B14.3 Smoking Cessation Services for People with Serious Mental Health Issues_Rosemary Lamont

Rosemary Lamont RN M.Ed York Region Community and Health Services Prevent More to Treat Less Conference Session # B14.3 June 4, 2014

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Tobacco-by the numbers

People with serious mental health issues (SMHI)

3x 25

44%

more likely to smoke years of life lost vs. general population with smoking as a major risk factor of all cigarettes smoked

Els C, Selby P. CAN-ADAPTT: The Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment Clinical Practice Guidelines [Internet]. Toronto, Canada: Centre for Addiction and Mental Health; 2011[updated 2012 March 30; cited 2014 May 20]. Available from: https://www.nicotinedependenceclinic.com/English/CANADAPTT/Guideline/Mental%20Health%20and%20Other%20Addictions/Background.aspx#_ftn7 Callahan et. al. Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression. Journal of Psychiatric Research 48 Issue 1January 2014. Available from ScienceDirect:http://www.sciencedirect.com/science/article/pii/S0022395613003063 Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states PrevChronic Dis [serial online] 2006 Apr [cited 2014 May 20]. Available from: http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm.

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Background  Public Health (PHU) received request from 2 mental    

health agencies- clients were asking for help to quit Another agency had done client survey on addictionstobacco #1- contacted PHU Wellness program initiated at hospital outpatient unit Environmental scan revealed no community based programs for people with SMHI Brought agencies’ together to discuss problem and solutions 3

Where we started

Galuzzi L, Namib Desert [image on the Internet]. 2004 July 19 [cited 2014 May 20]. Available from: http://en.wikipedia.org/wiki/File:Thorn_Tree_Sossusvlei_Namib_Desert_Namibia_Luca_Galuzzi_2004a.JPG#filelinks

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Community of practice (CoP)  Synergy working together

toward common goal  Sharing of research, knowledge, expertise and skills  Strategies for organizational change  Friendly competition  Moral support 6

Reaching out to providers  Breaking down silos  Speaking their mission  Connecting the dots…  Scope and skills  Building on relationships  Challenging myths

Mahalko D, Concrete Staves [image on the Internet]. 2009 June 14 [cited 2014 May 20]. Available from: http://en.wikipedia.org/wiki/File:Silo__height_extension_by_adding_hoops_and_staves.jpg

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Goals: accessibility, coordination, capacity building

Novak J, The Tridge, Michigan U.S.A. [image on the Internet]. 2006 June 20 [cited 2014 May 20].

Available from: http://en.wikipedia.org/wiki/File:Tridge-Midland-MI.jpg

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Model made for our region TEACH Tobacco Addiction Recovery Program (TARP)- Created by Tobacco Addiction Recovery Team. St. Joseph’s Healthcare, Hamilton Ontario

Nicotine replacement therapy (NRT)

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Case manager voices

Evaluation of Training- what I learned…  How to respond to clients in a positive way- even small steps are good  People with mental illness are able to quit smoking

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Community collaboration CoP members

Case manager

Client

Community pharmacist

Physician 11

Public health role  Outreach to partners and funders  Facilitate Community of Practice  Preparation support documents  Training of case managers  Consultation on best practices  Evaluation tools and results  Resources creation or purchasing

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Client participant voices 100% agreed that the group met all or most of their needs and they would recommend it to others The group helped me by…  Working towards building confidence  Encouragement to quit smoking from others  Free NRT  Hearing other’s successes  Positive reinforcement/ misconceptions

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Challenges Maintaining momentum  Funding- various sources, annual  Competing agency priorities  Scope of practice  Staff turnover  Timelines  Partnership development  Service interruption 14

Successes

 Our major mental health agencies’

and hospital staff now trained on tobacco management strategies  Varying agencies have taken lead on funding applications  CoP members are providing support and resources to new members agencies  Most important: groups are offered in various locations to clients of participating agencies 15

Lessons learned  Engage senior management – tell client stories  Increase awareness of issue with LHIN planners  Policy development for organizational change  Expand membership on Community of Practice  Regular training of case managers, new staff  Program evaluation, client feedback, successes 16

Key messages  Client driven- they are asking for help  Sharing the work  Integrating TM into daily practice  Utilizing skills and scope of practice

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Implications  Every location unique in assets and challenges  Think beyond traditional mental health agencies  Are there opportunities for regional/provincial CoP for

mental health and tobacco- strength in numbers  More data on health of people with SMHI as related to chronic disease risk factors  Enhance engagement of primary care providers

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Where are we now?

Shankbone D, Jewish National Fund Trees, Negev Desert [image on the Internet]. 2009 March [cited 2014 May 20]. Available from: http://en.wikipedia.org/wiki/File:Jewish_National_Fund_trees_in_The_Negev.jpg

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Last word…from clients  The program gave me incentive to quit for good  The program works and without it I could not have

quit…and I know other sick people  Due to circumstances… in my life I wasn’t ready to quit but when I get to that point I’d…give the program another try

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