Stop smoking interventions in mental health
Although there is insufficient evidence to suggest the best type of intervention for people with mental health problems, interventions which work for the general population also work for those with mental illness who experience disproportionate levels of smoking-related ill-health. Combining pharmacotherapy and other support such as counselling can increase abstinence rates in those with mental health problems to similar rates as for the general population. However, up to now people with mental illness have been less likely to receive smoking cessation interventions in primary care.
Developing this evidence will come under the remit of the NHS Centre for Smoking Cessation and Training. In the meantime, however, the basic quality principles remain the same, wherever the intervention takes place:
- offer a menu of evidence-based support options
- ensure the intervention is delivered by a trained stop smoking adviser
- allow access to approved pharmacotherapy
- use CO verification in at least 85% of cases
- provide support for the duration of the treatment episode
A sample care pathway, including these principles, can be found at Annex F.
recommendations
There are a number of additional considerations that should be taken into account when providing stop smoking support for people with mental health problems in either community or acute settings.
Community settings:
- ensure that the local mental health trust is aware of the local NHS Stop Smoking Service
- train all mental health colleagues (including local community mental health teams and voluntary sector helpers) and ensure there is a referral pathway into the local NHS Stop Smoking Service
- approach the local mental health trust to co-ordinate basic training for stop smoking advisers to increase their confidence in dealing with mental health problems
- offer training for people working in primary care to help them understand the issues people with mental health problems face when they try to stop smoking
- maintain links with local mental health services and seek guidance when specific issues arise
Acute settings:
- seek out top level approval and support
- provide brief or intermediate training for staff
- ensure stop smoking medicines are available for patients who wish to stop smoking and those who require withdrawal management (i.e. those who do not wish to stop smoking but have limited access to outdoor space and opportunities to smoke and therefore experience nicotine withdrawal symptoms)
- ensure stop smoking medicines are available for staff
- create a clear pathway to maintain support once the patient has been discharged into the community
