Smoking and mental health - NCSCT

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Smoking and mental health a pervasive culture of smoking in many mental health settings. In either case the paramount importance of all healthcare professionals taking the opportunity to address smoking in people with mental disorder is evident. Mental health facilities need to become comprehensively smoke free, in grounds as well as buildings, for all staff, visitors and patients. Abstinence from smoking, through cessation or harm reduction, needs to be established as the prevailing culture. Smoke-free policies work if comprehensive and delivered with appropriate leadership, training and support strategies for patients and staff. Investment in achieving smoke-free mental health settings, and in the support needed by patients and staff to allow this to happen, is therefore an urgent national priority. 10.6 Special circumstances Smoking, and particularly high levels of nicotine dependence, are especially common among people admitted to forensic psychiatric facilities and for many years was culturally entrenched in the working of these facilities. Since 2007 this has changed, radically. Rampton Hospital, and subsequently all high-secure units in the UK, has successfully implemented comprehensive smoke-free policies throughout their buildings and grounds. Contrary to expectation, this has been achieved without significant adverse effects. Strong leadership, clear policies and provision of cessation support for patients and staff are among the perceived determinants of success. The experience of these institutions indicates clearly that, with similar determination, mental health facilities for the wider population with mental disorders can also become smoke free. Smoking is also common among other population groups with a particularly high prevalence of mental disorders, including prisoners, homeless people, and people dependent on alcohol or other drugs. As in the wider mental health population, these smokers are no less likely to want to quit smoking than those in the general population, but they are more likely to be highly dependent, to be exposed to an institutional or facility culture in which smoking is engrained, and, perhaps as a result, quit attempts are less likely to succeed in this group. In drug dependence treatment facilities, addressing smoking probably improves, rather than reduces, the effectiveness of treatments for dependence on other drugs. Recent experience from New Zealand demonstrates that prisons can become smoke free, without major adverse effects, and that half of prisoners who quit smoking while in prison intend to remain non-smokers after release. Establishment of smoke-free cultures in facilities for homeless people or those with other drug dependence is likely to be equally important and effective in promoting smoking cessation. The experience of high-secure units in Britain, and prisons in New Zealand, demonstrates that such culture changes can be achieved, to widespread benefit. The National Offender Management Service for England and Wales is working towards making all prisons smoke free, 192 © Royal College of Physicians 2013
Summary and conclusions 10 although at the time of writing (February 2013) proposals to test implementation in a set of early adopter prisons, planned for spring 2013, had been postponed. Smoking during and after pregnancy has major adverse effects on fetal and child health. Women with mental disorders are more likely to smoke throughout pregnancy, and require systematic and sustained intervention and support to maximise smoking cessation. Many children in care have mental disorders, and many smoke. It is important that child and adolescent mental health services, and local authority foster care and smoking policies, explicitly protect children from passive smoke, and provide smoke-free environments. Professionals working with or caring for young people should provide positive (ie nonsmoking) role models and hence be supported to quit smoking; they should also be trained to deliver cessation advice and provide or arrange further support for children who want help to quit. 10.7 Economic costs of smoking in people with mental disorders Smoking in people with mental disorders causes an estimated 2.6 million hospital admissions, 3.1 million GP consultations and 18.8 million prescriptions each year, at a cost of around £720m per annum. Most of this cost arises from smoking in people with anxiety or depression. Psychotropic drug costs are increased by smoking, through more rapid drug metabolism, potentially by as much as £40m per year. Preventing smoking in people with mental disorders would avoid all of these costs, and gain up to 1 million discounted and 4 million undiscounted life-years. Smoking cessation interventions and harm reduction strategies are both highly cost-effective in this population. 10.8 Ethics People with mental disorders have an entitlement to smoking cessation support that is at least as strong as for those of the general population, but their need for support is in many cases greater. Prevention and treatment of smoking have failed this group for many years, and thus exacerbated the health inequalities sustained. It is therefore vital that patients with mental disorders receive at least the same level of access to smoking cessation treatment, and help with temporary abstinence, as members of the general population. Smoke-free policies, which help to break the culture of smoking in mental health settings, are a crucial component of this. The objectives of smoking cessation and tobacco control policies in the mental healthcare context need to take into account the complexity of the care needs of people with mental health problems. The case law relating to smoking policies in formal mental healthcare settings and prisons suggests that a careful balance © Royal College of Physicians 2013 193
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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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6 Population strategies to prevent
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Population strategies to prevent sm
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Smoking and mental health - NCSCT

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