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Otachi JK, Otis M, Flaherty C, Okoli CTC. Enhancing Provider Delivery of Tobacco Treatment Within the Inpatient Psychiatric Setting. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:72-83. [PMID: 35762032 DOI: 10.1080/19371918.2022.2093303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People with mental illnesses (MI) smoke at higher rates than the general population. However, few mental health providers (MHPs) deliver tobacco treatment to patients with MI especially within inpatient psychiatric settings. According to evidence, fewer than half of MHPs in the US mental and behavioral health settings provide the recommended evidence-based tobacco treatment interventions to their clients with MI. This paper uses the theory of planned behavior to examine factors associated with provider intentions to deliver and their experiences in providing evidence-based tobacco treatment to clients with MI. Data were obtained from a cross-sectional survey of 219 providers in a state psychiatric hospital in Kentucky. Attitudes, subjective norms, and perceived behavioral control were associated with providers' intentions to deliver tobacco treatment when controlling for demographic and work-related variables. However, only profession, subjective norms, and attitudes were associated with reported provision of evidence-based tobacco treatment. Given the underuse of routine tobacco treatment for this vulnerable population, understanding factors influencing provider delivery of tobacco treatment is needed to guide strategies for reducing the disproportionate rates of tobacco use and related burden among people with MI.
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Affiliation(s)
- Janet K Otachi
- Senior Behavioral Health Social Worker, University of Kentucky Health Care (UKHC), Lexington, Kentucky, USA
| | - Melanie Otis
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Chris Flaherty
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
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Jenkin G, McIntosh J, Hoek J, Mala K, Paap H, Peterson D, Marques B, Every-Palmer S. There's no smoke without fire: Smoking in smoke-free acute mental health wards. PLoS One 2021; 16:e0259984. [PMID: 34780542 PMCID: PMC8592473 DOI: 10.1371/journal.pone.0259984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People who smoke with serious mental illness carry disproportionate costs from smoking, including poor health and premature death from tobacco-related illnesses. Hospitals in New Zealand are ostensibly smoke-free; however, some mental health wards have resisted implementing this policy. AIM This study explored smoking in acute metal health wards using data emerging from a large sociological study on modern acute psychiatric units. METHODS Eighty-five in-depth, semi-structured interviews were conducted with staff and service users from four units. Data were analysed using a social constructionist problem representation approach. RESULTS Although high-level smoke-free policies were mandatory, most participants disregarded these policies and smoking occurred in internal courtyards. Staff reasoned that acute admissions were not the time to quit smoking, citing the sceptres of distress and possibly violence; further, they found smoking challenging to combat. Inconsistent enforcement of smoke-free policies was common and problematic. Many service users also rejected smoke-free policies; they considered smoking facilitated social connections, alleviated boredom, and helped them feel calm in a distressing environment - some started or increased smoking following admission. A minority viewed smoking as a problem; a fire hazard, or pollutant. No one mentioned its health risks. CONCLUSION Psychiatric wards remain overlooked corners where hospital smoke-free policies are inconsistently applied or ignored. Well-meaning staff hold strong but anachronistic views about smoking. To neglect smoking cessation support for people with serious mental illness is discriminatory and perpetuates health and socioeconomic inequities. However, blanket applications of generic policy are unlikely to succeed. Solutions may include myth-busting education for service users and staff, local champions, and strong managerial support and leadership, with additional resourcing during transition phases. Smoke-free policies need consistent application with non-judgemental NRT and, potentially, other treatments. Smoking cessation would be supported by better designed facilities with more options for alleviating boredom, expressing autonomy, facilitating social connections, and reducing distress.
