People with a serious mental illness (SMI), such as schizophrenia or bipolar disorder, die 15 to 20 years earlier than those without, largely due to poor physical health. Smoking prevalence among people with SMI is around three times that of those without. While the negative effects of smoking on physical health are known, one review also indicated that stopping smoking was associated with a significant improvement in mental health (Taylor et al, 2014).
CLAHRC South London's psychosis team worked with colleagues at South London and Maudsley NHS Foundation Trust (SLaM) as they introduced a comprehensive smoke-free policy in October 2014 in line with NICE guidance. They ensured that integral to the policy was a comprehensive tobacco dependence treatment pathway, so that smokers could be smoke-free whilst on Trust premises, but also supported to stop smoking completely.
Working with SLaM they: i) synthesised the existing evidence base for tobacco dependence treatment for people with psychosis (Roberts et al, 2015); ii) provided an e-learning training smoking cessation module for staff; iii) working with Maudsley NIHR Biomedical Research Centre, they enhanced the electronic patient healthcare record to improve the provision of very brief advice for smoking cessation (ie recording smoking, giving advice to quit and referring to a stop-smoking service).
They also identified and addressed barriers to implementing smoke-free policies in mental health settings, including staff perception that policies would lead to a rise in violence. In SlaM they found that physical violence actually fell by 39% overall after the new policy was introduced: 47% in patients toward staff and 15% towards patients (Robson et al, 2017).
Team members co-founded and co-chaired a new national Mental Health and Smoking Partnership, including national and local stakeholders, which was convened to tackle high smoking rates among people with mental illness.
Contribution of CLAHRC South London
NIHR CLAHRC funding contributed directly to researchers developing the tobacco dependence treatment pathway, evidence syntheses, research on identifying and addressing barriers, and on evaluating the impact of the smoke-free policy and treatment pathway. NIHR CLAHRC funding also enabled co-authorship of guidance entitled: Smoking cessation and smoke-free policies: good practice for mental health services, which is disseminated through the National Centre for Smoking Cessation and Treatment and is also being sent to every mental health trust in England. NIHR funding also supported team members to work on other related initiatives with Public Health England and other national and local partners.
What happened next?
Team members co-founded and co-chaired a new national Mental Health and Smoking Partnership, including national and local stakeholders, which was convened to tackle high smoking rates among people with mental illness. They have worked with other Trusts and CLAHRCs, for example the e-learning module is being used by five other NHS Trusts. They are currently updating the e-learning module and are now analysing the impact of the policy and treatment pathway on smoking behaviour. They have worked with commissioners locally to reconfigure stop-smoking services. They are also working with service users to develop a booklet for service users and carers on smoking.