Targeted Intervention to Reduce Smoking among People with Severe Mental Illness: Implementation of a Smoking Cessation Intervention in an Inpatient Mental Health Setting.

Julia M Lappin,Ryan Courtney,Jackie Curtis,Gareth Marr,Mike Gatsi,Dennis Thomas,Stephen Blowfield

doi:10.3390/medicina56040204

Julia M Lappin, Ryan Courtney + Show 5 more

Open Access

https://doi.org/10.3390/medicina56040204

Copy DOI

Abstract

Background and Objectives: Smoking and smoking-related harms are highly prevalent among people with severe mental illness. Targeted smoking cessation programs are much needed in this population. This pilot study aimed to assess the effectiveness of implementing smoking cessation system change interventions within an acute inpatient mental health unit. Materials and Methods: Design: Pre-post intervention study. System change interventions for smoking cessation were delivered over a three-month period (05 March 2018–04 June 2018) on an acute inpatient mental health unit. Participants (n = 214) were all individuals receiving care as inpatients during the three-month intervention. Outcomes assessed pre- and post-intervention were: (i) recording of patient smoking status in medical notes, (ii) number of inpatients offered smoking cessation medication, and iii) number of violent incidents reported. Results: Recording of smoking status significantly increased from 1.9% to 11.4% (X2 = 14.80; p ≤ 0.001). The proportion of inpatients offered smoking cessation treatment significantly increased from 11.0% to 26.8% (X2 = 16.01; p ≤ 0.001). The number of violent incidents decreased by half, which was not statistically significant. Conclusion: Evidence-based smoking cessation interventions can be successfully implemented on an inpatient mental health unit. Modest gains were made in routine screening for smoking and in smoking cessation treatment prescription. Future studies should prioritize effective participatory collaboration with staff to optimize effectiveness of interventions and should include additional strategies such as brief intervention training and smoking cessation treatments such as varenicline and buproprion in addition to nicotine replacement therapy (NRT).

Highlights

Smoking prevalence among psychiatric populations varies, with much higher rates among those with severe mental illnesses, such as schizophrenia and psychosis spectrum disorders and bipolar disorder than among the general population [1,2,3]
There was a non-significant decrease in violent incidents on the unit. These findings indicate that many individuals experiencing severe mental illness are willing to be prescribed smoking cessation treatment and that the inpatient mental health setting provides a key opportunity to offer smoking cessation interventions
While the finding that the number of violent incidents in the post-intervention period was not statistically significantly reduced compared to the pre-intervention period, it may at the very least be interpreted to reassure that this smoking cessation intervention did not increase violence incidents, a commonly-reported fear expressed by mental health staff

Summary

Introduction

Smoking prevalence among psychiatric populations varies, with much higher rates among those with severe mental illnesses, such as schizophrenia and psychosis spectrum disorders and bipolar disorder than among the general population [1,2,3]. Despite a steady decline in smoking rates in the general populations of high-income nations, the prevalence of smoking among people with severe. US data from the 2007 National Health Interview Survey showed that 34.3% of people with phobias or fears smoked, compared with 18.3% among the general population with no mental illness [1]. Smoking and smoking-related harms are highly prevalent among people with severe mental illness. Targeted smoking cessation programs are much needed in this population This pilot study aimed to assess the effectiveness of implementing smoking cessation system change interventions within an acute inpatient mental health unit.

Methods

Results

Discussion

Conclusion