- Smoking rates are much higher in people with serious mental illness (SMI) compared to the general population, contributing significantly to poor physical health outcomes and reduced life expectancy in people with SMI.
- Evidence from randomized controlled trials shows that smoking cessation interventions combining nicotine replacement therapy (NRT) and/or bupropion with behavioral support can help people with SMI quit smoking, with odds ratios for abstinence between 2-10 times higher than control groups.
- The most effective interventions provide combinations of pharmacotherapy (NRT and/or bupropion) along with individual or group behavioral support. These interventions show potential for reducing smoking rates and improving health outcomes in people with
Costs of Care for Persons with Opioid Dependence In Two Integrated Health Systems
Frances Lynch, PhD
April 30, 2012
HMO Research Network Conference 2012
Costs of Care for Persons with Opioid Dependence In Two Integrated Health Systems
Frances Lynch, PhD
April 30, 2012
HMO Research Network Conference 2012
Global Bridges: Pharmacotherapy for Tobacco DependenceGlobal Bridges
May 2012: Dr. Richard Hurt, director of the Nicotine Dependence Center at the Mayo Clinic and chair of Global Bridges: Healthcare Alliance for Tobacco Dependence Treatment, discusses pharmacotherapy for tobacco dependence at a workshop in Jamaica.
Laura Mann Center Integrative Lecture Series: Fall 2014Cara Feldman-Hunt
A Success Story: Incorporating Integrative Medicine into the Hospital and Outpatient Care
Courtney Jordan Baechler, MD, MS, Chief Wellness Officer Vice President, Penny George Institute for Health and Healing, Allina Health
This module was designed to meet the growing need for an applied course in the measurement of a variety of health indicators and outcomes. Whether you manage a health programme, a health facility, or simply have to interpret health data in the course of your work, this module sets out to increase your capacity to deal with health and disease information. It aims to assist you in applying epidemiological knowledge and skills to a variety of Public Health problems such as:
Is your DOTS programme succeeding?
What does it mean if a TB prevalence is 850/100 000?
Is this a Public Health problem or not?
What is the “burden of disease” in different communities?
Authors: Neil Myburgh, Debra Jackson
Institution: University of the Western Cape
This resource is part of the African Health Open Educational Resources Network: http://www.oerafrica.org/healthoer. The original resource is also available from the authoring institution at http://freecourseware.uwc.ac.za/
Creative Commons license: Attribution-Share Alike 3.0
Women and Smoking -- Ivana Croghan, Ph.D., Mayo ClinicGlobal Bridges
On March 8, 2012, Global Bridges presented the webinar "Women and Smoking," which featured Ivana Croghan, Ph.D., coordinator of the Mayo Clinic Nicotine Dependence Center's Research Program.
Smoking Cessation: Barriers and Available Methods Dr R R Kasliwal
Tobacco use is the leading global cause of avoidable death worldwide and a key modifiable risk factor for the development of a range of diseases, including cardiovascular disease, chronic obstructive pulmonary disease and some cancers (1-3). In the 1960s, the US Surgeon General and American Heart Association issued reports warning of the dangers of smoking on fatal coronary artery disease (4-6). Since those early publications, 32 US Surgeon General reports have been released exposing the harmful effects of cigarette smoking on cardiovascular health (7,8). The 1983 Surgeon General’s Report (9) was devoted entirely to cardiovascular disease. It concluded that cigarette smoking is one of the three major independent risk factors for heart disease.
This is a slideshow for a ten minute talk on system leadership challenges in health and social care, aimed at elected members as part of a "system challenges" workshop
The Intersection of Domestic Violence and Substance Abuse- April 2012Dawn Farm
"The Intersection of Domestic Violence and Substance Abuse" was presented on April 17, 2012, by Barbara Niess May, MPH, MSW; Executive Director, SafeHouse Center; and David J.H. Garvin, LMSW; Director, Alternatives to Domestic Aggression, Catholic Social Services of Washtenaw County. Domestic violence offender and survivor alcohol and other drug use/abuse is central to this discussion. The audience is provided with a primmer regarding batterer tactics, strategies, and core beliefs which hold the batterer accountable for his abusive behaviors while maintaining and promoting survivor safety. The program will help participants to recognize the critical importance of understanding domestic violence and alcohol/other drug use/abuse in order to safely and effectively intervene and/or interrupt the batterer's abusive behaviors and support the survivor. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
2008 Smoking Cessation Health Promotion Power point filled with history of glamour movie stars who died from smoking, medical/military history, statistics and facts, myth/truth, perception/reality, Nurses' role, Health effects of smoking, Helps to quit: web sites, medications: Zyban, Chantix, Addiction notations. Factual/non-fiction.
