Abstract
BackgroundSmoking is one of the major modifiable risk factors contributing to early mortality for people with serious mental illness. However, only a minority of service users access smoking cessation interventions and there are concerns about the appropriateness of generic stop-smoking services for this group. The SCIMITAR (Smoking Cessation Intervention for Severe Mental Ill-Health Trial) feasibility study explored the effectiveness of a bespoke smoking cessation intervention delivered by mental health workers. This paper reports on the nested qualitative study within the trial.MethodsQualitative semi-structured interviews were conducted with 13 service users receiving the intervention and 3 of the MHSCPs (mental health smoking cessation practitioners) delivering the intervention. Topic guides explored the perceived acceptability of the intervention particularly in contrast to generic stop-smoking services, and perceptions of the implementation of the intervention in practice. Transcripts were analysed using the Constant Comparative Method.ResultsGeneric services were reported to be inappropriate for this group, due to concerns over stigma and a lack of support from health professionals. The bespoke intervention was perceived positively, with both practitioners and service users emphasising the benefits of flexibility and personalisation in delivery. The mental health background of the practitioners was considered valuable not only due to their increased understanding of the service users’ illness but also due to the more collaborative relationship style they employed. Challenges involved delays in liaising with general practitioners and patient struggles with organisation and motivation, however the MHSCP was considered to be well placed to address these problems.ConclusionThe bespoke smoking cessation intervention was acceptable to service users and the both service users and practitioners reported the value of a protected mental health worker role for delivering smoking cessation to this group. The results have wider implications for understanding how to achieve integrated and personalised care for this high-risk population and further underscore the need for sensitised smoking cessation support for people with serious mental illness.Trial registrationCurrent Controlled Trials ISRCTN79497236. Registered 3rd July 2009.
Highlights
Smoking is one of the major modifiable risk factors contributing to early mortality for people with serious mental illness
In the UK, the Royal College of Psychiatrist’s 2013 report “Whole Person Care: Achieving parity between mental and physical health” argued that parity could be achieved for people by tackling the premature mortality rates of people with mental illness, and advised commissioners to ensure that a major focus of their smoking cessation services was on smokers with mental health problems [11]
We aimed to purposively sample both service users who had completed treatment with their Mental Health Smoking Cessation Practitioners (MHSCPs) and those who had withdrawn from treatment, Service users who had withdrawn were invited in order to ensure that factors impacting on disengagement with the BSC were captured and because we anticipated that disengagement would be an indicator of low acceptability, and this would ensure we captured both positive and negative views.. 15 participants responded to the initial invitation and expressed an interest in participating and 13 were interviewed Interviews took place between August 2012 and January 2013
Summary
Smoking is one of the major modifiable risk factors contributing to early mortality for people with serious mental illness. Service users with serious mental illness (SMI) have higher rates of morbidity and premature mortality compared to the general population, suffering the loss of an estimated 13–20 years of life compared to those without SMI [1] These excess mortality rates are largely due to modifiable risk factors such as smoking, but there are recognised barriers at the individual, health care professional and systems level to addressing these problems in this population [2,3,4]. In the UK, the Royal College of Psychiatrist’s 2013 report “Whole Person Care: Achieving parity between mental and physical health” argued that parity could be achieved for people by tackling the premature mortality rates of people with mental illness, and advised commissioners to ensure that a major focus of their smoking cessation services was on smokers with mental health problems [11]
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