Smoking Cessation in Mental Health
News and updates from today’s conference
Service user perspectives on smoking cessation by Paul Scates, Senior Peer Specialist, Campaigner and Ambassador
- understanding the side effects of smoking
- how we can support service users to quit
- service user views on smoke free inpatient units
"Bigger Picture – smoking cessation and mental health services aren’t well linked together – we need to improve this.
Category of ‘healthy lives’ we are not doing well – need to look at whole person, include family and friends, diet, exercise, smoking.
Need to change culture of staff – need everyone on board. People with mental health conditions smoke at higher rates and more heavily addicted. They are just as likely to want to stop but more barriers – e.g. inpatient setting not conducive to stopping smoking e.g. tobacco is like a currency, its used in socializing etc.
If you don’t have support networks or are really unwell with mental health issues you don’t have any coping strategies for stopping smoking.
Need to address what is behind people’s behaviours – e.g. anger, why are they angry? Who/what are they angry with? The answers will give you a good idea of how to address the issues.
Cultural shift needed – will take time.
Mental Health Network, NHS Confederation report 2013 highlighted tobacco smoking is main cause of preventable and premature deaths in the UK.
22% of English smoke regularly. People with mental health problems - 33% up to 40% of patients with psychosis.
Strength of association increases with severity of disorder.
In mental health units, it is estimated that 70% of patients smoke.
So therefore mental health patients have higher rates onf diseases – circulatory, cancer, lung, diabetes.
Need to be proactively working with people.
Economics – smoking increases psychotropic drug costs in the UK by up to £40m a year.
What do they get from cigarettes? Belief that its calming symptoms when in fact the opposite is true. Relying on cigarettes to feel accepted in social situations. Boredom.
Almost seems as if we think lets ignore the smoking as they have other things (e.g. depression, psychosis) going on in their life more worrying…
Psychological therapy is more important than drugs – educating patients about their conditions and enabling them to take control.
Judith Prochaska 2011 addressed each of previous arguments and calls them myths. Need to raise smoking cessation to higher priority.
Human rights v a right to health – Rampton hospital judgement – smoking ban. Patients lawyers argued against this.
Whole system approach is what we need – trust wide collaborative partnerships, change culture, nurse led clinics, support groups, advice, involve family and friends.
Recovery – you live with conditions.
The mountain climb – show them the way up or they will come back down sharply.
Be the change you want to see in the world – Mahatma Gandhi."
The importance of smoking cessation in improving the physical heath of people with mental disorder by Professor Jonathan Campion, Director for Public Mental Health and Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust and Visiting Professor of Population Mental Health, University College London
- impact of smoking on mental health, physical health and mortality he facts around
- smoking, physical health and mortality in mental health
- impact of smoking cessation on mental health and physical health
- smoking cessation interventions in people with mental disorder
"Physical health – 17% of all preventable deaths in 2014 due to smoking
475k hospital admissions
Smokers vs non smokers die 10 years earlier average.
Impact of smoking in people with mental disorder:
Smoking = Largest single contributor to reduced life expectancy for e.g. depression 11 years (men), 7 years (women)
Adults – amongst drug dependants, 69% of them are also smokers.
Cessation – significant impacts improved respiratory, vascular, reproductive etc health.
In terms of mental health – wellbeing, self confidence, social interaction, depression, anxiety – at least as large and impact as anti-depressants.
Financial gains – 25% reduction in financial distress.
Pharmacological interventions – people with mental disorders may need these combined with their other therapies – are they complimentary? Tend to need treatments for longer than 8-12 weeks.
Weight gain – is a problem and can affect physical health, needs to be managed.
Current provision – most people with mental disorder receive no treatment for their smoking addiction so there is a problem with data.
Provision is totally inadequate – missed commissioning and provider opportunity.
Now is the time to act to provide comprehensive and coordinated smoking cessation services for people with mental disorders."
NICE guidance - evidence into action by Qasim Chowdary, Tobacco Control Manager Alcohol, Drugs and Tobacco Division, Public Health England
- brief advice for smokers
- managing nicotine
- smoke-free environments
Qasim is Tobacco Control Manager for Public Health England and leads on reducing smoking among people with a mental health condition. He has worked in public health and mental health roles for the NHS, Local Government and the Civil Service. He was recently awarded a MPH from the University of Nottingham and his research interests include e-cigarettes, local healthcare systems and health inequalities.
Future conferences of interest:
Improving Mental Health Crisis Care: Maintaining Momentum
Safeguarding Vulnerable Adults in Hospitals: Improving Safeguarding Practice & Outcomes
Masterclass: Using Psycho-Social Interventions to Help People with SMI Quit Smoking
21 October 2016