BESPOKE SMOKING
CESSATION FOR MENTAL
HEALTH
MAGGIE STRONACH
CLINICAL NURSE LEAD
Today talk
• Background on smoking prevalence in
mental health.
• Smoking cessation and mental health.
• Bespoke service
• Case studies
• What next?.
Smoking is not good for you
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Cancers
Chromic lung disease
IHD
Osteoporosis
Etc etc
‘Current cigarette smoking will cause 450
million deaths over the next 50 years’
Richard Peto
Nicotine dependence
1. Acts in the midbrain creating impulse to
smoke in the face of smoking-associated
stimuli
2. Changes in the brain chemistry to
produce ‘nicotine hunger’
3. Nicotine withdrawal: unpleasant mood
and physical symptoms that occur on
abstinence and are relieved by smoking
Mental health and smoking
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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)
The smoking culture in mental health
services
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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
SCIMITAR
Smoking 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.
What helps
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NRT
CUTTING DOWN TO QUIT
FLEXIBILITY
ASKING THE QUESTION
LONGER SUPPORT
Case study 1
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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.
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
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
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’
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