Depending on diagnosis and setting, between 33 and 90 per cent of people with mental illness smoke tobacco, both in Australia and worldwide. As a result, tobacco-related diseases are one of the leading causes of mortality among this population subgroup. A paucity of research to date has examined the efficacy of cessation strategies to assist people with mental illness to quit smoking. However, limited findings have suggested that aids that have been found to be effective for the general population of smokers, including counselling and nicotine replacement therapy, are also efficacious for people with mental illness. The introduction of smoke free policies within mental health inpatient settings in Australia and other countries has created an opportunity to intervene and address the health and social inequities experienced by people with acute mental illness. An admission to a smoke-free psychiatric inpatient facility, where nicotine dependence was adequately treated, has been shown to increase patient self-efficacy to make longer term changes to their smoking. However without the provision of support post discharge, preadmission smoking levels typically resume.
To assess the efficacy of integrating inpatient smoking care with community based support upon discharge, a randomised controlled trial is being undertaken across four mental health inpatient settings within the Hunter New England Local Health District, New South Wales, Australia. All inpatients will be approached, assessed for eligibility and, if applicable, offered the opportunity to participate. All adult inpatients that smoked and had the capacity to give consent were eligible, regardless of their readiness to change or diagnosis. At the time of recruitment, participants were allocated to receive either standard hospital care or 16 weeks of support post discharge (consisting of NRT and supportive telephone calls).
As follow-up data collection is not yet complete, the outcomes of this trial have not been ascertained. However, analysis of process data suggests this project was well received by mental health inpatients; a finding that is contrary to current beliefs surrounding persons with mental illness receptivity to the offer of smoking care. Of the 2,317 patients approached, 91% agreed to discuss smoking with the research staff and, of the eligible patients, on average 65-70% agreed to participate (N = 754). Among the participants who were eligible to receive support post discharge (n= 379), 84% opted to utilise psychosocial and/or pharmacological support in the community. These findings suggest that people with mental illness are receptive to the offer of smoking cessation care and choose to utilise such care when offered.
For further information, please see the following article:
Metse, A., Bowman, J., Wye, P., Stockings, E., Adams, M., Clancy, R., Terry, M., Wolfenden, L., Freund, M., Allan, J., Prochaska, J., & Wiggers, J. (2014). Evaluating the efficacy of an integrated smoking cessation intervention for mental health patients: Study protocol for a randomised controlled trial Trials, 15 (266), 1-7 DOI: 10.1186/1745-6215-15-266
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