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
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
Historical • 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.)
Social • 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
Political • 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
Financing • Large role and influence of States as payors and regulators • Complex payment and reimbursement mechanisms • Severely under-funded systems
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.)
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.
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.
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
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
Key Resources: • New! Smoking Cessation Leadership Center website – mental health section: http://smokingcessationleadership.ucsf.edu/MH_Resources.html • New! NASMHPD Tool Kit, “Tobacco Free Living in Psychiatric Settings“:http://nasmhpd.org/general_files/publications/NASMHPD.toolkit.FINAL.pdf • New! “Mental Health Provider Toolkit for Smoking Cessation” from the Colorado State Tobacco Education and Prevention Program (STEPP). For now, contact Jeanette.Waxmonsky@UCHSC.edu • NAMI Position Statement:http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Public_Policy/NAMI_Policy_Platform/NAMI_public_policy_platform_Nov2006.pdf (see Section 7.3) • NASMHPD Position Statement:http://www.nasmhpd.org/general_files/position_statement/Smoking%20Position%20Statement.pdf
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.).