Given the association between smoking and mental illness, there is also a case for further integration and coordination of services, eg offering training on smoking cessation interventions to staff working in looked-after children CAMHS teams. Further work in these areas is clearly necessary. 7.6.6 Summary points > Smoking prevalence is high among children with mental disorders, and both smoking and mental disorders are common in looked-after children. > Professionals working with or caring for young people should provide positive (ie non-smoking) role models and be trained to deliver cessation advice and provide or arrange further support for those who want help to quit. > CAMHS should ascertain smoking status and provide cessation support as a routine component of their service. > In settings where young people are most vulnerable, such as adolescent inpatient units, there should be a broad programme of health promotion aimed at preventing initiation of smoking as well as smoking cessation. > Local authority foster care and smoking policies should explicitly protect children from passive smoke, and promote smoke-free foster homes. 7.7 Special circumstances summary > Smoking, and particularly high levels of nicotine dependence, are especially common among people in forensic psychiatric settings, prisons, homeless people, and those with alcohol or other drug misuse. > Smoking is also engrained in the culture of many of the institutions that care or provide for these groups. > People in these populations are no less likely to want to quit smoking, although the likelihood of success in any quit attempt may be lower than for the general population of smokers, and smokers may also encounter obstacles to engagement with existing cessation services. > It is therefore a priority to establish smoke-free cultures and to provide suitable smoking cessation support for all smokers, particularly those with high levels of dependence, in these settings. > Interventions to address smoking concurrently with alcohol and/or drug misuse are effective and can also support alcohol and drug abstinence. > Women with mental disorders are more likely to smoke throughout pregnancy, but are also more likely to accept cessation support. © Royal College of Physicians 2013 153
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:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Smoking cessation interventions for
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116: Smoking cessation interventions for
Page 125 and 126: 6 Population strategies to prevent
Page 127 and 128: Population strategies to prevent sm
Page 145 and 146: Smoking and mental disorders: speci
Page 165: Smoking and mental disorders: speci
Page 179 and 180: The economic cost of smoking in peo
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: Key conclusions and recommendations
Page 215: Key conclusions and recommendations
show all

Smoking and mental health - NCSCT

Create successful ePaper yourself

Delete template?

Save as template?