1. BESPOKE SMOKING CESSATION FOR MENTAL HEALTH MAGGIE STRONACH CLINICAL NURSE LEAD

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

3. 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

4. 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

5. 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)

6. 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

7. 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.

8. What helps NRT CUTTING DOWN TO QUIT FLEXIBILITY ASKING THE QUESTION LONGER SUPPORT

9. 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.

10. 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

11. 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

12. 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’

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