ASH: New report finds more must be done to help smokers with mental health conditions quit

• New report finds 1 in 5 mental health trusts still do not have a comprehensive smokefree policy in place, despite the Government deadline for implementation having passed last year
• Smoking prevalence amongst people with mental health conditions remains around 50% higher than among those without
• Staff behaviour often enables smoking, with staff accompanying patients on smoking breaks every day in 57% of trusts
• In 55% of trusts, patients were not always asked if they smoked on admission
• Only 47% of trusts offered the choice of combination NRT or varenicline in line with NICE best practice 

More must be done to help smokers with mental health conditions quit

A new report from Action on Smoking and Health, funded by Public Health England, has found that 82% of surveyed mental health trusts have a comprehensive smokefree policy in place, making good progress towards the Government’s 100% target. [1]

The findings from this report: “Progress towards smokefree mental health services” are important as smoking rates among people with serious mental health conditions are over 50% higher than in the general population [2]. 

Action on Smoking and Health (ASH) are also publishing a report into service users experiences of smokefree policies, funded by Cancer Research UK. The report includes key practical recommendations for implementing smokefree policies in a supportive and person-centred way. [3]

Smoking killed 78,000 people in England last year and is the largest single contributor to the average 10-20 year reduction in life expectancy among people with mental health conditions. [4]

The target in the Government’s Tobacco Control Plan was for all mental health trusts to implement comprehensive smokefree policies by 2018. By 2019, four fifths of surveyed trusts had a comprehensive smokefree policy in place. However, even for those trusts with a policy, there is plenty more work to be done.

Room for improvement

Not all in-patients with mental health conditions are getting the support they need to quit smoking. NICE guidance [5] makes clear recommendations to mental health trusts on helping people with mental health conditions to stop smoking. But some trusts have yet to implement these recommendations. 

1 in 5 trusts still do not have a comprehensive smokefree policy in place, despite the Government deadline for implementation being last year. These trusts should implement comprehensive smokefree policies as a matter of priority. If additional support is needed, they should seek guidance and support from Public Health England, NHS England and trusts where such policies are established and working well.

The report also found that, of those trusts that responded: 

• All trusts offered Nicotine Replacement Therapy (NRT) to their patients but only 47% offered the most effective smoking treatment of either combination NRT, or varenicline.
• Despite NICE PH48 recommendations highlighting strong leadership as a key feature, it was one of the most commonly identified barriers to smokefree policy implementation. 
• In 55% of surveyed trusts, patients were not always asked their smoking status on admission, against NICE PH48 recommendations.
• Staff accompanied patients on smoking breaks every day in 57% of surveyed trusts. This is despite NICE PH48 recommending no staff-supervised or staff-facilitated smoking breaks for people using secondary care services.

Key recommendations:

• All trusts without a comprehensive smokefree policy in place should implement one as a matter of priority
• Trusts should offer both combination NRT and varenicline to inpatient smokers, with behavioural support, to give them the best possible chance of quitting.
• Mental health trust managers and smokefree leads should work with ward managers and staff to audit and eliminate the time spent by staff escorting patients on smoking breaks.
• Smoking status should be routinely and consistently asked and recorded on patients’ admission to acute mental health services.
• Local authorities should work with mental health trusts to ensure that people with mental health conditions in the community can access appropriate specialist support to enable them to quit. 

Ann McNeill, Professor of Tobacco Addiction and Co-Chair of the Mental Health and Smoking Partnership said: 

“Helping people with mental health conditions to quit smoking is the best way to help them live longer. While we have seen smoking rates fall dramatically for the population as a whole over the last four decades, we haven’t seen the same decline for people with mental health conditions. More work needs to be done, including by mental health trusts providing support for smokers to stop smoking.

At a minimum, trusts should ensure they meet the recommendations set out in NICE guidance and ensure they contribute to the Government’s target for all mental health trusts to have a comprehensive smokefree policy in place. Let’s stop smokers with mental health conditions from slipping through the gaps in the system.” 

ENDS

Notes to the editor:

[1] Findings are from an online survey of mental health trusts in England with an 83% response rate (45 out of 54 trusts responded in full) undertaken by ASH on behalf of Public Health England. Full report here: https://ash.org.uk/uncategorized/progress-towards-smokefree-mental-health-services/

[2] Richardson et al. Smoking and quitting behaviours by mental health conditions in Great Britain (1993-2014). 2018. doi: 10.1016/j.addbeh.2018.10.011.

[3] Smokefree trusts: making it work for service users. Full report here: https://ash.org.uk/information-and-resources/reports-submissions/reports/progress-towards-smokefree-mental-health-services/

[4] Chesney E et al. 'Risks of all-cause and suicide mortality in mental disorders: a meta-review.' World Psychiatry, 2014 & Chang CK et al. 'Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London'. 2011. doi: 10.1371/journal.pone.0019590.

[5] NICE. Smoking: acute, maternity and mental health services. 2013