Smoke Free Mental Health

1
Smoke Free Mental Health

• Karen Harris
• Stop Smoking Support Service Co-ordinator
• Chelmsford PCT
• Witham Braintree and Halstead CT

2
Introduction

• Choosing Health (Nov 2004)
• - All NHS sites will be smoke free by the end of
  
• 2006.
• Health Bill
• - Less than 6 month stay no exemptions
• - More than 6 month stay limited exemptions
• 34,000 people resident in mental health
  facilities in England and Wales on any one day.

3
Rationale

• Protect and improve the health of patients and
  staff.
• Protect smokers and non-smokers from the danger
  of exposure to second-hand smoke
• Reduce sickness and absenteeism
• Reduce costs
• Improve productivity
• Most smokers want to stop smoking (70)
• Comply with legislation (Health and Safety)
• To set an example, particularly as we work in a
  health care environment

4
Statistics in mental health

• 25 of current UK population smokes
• (9 heavy smokers)
• Psychiatric patients in hospital 70 smoke (50
  heavy smokers)
• People with mental illness in the community 40
  smoke
• (30 heavy smokers)
• Heavy smokers consume more than 20 cigarettes
  a day.

5
Why Smoke Free?

• Smoking kills approx 106,000 annually
• Prevalence of smoking in psychiatric patients is
  nearly 3x higher (74) than the rate in the
  general population (25)
• Twice as likely to die from CHD and cancer
• Up to 50 of staff smoke
• Duty of care under the Health and Safety at Work
  Act
• 70 still wish that they could stop.

6
Planning Smoke Free

• Regular consultation with staff and patient
  groups, to explain reasons for policy and listen
  to fears and objections
• Provide information for staff and service users
  on the forthcoming ban and its effects
• Training for staff in smoking support and NRT,
  discussions in different ways to manage patients
• Provision of NRT for staff and patients
• Planning the closure of current smoking rooms

7
Planning Smoke Free Cont.

• Co-ordinate with community health teams and
  support service for provision of support upon
  patient discharge and outpatients.
• Regularly check compliance
• Be consistent at all times
• Contact support service to arrange support for
  staff and patients
• Create alternative activities to interest patients

8
Key issues to implementation

• Staff fears
• Fear of aggression
• Effect on drug therapy
• Part of social activity
• Additional work load
• Compliance
• Managing nicotine withdrawal at a time of stress
• Estate variances

9
Key elements to success

• Clear policy key champion
• Implementation guidance
• Consultation staff, managers and service users
• Information for staff, visitors, users
• Staff training and briefing
• NRT prescribing guidance
• Stop Smoking Service Support
• Monitoring and evaluating
• Lead in period
• Consistency

10
Summary

• Problems with consistency
• Problems with compliance
• Problems with estate variances
• Staff pressures