1. Providing Sustainable Tobacco Cessation Services to the Mental Health Community Beth Lillard, BA Evelyn Castillo, MPH A Program of Bay Area Community Resources. In collaboration with Marin County Tobacco Education Program. Funded by MSA.

2. CharynSutton 4.6.1947 – 12.30.2004

3. Once upon a time….. ‘Providers’ ‘Clients’ and ‘Patients’ a few ‘Questioners’

4. Questioners from the field: Questioners from the field: Lowell Dale, M.D., Mayo Clinic Douglas Ziedonis,M.D., and Bernice Order-Connors, LCSW, University of Medicine and Dentistry of New Jersey Phillip Gardiner, DrPH, TRDRP SANE Australia David Staba, Editor, Schizophrenia Digest

5. Some of the Questioners in Marin County: Lou Anne Sweaney, FNP, CMH Richard Glass, MD, CMH Karen Balsamico, Mental Health Consumer Evelyn Castillo, MPH, BACR Amy Rogers, OTR/L, Linda Reed Day Services Alan Jamison, Program Director, Canyon Manor

6. Mental Health & Tobacco Cessation Working Group BACR Tobacco Program Staff Directors of Community Mental Health Services Nurses…Physicians…Psychiatrists Mental Health Agencies Consumer Advocates Peer Counselors Case Managers

7. The Challenge: Ask Linda Reed Day Services Survey* N=47 72% smoke currently (average: 17 cpd) 88% of smokers have attempted to quit 88% perceive negative health effects 65% have a desire to quit within the year * Unpublished survey conducted by Amy Rogers, OTR/L, Linda Reed Day Services, 2004.

8. Linda Reed Day Services BACR staff/client trainings ‘Quitters’ Club’ ‘Smoking Area’ Committee 2 peer-led quit groups added Quit group institutionalized as part of recovery and socialization programs

9. Canyon Manor BACR staff/patient trainings Positive patient feedback ‘No Smoking’ area created – The Gazebo Nicotine patch program developed Tobacco cessation program expands to staff

10. Lessons Learned: Mental health clients DO want to quit smoking! Harm reduction can be a goal Multi-disciplinary support for individuals * Keep attending physician/psychiatrist updated on cessation progress and NRT use Working group facilitates resource-sharing * It’s O.K. to say, “I don’t know, but I’ll find out.”

11. Why Integrate Tobacco Cessation and Mental Health Services? Smokers suffering from mental illness account for nearly half (44.3%) of all cigarettes consumed in America. Adler, Olincy, et al. Schizophrenia Bulletin 24:196. 1998 The death rate among young adults with mental illness is more than triple that of their peers. Department of Mental Health, Massachusetts, 2001.

12. Why……? For mentally ill clients 25-44 years old, heart disease was 7X higher than peers and more than 7x the suicide rate. Department of Mental Health, Massachusetts, 2001. Nicotine often influences the impact of psychotropic medications; smokers may need higher doses, which can produce more negative side effects. Lasser, K., et al. JAMA, 284:2606-2610. November 2000

13. Why not…? Comparative smoking cessation rates Smokers with any history of mental illness 37.1% Smokers with past-month mental illness 30.5% Smokers with no history of mental illness 42.5% Persons with mental illness are about twice as likely to smoke as other people but have substantial quit rates. Lasser, K., et al. JAMA 284:2606-2610, November 2000

15. Contact Information Beth Lillard Marin Tobacco Cessation Project Director Bay Area Community Resources (415) 444-5580 ext 334 blillard@bacr.org