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Smoking Cessation in Mental Health Speaker Presentations

News and updates from today's conference in London focusing on smoking cessation in mental health including; ensuring your service effectively supports people with mental illness to stop smoking and does so within a smoke free environment, which is key to the government ambition for parity of esteem and reducing the lower life expectancy of people with mental health disorders.

The conference opened with a presentation from Paul Scates Peer Specialist Campaigner and Ambassador on the ‘Service user perspectives on smoking cessation’. Followed by a presentation from Dr Jonathan Campion Director for Public Mental Health and Consultant Psychiatrist South London and Maudsley NHS Foundation Trust Visiting Professor of Population Mental Health University College London on ‘The importance of smoking cessation in improving the physical heath of people with mental disorder: The evidence’. Jonathan discussed:

  • Impact of smoking
  • Smoking cessation and reduction interventions
  • Prescribing considerations
  • Provision of smoking cessation for people with mental disorder
  • Public mental health context of smoking
  • Assessment of local levels of smoking and associated harm
  • Assessment of local size and cost of smoking cessation intervention gap to inform commissioning

In his presentation Dr Jonathan Campion Stated: 

 “Compared to the general population, people with mental disorders are more likely to smoke, smoke more heavily and experience disproportionate levels of smoking associated harm”

“The proportion of tobacco consumption in England by adults with: Mental disorder: 42%. Anxiety and depressive disorders (common mental disorder): 31%”

 “Smoking also increases risk of developing mental disorder”

“Smoking during pregnancy associated with - 2-fold increased risk of conduct disorder in boys at age 3 (Hutchinson et al, 2010) and 2-fold increased risk of antisocial behaviour and ADHD in older children (Button et al, 2007)”

“Benefits of smoking cessation in Mental Health…Improved mental health/wellbeing, self-confidence, social interaction (RCP/RCPsych 2013) …Reduced depressive and anxiety symptoms (RCP/RCPsych 2013)…Impact of cessation on mood and anxiety disorders at least as large as antidepressant treatment (Taylor et al, 2014) – important for all providers of treatment for common mental disorder such as IAPT …Pharmacotherapy minimises withdrawal symptoms which are relatively short lived”

“Benefits of smoking cessation even greater for people with mental disorder given 10-20 year lower life expectancy”

“Smokers with mental disorder - as motivated to stop as smokers without mental disorder”

“Evidence based smoking cessation interventions effective for people with mental disorder”

“Greater levels of cessation/ reduction in people with mental disorder by combined pharmacological interventions at higher doses and behavioural support……as for other people with higher levels of nicotine dependence”

“Combination NRT for people with mental disorder more effective and required for longer than 8-12 weeks”

“Bupropion almost triples cessation rates at 6 months for those with schizophrenia with no reported serious adverse events”

“For smokers with mental disorder motivational interviewing increases referrals for smoking cessation”

“Depressive symptoms may worsen in a minority of people following cessation, but need to take account of impact of cessation on reduced anxiety/ depression and physical health”

“Most people with mental disorder receive no treatment for their mental disorder…Far fewer receive appropriate treatment for associated physical health problems or health risk behaviour…Largest proportion who do receive treatment do so from primary care…3% of adults receive treatment from secondary mental health services – over 95% from community secondary mental health services”

“Key reason for the perpetuation of the 10-20 year reduced life expectancy of people with mental disorder is that only a minority of smokers with mental disorder receive any help - in most areas, size of unmet need not even assessed”

“Important to ensure coordinated provision of smoking cessation interventions across different sectors in order to effectively address smoking and its impacts on both mental and physical health”

“Stopping smoking requires immediate reduction of doses of some antidepressants, antipsychotics and benzodiazepines by up to 25% within 1st week and up to 50% within 4 weeks”

“People with mental disorder receive lower rates of smoking cessation support despite higher smoking rates and associated lower life expectancy”

Dr Jonathan Campion Biography:

Jonathan is Director for Public Mental Health and Consultant Psychiatrist at South London and Maudsley NHS Foundation Trust, and Visiting Professor of Population Mental Health at University College London.

Jonathan is involved in the development and implementation of national and local public mental health strategy. He has worked with local authorities in England covering more than 7 million people to assess the local size, impact and cost of the public mental health intervention gap including for smoking cessation in those with mental disorder. He is co-author of a RCP/RCPsych report on smoking and mental disorder (2013) and was part of the NICE committee which produced guidance on smoking cessation in secondary care including mental health services (NICE, 2013). In 2014, he updated primary care guidance on smoking and mental disorder. He contributed to recent PHE guidance on smoking cessation in secondary mental health settings.

Between 2008 and 2011, Jonathan was policy advisor and public mental health evidence lead at the Department of Health. During this time, he contributed to two cross government mental health strategies, a public mental health strategy and the public health white paper as well as work with the LSE to estimate savings from a range of public mental health interventions.

Following the morning tea break Jane Beenstock Consultant in Public Health and Sarah Heys Service Manager Lancashire Care NHS Foundation Trust delivered an extended session on ‘Developing a smoke free organisation’ and discussed developing a smoke free organisation sharing our challenges and successes, with a particular focus on specialist services.

Jane Beenstock Consultant in Public Health and Sarah Heys Service Manager Lancashire Care NHS Foundation Trust Full Presentation Click Here

In there presentation Jane and Sarah stated: 

“Our specialist services network comprises of Secure mental health (inpatient and Community) and health and justice…we offer ……physical and mental healthcare, social care, substance misuse services and a range of therapy services to a population of over 4,000 people, predominantly in prisons and secure settings. We also provide community outreach services throughout Lancashire and South Cumbria across a range of specialities.”

“We …..are fully committed to improving the health outcomes and maintaining safety for the population of service users and communities….have a focus on rehabilitation, support and integration, services support inclusion and the reduction of re-offending.”

