Smoking Cessation and Mental Health Environmental Context, Policy Issues, Resources

1. 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

2. 2 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

3. 3 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.)

4. 4 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

5. 5 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

6. 6 Financing Large role and influence of States as payors and regulators Complex payment and reimbursement mechanisms Severely under-funded systems

7. 7 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.)

8. 8 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.

9. 9 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.

10. 10 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

11. 11 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

12. 12 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

13. 13 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.).