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Affiliation(s)
- Gabrielle Jenkin
- Department of Psychological Medicine, Suicide and Mental Health Research Group, University of Otago Wellington, Wellington, New Zealand
| | - Jacqueline McIntosh
- School of Architecture, Victoria University of Wellington, Wellington, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Krishtika Mala
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Hannah Paap
- Department of Psychological Medicine, Suicide and Mental Health Research Group, University of Otago Wellington, Wellington, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Bruno Marques
- School of Architecture, Victoria University of Wellington, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
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Lores L, Monje A, Bergada M, Arellano E, Rodríguez-Larrea J, Miravitlles M. Prevalence of smoking in a psychiatric hospital and its relationship with respiratory symptoms and the prevalence of COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2797-2804. [PMID: 30233170 PMCID: PMC6135082 DOI: 10.2147/copd.s165880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Psychiatric patients present an elevated rate of smoking, and the smoking habit is related to a high morbidity and mortality in this collective. The aim of this study was to determine the prevalence of smoking in patients admitted for psychiatric disorders and its relationship with respiratory disease, the prevalence of COPD, and alterations in the quality of life. Patients and methods A cross-sectional, observational study was conducted and detailed information on smoking and respiratory symptomatology was obtained. The study participants underwent the following tests: spirometry with bronchodilator test, Fagerström test, determination of physical activity using the LCADL questionnaire, and evaluation of quality of life with the EuroQoL-5 Dimensions EQ-5D questionnaire. Results Two hundred seventy-six patients (mean age 56.8 years) were included: 155 with schizophrenia (87.7% smokers), 46 with depressive or anxiety disorders (54.3% smokers), and 49 and 25 with intellectual disability and dementia (43.2% smokers), respectively. The mean Fagerström test score was 5.75 points. Smokers presented with cough (47.6%), expectoration (41.4%), and chronic bronchitis (36.6%). The prevalence of COPD in the total population was 28.9%. The EQ-5D and LCADL scores were better in smokers because of their younger age and lesser psychiatric involvement. A high prevalence of smoking was observed in the psychiatric population studied, and 28.9% were diagnosed with COPD. Conclusion Smokers presented many more respiratory symptoms and chronic bronchitis but did not present a worse quality of life or physical activity due to their younger age and milder psychiatric involvement.
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Affiliation(s)
- Luis Lores
- Pneumology Department, Hospital General Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Alfonso Monje
- Mental Health Services, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Manel Bergada
- Mental Health Services, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Elisabeth Arellano
- Pneumology Department, Hospital General Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Julian Rodríguez-Larrea
- Cardiology Department, Hospital General Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain,
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Huddlestone L, Sohal H, Paul C, Ratschen E. Complete smokefree policies in mental health inpatient settings: results from a mixed-methods evaluation before and after implementing national guidance. BMC Health Serv Res 2018; 18:542. [PMID: 29996855 PMCID: PMC6042321 DOI: 10.1186/s12913-018-3320-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco smoking is extremely prevalent in people with severe mental illness (SMI) and has been recognised as the main contributor to widening health inequalities in this population. Historically, smoking has been deeply entrenched in the culture of mental health settings in the UK, and until recently, smokefree policies tended to be only partially implemented. However, recent national guidance and the government's tobacco control plan now call for the implementation of complete smokefree policies. Many mental health Trusts across the UK are currently in the process of implementing the new guidance, but little is known about the impact of and experience with policy implementation. METHODS This paper reports findings from a mixed-methods evaluation of policy implementation across 12 wards in a large mental health Trust in England. Quantitative data were collected and compared before and after implementation of NICE guidance PH48 and referred to 1) identification and treatment of tobacco dependence, 2) smoking-related incident reporting, and 3) prescribing of psychotropic medication. A qualitative exploration of the experience of inpatients was also carried out. Descriptive statistical analyses were performed, and the feasibility of collecting relevant and complete data for each quantitative component was assessed. Qualitative data were analysed using thematic framework analysis. RESULTS Following implementation of the complete smokefree policy, increases in the numbers of patients offered smoking cessation advice (72% compared to 38%) were identified. While incident reports demonstrated a decrease in challenging behaviour during the post-PH48 period (6% compared to 23%), incidents relating to the concealment of smoking materials increased (10% compared to 2%). Patients reported encouraging changes in smoking behaviour and motivation to maintain change after discharge. However, implementation issues challenging full policy implementation, including covert facilitation of smoking by staff, were reported, and difficulties in collecting relevant and complete data for comprehensive evaluation purposes identified. CONCLUSIONS Overall, the implementation of complete smokefree policies in mental health settings may currently be undermined by partial support. Strategies to enhance support and the establishment of suitable data collection pathways to monitor progress are required.