14 slides plus 2 reference slides. 2008.
Global Bridges: Pharmacotherapy for Tobacco DependenceGlobal Bridges
May 2012: Dr. Richard Hurt, director of the Nicotine Dependence Center at the Mayo Clinic and chair of Global Bridges: Healthcare Alliance for Tobacco Dependence Treatment, discusses pharmacotherapy for tobacco dependence at a workshop in Jamaica.
Laura Mann Center Integrative Lecture Series: Fall 2014Cara Feldman-Hunt
A Success Story: Incorporating Integrative Medicine into the Hospital and Outpatient Care
Courtney Jordan Baechler, MD, MS, Chief Wellness Officer Vice President, Penny George Institute for Health and Healing, Allina Health
This module was designed to meet the growing need for an applied course in the measurement of a variety of health indicators and outcomes. Whether you manage a health programme, a health facility, or simply have to interpret health data in the course of your work, this module sets out to increase your capacity to deal with health and disease information. It aims to assist you in applying epidemiological knowledge and skills to a variety of Public Health problems such as:
Is your DOTS programme succeeding?
What does it mean if a TB prevalence is 850/100 000?
Is this a Public Health problem or not?
What is the “burden of disease” in different communities?
Authors: Neil Myburgh, Debra Jackson
Institution: University of the Western Cape
This resource is part of the African Health Open Educational Resources Network: http://www.oerafrica.org/healthoer. The original resource is also available from the authoring institution at http://freecourseware.uwc.ac.za/
Creative Commons license: Attribution-Share Alike 3.0
Women and Smoking -- Ivana Croghan, Ph.D., Mayo ClinicGlobal Bridges
On March 8, 2012, Global Bridges presented the webinar "Women and Smoking," which featured Ivana Croghan, Ph.D., coordinator of the Mayo Clinic Nicotine Dependence Center's Research Program.
Smoking Cessation: Barriers and Available Methods Dr R R Kasliwal
Tobacco use is the leading global cause of avoidable death worldwide and a key modifiable risk factor for the development of a range of diseases, including cardiovascular disease, chronic obstructive pulmonary disease and some cancers (1-3). In the 1960s, the US Surgeon General and American Heart Association issued reports warning of the dangers of smoking on fatal coronary artery disease (4-6). Since those early publications, 32 US Surgeon General reports have been released exposing the harmful effects of cigarette smoking on cardiovascular health (7,8). The 1983 Surgeon General’s Report (9) was devoted entirely to cardiovascular disease. It concluded that cigarette smoking is one of the three major independent risk factors for heart disease.
This is a slideshow for a ten minute talk on system leadership challenges in health and social care, aimed at elected members as part of a "system challenges" workshop
The Intersection of Domestic Violence and Substance Abuse- April 2012Dawn Farm
"The Intersection of Domestic Violence and Substance Abuse" was presented on April 17, 2012, by Barbara Niess May, MPH, MSW; Executive Director, SafeHouse Center; and David J.H. Garvin, LMSW; Director, Alternatives to Domestic Aggression, Catholic Social Services of Washtenaw County. Domestic violence offender and survivor alcohol and other drug use/abuse is central to this discussion. The audience is provided with a primmer regarding batterer tactics, strategies, and core beliefs which hold the batterer accountable for his abusive behaviors while maintaining and promoting survivor safety. The program will help participants to recognize the critical importance of understanding domestic violence and alcohol/other drug use/abuse in order to safely and effectively intervene and/or interrupt the batterer's abusive behaviors and support the survivor. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
2008 Smoking Cessation Health Promotion Power point filled with history of glamour movie stars who died from smoking, medical/military history, statistics and facts, myth/truth, perception/reality, Nurses' role, Health effects of smoking, Helps to quit: web sites, medications: Zyban, Chantix, Addiction notations. Factual/non-fiction.
