Mental health and smoking for GPs
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Tobacco use remains a major public health issue and is disproportionately impacting those with mental health conditions, as smoking prevalence has not changed in 20 years for this group. The document outlines strategies to address high smoking rates among those with mental health conditions, including implementing clinical guidelines on smoking cessation support, harm reduction, and engaging mental health services and providers. Reducing smoking among those with mental health conditions is a priority to improve health outcomes and reduce health inequalities.
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Mental health and smoking for GPs
- 1. www.hertsdirect.org Smoking and Mental Health For GP Mental Health Leads Jim McManus Director of Public Health Liz Fisher Head of Provider Services, Tobacco Control Lead Emily Clarke Assistant Manager Hertfordshire Stop Smoking Service
- 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 Smoking not social status is the greatest cause of health inequalities References: 1. Gruer L et al. BMJ 2009;338;bmj.b480 (Relative mortality assessed at 2nd 14 year follow-up between male smokers & non-smokers of highest & lowest social class) Smokers from the highest social class have a lower life expectancy than non-smokers in the lowest social class 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 I+II IV+V Social Class Relativemortality Male non-smokers Male smokers Highest Lowest The life expectancy between rich and poor smokers is similar Richer smokers have a lower life expectancy than poorer non- smokers
- 5. www.hertsdirect.org Herts smoking attributable morbidity and mortality
- 6. www.hertsdirect.org Herts smoking prevalence 2010-2013
- 7. www.hertsdirect.org Herts routine and manual prevalence
- 8. www.hertsdirect.org Smoking and Mental Health • Greatest impact on health inequalities • High prevalence – no change over 20 years • 70% in some groups • 16-25 years of life lost • 42% of all tobacco smoked • Misconceptions about wanting to quit and impact on mental health
- 9. www.hertsdirect.org Smoking and Mental Health • Improved mental health reduces lifestyle risk behaviours • Mental ill health: increased risk - range of unhealthy lifestyle behaviours • Smoking responsible for most of the excess mortality in people with severe mental health conditions • Young people - emotional disorders
- 10. www.hertsdirect.org RCGPs: guidance smoking and mental disorders • Smoking is the largest avoidable cause of premature death and health inequality in those with mental disorders who die 10-20 years earlier than the general population. • Adults with mental disorders disproportionately experience tobacco related harm. • With appropriate support, people with mental disorder are able to stop smoking. • Smoking cessation improves mental and physical health even in the short term and reduces risk of premature death. • Impact of smoking cessation on mood and anxiety disorders is at least as large as antidepressant treatment.
- 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 Tobacco – an NHS priority • NICE PH48 • NICE PH45 No change in smoking prevalence in people with a mental health disorder for 20 years
- 15. www.hertsdirect.org What’s happening locally? • 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 • Developing more specialist stop smoking services – behavioural sciences
- 16. www.hertsdirect.org Harm Reduction Guidance • Implementing NICE PH 45 • 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 • 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 Medicines that need dose adjusting • Stopping smoking requires the immediate reduction of doses of some antidepressants, antipsychotics and benzodiazepines by up to 25% within the first week and up to 50% within 4 weeks.
- 19. www.hertsdirect.org Medicines that need dose adjusting
- 20. 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
- 21. 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).
- 22. 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)
- 23. 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
- 24. 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
- 26. 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
- 27. www.hertsdirect.org SAVE THE DATE Smoking and Mental Health Masterclass Wednesday 29th April 2015
- 28. www.hertsdirect.org Further reading Primary Care Guidance on Smoking and Mental Disorders: http://www.rcgp.org.uk/clinical-and-research/clinical-resources/mental-health.aspx RCP report: https://www.rcplondon.ac.uk/sites/default/files/smoking_and_mental_health_-_key_re NICE PH 48: https://www.nice.org.uk/guidance/ph48 NICE PH 45: https://www.nice.org.uk/guidance/ph45 BI training for GPs : http://learning.bmj.com/learning/module-intro/advice-smoking.html? moduleId=10032720&locale=en_GB
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
- the mortality rate of people with mental illness (Domain 5); in Domain 1 of the NHS Outcomes Framework a related indicator is ‘under 75 mortality rate in people with serious mental illness’;