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Smoking Cessation and Mental Health Environmental Context, Policy Issues, & Resources. Gail P. Hutchings, MPA Behavioral Health Policy Collaborative & Connie Revell Smoking Cessation Leadership Center July 26, 2007 National Association of Psychiatric Hospital Systems.

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Smoking Cessation and Mental HealthEnvironmental Context, Policy Issues, & Resources

Gail P. Hutchings, MPA

Behavioral Health Policy Collaborative


Connie Revell

Smoking Cessation Leadership Center

July 26, 2007

National Association of Psychiatric Hospital Systems

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Unique environmental and contextual issues to mental health

  • How Does Mental Health Differ from Other Health Systems?

    • Historical

    • Social

    • Political

    • Financing

    • Data and Technology

    • Other

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  • Centuries-old split between treating the mind “vs.” the body.

    • Advent of psychiatric hospitals (asylums).

    • Variety of organizational sequencing for State Departments

      • Separation of State Mental Health Authorities from State Health Departments in many States

    • Different from other partners of the Smoking Cessation Leadership Center (anesthesiologists, dental hygienists, etc.)

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  • Stigma!

    • Negative impact on help-seeking behaviors

    • Social isolation

    • Family disintegration

    • Segregation (housing)

    • Suspicion of criminal behavior despite the science

  • Recovery as relatively new concept – not universally embraced nor understood

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  • Interpersonal-level

    • Various power dynamics

    • Involuntary commitment

    • Lack of choice and control

    • Traumatic experiences

  • Other levels

    • Persons with serious mental illnesses perceived as non-voters

    • Ability to influence political dynamics?

    • Inability to form united lobby across disability groups

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  • Large role and influence of States as payors and regulators

  • Complex payment and reimbursement mechanisms

  • Severely under-funded systems

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Data and Technology

  • Mental health has not been universally effective at using data to “make the case” for mental health treatment and services.

  • Mental health typically lags behind technological innovations in healthcare (e-health records, etc.)

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Smoking cessation as a newer issue…

  • Historical use of cigarettes as behavior modification/control in psychiatric settings.

  • Relatively recent focus on health and wellness

    • Clash of emerging sense of inappropriateness of health care settings encouraging/permitting smoking.

    • New data re: people with serious mental illnesses dying on average 25 years earlier than non mi peers.

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Policy and practice issues

  • Consumer rights issue?

  • When is the “right time” to address smoking with consumers?

    • Considerations: Crisis; Short-length hospital stays; co-occurring disorders; etc.

  • Payment and reimbursement issues (or lack of specific financing-related information)

  • Lack of data on intervention/cessation effectiveness for inpatient and outpatient settings.

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Policy and practice issues (cont’d)

  • New drugs for treatment – what are the interactive effects with psychotropic medications?

  • State-level Smoking Quitlines (1-800-QUIT NOW)

    • Efficacy data exists, but appropriate/effective for mental health consumers? Need data

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Recent Developments

  • NAMI Position Statement

  • NASMHPD Position Statement

  • National summit of key national mental health national organizations held March 2007 and sponsored by the Smoking Cessation Leadership Center.

  • Led to new National Partnership on Wellness and Smoking Cessation.

    • Members: NAPHS, NASMHPD, National Alliance on Mental Illness, Mental Health America, Depression and Bi-Polar Support Alliance, NASW, (+ approx. 20 other organizations and growing)

    • Developing a national action agenda

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Key Resources:

  • New! Smoking Cessation Leadership Center website – mental health section:

  • New! NASMHPD Tool Kit, “Tobacco Free Living in Psychiatric Settings“:

  • New! “Mental Health Provider Toolkit for Smoking Cessation” from the Colorado State Tobacco Education and Prevention Program (STEPP). For now, contact [email protected]

  • NAMI Position Statement: (see Section 7.3)

  • NASMHPD Position Statement:

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Final thoughts…

  • The data is simply too compelling re: loss of life and function to continue to ignore the issues of smoking and mental illness any longer. This is a leadership issue as much as it is a policy and practice issue.

  • We must address staff-related smoking prevalence and quitting. Otherwise, culture change will not occur.

  • We often tend to leap to the “worst case scenarios” – what we are really talking about at this point is offering EDUCATION and ACCESS to smoking cessation resources (medications, groups, quitlines, etc.).