Download Smoking and mental health: working with the community

Smoking and mental health: working with the
community
Linda Bates
Development Officer
About this presentation
1. Why we’re doing this work
2. What we’ve done so far
3. What we’re doing next (hopefully!)
Who: Development Lead (2½ days per week)
Development Officer (4 days per week)
1. Why are we doing this work?
People with mental health issues:
• tend to smoke more than the general population, which leads to:
• very poor physical health outcomes that means they:
• experience a wide health inequalities gap and:
• have a reduced quality of life leading to:
• earlier death:
– 9-20 years shorter life expectancy for people with bipolar disorder
– 10-20 years shorter life expectancy for people with schizophrenia
– 7-11 years shorter life expectancy for people with recurrent depression
Those who do manage to stop smoking improve
their mental wellbeing as well as their physical health
2. What have we done so far?
• IMPACT Project (Improving Mental and Physical
health – Achieving Cessation Targets)
• Royal Edinburgh Hospital consultation
• Scottish Government’s 10 year mental health
strategy
• Smoking and mental health training pilot
IMPACT Project
Two-year IMPACT project (funded by the Edinburgh & Lothians Health
Foundation) aims to develop and deliver guidelines and implementation
suggestions so that community-based mental health organisations in the
Lothians can address smoking with the people they support.
How will we do this?
- gather evidence on smoking & mental health and produce a report
- map existing community-based MH services across the region
- interview service providers about their practice/policy
- hold focus groups with people supported by services
- hold workshops with staff from community-based services
- distribute a survey which gauges staff knowledge/confidence
- produce guidelines and implementation plan (late ‘16-early ‘17)
- develop related website for ongoing use (early-mid ‘17)
NOT NHS SETTINGS!
IMPACT Project
Focus groups (x4) held in Feb-March ’16:
- 24 people (15 women, 9 men), age range mid-20s to 55+
- experiences varied widely (from recent acute hospital admission to
never hospitalised)
Knowledge Exchange workshops (x2) held in Feb-April ’16:
- 18 people from 12 different organisations (mainly communitybased, but also four NHS: two stop-smoking services plus Breathing
Space and Smokeline)
Survey distributed to MH service staff Aug-Sept ‘16:
- sent to 60 contacts; 39 responses from 15+ workplaces
IMPACT Project
Themes from fieldwork - from the focus groups and knowledge exchange
workshops:
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very little knowledge about links between smoking and mental health
some didn’t believe there were links: “Smoking and mental health? It’s just another
layer of bullshit.”
most were unaware of how smoking can reduce the efficacy of MH medications
(such as anti-depressants and anti-psychotics): “It should just become common
knowledge… when you go to your doctor’s; [they should] mention that actually you’re not
getting the benefit of your medication if you’re taking other chemicals such as nicotine.”
electronic cigarettes are reportedly being widely used by this cohort, as with the
general public - any guidance should provide the most up-to-date information about their
safety/efficacy within a mental health context
good ideas were generated for alternative coping mechanisms
a person-centred, holistic approach was felt to be the best way of providing ongoing
support, ideally provided by staff at mental health services. Such support would need to be
intensive and ongoing
IMPACT Project
Themes from fieldwork - from the MH services staff survey:
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knowledge and understanding of topics relating to smoking and mental
health was generally good
confidence in discussing these topics was lower
some attitudes and assumptions still need to be addressed: “I work to
build a safe trusting relationship with service users - lecturing them about
smoking doesn't help build this relationship. Service users know that
smoking is bad; they don't need it repeated by every mental health
professional they come into contact with. And to think they do is
condescending and patronising”
Overall, practitioners welcomed the idea of better support and guidance
on this issue
IMPACT Project
Closing phase of funded Project:
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creating a Guidance document for community-based mental health
organisations across the Lothians, to help their support workers talk about
issues relating to smoking and mental health (launching March 2017).
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developing a website – www.impact.scot – which will host the Guidance,
related evidence and a practice-sharing forum (launching spring/summer
2017)
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dissemination event 21st March 2017
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repeat survey and compare to original results
Royal Edinburgh Hospital consultation
Context for consultation
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Inpatient mental health services: 10 wards providing acute admission,
adult acute, intensive psychiatric care (IPCU), forensic psychiatry and
psychiatric rehabilitation
Each ward has approximately 30 members of staff (12 per shift) and beds
available for 15-20 patients
NHS Lothian wide Smokefree Policy
Site specific Standard Operating Procedure (SOP): management of
smoking within adult mental health inpatient areas
Number of challenges and issues around compliance
Moving to a new build early 2017
Very quick turnaround!! Initial approach in June, September before
consultation agreed, consultation report anticipated March 2017
Royal Edinburgh Hospital consultation
Consultation process
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Involving: patients, staff, family and carers
Combination of questionnaires and focus groups
Patient consultation (December 2016):
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7 participants across 4 focus groups (acute, rehab and IPCU)
In addition, 6 completed questionnaires
2 x staff focus groups, plus questionnaires (January/February 2017)
1 x family and carer focus group, plus questionnaires
(January/February 2017)
Draft report by end of March
Meeting to discuss findings and agree what next in April (tbc)
Scottish Government’s 10 year mental health strategy
(currently in draft – awaiting publication)
• A lot of lobbying!!!
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Scottish Government: Ministers, MSPs and civil servants
Royal College of Psychiatrists
Third-sector mental health organisations
Mental Health Partnership in Scotland
NHS Health Scotland
COSLA (Convention of Scottish Local Authorities)
Royal College of Physicians Edinburgh
Blog pieces
Learning from ASH in London “Stolen Years” report
Scottish Government’s 10 year mental health strategy
(draft)
• Live Well – supporting people to look after themselves to stay
mentally and physically healthy, to get help quickly when they need
it, and to reduce inequalities for people living with mental health
problems
• Priority 6: Improve the physical health of people with severe and
enduring mental health problems to address premature mortality
– Ensure that prevention programmes e.g. smoking cessation are
accessible to people with mental health problems
• Priority 7: Focus on ‘All of Me’. Ensure parity between mental
health and physical health
– Develop more effective alignment with wider population health
improvement (including smoking)
Mental Health Training Pilot
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Half-day training course, run in November ‘16 within NHS Borders as a
pilot to gather feedback on content (specifically level of information
contained within the course)
Course aimed to challenge attitudes and perceptions, build confidence
and knowledge levels of participants, and encourage participants to
engage in the topic of smoking with the people they support who have
existing and ongoing mental health issues
Aimed at third-sector community based mental health services,
however NHS also attended
12 participants attended the pilot and it evaluated well
Currently undertaking a 3 month follow up survey to determine any lasting
impacts/changes to practice
3. What we’re doing next (hopefully!)
• Supporting implementation of 10 year mental health strategy
• Roll out of IMPACT Project
– Encouraging practitioners within Edinburgh and the Lothians to engage
with guidance
– Support for practitioners: IMPACT website and developing pilot
training for roll out
– Identify other geographic areas
• Royal Edinburgh Consultation
– Develop project to address findings from consultation: working with
REH colleagues, Advocacy Services and Family & Carers’ council
Linda Bates
ASH Scotland
8 Frederick Street
Edinburgh
EH2 2HB
[email protected]
Tel: 0131 225 4725