14 slides plus 2 reference slides. 2008.
Lecture 12 from a college level neuropharmacology course taught in the spring 2012 semester by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University. Focus is on pharmacokinetics, pharmacodynamics, epidemiology, and health risks
A Look at a Consumer Peer Based Program with Jill Williams, MDsfary
From the the first Annual National Conference on Tobacco and Behavioral Health, which occurred May 19-20, 2014 in Bethesda, MD and was hosted by the Central East Addiction Technology Transfer Center, a program of The Danya Institute. You can see videos from the conference on our website www.ceattc.org (go to “Tobacco and Behavioral Health Resources” under “Special Topics”).
Having peers who have succeeded in recovering from tobacco dependence talk to smokers with mental illness offers advantages. Advantages of using peer counselors include reduced language and cultural barriers, increased trust and lowered defenses, and low cost. Peer counselors are often rated highly by other consumers and there is an added benefit in the modeling that comes from seeing peers do well and return to work. We have promoted community based advocacy and education through the CHOICES Program (Consumers Helping Others Improve their Condition by Ending Smoking). CHOICES employs mental health peer counselors known as Consumer Tobacco Advocates (CTA) to deliver the vital message to smokers with mental illness that addressing tobacco use is important and to motivate them to seek treatment. The philosophy of CHOICES is to bring information to smokers with mental illness about the harm of tobacco, as well as the benefits of quitting and possibilities of treatment. Additional goals are to enhance advocacy and education about addressing tobacco in mental health treatment settings through strong partnerships with a consumer advocacy organization (Mental Health America) and state government (New Jersey Division of Mental Health Services).
Participants will be able to:
- Understand the benefits of using peer counselors to disseminate health education information and increase demand for tobacco services
- Examine existing community relationships and partnerships that will help promote culture change in mental health systems.
- Understand how materials like newsletters and websites increase the reach of peer counselors
- Become familiar with CHOICES, a peer delivered tobacco dependence education and intervention program in New Jersey
Katherine Promer Flores, MD (she/her)
Staff Physician
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California San Diego
Peripheral Neuropathy: Will it ever go away? Problems, Causes, SolutionsFight Colorectal Cancer
Have you ever experienced peripheral neuropathy? Did it feel like a numbness or tingling in your hands or feet? Did it last several weeks, or several years? Join us, as Cindy S. Tofthagen, PhD, ARNP, AOCNP, University of South Florida College of Nursing Assistant Professor and Concentration Director of Oncology, will discuss this important topic and ways to manage it.
Although peripheral neuropathy is a known common side effect of some chemotherapy regimens, there are many different types of peripheral neuropathy, and many different causes. Cindy will explain exactly what it is that's happening, why it happens, and what causes it to happen. And then, most importantly, will provide tips on the best ways to manage it. You're not going to want to miss this!
Presentation by:
Joseph Guydish
Catherine Saucedo
University of California, San Francisco
County Behavioral Health Directors Association of California
September 25, 2019
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502
Presentation by: Roger Chou, MD, Associate Professor of Medicine for Oregon Health & Science University
and Director of Pacific Northwest Evidence-based Practice Center.
Audio and slides for this presentation are available on YouTube: http://youtu.be/dYRu8PVLU14
Cindy Tofthagen, PhD, ARNP, an assistant professor of nursing at the University of South Florida in Tampa and a post-doctoral fellow at the University of Massachusetts and Dana-Farber Cancer Institute, talks about chemotherapy-induced peripheral neuropathy (CIPN), the risk factors of CIPN, and how to manage the condition. This presentation was originally given at Dana-Farber Cancer Institute on Aug. 6, 2013 and put on by Dana-Farber's Blum Resource Center.
1. Smoking cessation and mental ill health:
what does trial based evidence tell us?
Dr Tim Bradshaw
Senior Lecturer
University of Manchester
2. Content
• Review issues related to mortality and
morbidity in people with serious mental illness
(SMI)
• Consider some of the reasons for poor
physical health including smoking
• Examine evidence for the effectiveness of
smoking cessation in people with SMI
• Present the Scimitar bespoke smoking
cessation in SMI trial
3.
4.
5.
6.
7.
8.
9.
10.
11.
