Smoking Cessation and Mental Health How Does Mental Health Differ from Other Health Systems?

1. Smoking Cessation and Mental HealthHow Does Mental Health Differ from Other Health Systems? Gail P. Hutchings, MPA Behavioral Health Policy Collaborative March 22-23, 2007 Lansdowne, VA

2. Unique environmental and contextual issues to mental health • Historical • Social • Political • Financing • Data and Technology • Other

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 SCLC partners (anesthesiologists, dental hygienists, etc.)

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

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

8. Others?

9. Where do people with mental illness get care and what is their access to smoking per locus? • Primary care • Specialty care • Outpatient • Inpatient • Residential • Homes (private) • Group homes • Clubhouses • Employers