Smoking Cessation and Mental Health Environmental Context, Policy Issues,

1
Smoking Cessation and Mental HealthEnvironmental
Context, Policy Issues, Resources

• Gail P. Hutchings, MPA
• Behavioral Health Policy Collaborative
• Connie Revell
• Smoking Cessation Leadership Center
• July 26, 2007
• National Association of Psychiatric Hospital
  Systems

2
Unique environmental and contextual issues to
mental health

• How Does Mental Health Differ from Other Health
  Systems?
• Historical
• Social
• Political
• Financing
• Data and Technology
• Other

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Historical

• Centuries-old split between treating the mind
  vs. the body.
• Advent of psychiatric hospitals (asylums).
• Variety of organizational sequencing for State
  Departments
• Separation of State Mental Health Authorities
  from State Health Departments in many States
• Different from other partners of the Smoking
  Cessation Leadership Center (anesthesiologists,
  dental hygienists, etc.)

4
Social

• Stigma!
• Negative impact on help-seeking behaviors
• Social isolation
• Family disintegration
• Segregation (housing)
• Suspicion of criminal behavior despite the
  science
• Recovery as relatively new concept not
  universally embraced nor understood

5
Political

• Interpersonal-level
• Various power dynamics
• Involuntary commitment
• Lack of choice and control
• Traumatic experiences
• Other levels
• Persons with serious mental illnesses perceived
  as non-voters
• Ability to influence political dynamics?
• Inability to form united lobby across disability
  groups

6
Financing

• Large role and influence of States as payors and
  regulators
• Complex payment and reimbursement mechanisms
• Severely under-funded systems

7
Data and Technology

• Mental health has not been universally effective
  at using data to make the case for mental
  health treatment and services.
• Mental health typically lags behind technological
  innovations in healthcare (e-health records,
  etc.)

8
Smoking cessation as a newer issue

• Historical use of cigarettes as behavior
  modification/control in psychiatric settings.
• Relatively recent focus on health and wellness
• Clash of emerging sense of inappropriateness of
  health care settings encouraging/permitting
  smoking.
• New data re people with serious mental illnesses
  dying on average 25 years earlier than non mi
  peers.

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Policy and practice issues

• Consumer rights issue?
• When is the right time to address smoking with
  consumers?
• Considerations Crisis Short-length hospital
  stays co-occurring disorders etc.
• Payment and reimbursement issues (or lack of
  specific financing-related information)
• Lack of data on intervention/cessation
  effectiveness for inpatient and outpatient
  settings.

10
Policy and practice issues (contd)

• New drugs for treatment what are the
  interactive effects with psychotropic
  medications?
• State-level Smoking Quitlines (1-800-QUIT NOW)
• Efficacy data exists, but appropriate/effective
  for mental health consumers? Need data

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Recent Developments

• NAMI Position Statement
• NASMHPD Position Statement
• National summit of key national mental health
  national organizations held March 2007 and
  sponsored by the Smoking Cessation Leadership
  Center.
• Led to new National Partnership on Wellness and
  Smoking Cessation.
• Members NAPHS, NASMHPD, National Alliance on
  Mental Illness, Mental Health America, Depression
  and Bi-Polar Support Alliance, NASW, ( approx.
  20 other organizations and growing)
• Developing a national action agenda

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Key Resources

• New! Smoking Cessation Leadership Center website
  mental health section http//smokingcessationle
  adership.ucsf.edu/MH_Resources.html
• New! NASMHPD Tool Kit, Tobacco Free Living in
  Psychiatric Settings http//nasmhpd.org/general_
  files/publications/NASMHPD.toolkit.FINAL.pdf
• New! Mental Health Provider Toolkit for Smoking
  Cessation from the Colorado State Tobacco
  Education and Prevention Program (STEPP). For
  now, contact Jeanette.Waxmonsky_at_UCHSC.edu
• NAMI Position Statement http//www.nami.org/Conte
  nt/NavigationMenu/Inform_Yourself/About_Public_Pol
  icy/NAMI_Policy_Platform/NAMI_public_policy_platfo
  rm_Nov2006.pdf (see Section 7.3)
• NASMHPD Position Statement http//www.nasmhpd.org
  /general_files/position_statement/Smoking20Positi
  on20Statement.pdf

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Final thoughts

• The data is simply too compelling re loss of
  life and function to continue to ignore the
  issues of smoking and mental illness any longer.
  This is a leadership issue as much as it is a
  policy and practice issue.
• We must address staff-related smoking prevalence
  and quitting. Otherwise, culture change will not
  occur.
• We often tend to leap to the worst case
  scenarios what we are really talking about at
  this point is offering EDUCATION and ACCESS to
  smoking cessation resources (medications, groups,
  quitlines, etc.).