12. Life expectancy in people with SMI?
• People with SMI die on average 15 - 25 years earlier
than other members of general population
(Schizophrenia Commission, 2012, Tiihonen et al.,
2009)
• While most of the world’s population has enjoyed
increasing longevity people with SMI are dying at a
younger age than they were 30 years ago (Saha et al.
2007)
13. Reasons for poor physical health
• Poor diet (McCreadie, 2003)
• Low levels of physical activity (Brown et al, 1999)
• Approximately 70 – 80% of people with
schizophrenia are overweight or obese
(McCreadie, 2003)
• High prevalence of smoking (Kelly and
McCreadie, 1999)
• Effect of atypical neuroleptic medication (Sims,
1987; Mortenson and Juel, 1990; Appleby, 2000)
15. Smoking is not good for you
• Cancers
• Chromic lung disease
• IHD
• Osteoporosis
• Etc etc
• ‘Current cigarette smoking will cause 450
million deaths over the next 50 years’ Richard
Peto
16. Smoking and SMI
• People with SMI smoke more, more often,
start earlier and inhale more deeply and
spend a greater proportion of their income on
cigarettes
17. Effect of smoking on premature mortality
• Brown et al (2010) 25-year follow up of a
community cohort of 370 people with
schizophrenia.
– 164 (44%) had died (mean age of death 57.3 years
men v. 65.5 years women)
– 81% of excess mortality was from natural causes
– Smoking-related diseases estimated to account
for 70% of the excess natural mortality
18. Tobacco poverty & SMI
• SMI = income from benefits
• ‘Give back’ 25-38% benefits to the state
based on a 20-30/day habit
McCreadie & Kelly (2000)
19. Why do so many people with SMI
smoke?
• Biological reasons / Self medication
– Reduces negative symptoms (Glassman, 1993)
– Improves cognitive functioning (Levin, 1996).
– Reduces EP side effects of anti-psychotics (Ziedonis et al,
2003)
– Reduces tension??? Or gives relief from nicotine
withdrawal
• Culture of MH services
• Addictive Pharmacology of nicotine
20. When do people with SMI start
smoking?
• Estimated prevalence of tobacco users in first
episode in 58.9% (Myles et al, 2012) it has
been hypothesised it may be a vulnerability
factor to developing psychosis (de Leon, 1996)
• People with SMI ‘enter the service as non-
smokers and come out … as smokers because
of the culture’ (House of Commons Health
Committee 2005, question 239)
21. The smoking culture in mental health
services
• Elevated smoking rates amongst MH staff
• Staff accept smoking as routine and offer cigarettes
• Staff smoke with patients
• Means of pacifying distressed inpatients
• Lack of stimulation and relief of boredom in inpatient
units
• Access to cigs is a source of conflict and control
between staff and patients and between patients
• The ‘cigarette economy of institutions’
• Trade cigarettes for sexual favours
• Non-smokers initiated in smoking upon admission
Lawn 2004; Hempel et al 2000
22. Smoking bans in the NHS
• Many MH staff resisted the implementation of
smoking bans stating that patients should be allowed
to smoke because it was “a comfort” and that they
had “nothing else to live for” or “nothing else to do”
(Jochelson and Majrowski, 2006)
• Staff argued that levels of untoward incidents would
increase if smoking bans were implemented however
evidence does not support this (el-Guebaly et al,
2002)
• Once smoking is banned therapeutic activities may
increase (Jochelson and Majrowski, 2006)
24. Other adverse effects of smoking
• Heavy smokers with SMI have higher rates of
rehospitalisation
• They require larger doses of anti-psychotic
medication (Ziedonis and George, 1997)
• They are more likely to have other co-morbid
substance misuse problems (Wehring et al,
2012)
25. Story so far…
• Elevated smoking levels and SMI
• Poor physical health and poor
provision/uptake of healthcare/health
promotion
• Strong chemical and cultural influences on
smoking
• But, some expressed desire to quit
28. Nicotine replacement therapy
• 123 trials NRT vs
placebo
• OR 1.77 (95%CI 1.66 –
1.88)
• No clear evidence of
which form/mode of
delivery best
29. Bupropion (‘Zyban’)
• Bupropion v placebo
• 31 trials
• OR 1.94 (95%CI 1.72-
2.19)
30. Varenicline (‘Champix’)
• Nicotine receptor
partial agonist
• versus placebo
• OR 3.22 (95%CI 2.43 –
4.27)
• Versus bupropion
• OR 1.66 (95% CI 1.28 -
2.16)
31. Behavioural support
• Brief advice
• Different models of psychological intervention
• Motivational enhancement
• CBT
• Support over the telephone
• Individual or group?
