NHS Stop Smoking Services Perspective

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NHS Stop Smoking Services Perspective
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Background

• 26 of population in UK will have a mental health
  problem
• 30-50 of these will have depression
• 70 will have a mood disorder
• 70-90 will have schizophrenia

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Some facts..

• Smoking rates among adults with major depression
  are 2 times higher than those without depression
• People with mental health conditions are 10 times
  more likely to die of respiratory disease
• Life expectancy is 10 years less for those with
  long-term serious mental illness

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Schizophrenia

• Approx 200 000 people in UK have schizophrenia
• Smoke more cigarettes
• Take more puffs
• Extract more nicotine
• 4.5 times more likely to die of cardiac problems

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Summary

• Smoking is the single biggest cause of inequality
  in death rates
• People with MH problems are twice as likely to
  smoke
• This leads to further financial burden for these
  individuals
• Smoking impacts on their physical and mental
  health exacerbation of stress, anxiety and
  sleep disorders

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Smoking and mental health

• Smoking is a way to cope with anxiety symptoms
• Nicotine induces anxiety
• Relieves boredom
• Socialise
• Cope with side effects of medication
• Control symptoms

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Smoking and mental health

• Mental illness needs to be stable before quit
  attempt
• Treat depression prior to quit attempt
• 50 of people with mental health problems want to
  quit
• Less likely to be offered cessation support
• Should be encouraged!

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Smoke Free Mental Health

• There is good evidence that smokers with mental
  health problems can be helped to stop smoking
  (1)
• Smoke free policies encourage smokers to quit and
  make non smoking the norm
• 1. Health Development Agency 2004. Smoking with
  patients and mental health problems. London

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Involvement of Stop Smoking Services

• Training
• Help with PGD development and hospital admission
  assessment
• Data on mental health service providers
• Information for service users/providers
• Support to treatment providers

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PCT Stop Smoking Services

• Offer stop smoking clinics in a variety of
  settings
• Community Supermarkets, pharmacies, public
  houses, health centres, libraries, leisure
  centres etc
• Primary/secondary care
• Prisons

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PCT Stop Smoking Services

• Support available
• - one to one
• - group
• - drop in
• - home visit
• Aim to make services accessible to everyone

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INCLUDING

• Any age
• Light/ heavy smokers
• Different types of tobacco users
• People who are ready to quit/thinking about
  quitting
• Pregnant/breast feeding
• Every smoker treated as an individual!

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What support is offered?

• Pharmacological aids
• Motivational support from stop smoking advisor
• - identifying triggers
• - coping with withdrawal side effects
• - behaviour change/coping strategies
• Carbon monoxide testing

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Treatment in mental health

• Need to develop a detailed quit plan
• Need help in developing problem solving skills
• Role play refusal
• Same triggers but need help to identify warning
  signs of relapse
• Intensive follow up for longer

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Medication Issues

• Nicotine modulates cognitive function
• Nicotine may reduce depression
• Smoke affects some antipsychotic medication
  (Cytochrome p450 system)

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Difficulties for services

• Capacity
• Training
• Expectations
• Expertise
• Medication
• Conflicting priorities

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Food for Thought

• Stop smoking Services are very target driven
• Are our services flexible enough to meet the
  needs of people suffering from mental health
  conditions?