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Affiliation(s)
- Lisa Huddlestone
- Department of Epidemiology and Public Health, University of Nottingham, City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Harpreet Sohal
- Department of Epidemiology and Public Health, University of Nottingham, City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Claire Paul
- Leeds and York Partnership NHS Foundation Trust, Becklin Centre, Alma Street, Leeds, LS9 7BE UK
| | - Elena Ratschen
- Department of Health and Social Sciences, University of York, Heslington, York, YO10 5DD UK
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Riad-Allen L, Dermody SS, Herman Y, Bellissimo K, Selby P, George TP. Becoming tobacco-free: Changes in staff and patient attitudes and incident reports in a large academic mental health and addictions hospital. Am J Addict 2017; 26:183-191. [PMID: 28211960 DOI: 10.1111/ajad.12513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 01/24/2017] [Accepted: 02/04/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Complete tobacco bans in mental health facilities are thought to have the potential for adverse consequences. We evaluated staff and patient attitudes and adverse events associated with implementing Canada's largest, multi-site academic psychiatric hospital tobacco ban. METHODS A total of 1,173 staff and 422 patients completed an anonymous attitudes survey at prior to implementation (baseline), and 4-6 months and 10-12 months post-implementation. The tobacco-free initiative was implemented in a phased approach, allowing the prospective measurement of changes in attitudes and adverse outcomes such as agitation over a 1-year period. RESULTS We observed positive changes in staff and patient attitudes toward the tobacco-free policy for both staff and patients. Moreover, there was also a statistically significant decrease in patient agitation F (2, 99) = 3.25, p = .04, but no change F (2, 21) = 1.09, p = .35 in fire-related incidents. DISCUSSION AND CONCLUSIONS We observed positive changes in staff and patients attitudes and significant decrease in patient agitation during the first year of this tobacco-free hospital initiative. SCIENTIFIC SIGNIFICANCE During the first year of this tobacco-free psychiatric hospital policy, implementation of a tobacco-free environment in a large mental health and addictions setting was feasible and perceived as desirable by the majority of staff and patients surveyed and a decrease in incidents related to patient agitation was also observed. Further well-controlled studies with longer study durations are warranted. (Am J Addict 2017;26:183-191).
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Affiliation(s)
| | | | - Yarissa Herman
- Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kim Bellissimo
- Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- Center for Addiction and Mental Health, Toronto, Ontario, Canada.,Departments of Family and Community Medicine, Psychiatry and Dalla Lana School of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Tony Peter George
- Center for Addiction and Mental Health, Toronto, Ontario, Canada.,Divison of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Okoli CTC, Otachi JK, Kaewbua S, Woods M, Robertson H. Factors Associated With Staff Engagement in Patients' Tobacco Treatment in a State Psychiatric Facility. J Am Psychiatr Nurses Assoc 2017; 23:268-278. [PMID: 28398833 DOI: 10.1177/1078390317704045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons with mental illnesses (MI) who use tobacco are likely to experience poorer physical health and worsened psychiatric symptomology as compared to their non-tobacco-using counterparts. Therefore, engaging them in treatment is an important aspect of evidence-based care. OBJECTIVE To use the theory of planned behavior to examine factors associated with intentions to provide and the provision of evidence-based tobacco treatment. DESIGN This study is based on a cross-sectional analysis of survey data from 195 staff at a state psychiatric hospital. RESULTS When controlling for demographic variables, attitudes, subjective norms, and perceived behavioral control toward providing tobacco treatment were associated with intentions to provide tobacco treatment, but only subjective norms and perceived behavioral control were associated with reported provision of evidence-based tobacco treatment. CONCLUSIONS Understanding factors that influence provider delivery of tobacco treatment can better determine strategies to reduce the disproportionate tobacco use and related illnesses in behavioral health settings.
