The NHS Five Year Forward View says that by 2018, all inpatient units should be smoke free. This provides an opportunity to:
- increase quit rates
- release time through reduction in escorted smoking breaks
- start the required cultural change towards smoking cessation
- extend the learning, skills, leadership and systems required to deliver this organisational level change to community settings.
There is still more that can be done to achieve a reduction in smoking rates among people living with serious mental illness (SMI).
Actions to take
- Improve preventative messaging.
- Commissioners and providers to look to more evidenced-based interventions, increasing coverage. and uptake of tailored services across a number settings, including stop smoking services.
- Develop simple and clear systems to support local referrals to stop smoking services.
- Adjust contracts for stop smoking services to support those living with SMI who may have different needs (e.g. longer treatment courses) and different targets (e.g. smoking reduction rather than quit targets) to the general population.
- Develop a strategy using existing levers to scale up and improve quality of multi-level stop smoking interventions across sectors, ensuring it includes work to address:
- Population planning
- Leadership and oversight mechanisms for delivery
- Indicator development, data quality and data sharing
- Pathway mapping including: health promotion, screening, referral and treatment interventions across sectors and settings
- Workforce strategies to skill up and scale up statutory, non-statutory, professionals and non-professionals in the stop smoking agenda
- Innovation to optimise other preventative agendas and initiatives across organisations, communities and government agencies
- Mapping and quality review of existing services for the presence of reasonable adjustments so those living with SMI can benefit equally.
- Primary care and community services need to ensure ongoing support and interventions are continued once individuals are discharged, to further build on the impact of inpatient efforts.
Tools to help you
The Smoking Cessation Intervention for Severe Mental Ill Health (SCIMITAR) Trial This paper is the first to present a highly promising bespoke intervention for smokers with severe mental health disorders. Further research is now required to examine both bespoke programs and general smoking cessation interventions for those with mental ill health to determine the most clinically effective and cost-effective form of treatment.
Right From The Start – y-QUIT: Keeping Your Body In Mind y-QUIT – KEEPING YOUR Body IN MIND is a guide for people experiencing psychosis or other mental health issues & want to quit smoking.
Smokefree policies in mental health inpatient services – Brief guide from Care Quality Commission. This document sets the context, provides the evidence, highlights what you need to consider, and identifies linked regulations.
Public Health England Smokefree mental health services in England- implementation document for providers of mental health services. Provides guidance and a self-assessment framework for mental health trusts to reduce smoking use and prevalence through developing local actions.
The Royal College of Physicians and Royal College of Psychiatrists 2013 report- Smoking and Mental Health. Provides an overview of the substantial evidence indicating that only a minority of smokers with SMI are receiving successful interventions provided by the NHS. “This report covers the incidence of smoking in people with mental health disorders; cessation interventions; smoking in special circumstances such as forensic psychiatric services, secure units and prisons; costs to the NHS; and the ethical and legal aspects of smoking in people with mental health disorders.”
National Audit of Schizophrenia. A clinical resource aiming to support the implementation of the physical health Commissioning for Quality and Innovation (CQUIN) to improve the physical health monitoring of people living with SMI.
There are a range of pharmacotherapies and behavioural interventions that are effective in supporting the management of nicotine addiction.
NICE has identified these in successive guidance, most notably PH10, PH28, PH45 and PH48. These, and other commonly delivered interventions, are described and the evidence for them is rated in the NCSCT local stop smoking service and delivery guidance 2014.
- NICE guidance PH48 = support in mental health settings
- NICE guidance PH45 = for those who find it difficult to give up completely
Economic Analysis – Cost effectiveness of smoking cessation interventions
- Priorities for Mental Health: Economic report for the NHS England Mental Health Taskforce
- Investing in recovery – making a business case for effective interventions for people with schizophrenia and psychosis. A Rethink Mental Illness resource.
- Local Resources on Action on Smoking and Health (ASH) website, including: