‘Clients are the problem owners’: a qualitative study into professionals’ and clients’ perceptions of smoking cessation care for smokers with mental illness

Abstract

ABSTRACT Objective To understand mental healthcare professionals’ and clients’ needs and preferences regarding smoking cessation care in mental healthcare settings. Method Individual semi-structured interviews conducted in the Netherlands between March and July 2021, with 18 mental healthcare professionals and 16 people with a DSM 5 diagnosis who smoked. Qualitative analysis followed the framework approach. Results Both professionals and clients reported that successful smoking cessation would benefit client’s health, but was difficult to achieve. There were different views on who was responsible for smoking cessation care. Clients do not often initiate or bring up smoking cessation, although they often want to quit smoking to improve their overall (mental) health. Most clients stressed the need for support in quitting smoking, provided by an active, experienced professional who takes the initiative to discuss cessation. Conversely, professionals indicated that they rarely initiate this discussion, because they believe that clients should decide the focus of treatment, and that addressing smoking cessation may harm the therapeutic relationship. Professionals perceived clients as carrying the ultimate responsibility for smoking cessation. Discussion Professionals and clients agree that smoking cessation care should be tailored to the client’s needs. However, as both clients and professionals wait for the other party to initiate a discussion about cessation, the issue often remains unaddressed. To increase chances of successful smoking cessation, clearly defined responsibilities regarding initiation and provision of smoking cessation care are required.