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Affiliation(s)
- Chizimuzo T C Okoli
- 1 Chizimuzo T. C. Okoli, PhD, MPH, MSN, RN, University of Kentucky College of Nursing, Lexington, KY, USA
| | - Janet K Otachi
- 2 Janet K. Otachi, MA, BASW, University of Kentucky Center of Health Services Research, Lexington, KY, USA
| | - Sooksai Kaewbua
- 3 Sooksai Kaewbua, BSN, BA, RN, Eastern State Hospital, Lexington, KY, USA
| | - Marc Woods
- 4 Marc Woods, BSN, RN, Eastern State Hospital, Lexington, KY, USA
| | - Heather Robertson
- 5 Heather Robertson, MA, University of Kentucky College of Nursing, Lexington, KY, USA
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Abstract
Individuals with serious mental illnesses such as psychosis still experience higher mortality rates than the general population, decades after data have linked the gap to increased rates of physical illness, delayed diagnosis, low treatment rates and worse outcomes from treatment received. The nature of the relationship between psychosis and comorbid physical illness is complex. Multiple strategies directed at different levels of disease process, health care systems and stakeholder culture are likely required to make sustained progress in reducing the mortality gap. Evidence for strategies that effectively reduce the burden of physical co-morbidity and lead to improved health outcomes are still in their infancy but growing at a reassuringly fast rate. This editorial considers the existing evidence base and makes suggestions for the development and future direction of this urgent research agenda and how this knowledge can be implemented in clinical practice.
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Affiliation(s)
- M. Docherty
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - B. Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - F. Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Collaborative Leadership in Applied Heath Research Centre and Care, South London, UK
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Hashimoto K, Makinodan M, Matsuda Y, Morimoto T, Ueda S, Kishimoto T. Smoking bans in mental health hospitals in Japan: barriers to implementation. Ann Gen Psychiatry 2015; 14:35. [PMID: 26516338 PMCID: PMC4625877 DOI: 10.1186/s12991-015-0076-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A number of studies have reported that smoking rates are higher and smoking cessation rates are lower in patients with mental disorders than in the general population. Despite the harmful effects of smoking, implementing total smoking bans in mental health hospitals is difficult. We investigate the status of smoking bans and the barriers to the implementation of total smoking bans in Japanese mental health hospitals. METHODS A questionnaire survey was administered to the directors of 1242 Japanese mental health hospitals in March 2013. RESULTS Forty-nine percent (n = 612) of the hospital directors responded. Of these, 24 % implemented total smoking bans and 14 % limited the bans to hospital buildings. In 66 and 68 % of the remaining hospitals, smoking rooms were located in open and closed wards, respectively, and completely separate from nonsmoking areas. Hospitals that had not implemented total smoking bans were concerned that introducing a total ban would exacerbate patients' psychiatric symptoms (46 %) or increase the incidence of surreptitious smoking (65 %). However, of the hospitals that had implemented total smoking bans, only 2 and 30 % identified "aggravation of psychiatric symptoms" and "increased surreptitious smoking" as disadvantages, respectively. The other concerns regarding the implementation of total smoking bans were staff opposition (21 %) and incidence of smoking around hospital grounds (46 %). These concerns were overcome by educating staff about smoking and cleaning the area around the hospital. CONCLUSIONS There are some barriers to implementing total smoking bans in Japanese mental health hospitals. However, our study indicates that implementation of total smoking bans in mental health hospitals was minimally problematic and that barriers to the implementation of smoking bans could be overcome. As the current number of hospitals that have implemented total smoking bans is low in Japan, more hospitals should introduce total smoking bans.
