BESPOKE SMOKING CESSATION FOR MENTAL HEALTH

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BESPOKE SMOKING CESSATION FOR MENTAL HEALTH

• MAGGIE STRONACH
• CLINICAL NURSE LEAD

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Today talk

• Background on smoking prevalence in mental
  health.
• Smoking cessation and mental health.
• Bespoke service
• Case studies
• What next?.

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Smoking is not good for you

• Cancers
• Chromic lung disease
• IHD
• Osteoporosis
• Etc etc
• Current cigarette smoking will cause 450 million
  deaths over the next 50 years Richard Peto

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Nicotine dependence

• Acts in the midbrain creating impulse to smoke in
  the face of smoking-associated stimuli
• Changes in the brain chemistry to produce
  nicotine hunger
• Nicotine withdrawal unpleasant mood and physical
  symptoms that occur on abstinence and are
  relieved by smoking

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Mental health and smoking

• People with a diagnosis of Schizophrenia die on
  average 15-20 yrs younger than the general
  population. (Thorncroft, 2011, Chang et al 2011,
  Tiihonan et al 2009)
• Prevalence rates as high as 70
• Smokers with MH problems tend to be more
  dependant heavy smokers needing specialist
  support.. (Mental Health Foundation 2007)

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The smoking culture in mental health services

• Elevated smoking rates amongst MH staff
• Staff smoke with users of services
• Means of pacifying distressed people in inpatient
  settings
• Lack of stimulation and relief of boredom in
  inpatient units
• Access to cigs is a source of conflict and
  control between staff and users (between users of
  services)
• The cigarette economy of institutions
• Non-smokers initiated in smoking upon admission
• Lawn 2004 Hempel et al 2000

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SCIMITARSmoking Cessation In Mental ILL Health
Trial

• Pilot study to compare the effects of standard
  smoking cessation services against a bespoke
  service, for people suffering from SMI.

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What helps

• NRT
• CUTTING DOWN TO QUIT
• FLEXIBILITY
• ASKING THE QUESTION
• LONGER SUPPORT

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Case study 1

• 65 year old gentleman with 40yr hx of smoking
• Diagnosis of bi-polar
• Starting to affect his breathing and general
  physical health.
• Other attempts failed when mood dipped
• Cutting down to quit
• Wife's support
• Two nrt products
• Included mental health worker
• Relapse prevention plan
• Longer involvement.

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CASE STUDY

• 48 yr old been smoking since 14
• Was smoking up to 100 roll-ups a day
• Had come off hard drugs in the past, said
  stopping smoking was harder
• Tried cold turkey
• Cut down to quit
• Electronic cigarette and 2 NRT products.
• Quit over 6 months

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WHAT NEXT

• Smoking cessation training for mental health
  staff.
• Embed in services
• As part of wider physical health checks
• Asking the questions
• Sharing stories and strategies

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Mode of delivery

• Who?
• Mental health staff
• With additional training
• NHS-assured Level II training and competencies
• How?
• Telephone, and face to face
• Group support?
• One stop shop

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REFERENCES

• Schizophrenia commission 2012
• www.ncst.co.uk (National Centre for Smoking
  Cessation and Training)
• ASH (action on smoking and health) www.ash.org.uk
• Smoking and mental health The Mental Health
  Foundation www.mentalhealth.org.uk
• www.nhs.uk/smokefree