• Specialist training?
33. ‘Cut down to quit’: CDTQ
‘This aims at smokers who
express unwillingness or
inability to stop smoking
in the short term by
enabling them gradually
to cut down their smoking
over an extended period
while supported by NRT
so that they may
eventually become able
and willing to attempt to
quit altogether.
34. ‘Cut down to quit’: CDTQ
• Sustained NRT for
smokers
• Some behavioural
support/motivational
enhancement
• No obligation to set a quit
date
• Build upon early success
from smoking reduction
• Look at longer-term quit
rates
37. Preventing relapse
• No effective long term psychological
intervention
• Extending the use of bupropion, varenicline or
NRT improves longer-term abstinence
38. So what works in SMI?
• Hardcore smokers
• Expressed desire to quit; motivational deficits
• Poorer provision/uptake of general/primary
healthcare and health promotion
• Poorer uptake of smoking cessation services
• Cultural influences and barriers to quitting
• Polyphamacy – powerful psychotropics
39. • Systematic review of
randomised evidence
• Non-organic psychotic
disorders
• Excluded populations
with drugs and alcohol
problems
• Any intervention
• Outcomes:
– Abstinence
– Reduction in smoking
40. Included studies
• 10 RCTs (n=10 to 298)
• 8 US studies, 1 Australian, 1 Taiwan
• Schizophrenia/schizoaffective disorder
• Usually ‘an interest in stopping or cutting
down’
• Point prevalent abstinence
41. Interventions
• Combinations of:
• NRT (6 studies)
• +/-Bupropion (3 studies)
• +/- Individual support (1 study)
• +/- group support (3 studies)
• Bupropion (5 studies)
42. Point prevalence abstinence at 3-6
months
Odds Ratio
study (95% CI)
SMI smoking prog+NRT v ALA smoking prog+NRT
George et al 2000 1.02 ( 0.29, 3.59)
Subtotal 1.02 ( 0.29, 3.59)
Individual therapy+NRT v usual care
Baker et al 2006 2.78 ( 1.23, 6.25)
Subtotal 2.78 ( 1.23, 6.25)
Bupropion+group therapy v Placebo+group therapy
Evins et al 2001 2.13 ( 0.06, 72.52)
Evins et al 2005 10.48 ( 0.52, 209.31)
George et al 2002 7.00 ( 1.19, 41.34)
Subtotal 6.34 ( 1.56, 25.74)
Bupropion+group therapy+NRT v Placebo+group therapy+NRT
Evins et al 2007 2.36 ( 0.66, 8.43)
George et al 2006 7.80 ( 0.87, 70.05)
George et al 2007 4.56 ( 1.10, 18.86)
Subtotal 3.65 ( 1.53, 8.71)
.01 .1 .2 .5 1 5 10 20 50
Odds Ratio
Favours control Favours interevention
43. Key findings
• Most studies demonstrate that those with SMI are
able to quit or reduce smoking.
• Pharmaceutical and behavioural treatments used to
treat nicotine dependence in the general population
seem to be effective in the SMI population.
• If participants were psychiatrically stable at initiation
of quit attempts, smoking cessation interventions did
not worsen their mental state.
44. Complications!
• Varenicline has been linked to suicidal behaviour
(Gunnel et al, 2009)
• Stopping smoking can reduce metabolism of some
medication resulting in higher, sometimes toxic
blood levels
Clozapine and Olanzapine – baseline bloods
should be taken and dosage reduced by 25% in
the first week of cessation followed by weekly
blood tests until levels stabalise
45. Varenicline more recent evidence
• A recent systematic review by Cerimele and Durango
(2012) examined data from 17 studies concluded
that Verenicline treatment was not associated with
worsening of psychiatric symptoms in patients with
SMI
• No patients experienced suicidal ideation or suicidal
behaviours
• Although sample sizes were small i.e. total = 260
patients
46. Bespoke Smoking
Cessation (BSC) trial for
SMI (NIHR HTA funded)
• Prof Simon Gilbody (PI)
• Prof Helen Lester
• Dr Tim Bradshaw
• Prof Susan Michie
• Prof Robert West
• Dr Mei-See Man
47. This project was funded by the National Institute for Health Research Health
Technology Assessment (NIHR HTA) Programme (project number 07/41/05) and will
be published in full in Health Technology Assessment.