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Affiliation(s)
- Kazumichi Hashimoto
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Manabu Makinodan
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Yasuhiro Matsuda
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Tsubasa Morimoto
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Shotaro Ueda
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
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Grant LG, Oliffe JL, Johnson JL, Bottorff JL. Health care professionals implementing a smoke-free policy at inpatient psychiatric units. QUALITATIVE HEALTH RESEARCH 2014; 24:1732-1744. [PMID: 25216860 DOI: 10.1177/1049732314549026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Smoke-free grounds policies (SFGPs) were introduced to inpatient psychiatric hospital settings to improve health among patients, staff, and visitors. We conducted an ethnographic study in Northern British Columbia, Canada, to describe how the implementation of SFGPs is affected by institutional cultures. Data reported here included participant observation, document review, informal discussions (n = 11), and interviews with health care professionals (HCPs; n = 19) and staff (n = 2) at two hospitals. We used iterative and inductive processes to derive thematic findings. Findings related to HCPs illustrate how local contexts and cultural factors affect SFGP implementation. These factors included individual beliefs and attitudes, the influence of group norms, leadership and consensus building, and locale-specific norms. Strong, consultative leadership, in which leaders solicited input from and long-term support of people most directly responsible for policy implementation, was key to success.
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Affiliation(s)
- Lyle G Grant
- Saskatchewan Institute of Applied Science and Technology, Saskatoon, Saskatchewan, Canada
| | - John L Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joy L Johnson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Bottorff
- University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
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Treatment of Comorbid Tobacco Addiction in Substance Use and Psychiatric Disorders. CURRENT ADDICTION REPORTS 2013. [DOI: 10.1007/s40429-013-0001-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Lawn S, Campion J. Achieving smoke-free mental health services: lessons from the past decade of implementation research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4224-44. [PMID: 24025397 PMCID: PMC3799524 DOI: 10.3390/ijerph10094224] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 11/16/2022]
Abstract
The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders' continuing fierce debate about rights, choice and duty of care. This culture has played a significant role in perpetuating physical, social and economic smoking associated impacts experienced by people with mental disorder who receive care within mental health care settings. The past decade has seen a clear policy shift towards smoke-free mental health settings in several countries. While many services have been successful in implementing this change, many issues remain to be resolved for genuine smoke-free policy in mental health settings to be realized. This literature review draws on evidence from the international published research, including national audits of smoke-free policy implementation in mental health units in Australia and England, in order to synthesise what we know works, why it works, and the remaining barriers to smoke-free policy and how appropriate interventions are provided to people with mental disorder.
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Affiliation(s)
- Sharon Lawn
- Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, Flinders University, Room 4T306, Margaret Tobin Centre, Flinders University, GPO Box 2100, Adelaide 5001, Australia
| | - Jonathan Campion
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham PR3 3BX, UK; E-Mail:
- Department of Population Mental Health, University College London, UCL Partners, London WC1E 7HB, UK
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12
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Hehir AM, Indig D, Prosser S, Archer VA. Implementation of a smoke-free policy in a high secure mental health inpatient facility: staff survey to describe experience and attitudes. BMC Public Health 2013; 13:315. [PMID: 23566256 PMCID: PMC3648483 DOI: 10.1186/1471-2458-13-315] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 03/21/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In 2008, a new forensic hospital was opened as a totally smoke-free facility. This study describes the attitudes and experience of mental health professionals working in the high secure mental health facility three years after it was opened. It is part of a larger evaluation describing the experience of current and discharged hospital patients. METHODS Quantitative data was collected using a survey of hospital staff (N = 111) with a 50% response rate. The survey collected demographic and smoking data to describe staff responses to statements relating to hospital smoking policy, patient care and staff support. RESULTS Among staff surveyed, 13% were current smokers and 41% were ex-smokers (10% quit after commencing employment in the smoke-free hospital). Most (88%) preferred to work in a smoke-free environment, although this was significantly lower in smokers compared to non-smokers (39% vs. 95%). While most staff felt that the smoke-free environment had a positive impact on the health of patients (86%) and on themselves (79%), smokers were significantly less likely to agree. Just over half (57%) of staff surveyed agreed that patient care was easier in a totally smoke-free environment, although less smokers agreed compared to non-smokers. Staff who smoked were also significantly less likely to indicate they had sufficient support working in a smoke-free environment, compared to non-smokers (15% vs. 38%). CONCLUSIONS The staff surveyed supported the smoke-free workplace policy; most agreed that patient care was easier and that the policy did not lead to an increase in patient aggression. Implementation of a total smoking ban can result in positive health outcomes for patients and staff, and may influence some staff to quit. Staff who smoke have a less positive experience of the policy and require additional support.
