caring Communication

all with a clear focus on managing risk and
ensuring safety. It includes information and
suggestions on the governance and leadership
required to implement the policy, development
of an action plan for implementation,
and communicating the policy with all those
concerned for example there are template
signage designs and a press release included
within the resource.
Tools
In addition there are tools to support staff to
assess levels of nicotine addiction among clients
and direction on providing best practice
treatments options to tobacco dependent
clients. There is detail on training options
to ensure staff access appropriate training,
tools on how to carry out a comprehensive
risk assessment process around tobacco use
and to assess the key criteria to be considered
in the development of an exemption process.
Finally, there are a variety of other resources
to support auditing and compliance monitoring
in preparation for a potential audit on implementation
within your service.
Who is it aimed at?
We would suggest that all TFC policy leads
and members of TFC local groups familiarise
themselves with the resource and supporting
tools, in an effort to minimise work and build
the foundations for successful policy implementation.
For more information go to www.
hse.ie/tobaccocontrol
Feedback
Send your feedback on using this resource to
miriam.gunning@hse.ie
If you are a smoker and
would like support to QUIT
contact
Freephone: 1800 201 203 and visit
www.quit.ie and www.facebook.com/HSEquit
EMAIL: QUIT on support@quit.ie | FREE TEXT
QUIT: 50100 | TWEET QUIT : @HSEQuitTeam
Tobacco Free in Mental
Health Services
Health and Wellbeing in conjunction with the Mental Health Division launch a briefing document
on ‘Smoking Cessation and Mental Health’. Research shows that people with a mental illness tend to
smoke more heavily and be more dependent on nicotine than those without a mental illness. However,
they are just as likely to want to stop smoking but often lack confidence in their ability to quit and
historically have not routinely been offered specialist support to quit. The implementation of Tobacco
Free services in mental health and the introduction of tobacco dependence treatments into routine
care are some of the many measures helping to address this issue.
How big a problem is tobacco addition?
Currently in Ireland, 19pc of Irish people aged 15 plus are reported as daily smokers and 4pc as occasional
smokers (Healthy Ireland Survey, 2015). There is no definitive data available on smoking rates
among adults with mental health conditions as yet. Further cross referencing studies are ongoing
using the recently acquired Healthy Ireland data in 2015. However in the UK, smoking rates among
adults with a common mental disorder such as depression and anxiety are almost twice as high compared
to adults who are mentally well and three times higher for those with schizophrenia or bipolar
disorder. Those with substance use disorders, with or without a co-morbid mental health problem,
have the highest rates of smoking. In every area of mental health, even child and adolescent mental
health services, perinatal psychiatry and older adults care, smoking rates are disproportionally high.
It is estimated that people with a mental health or substance use problem buy approximately 42% of
the tobacco sold in the UK.
How do we address the inequality that presents itself?
The HSE’s Healthy Ireland Implementation plan 2015-17 in conjunction with ‘Vision for Change‘ have
prioritised work which tackles inequality in health care. The implementation of Tobacco Free services
in mental health and the introduction of tobacco dependence treatments into routine care is one of
the many measures helping to address this health inequality. Recording tobacco use at every service
contact point, offering brief advice, cessation medication and specialist support to quit can have
an enormous impact on quitting levels. The roll out of the policy commenced in 2015, with many
approved and residential services making that all important change. There has been tremendous
work in this regard with CHO 2 (Mid Western Mental health Services) and CHO 8 (Laois, Offaly, Louth,
Meath and West Meath) taking a co-ordinated approach by establishing working groups, consulting
with stakeholders, providing training for staff, cessation support and medication and instigating a
phased approach to the roll out of the policy within their services.
Targets for 2016
This year’s target is to have all approved units tobacco free by the end of 2016. It is certainly acknowledged
that implementation of the policy presents a significant challenge. It is hoped that the journey
to tobacco free will be smoother with the shift in mindset and cultural change already seen in a number
of services, along with the online suite of tools and resources already developed.
For more information on smoking cessation and mental health, tobacco cessation training opportunities
and to download the new briefing document on smoking cessation and mental health go to the
‘Brief Intervention Training’ section on hse.ie/tobaccocontrol
What is the impact of smoking on our general health and
on our mental health?
The combined evidence of thousands of published scientific papers confirms that there is undisputable
evidence that tobacco use has detrimental health effects for those who use tobacco and for
those exposed to second-hand smoke (SHS).
Second hand or passive smoke as it is otherwise known is defined as a class ‘A’ carcinogen by the
US Surgeon General’s Report. Research tells us that half of all smokers are killed as a direct result of
their smoking, and half of them die prematurely. On average, smokers lose 10 healthy quality years
of life. Tobacco use is a significant cause of ill health (particularly chronic illnesses) and mortality in
the population and as smoking is more common among lower socio economic groups it exacerbates
health inequalities. Evidence shows that those who smoke cigarettes have more severe mental health
symptoms, require higher doses of psychotropic medication and spend more time in hospital, compared
to people with a mental illness who do not smoke. They spend more of their disposable income
on cigarettes and often prioritise cigarettes over food and leisure activities.
While those with a mental illness tend to smoke more heavily and be more dependent on nicotine
than those without a mental illness, they are just as likely to want to stop smoking but often lack confidence
in their ability to quit and historically have not routinely been offered specialist support to quit.
spring 2016 | health matters | 49