mental health and smoking for gps
TRANSCRIPT
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Smoking and Mental Health For GP Mental Health LeadsJim McManusDirector of Public Health
Liz FisherHead of Provider Services, Tobacco Control Lead
Emily ClarkeAssistant ManagerHertfordshire Stop Smoking Service
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Why Tobacco Control remains important• Single most important cause of premature
morbidity and mortality • Kills 80,000 people prematurely in England alone
and 1,500 people in Herts die every year• Accounts for 50% of health inequalities between
better and worst off • Disproportionately affects most deprived groups• 135,300 smokers in Herts• Cost the NHS £55 million in 2013-2014
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Smoking not social status is the greatest cause of health inequalities
References:1. Gruer L et al. BMJ 2009;338;bmj.b480 (Relative mortality assessed at 2nd 14 year follow-up between male smokers & non-smokers of highest & lowest social class)
Smokers from the highest social class have a lower life expectancy than non-smokers in the lowest social class
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I+II IV+VSocial Class
Rel
ativ
e m
orta
lity
Male non-smokers Male smokers
Highest Lowest
The life expectancy
between rich and poor smokers is
similarRicher smokers have a lower life expectancy than
poorer non-smokers
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Herts smoking attributable morbidity and mortality
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Herts smoking prevalence 2010-2013
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Herts routine and manual prevalence
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Smoking and Mental Health• Greatest impact on health
inequalities• High prevalence – no
change over 20 years• 70% in some groups• 16-25 years of life lost• 42% of all tobacco smoked• Misconceptions about
wanting to quit and impact on mental health
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Smoking and Mental Health• Improved mental health
reduces lifestyle risk behaviours
• Mental ill health: increased risk - range of unhealthy lifestyle behaviours
• Smoking responsible for most of the excess mortality in people with severe mental health conditions
• Young people - emotional disorders
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RCGPs: guidance smoking and mental disorders • Smoking is the largest avoidable cause of premature
death and health inequality in those with mental disorders who die 10-20 years earlier than the general population.
• Adults with mental disorders disproportionately experience tobacco related harm.
• With appropriate support, people with mental disorder are able to stop smoking.
• Smoking cessation improves mental and physical health even in the short term and reduces risk of premature death.
• Impact of smoking cessation on mood and anxiety disorders is at least as large as antidepressant treatment.
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What is difficult about smoking and mental health:• Mental health care staff see smoking as less of a priority
than general NHS staff• There remains a culture of acceptability within mental
health providers• There are no national reporting systems on stopping
smoking and mental healthMyths:• Stopping smoking has adverse effects on mental health• Mental health service users have other priorities• Mental health service users don’t want to stop smoking• Mental health service users can’t stop smoking
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Reducing the harm from tobacco - HWbB and PH Priority
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Tobacco – an NHS priority • NICE PH48• NICE PH45
No change in smoking prevalencein people with a mental health disorder for 20 years
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What’s happening locally?• Regional smoking and mental health seminar• CLeaR review on tobacco control• NHS systems leaders’ commitment to tobacco
control• Herts smoking and mental health action group • Implementing NICE PH48• Implementing NICE PH45 – harm reduction• Mental health and smoking master classes• Developing more specialist stop smoking services
– behavioural sciences
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Harm Reduction Guidance
• Implementing NICE PH 45• Stopping smoking main recommendation • Effectiveness and cost effectiveness of harm
reduction• For smokers not ready/unable to quit in one step• Behavioural support • Nicotine containing products – right doses• Role of e –cigarettes for harm reduction
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Mental Health and Primary care
• The scale of the problem – 1:4 adults have a mental health problem in any one year
• QOF points • Identification of all smokers• MECC – build confidence in ability to quit with
specialist support• Referring to specialist services• Heavier smokers – need higher doses and
longer term NRT• Role of varenicline
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Medicines that need dose adjusting
• Stopping smoking requires the immediate reduction of doses of some antidepressants, antipsychotics and benzodiazepines by up to 25% within the first week and up to 50% within 4 weeks.
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Medicines that need dose adjusting
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Commissioning for smoking and mental health• HPfT CQUIN 13/14
Herts.P.f.T (Mental Health)Department Total Referrals
A.O.T. 25
Community Mental Health Team (CMHT) 318
Early Intervention in Psychosis 4
Enhanced Primary Mental Health Service 2
RAID 2
Hertfordshire Commuinty Eating Disorder Service 2
TOTAL 353
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Proposed Quality Schedule metrics 15/16• All service users to have smoking status recorded • Brief intervention advice to be given to all smokers• All smokers to be referred to Hertfordshire Stop
Smoking Service (HSSS) unless they ‘opt out’• All staff to be asked to complete an online survey
(in Q1) on attitudes to smoking and electronic cigarettes (to be provided by Hertfordshire Stop Smoking Service).
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Quality Schedule metrics15/16 cont.• All staff to be encouraged to quit smoking and offered a
referral to HSSS • To promote campaigns such as Stoptober and National
No Smoking Day with service users and staff• Adopt Hertfordshire Tobacco Harm Reduction Guidance • HPfT to become Smokefree by the end of 2016, with the
Lister site becoming Smokefree pilot site by 1 October 2015 (plans to achieve this at the Lister are already in progress)
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Public Health
• TC Alliance – representation from mental health stakeholders
• NHS Health Checks• Mental Health Health Checks• Vol orgs (MIND, Viewpoint, Living Room)• Drug and alcohol services
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Offender health• Smoking prevalence similar to mental health
clients• 770 prisoners – but expanding• Health of probation caseload• Prison and specialist SSSs• Smokefree prison/Smokefree cells• Access to NRT for harm reduction• Staff SSSs• Probation action plan being developed
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PRIORITY Groups
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Next Steps
• Ensure revisions to HWb Board tobacco control priorities include mental health
• Agree QS metrics with HPfT15/16• Improve quality of stop smoking services for
metal health service users• Implement harm reduction guidance• Increase knowledge and skills of frontline staff
and volunteers who work with mental health service users
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SAVE THE DATE
Smoking and Mental Health Masterclass
Wednesday 29th April 2015
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Further readingPrimary Care Guidance on Smoking and Mental Disorders:http://www.rcgp.org.uk/clinical-and-research/clinical-resources/mental-health.aspx
RCP report: https://www.rcplondon.ac.uk/sites/default/files/smoking_and_mental_health_-_key_recommendations.pdf
NICE PH 48: https://www.nice.org.uk/guidance/ph48
NICE PH 45: https://www.nice.org.uk/guidance/ph45
BI training for GPs :http://learning.bmj.com/learning/module-intro/advice-smoking.html?moduleId=10032720&locale=en_GB