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Affiliation(s)
- Angela M Hehir
- Centre for Health Research in Criminal Justice, Justice and Forensic Mental Health Network (J&FMHN), Suite 302, Level 2, 152 Bunnerong Rd, Eastgardens, NSW, 2036, Australia
| | - Devon Indig
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Shani Prosser
- J&FMHN, 1300 Anzac Parade, Malabar, NSW, 2036, Australia
| | - Vicki A Archer
- J&FMHN, Suite 302, Level 2, 152 Bunnerong Rd, Eastgardens, NSW, 2036, Australia
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Using electronic health records data to assess comorbidities of substance use and psychiatric diagnoses and treatment settings among adults. J Psychiatr Res 2013; 47:555-63. [PMID: 23337131 PMCID: PMC3581730 DOI: 10.1016/j.jpsychires.2012.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 12/18/2012] [Accepted: 12/20/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine prevalences of substance use disorders (SUD) and comprehensive patterns of comorbidities among psychiatric patients ages 18-64 years (N = 40,099) in an electronic health records (EHR) database. METHOD DSM-IV diagnoses among psychiatric patients in a large university system were systematically captured: SUD, anxiety (AD), mood (MD), personality (PD), adjustment, childhood-onset, cognitive/dementia, dissociative, eating, factitious, impulse-control, psychotic (schizophrenic), sexual/gender identity, sleep, and somatoform diagnoses. Comorbidities and treatment types among patients with a SUD were examined. RESULTS Among all patients, 24.9% (n = 9984) had a SUD, with blacks (35.2%) and Hispanics (32.9%) showing the highest prevalence. Among patients with a SUD, MD was prevalent across all age groups (50.2-56.6%). Patients aged 18-24 years had elevated odds of comorbid PD, adjustment, childhood-onset, impulse-control, psychotic, and eating diagnoses. Females had more PD, AD, MD, eating, and somatoform diagnoses, while males had more childhood-onset, impulse-control, and psychotic diagnoses. Blacks had greater odds than whites of psychotic and cognitive/dementia diagnoses, while whites exhibited elevated odds of PA, AD, MD, childhood-onset, eating, somatoform, and sleep diagnoses. Women, blacks, and Native American/multiple-race adults had elevated odds of using inpatient treatment; men, blacks, and Hispanics had increased odds of using psychiatric emergency care. Comorbid MD, PD, adjustment, somatoform, psychotic, or cognitive/dementia diagnoses increased inpatient treatment. CONCLUSION Patients with a SUD, especially minority members, use more inpatient or psychiatric emergency care than those without. Findings provide evidence for research on understudied diagnoses and underserved populations in the real-world clinical settings.
