Smoking Cessation in Mental Health

1
Smoking Cessation in Mental Health

• In the beginning-
• Lack of support.
• Internal smoking rooms.
• Attitudes.
• People with mental illness, substance and alcohol
  abuse have
• enough trouble without the added stress of
  tobacco cessation.
• We have limited resources and need to set
  sensible priorities,
• this isnt one of them.
• If we stop smoking it will increase violence and
  aggression.
• Cigarettes have a positive side, they calm
  patients.
• Cigarettes can motivate patients.
• Bottom line-
• This isnt a priority for us!

2
Counterarguments

• Tobacco is the leading cause of death for
  patients.
• Smoking exacerbates mental illness symptoms.
• Impact of exposure to second hand smoke among
  non-smoking patients and staff is a serious
  issue.
• The bottom line is that evidence pouring in on
  the harm caused by second hand smoke means
  facilities are being mandated to go smoke free,
  there will be no choice.

3
Barriers

• Staff smoke in large numbers.
• Staff lack information and training on nicotine
  cessation.
• Tobacco use is not viewed as substance
  misuse/abuse.
• Staff and patients smoking together was viewed as
  therapeutic opportunity rather than a barrier.
• Smoking viewed as a reward.
• Lack of management support.

4
Misconceptions

• One drug at a time.
• Quitting smoking will jeopardise recovery.
• Patients dont want to quit.
• Violence and aggression will increase.
• Not the right time to quit.
• Staff will be unhappy.

5
Background

• People with mental illness are more than twice as
  likely to smoke than others.
• Roughly 60-95 of patients in addiction treatment
  are tobacco dependant.
• Of these individuals, roughly half of them smoke
  more than 25 cigarettes a day.
• Cigarette smoking appears consistently highest
  among people with psychotic disorders, but
  remains high also for depression, anxiety,
  substance abuse and personality disorder.

6
Background (continued)

• An estimated 200,000 smokers with mental illness
  and addiction die each year due to smoking in the
  U.S., a figure highly disproportionate to the
  number of those with mental health disorders in
  the general population. Patients with
  Schizophrenia smoke at 3 times the rate of the
  general population.
• Some studies show prevalence rates as high as
  90.
• Smokers with Schizophrenia experience increased
  psychiatric symptoms, hospitalisations and need
  for higher medication dosing.
• Often smokers require a doubling of medication
  dosage.

7
Smoking and Alcohol Dependence

• Smokers have 2-3 times greater risk for alcohol
  dependence than non-smokers.
• An estimated 80 of alcoholics currently smoke.
• Most alcoholics die from smoking related diseases
  than from alcohol related ones.
• Both founders of Alcoholics Anonymous died from
  smoking related diseases.

8
Smoking and other Substance Abuse

• Smoking rates are 2 to 4 times higher among drug
  addicts than the general population.

9
Second hand Smoke

• Second hand smoke contains 4000 chemicals, 50 of
  which are known carcinogens and 6 that negatively
  impact on childhood development and reduce
  fertility in both sexes.
• More non-smokers will die from exposure to second
  hand smoke than from any other air pollutant.
• Children of parents who smoke are at a higher
  risk for developing chronic coughing, wheezing,
  middle ear infections and asthma.
• Infants are 4 times as likely to die from SIDS if
  their mothers smoked during and after pregnancy,
  and twice as likely if their mothers stop smoking
  during pregnancy but resume again following
  birth.

10
Next Steps

• What did we do?
• Management support.
• How was this gained?

11
Challenges and successes

• Development of core organisational Trust meeting
  chaired by the Nurse Director aim to implement
  Policy.
• Specialised No Smoking in-patient Implementation
  Group meeting monthly, for support and problem
  solving.
• Membership of Groups
• Facilities involvement
• Written and agreed Trust policy
• Patients given information, choice, respect,
  honesty, and the opportunity to make decisions
  and feel in control of the process. e.g. PICU
  experience.
• Training of staff at Level 1 and Level 2 in
  Smoking cessation.
• De commissioned the internal smoking areas.
• Erected External Smoking Shelters and made safe
  external areas.
• Re-decoration of internal smoking rooms and
  change of use.
• Signage both internal and external.

12
Challenges and successes (continued)

• Educational resources/information for both staff
  and patients.
• Implementation of Care plans on admission plus a
  Health Screening tool.
• Introduction of Fagerstrom Tolerance
  Questionnaire.
• Weekly Pop In sessions on the unit run by the
  Level 2 trainers.
• All staff now trained at Level 1 able to take the
  opportunity to discuss at any time the
  possibility of quitting.
• There has been no increase in violence and
  aggression.
• Environments much better and cleaner internally.
• Patients sleeping much better.
• Patients requesting information on stopping
  smoking and although may not be stopping
  completely there is certainly evidence of
  patients cutting down on cigarettes and thinking
  more about quitting.
• Use of CO² Monitor very powerful.
• Training more accessible.

13
The changes and challenges following the
introduction of the Policy

• Management support
• Staff and Patients attitudes.
• Acknowledgement and Acceptance of Policy.
• Staff much more educated confident and
  knowledgeable.
• There has been no increase in violence and
  aggression.
• Environments much better and cleaner internally.
• Patients sleeping much better.
• Patients requesting information on stopping
  smoking and although may not be stopping
  completely there is certainly evidence of
  patients cutting down on cigarettes and thinking
  more about quitting.
• Use of CO² Monitor very powerful.
• Training more accessible.
• Written information and resources now available
  for both staff and patients.
• An increase in absconscions from 2 areas.

14
Challenges still to face and areas to develop

• Cleaning of external areas.
• Selling of cigarettes within locked/secure
  facilities? Cigarettes on sale in the hospital
  shop.
• Its a meaningful intervention and not just a care
  plan written and signed off.
• Level One training as an E Learning package.
  Introduction of Patient Group Directive re NRT.
• Introduction and development of a staff and
  patient information drop in re access to services
  and support in quitting smoking.
• Use of terminology Smoking Cessation V Nicotine
  addiction.