Smoking and mental health - NCSCT

More documents

Recommendations

Info

Smoking and mental health > Achieving cessation in 25%, 50% and 100% of people with mental disorders would, respectively, result in a gain of 5.5 million, 11 million and 22 million undiscounted life-years in the UK. At 3.5% discounting, the corresponding figures are 1.4, 2.7 and 5.4 million life-years gained. > Harm reduction through lifelong substitution with medicinal nicotine is highly cost-effective when compared with continuing smoking, at around £8,000 per quality-adjusted life-year (QALY) gained for lifetime nicotine patch use and £3,600 per QALY for inhalators. > Addressing the high prevalence of smoking in people with mental disorders offers the potential to realise substantial cost savings to the NHS, as well as benefits in quantity and quality of life. Ethical and legal aspects > The entitlement of people with mental disorders to smoking cessation support is at least as strong as that of the general population. > Their need for such support is in many cases actually greater. > Patients with mental health problems should receive at least the same level of access to smoking cessation treatment and aids to quitting as members of the general population. > The objectives of smoking cessation and tobacco control policies in the mental healthcare context need to take account of 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 needs to be struck between personal rights and welfare, the objectives of the institutions, and the rights and interests of other staff and residents/inmates. > There is a need for greater investment in smoking cessation treatment in the mental healthcare context. > Smoke-free policies in mental health institutions, as in other public places, are justified on the grounds of health and wellbeing of non-smoking patients and staff. > The moral imperative of healthcare institutions to promote the mental and physical health of their patients (and to protect and support the mental and physical health of their staff) justifies a shift in culture within mental health institutions away from one that supports smoking. Overall conclusions > Smoking is extremely common in people with mental disorders, causing major reductions in life expectancy and quality of life, exacerbating poverty and presenting major economic costs to the NHS and wider society. 200 © Royal College of Physicians 2013
Key conclusions and recommendations 11 > Despite consuming a large proportion of tobacco in the UK and being heavier smokers, only a minority of people with mental disorders receive effective smoking cessation interventions. > Prevention and treatment strategies to date have made little if any impact on smoking in this population. > This failure does not arise from substantially lower motivation among smokers with mental disorders to quit smoking. > It is likely that the persistent acceptance of smoking as a normal behaviour in primary and secondary care, and failure by health professionals to address smoking prevention as a health priority, drives and perpetuates the high prevalence of smoking in people with mental disorders. > This persistent high prevalence of smoking reflects a major failure of public health and clinical services to address the needs of a highly disadvantaged sector of society. > There is a moral duty to address this problem in the future, and to prioritise the rights of people with mental disorders to the same protection and health interventions as the general population > Smoke-free policy is crucial to promoting smoking cessation in mental health settings. > All healthcare settings used by people with mental disorders should therefore be completely smoke free. > Smokers with mental disorders using primary and secondary care services, at all levels, should be identified and provided routinely and immediately with specialist smoking cessation behavioural support, and pharmacotherapy to relieve nicotine withdrawal, promote cessation and reduce harm. > Commissioners should require mental health service settings to be smoke free, and to provide support for cessation, temporary abstinence and harm reduction. > Service indicators, such as the primary care Quality Outcome Framework (QOF) and Commissioning for Quality and Innovation (CQUIN), should measure and incentivise cessation, not just delivery of advice to quit. > All professionals working with or caring for people with mental disorders should be trained in awareness of smoking as an issue, to deliver brief cessation advice, to provide or arrange further support for those who want help to quit and to provide positive (ie non-smoking) role models. Such training should be mandatory. > There is no justification for healthcare staff to facilitate smoking. > Research funding agencies should consider encouraging and investing in research to address this major cause of ill-health, and health inequalities, in British society. © Royal College of Physicians 2013 201
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:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
6 Population strategies to prevent
Page 127 and 128:
Population strategies to prevent sm
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Smoking and mental disorders: speci
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164: 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: Key conclusions and recommendations
show all

Smoking and mental health - NCSCT

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?