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Mackowick KM, Lynch MJ, Weinberger AH, George TP. Treatment of tobacco dependence in people with mental health and addictive disorders. Curr Psychiatry Rep 2012; 14:478-85. [PMID: 22821177 PMCID: PMC3722553 DOI: 10.1007/s11920-012-0299-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
People with mental health and addictive disorders (MHADs) have higher rates of cigarette smoking, and less success in quitting smoking compared with the general population. Moreover, tobacco-related medical illness may be the leading cause of death in the MHAD population. We discuss the scope of this comorbidity, and approaches to the treatment of tobacco dependence in people with MHAD, including schizophrenia, mood disorders, anxiety disorders, and alcohol and substance use disorders. Finally, at the level of health systems, we emphasize the importance of integrated treatment of tobacco dependence in MHADs.
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Affiliation(s)
- Kristen M. Mackowick
- Intramural Research Program, National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Baltimore, MD USA; Institute of Medical Sciences, University of Toronto, Toronto, ON Canada
| | - Marie-Josee Lynch
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto; Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Toronto, ON Canada
| | - Andrea H. Weinberger
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Cancer Prevention and Control Research Program, Yale Cancer Center, New Haven, CT USA
| | - Tony P. George
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto; Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Toronto, ON Canada
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Drach L, Morris D, Cushing C, Romoli C, Harris R. Promoting smoke-free environments and tobacco cessation in residential treatment facilities for mental health and substance addictions, Oregon, 2010. Prev Chronic Dis 2011; 9:E23. [PMID: 22172190 PMCID: PMC3277379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We assessed tobacco-related policies and procedures at all state-funded, community-based residential mental health and substance addiction treatment facilities before implementation of new state policy requirements. We conducted telephone interviews with 162 of 166 (98%) facility administrators. Only 15% had voluntarily implemented 100% smoke-free campus policies, and 47% offered cessation resources at patient discharge; however, less than 10% expressed opposition to these future requirements. Smoking bans and cessation support in residential treatment facilities can reduce tobacco-related disparities among people with mental illness and addictions, but states may need to be the catalyst for policy implementation.
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Affiliation(s)
- Linda Drach
- Oregon Public Health Division, Program Design and Evaluation Services
| | - Daniel Morris
- Oregon Public Health Division and Oregon Addictions & Mental Health Division, Portland, Oregon
| | - Cathryn Cushing
- Oregon Public Health Division and Oregon Addictions & Mental Health Division, Portland, Oregon
| | - Cinzia Romoli
- Oregon Public Health Division and Oregon Addictions & Mental Health Division, Portland, Oregon
| | - Richard Harris
- Oregon Public Health Division and Oregon Addictions & Mental Health Division, Portland, Oregon
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Lee JGL, Ranney LM, Goldstein AO, McCullough A, Fulton-Smith SM, Collins NO. Successful implementation of a wellness and tobacco cessation curriculum in psychosocial rehabilitation clubhouses. BMC Public Health 2011. [PMID: 21917179 DOI: 10.1186/1471–2458-11–702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco remains a seemingly intractable problem for individuals living with severe and persistent mental illness. This study evaluated the implementation, technical assistance, and perceived impact of a model curriculum ("Learning About Healthy Living") to promote wellness and motivation to quit tobacco use in psychosocial rehabilitation clubhouses. METHODS We used semi-structured interviews (n = 9) with clubhouse staff (n = 12) and a survey of participating clubhouse members (n = 271) in nine clubhouses. RESULTS Fifty-eight percent of clubhouse participants completed surveys. Results showed tobacco users open to tobacco-free policies (62%) and perceiving more discussions about quitting tobacco with healthcare providers (69%). Analyses of staff interviews and member surveys revealed four key themes: (1) the curriculum was successfully implemented and appreciated; (2) technical assistance kept implementation on track; (3) adding wellness content and interactive components should enhance the curriculum; and, (4) the curriculum advanced other healthful policies and practices. CONCLUSIONS Mental health settings are important locations for implementing programs to address tobacco use. In this real-world implementation of a model curriculum in psychosocial rehabilitation clubhouses, the curriculum tested well, was feasible and well-received, and suggests potential impact on tobacco use outcomes. Revision, dissemination, and a randomized controlled trial evaluation of the model curriculum should now occur.
