Abstract
BackgroundTobacco smoking rates are significantly higher in people with common mental illness compared to those without. Smoking cessation treatment could be offered as part of usual outpatient psychological care, but currently is not.ObjectiveTo understand patient and health care professionals' views about integrating smoking cessation treatment into outpatient psychological services for common mental illness.DesignQualitative in‐depth interviews, with thematic analysis.ParticipantsEleven Improving Access to Psychological Therapies (IAPT) psychological wellbeing practitioners (PWPs), six IAPT patients, and six stop smoking advisors were recruited from English smoking cessation, and IAPT services.ResultsPatients reported psychological benefits from smoking, and also described smoking as a form of self‐harm. Stop smoking advisors displayed therapeutic pessimism and stigmatizing attitudes towards helping people with mental illness to quit smoking. PWPs have positive attitudes towards smoking cessation treatment for people with common mental illness. PWPs and patients accept evidence that smoking tobacco may harm mental health, and quitting might benefit mental health. PWPs report expertise in helping people with common mental illness to make behavioural changes in the face of mood disturbances and low motivation. PWPs felt confident in offering smoking cessation treatments to patients, but suggested a caseload reduction may be required to deliver smoking cessation support in IAPT.ConclusionsIAPT appears to be a natural environment for smoking cessation treatment. PWPs may need additional training, and a caseload reduction. Integration of smoking cessation treatment into IAPT services should be tested in a pilot and feasibility study.Patient or public contributionService users and members of the public were involved in study design and interpretation of data.
Highlights
Smoking tobacco is the world's leading cause of preventable illness and death.[1]
A Cochrane review of smoking cessation interventions for people with current and historical depression found that adding psychosocial mood management to usual smoking cessation treatment increased smoking cessation rates compared to usual smoking cessation treatment alone, risk ratio of 1.47.20
Our study provides preliminary evidence that Improving Access to Psychological Therapies (IAPT) may be a suitable setting for offering smoking cessation treatment to patients who would like help to quit, and that IAPT may be more appropriately suited to offer smoking cessation treatment to patients with common mental illness than current smoking cessation services
Summary
Smoking tobacco is the world's leading cause of preventable illness and death.[1]. One in every two smokers will die of a smoking-related disease, unless they quit.[2,3] Globally, smoking prevalence has decreased from 29% during the 1990s to about 15% in recent years.[4]. Tobacco smoking rates are significantly higher in people with common mental illness compared to those without. Objective: To understand patient and health care professionals' views about integrating smoking cessation treatment into outpatient psychological services for common mental illness. Stop smoking advisors displayed therapeutic pessimism and stigmatizing attitudes towards helping people with mental illness to quit smoking. PWPs have positive attitudes towards smoking cessation treatment for people with common mental illness. PWPs report expertise in helping people with common mental illness to make behavioural changes in the face of mood disturbances and low motivation. PWPs felt confident in offering smoking cessation treatments to patients, but suggested a caseload reduction may be required to deliver smoking cessation support in IAPT. Integration of smoking cessation treatment into IAPT services should be tested in a pilot and feasibility study. Patient or public contribution: Service users and members of the public were involved in study design and interpretation of data
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