The views and opinions expressed therein are those of the authors and do not
necessarily reflect those of the HTA programme, NIHR, NHS or the Department of
Health.
49. Uncertainties:
• Content of the intervention
• Acceptability of the intervention
• Barriers to recruitment (staff and patients)
• Setting and mode of delivery
• Feasibility of longer-term follow-up
50. 100 service users with a
diagnosis of SMI
Randomised individually.
Bespoke smoking cessation Usual care only
Intervention plus usual care
Primary outcome expired Primary outcome expired
breath Carbon Monoxide (CO) breath Carbon Monoxide (CO)
0 6 12 0 6 12
wks mths mths wks mths mths
51. Inclusion criteria
• Documented diagnosis of Schizophrenia, schizoaffective
disorder, psychosis or Bipolar disorder
• Currently a smoker but willing to do something about
smoking
• Over 18 years age
Exclusion criteria
• Pregnant or breastfeeding
• Current co-morbid drug or alcohol abuse
• Currently being prescribed smoking cessation treatments
(NRT, Zyban, Champix)
52. Scimitar intervention
• Smoking cessation therapists trained to NHS
Level 2 Intermediate Advisor standard
• However flexible delivery to include
– More than the usual six sessions as per need
– Offer Cut Down to Quit (CDtQ) as an alternative to
abrupt cessation
– NRT – as much and for as long as patients want it
– Bupropion if requested, but not Varenicline
– Venue and times of sessions according to patient
preference
53.
54. Outcome measures
• Primary outcome will be expired CO measurement at
12 months post-recruitment plus
– Reduction in number of cigarettes smoked (self report)
– Fagerstrom test of nicotine dependence
– Motivation to Quit questionnaire
– If successfully quit smoking, the number of cessation attempts and the
periods of cessation.
• General mental health (PHQ-95 & SF-126)
• Cost effectiveness (EuroQol EQ-5D7, Health
Economics/Service utilisation Questionnaire)
• Acceptability, fidelity and adherence with smoking cessation
programme
56. Recruitment (2)
3% YORK MANCHESTER HULL
(1/38)
8%
(1/13) GP Database
29% 37%
(11/38) (17/46) Secondary Care
referral
71% 63% 92%
(27/38) (29/46) (12/13) Self Referral
Total = 97 participants
57. Qualitative study
• Semi-structured interviews with:
14 patients with SMI from across the 3
sites who received the intervention
3 MH-SCPs (one from each site)
• Thematic analysis (blind to study outcome)
58. Routine Primary Care is unsuitable
• “Doctors are always recommending me to give up smoking.
Yes. I can’t really remember what they said. They just say,
‘Do you smoke?’ And I say yeah, and they said, ‘Give up.’”