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Affiliation(s)
- Joseph G L Lee
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, CB 7595, 590 Manning Drive, Chapel Hill, North Carolina 27599, USA.
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17
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Lee JGL, Ranney LM, Goldstein AO, McCullough A, Fulton-Smith SM, Collins NO. Successful implementation of a wellness and tobacco cessation curriculum in psychosocial rehabilitation clubhouses. BMC Public Health 2011; 11:702. [PMID: 21917179 PMCID: PMC3184072 DOI: 10.1186/1471-2458-11-702] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 09/14/2011] [Indexed: 11/17/2022] Open
Abstract
Background Tobacco remains a seemingly intractable problem for individuals living with severe and persistent mental illness. This study evaluated the implementation, technical assistance, and perceived impact of a model curriculum ("Learning About Healthy Living") to promote wellness and motivation to quit tobacco use in psychosocial rehabilitation clubhouses. Methods We used semi-structured interviews (n = 9) with clubhouse staff (n = 12) and a survey of participating clubhouse members (n = 271) in nine clubhouses. Results Fifty-eight percent of clubhouse participants completed surveys. Results showed tobacco users open to tobacco-free policies (62%) and perceiving more discussions about quitting tobacco with healthcare providers (69%). Analyses of staff interviews and member surveys revealed four key themes: (1) the curriculum was successfully implemented and appreciated; (2) technical assistance kept implementation on track; (3) adding wellness content and interactive components should enhance the curriculum; and, (4) the curriculum advanced other healthful policies and practices. Conclusions Mental health settings are important locations for implementing programs to address tobacco use. In this real-world implementation of a model curriculum in psychosocial rehabilitation clubhouses, the curriculum tested well, was feasible and well-received, and suggests potential impact on tobacco use outcomes. Revision, dissemination, and a randomized controlled trial evaluation of the model curriculum should now occur.
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Affiliation(s)
- Joseph G L Lee
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, CB 7595, 590 Manning Drive, Chapel Hill, North Carolina 27599, USA.
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Heffner JL, Strawn JR, DelBello MP, Strakowski SM, Anthenelli RM. The co-occurrence of cigarette smoking and bipolar disorder: phenomenology and treatment considerations. Bipolar Disord 2011; 13:439-53. [PMID: 22017214 PMCID: PMC3729285 DOI: 10.1111/j.1399-5618.2011.00943.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Despite recent advances in understanding the causes and treatment of nicotine dependence among individuals with psychiatric disorders, smoking among individuals with bipolar disorder (BD) has received little attention. The goal of this review is to synthesize the literature on the epidemiology, consequences, and treatment of smoking and nicotine dependence among individuals with BD and to delineate a future research agenda. METHODS We conducted a PubMed search of English-language articles using the search terms bipolar disorder, mania, tobacco, nicotine, and smoking, followed by a manual search of the literature cited in the identified articles. Articles were chosen by the authors on the basis of their relevance to the topic areas covered in this selective review. RESULTS Adults with BD are two to three times more likely to have started smoking and, on the basis of epidemiological data, may be less likely to initiate and/or maintain smoking abstinence than individuals without psychiatric disorders. Smoking cessation is achievable for individuals with BD, but challenges such as chronic mood dysregulation, high prevalence of alcohol and drug use, more severe nicotine dependence, and limited social support can make quitting more difficult. Effective treatments for tobacco cessation are available, but no controlled trials in smokers with BD have been conducted. CONCLUSIONS Cigarette smoking is a prevalent and devastating addiction among individuals with BD and should be addressed by mental health providers. Additional research on the mechanisms of, and optimal treatment for, smoking and nicotine dependence in this population is desperately needed.
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Affiliation(s)
- Jaimee L. Heffner
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jeffrey R. Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Melissa P. DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Stephen M. Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Robert M. Anthenelli
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A
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