“Our Starting point, Five facilitated smoke breaks daily for service users, Disruption to therapeutic activities, Drain on nursing staff capacity, Clinical time spent completing additional safety and security checks, Additional breaks for staff smokers and Clinical staff frequently exposed to second hand smoke”

“Where we are now 20 staff trained as level 2 champions, Violence and aggression has reduced, particularly in the ABI service, Support from MDT members, creation of the consultant charter, Very few staff continue to smoke on duty and Culture shift towards being a health and wellbeing organisation, viewed less as a ban”

“We are trying to not use the term smoking band – it is very much about facilitating a health lifestyle”

“The challenges - Staff (personal and professional) The therapeutic relationship, Restrictive practice, Capacity issues, Right to choose?, Personal smoking habits, Cultural beliefs about smoking, Inconsistent approach across sites, Inconsistent NRT prescription and Conflict of leave prescriptions”

“One of the things we had to make clear is we could not have staff coming back from a break smelling of smoke and had to have conversations about why its important that we are going smokefree”

“Challenges – training and NRT, Time to releases staff and knowledge and skills to use NRT”

“We had to adapt the 2 days training to 1 day and onsite to ensure the staff could do the training and be available for it”

“We offered staff that smoke free NRT’s from the trust to help the process”

“Challenges – Services users – Subversions and Security – we have services hiding cigarettes around the grounds of the hospital”

“If some one wants to smoke it’s a powerful addiction and sometime hard to deal with”

“External challenges – the media – we did a press release to say we where doing this great thing and the headlines were outrage: East Lancashire NHS Chiefs ban smoking at all mental health facilities”

“External challenges – local community – residents did not like patients smoking on the street as they were not able to open windows, people smoking outside the trust on the street, increasing littler and passive smoking for local residents. We set up discussions with the local residents and services users to come to a conclusion and things have improved.”

“Successes - Regular meetings with local residents, Wards no longer store nicotine products, Leave is only prescribed for therapeutic purposes (consultants charter), Positive feedback from staff and service users and Staff report when they have been exposed to secondary smoke”

“We now have 25 services users that are smoke free and have stayed smoke free – we feel this is a great achievement. We decided to celebrate this with rewards and vouchers”

“Our learning has been Always celebrate the successes, Keep working with the challenges, Have conversations with everyone about what you are trying to achieve and why and Challenge the smoking culture at every step..”

“Above all it’s the culture that matters”

Jane Beenstock Biography:  

Jane Beenstock is a consultant in public health working for Lancashire Care NHS Foundation Trust. Before joining the specialty training programme (in the North East) she was a manager, mainly in physical acute services and primary care services, working in London and the North West.  

Sarah Heys Biography:

Sarah Heys is a mental health nurse managing Guild Lodge, a secure mental health unit for Lancashire Care NHS Foundation Trust. Sarah has experience of working in a variety of mental health services across Lancashire and is also a trained violence reduction instructor.

Following the lunch break Emily James Policy and Campaigns Officer Action on Smoking and Health discussed ‘The Stolen years: The Mental Health and Smoking Action Report’ and covered:

  • offering harm reduction approaches to those who are not ready to quit
  • implementing the new NICE Quality Standard
  • how do we integrate a harm reduction approach into stop smoking services?

Emily James Policy and Campaigns Officer Action on Smoking and Health Full Presentation Click Here

Emily James Presentation Abstract:

While smoking rates amongst the general population have fallen dramatically in the past few decades they remain stubbornly high amongst people with mental health condition. In fact smoking rates are more than double amongst people with a mental health than that of the general population and this group accounts for around one third of adult tobacco consumption in the UK.

The severe consequences of this, which contributes to people with a mental health condition dying on average 10-20 year earlier than those without, are simply unacceptable.
In light of these growing inequalities ASH has produced a new report The Stolen Years: A Smoking and Mental Health Action Report. The report written in collaboration with Rethink and the Royal College of Psychiatrists and endorsed by 27 health and mental health organisations, challenges defeatist assumptions that addiction to smoking amongst people with mental health conditions is either inevitable or intractable: it is not.

Our ambition is that smoking among people with a mental health condition declines to be less than 5% by 2035, with an interim target of 35% by 2020. The report sets out recommendations for how this can be achieved. This includes improved training of healthcare staff, better access to stop smoking medication and a move towards smokefree mental health settings.

This is an undeniably ambitious target and there is no single measure that will help us get there. If we are to achieve our ambition and drive real change in this area all parts of the health and social care system from national government through to local authorities, the NHS and care providers will need to play their part. Key areas for action include:

  • National targets and leadership to drive action across the country
  • A strong focus on the skills and training of the workforce
  • Availability of evidence-based services alongside peer support for all those who need them
  • Better access to the medications that will help people to quit
  • Improved understanding that electronic cigarettes provide a less harmful alternative to smoking
  • Moving to smokefree mental health settings alongside provision of the right support to smokers

Emily James Biography:

Emily James is Policy & Campaigns Officer for ASH. Prior to working for ASH, Emily worked at the British Red Cross and in advertising. She holds an MSc in International Development from the University of Bristol and a BA in History from the University of Birmingham. At ASH, Emily has been involved in the campaign for standardised packaging, communicating information to local areas and Parliamentarians and supporting the Smokefree Action Coalition. She has been involved in ASH’s work surrounding Health Inequalities and more recently worked with colleagues to support the production of ASH new report: The Stolen Years: A Smoking and Mental Health Action Report and led on two surveys, the results of which were used to inform the report.  

The conference continued with presentations on:

  • Quitting cannabis: What works and what are the benefits?
  • The role of e-cigarettes
  • EXTENDED SESSION: Changing culture and attitudes in staff and patients

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