M1037
• “I’ve actually had a doctor turn round and say, after quite an
episode which was quite a lengthy episode, and I talked about
giving up, he said, oh no, you don’t want to be giving up at
the moment. So it was kind of like a medical permission to
carry on smoking… The doctor might say, as he said, terrible
thing smoking. But never actually say, you should give up,
and I’ll refer you. I’ve had to ask for that. The last thing you
want to think about is giving up, that sort of comment comes
across”. Y1085
59. Need a separate MHSCP in primary care
• “[The practice nurse] just simply said, “We’re not
putting you on the Champix”, and the other one as
well, “Not putting you on them”. And that was it. I
was out the door, gone.” M1100
• “The nurses, they don’t give you much time to talk
about it really. They just sort of pack you off with
some boxes of patches. [The MHSCP] listens to your
mental health problems as well, what you’re thinking…
she helped me to... feel at ease about not being so
hard on myself again if I’m suffering from illness…she
gave me a lot of peace of mind “ M1037
60. Need a separate MHSCP in primary care
• “A lot of the people with serious mental illness are
now seen in general practice and nowhere else..so
people are handed back to general practice, to benefit
most people, there’d have to be something done in
primary care”.MHSCP3
• “You could put this work into main stream, you know,
into CPN’s work, but I don’t know that everybody
would do it, that’s the thing, and how much time and
attention they would give, because you need to be
quite focused” MHSCP 3
61. Need for Mental Health background (1)
• It wasn’t just a stop smoking clinic for Tom, Dick and
Harry, she understood the mental health side, which is
obviously a big concern… Because I wouldn’t go to a
normal…because I’m frightened…Well [the MHSCP]
knows what I’ve got. Whereas if you go to a normal stop
smoking thing and they know you’ve got mental health
problems then it’s stigma isn’t it?... you’ve got to trust
the person who you’re talking to and be comfortable
with them, especially on mental health issues, because if
you’re talking to somebody who doesn’t understand
then you think well, you’re not on the same wavelength
as me, you don’t understand me Y1098
62. Need for Mental Health background (2)
• I found that the relationship I had with [the MHSCP],
was such that she was supportive without pushing.
And it’s very much the case that she was there to
help, for advice, rather than to ram anything down
my throat…It becomes more of a therapeutic
relationship, rather than the nurses making me, or
the nurses leading me, whereas in a therapeutic
relationship, it’s the nurses walking along beside me,
making the journey with me rather than pushing me
Y1053
63. What does ‘bespoke’ mean?
• “You work flexibly, they get someone that’s got some
understanding of their mental health issues, someone
who can work with, you know, have the time to work
with the other network of people that are involved
with them as well” MHSCP 3
• “It was individual to the person really, flexible to their
needs, like seeing them when they wanted within
reason and then not putting too much pressure on
them that’s how I saw it…just tailored to the person
see what works for each person” MHSCP2
64. Barriers to implementation (1)
• ‘Chaotic’ population
“She disengaged and was texting me saying, ‘Oh
I’ve not done too well this week so can you come
next week?’ And I’d go and she wouldn’t be
there. .. even if I could say only one of my clients
attended every appointment [but] none of them
did…I think it’s reflective of the patient group
really…. they’re just so chaotic, very few of them
had diaries and if they did it wasn’t really like a
diary it was a notebook that was all upside
down... they’d just write on one page that you
were coming and then they just put it in a
drawer” MHSCP 2
65. Barriers to implementation (2)
• Difficulty liaising with GPs:
“If the GP wouldn’t prescribe... then you’re chasing it up and then
when the client goes it’s not there and they get annoyed that
they’ve wasted a visit to the doctors. Some GP surgeries refused to
do it on my recommendation and had to see the client. So then the
client had to make an appointment with the GP which just didn’t
happen. So then I’d say well I’ll give you a letter to take with the
doc... and then they lose the letter.” MHSCP2
• Patients struggle with motivation – getting the ‘window of
opportunity’:
“I know at the moment it’s not the right time…it’s hitting the right
time with the right stuff” Y1098
for individuals prescribed clozapine there are important considerations which need to be explored before cessation commences (Cormac et al., 2009). Individuals have reported increases in positive illness related symptoms as well as a decline in cognitive ability and function, following smoking cessation (Cole et al., 2010). The same enzyme which is used to metabolise clozapine, CYP 1A2 (Urichuk et al., 2008), is also induced in smokers by the polycyclic aromatic hydrocarbons found in tobacco smoke (Kroon, 2009), which in turn effects the metabolism of clozapine (Schaffer et al., 2009), causing a reduction in plasma concentrations (Sepalla et al., 1999; Bondolfi et al., 2005). Consequently, smokers will require a higher maintenance dose to generate the same therapeutic response in comparison to non-smokers (Meyer, 2001; van der Weide et al., 2003; Bondolfi et al., 2005; Taylor et al., 2005). Whilst very heavy smoking has also been linked to a total inability to achieve therapeutic levels with clozapine (Bender & Eap, 1998). In Contrast, plasma concentration will increase if an individual commences smoking cessation;
Three centered study and is the first RCT of smoking cessation for SMI conducted in the UK
Measured by patient treatment records kept by MH-SCPs, qualitative interviews with intervention and control participants and MH-SCPs