Smoking and mental health - NCSCT

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Smoking and mental health services is limited, as, for example, in secondary care settings, services should be provided in house. > As many people with mental disorders are managed by both primary and secondary care, provision of smoking cessation support in primary and secondary care settings requires coordination to ensure consistency. > Further research is urgently required to improve the design and content of cessation and harm reduction interventions in mental health settings, and to maximise access to and delivery of evidence-based support. Population strategies to prevent smoking in mental disorders > Population-level tobacco control policies have a significant effect on smoking prevalence in the general population by promoting quit attempts, and discouraging smoking uptake. > Although specific evidence on the effect of existing population-level policies in people with mental disorders is lacking, the stability of smoking prevalence in mental health populations over recent decades in the UK suggests that they are less effective in this group. > It may be possible to increase the impact of some approaches, such as media campaigns, by tailoring to the specific needs of mental health populations. > However, it is also important to capitalise on the opportunities presented by contacts with mental health services to intervene to support smoking cessation and harm reduction. > Smoking is, however, a widely accepted component of the culture of many mental health settings, making cessation more difficult for smokers. > Smoke-free policies are a vital means of changing this culture. > Smoke-free policies are more likely to be successful and effective if they are comprehensive, and can be implemented successfully in mental health settings with appropriate leadership and support strategies for patients and staff. > Training and support to overcome prevailing misconceptions and negative or indifferent attitudes towards treating smoking among mental health staff are urgently needed. > Provision of effective smoking cessation and harm reduction support for people who smoke is crucial in maintaining smoke-free policy. > 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. Smoking and mental disorders: special circumstances > Smoking, and particularly high levels of nicotine dependence, are especially common among people in forensic psychiatric settings and prisons, homeless people, and those with alcohol or other drug misuse. 198 © Royal College of Physicians 2013
Key conclusions and recommendations 11 > 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. > Smoking cessation interventions are effective among pregnant women but may be more so if tailored to the specific needs and co-morbidities of women with mental disorders. > Systematic and sustained intervention and support are necessary to maximise smoking cessation among pregnant women. > Child and adolescent mental health services, and local authority foster care and smoking policies, should explicitly protect children from passive smoke, and promote smoke-free foster homes. > 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. > 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. > In view of the current lack of evidence on safe, feasible and effective tobacco dependence treatment in the settings and populations covered in this book, further research is urgently required. The economic cost of smoking in people with mental disorders > The NHS spends approximately £720m per annum in primary and secondary care treating smoking-related disease in people with mental disorders. > These costs arise from an annual estimated 2.6 million avoidable hospital admissions, 3.1 million GP consultations and 18.8 million prescriptions. > Most of these service costs arise from people diagnosed with anxiety and/or depression. > Smoking increases psychotropic drug costs in the UK by up to £40m per annum. © Royal College of Physicians 2013 199
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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 and mental health - NCSCT

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