Implementing NICE Guidance on Smoking Cessation and Mental Health
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This document summarizes efforts in Hertfordshire, UK to implement tobacco control strategies among populations with mental health conditions, as outlined in UK guidance documents. It notes that smoking disproportionately impacts more deprived groups and those with mental health conditions. Initiatives discussed include developing specialized stop smoking services, implementing harm reduction guidance, improving identification and support of smokers in mental health and criminal justice settings, and engaging partners across sectors. Metrics are proposed for new contracts to improve screening, brief advice, and referral of mental health clients who smoke to quit support.
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Implementing NICE Guidance on Smoking Cessation and Mental Health
- 1. www.hertsdirect.org Leadership and Clear Priorities: The Hertfordshire Context Smoking Cessation and Mental Health: Implementing NICE Guidance PH48 Jim McManus, Director of Public Health Liz Fisher, Head of Provider Services, Tobacco Control Lead East of England Seminar, 24 March 2015
- 2. www.hertsdirect.org Why Tobacco Control remains important • Single most important cause of premature morbidity and mortality • Kills 80,000 people prematurely in England alone and 1,500 people in Herts die every year • Accounts for 50% of health inequalities between better and worst off • Disproportionately affects most deprived groups • 135,300 smokers in Herts • Cost the NHS £55 million in 2013-2014
- 3. www.hertsdirect.org A call to action • Gay Sutherland as Keynote at our Public Health Conference 2014 on smoking and mental health • Here are some killer points from her....
- 4. www.hertsdirect.org Slide courtesy of Gay Sutherland
- 5. www.hertsdirect.org Slide courtesy of Gay Sutherland
- 6. www.hertsdirect.org Slide courtesy of Gay Sutherland
- 7. www.hertsdirect.org Slide courtesy of Gay Sutherland
- 8. www.hertsdirect.org Slide courtesy of Gay Sutherland
- 9. www.hertsdirect.org Herts smoking attributable morbidity and mortality
- 10. www.hertsdirect.org Herts smoking prevalence 2010-2013
- 11. www.hertsdirect.org Herts routine and manual prevalence
- 12. www.hertsdirect.org What is difficult about smoking and mental health: • Mental health care staff see smoking as less of a priority than general NHS staff • There remains a culture of acceptability within mental health providers • There are no national reporting systems on stopping smoking and mental health Myths: • Stopping smoking has adverse effects on mental health • Mental health service users have other priorities • Mental health service users don’t want to stop smoking • Mental health service users can’t stop smoking
- 13. www.hertsdirect.org Reducing the harm from tobacco - HWbB and PH Priority
- 14. www.hertsdirect.org The Hertfordshire Context 1 • Regional smoking and mental health seminar • CLeaR review on tobacco control • NHS systems leaders’ commitment to tobacco control • Herts smoking and mental health action group • Implementing NICE PH48 • Implementing NICE PH45 – harm reduction • Mental health and smoking master classes
- 15. www.hertsdirect.org The Hertfordshire Context 2 • Developing more specialist stop smoking services – – behavioural sciences training from motivational interviewing to sponsoring people to become Chartered Health Psychologists
- 16. www.hertsdirect.org Herts Harm Reduction Guidance • Implementing NICE PH 45 – clinical guidelines • Stopping smoking main recommendation • Effectiveness and cost effectiveness of harm reduction • For smokers not ready/unable to quit in one step • Behavioural support • Nicotine containing products – right doses • Role of e –cigarettes for harm reduction
- 17. www.hertsdirect.org Mental Health and Primary care Project • The scale of the problem – 1:4 adults have a mental health problem in any one year • QOF points • Identification of all smokers • MECC – build confidence in ability to quit with specialist support • Referring to specialist services • Heavier smokers – need higher doses and longer term NRT • Role of varenicline
- 18. www.hertsdirect.org Commissioning for smoking and mental health • HPfT CQUIN 13/14 Herts.P.f.T (Mental Health) Department Total Referrals A.O.T. 25 Community Mental Health Team (CMHT) 318 Early Intervention in Psychosis 4 Enhanced Primary Mental Health Service 2 RAID 2 Hertfordshire Commuinty Eating Disorder Service 2 TOTAL 353
- 19. www.hertsdirect.org Proposed Quality Schedule metrics 15/16 • All service users to have smoking status recorded • Brief intervention advice to be given to all smokers • All smokers to be referred to Hertfordshire Stop Smoking Service (HSSS) unless they ‘opt out’ • All staff to be asked to complete an online survey (in Q1) on attitudes to smoking and electronic cigarettes (to be provided by Hertfordshire Stop Smoking Service).
- 20. www.hertsdirect.org Quality Schedule metrics15/16 cont. • All staff to be encouraged to quit smoking and offered a referral to HSSS • To promote campaigns such as Stoptober and National No Smoking Day with service users and staff • Adopt Hertfordshire Tobacco Harm Reduction Guidance • HPfT to become Smokefree by the end of 2016, with the Lister site becoming Smokefree pilot site by 1 October 2015 (plans to achieve this at the Lister are already in progress)
- 21. www.hertsdirect.org Public Health • TC Alliance – representation from mental health stakeholders • NHS Health Checks • Mental Health Health Checks • Vol orgs (MIND, Viewpoint, Living Room) • Drug and alcohol services
- 22. www.hertsdirect.org Offender health • Smoking prevalence similar to mental health clients • 770 prisoners – but expanding • Health of probation caseload • Prison and specialist SSSs • Smokefree prison/Smokefree cells • Access to NRT for harm reduction • Staff SSSs • Probation action plan being developed
- 24. www.hertsdirect.org Next Steps • Ensure revisions to HWb Board tobacco control priorities include mental health • Agree QS metrics with HPfT15/16 • Improve quality of stop smoking services for metal health service users • Implement harm reduction guidance • Increase knowledge and skills of frontline staff and volunteers who work with mental health service users
- 26. www.hertsdirect.org Hertfordshire Masterclass for Practitioners... Smoking and Mental Health Masterclass Wednesday 29th April 2015 And enormous thanks to Liz Fisher, my Tobacco Control Alliance including Joel Bonnet, and all our partners Jim.mcmanus@hertfordshire.gov.uk
Editor's Notes
- What we want to cover Why tobacco remains important National and Local Tobacco Control Priorities Review of progress towards meeting TC ambitions Review of smoking cessation targets/performance Highlight the importance of priority groups Discuss and debate the issues and consider what our Tobacco Control ambitions Consider how smoking cessation services should be prioritised
- 170,000 smokers in 2011