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Nice guidance on smoking cessation in mental health settings


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Presentation from the International Congress of the Royal College of Psychiatrists 24-27 June 2014, London

Published in: Health & Medicine
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Nice guidance on smoking cessation in mental health settings

  1. 1. NICE Guidance on smoking cessation in mental health settings Royal College of Psychiatry International Congress. Professor Mike Kelly, Director of the Centre for Public Health, NICE and the Institute of Public Health, University of Cambridge.
  2. 2. NICE The National Institute for Health and Care Excellence (NICE) is the independent organisation in the UK responsible for providing national guidance to the NHS, local authorities and the wider public health community on the promotion of good health and the prevention and treatment of ill health.
  3. 3. The pillars of our work • Comprehensive evidence base • Expert input • Patient and carer involvement and community engagement. • Independent advisory committees • Lengthy consultation • Regular review • Open and transparent process.
  4. 4. • Smoking cessation in secondary care: acute, maternity and mental health services PH48 • e/pdf/English
  5. 5. What the guidance was not: • About banning smoking; • About disciplining staff; • About punishing relatives.
  6. 6. It is about • Providing support and help for people addicted to nicotine deal with their addiction while in hospital.
  7. 7. Background. • Smoking prevalence is particularly high among people with mental health problems, and has changed little in this group in the past 20 years. • Most of the reduction in life expectancy among people with serious mental illness is attributable to smoking.
  8. 8. • Treating smoking-related illnesses in people with mental health problems costs the NHS £720 million a year. • Smoking increases psychotropic drug costs in the UK by up to £40 million.
  9. 9. • 33% of people with mental health problems and 70% of people in psychiatric units smoke tobacco. • Smoking is common among young people with mental health problems. • Young people aged 11–16 years with an emotional, hyperkinetic or conduct disorder were much more likely to be smokers (19%, 15% and 30% respectively) than other young people (6%)
  10. 10. • People with mental health problems are just as likely to want to stop as the general population – and are able to stop when offered evidence-based support. • Effective stop smoking treatment is not always offered.
  11. 11. • There is a lack of support for smoke free policies among healthcare staff working in mental health. • Staff report lacking specific knowledge about the influence of smoking – and cessation activities – on a person’s mental health. • Some physicians unaware that the dosage of some antipsychotic medications may need to be reduced when a person stops smoking .
  12. 12. Principles. • Secondary care providers have a duty of care to protect the health of, and promote healthy behaviour among, people who use, or work in, their services. • This duty of care includes providing them with effective support to stop smoking or to abstain from smoking while using or working in secondary care services.
  13. 13. • The guidance aimed to support smoking cessation, temporary abstinence from smoking and smoke free policies in all secondary care settings.
  14. 14. Main recommendations.
  15. 15. • There must be strong leadership and management to ensure secondary care premises (including grounds, vehicles and other settings involved in delivery of secondary care services) remain smoke free and to help to promote non-smoking as the norm for people using these services.
  16. 16. • All hospitals should have an on-site stop smoking service. • People who smoke should be offered support at the first opportunity, be advised to stop, provided with pharmacotherapy and intensive behavioural support.
  17. 17. • Providing intensive behavioural support and pharmacotherapy should be an integral component of secondary care. • Continuity of care should be the goal on into the community.
  18. 18. • Staff should be trained to support people to stop smoking while using secondary care services. • Staff should be supported to themselves stop smoking or to abstain while at work. • There should be no designated smoking areas, no exceptions for particular groups, and no staff-supervised or staff-facilitated smoking breaks for people using secondary care services.
  19. 19. Who is this guidance for? • The guidance is for: commissioners, clinical leads in secondary care services, health and social care practitioners, leaders of the local health and care system, managers of clinical services, estate managers and other managers, trust boards, and other staff with any aspect of secondary care or public health as part of their remit.
  20. 20. Recommendation 3 Provide intensive support for people using acute and mental health services
  21. 21. • Discuss current and past smoking behaviour and develop a personal stop smoking plan as part of a review of patients’ health and wellbeing. • Provide information about the different types of stop smoking pharmacotherapies and how to use them. • Provide information about the types of intensive behavioural support available.
  22. 22. • Offer and arrange or supply prescriptions of stop smoking pharmacotherapies. • For anyone who does not want, is not ready or is unable to stop completely, encourage the use of licensed nicotine-containing products to help them abstain and provide intensive behavioural support to maintain abstinence from smoking while in secondary care.
  23. 23. • Offer, and if they agree, use measurements of exhaled carbon monoxide during each contact, to motivate and provide feedback on progress. • Alert the person’s healthcare providers and prescribers to changes in smoking behaviour because other drug doses may need adjusting
  24. 24. • In addition, for people admitted to a secondary care setting: – Provide immediate support if necessary, and otherwise within 24 hours of admission. – Provide support (delivered in the setting) as often and for as long as needed during admission. – Offer weekly sessions, preferably face-to-face, for a minimum of 4 weeks after discharge. If it is not possible to provide this support after discharge, arrange a referral to a local stop smoking service.
  25. 25. • In addition, for people receiving secondary care services in the community or at outpatient clinics : – Provide immediate support in the outpatient setting. – Offer weekly sessions, preferably face-to-face, for a minimum of 4 weeks after the date they stopped smoking. Arrange a referral to a local stop smoking service, if preferred by the person.
  26. 26. • Ensure people who use drugs that are affected by smoking (or stopping smoking) are monitored, and the dosage adjusted if appropriate. Drugs that are affected include clozapine, olanzapine, theophylline and warfarin.
  27. 27. Conclusions • Key health inequalities and social justice issue. • Evidence of successes. • Opposition from professionals and managers. • A worthy aspiration.