1. P Wye, J Bowman, A Baker, J Wiggers, C Foster, M Terry, J Knight, R Clancy and V Carr THE UNIVERSITY OF NEWCASTLE AUSTRALIA

2. The big picture This study Preliminary findings Attitudes Knowledge Skills Key issues for Smoke Free Mental Health Attitudes, Knowledge and Skills...

3. The Big Picture Part of a PhD project involving... September 2005- Patient file audit at James Fletcher Hospital February 2006- Survey of all NSW Mental Health Units June 2006- Focus Groups for Staff and Ex-Patients October 2006- Survey of Staff at James Fletcher Hospital 31 October 2006- Smoke Free Workplace Policy May 2007- Follow-up audit at James Fletcher Hospital October 2007- Follow-up survey at James Fletcher Hospital

4. Smoking - People with Mental Illness General Community -17% (Australian Institute of Health and Welfare, 2004) People with Mental Illness-32% (NSW Department of Health, 2004) Mental Health Inpatients-70 – 80% (NSW Department of Health, 2004)

5. James Fletcher Hospital 5 wards, 82 beds, 2000 admissions p.a. Age: Mean 39 (SD 16), range 11-91 Gender:51% male Length of Stay: Mean 16 days (SD 26), range 1-266 First admission:38% of all discharges Aboriginal/Torres Strait islander: 6%

6. The Survey... N = 183 (51% response rate) 21.3% smokers, 26.8% former smokers 33% male – 22% nurses – 10% allied health – 7% medical/psychiatry – 23% admin with patient contact – 18% admin no contact – 20% researchers, domestic services, or maintenance

7. Attitudes When asked if smoking should be banned in all health services… – 20.8% said no – 23% uncertain – 56.3% yes When asked if smoking should be banned throughout their Area’s mental health services… – 7% strongly unsupportive – 14% unsupportive – 11.5% no view either way – 32% supportive – 34% strongly supportive Support for SFWP

8. 66% supported a smoking ban in their workplace 65% thought SFWP would improve patient physical health 29% thought SFWP would improve patient mental health 88% believe patients should be encouraged to quit 76% saw smoking care as an integral function of their unit 54% believe most patients are interested in quitting 54% believe quit advice as important as other roles 45% believe it is useful to smoke with patients Staff Attitudes

9. Clinical Staff Knowledge 46% of clinical staff concerned about lack of information available about procedural changes 54% of clinical staff concerned about lack of knowledge 69% of clinical staff interested in attending training 82% of clinical staff reported not receiving any formal training on smoking cessation care

10. Clinical Staff Skills 88% feel competent to assess patient smoking behaviour 77% feel competent to diagnose nicotine dependence 73% feel competent to assess smoking care needs 69% feel competent to provide quit advice 89% feel competent to refer to Quitline 57% feel competent to provide NRT 67% feel competent to manage withdrawal symptoms 85% feel competent to manage negative behaviours 75% feel competent to deal with non-compliance issues

11. Conclusions Attitudes – 66% of staff support SFWP Knowledge – perceived lack of knowledge and training opportunities – time to attend Skills – self report competencies, doesn’t infer skills are exercised

12. Conclusions Foster a changing attitude... many still see smoking care as different to routine healthcare Not only provide training, but provide time for staff to attend training Support staff competence and encourage file documentation of smoking care

13. Development of survey Comparison of pre and post measures to see what changes have occurred after twelve months smoke-free – Attitudes – Knowledge – Skills Evaluation of the Policy – – Process – Impact – Outcomes Future Studies

14. Thank you to the Hunter New England Area Health Service staff, particularly the staff located at the James Fletcher Hospital site, for participating in this research. This research is supported by a grant provided by the Commonwealth of Australia Department of Health and Ageing. Acknowledgements