A Comprehensive Model for Mental Health Tobacco Recovery in New Jersey

Abstract

Despite the high prevalence of tobacco use, disproportionate tobacco consumption, and excess morbidity and mortality, smokers with mental illness have reduced access to tobacco dependence treatment across the health care spectrum. We have developed a comprehensive model for Mental Health Tobacco Recovery in New Jersey (MHTR-NJ) that has the overarching goal of improving tobacco cessation for smokers with serious mental illness. Important steps involve engaging patients, professionals and the community to increase understanding that addressing tobacco use is important. In addition to increasing demand for tobacco treatment services, we must educate mental health professionals in evidence-based treatments so that patients can seek help in their usual behavioral health care setting. Peer services that offer hope and support to smokers are essential. Each of the policy or cessation initiatives described address the two core goals of this model: to increase demand for tobacco cessation services for mentally ill smokers and to help more smokers with mental illness to quit. Each has been pilot tested for feasibility and/or effectiveness and revised with feedback from stakeholders. In this way this implementation model has brought together academics, clinicians, administrators and mental health consumers to develop tobacco programming and policy that has been tested in a real world environment and serves as a model for other states.

Tobacco smoking policies in Australian alcohol and other drug treatment services, agreement between staff awareness and the written policy document

“…Importantly, the implementation of a total ban smoking policy is both feasible and acceptable for AOD services and their clients [30–32]. The adoption of a total ban smoking policy has the potential to create culture change within the service and has implications for clinical practice [33]. Staff attitudes are found to become more favourable towards addressing client smoking in addition to facilitating the assessment and delivery of consistent SCC [10, 22, 34].…”

Peer Supports for Tobacco Cessation for Adults With Serious Mental Illness: A Review of the Literature

“…We also excluded articles that did not define peers as adults with mental health conditions. Applying these criteria narrowed the total number of articles reviewed to seven (Ashton, Miller, Bowden, & Bertossa, 2010; Lee et al, 2011; O'Shaughnessy, Cain, & Fredericks, 2008; Williams, Cain, Fredericks, & O'Shaughnessy, 2006; Williams, 2007; Williams, Dwyer et al, 2011; Williams, Zimmermann et al, 2011). …”

“…To compound the adverse effects of tobacco use in this population, individuals with serious mental illness have less access to tobacco cessation treatment services compared with the general population (Williams, Zimmerman et al, 2011). Tobacco use is typically not prioritized or addressed routinely in mental health treatment for persons with serious mental illness (American Legacy Foundation, 2011; Schroeder & Morris, 2010; Solway, 2009; Ziedonis & Williams, 2003; Ziedonis et al, 2008).…”

“…Among persons with serious mental illness, several surveys of mental health consumers indicate that receiving support from consumers or peers who have quit smoking would be useful strategies (Dickerson et al, 2011; Goldberg, 2010; Lucksted et al, 2000; Morris, Waxmonsky, May, & Giese, 2009; Schroeder & Morris, 2010) or that peer supports are essential (Williams, Zimmermann et al, 2011). …”

“…In mental health services more generally, peers may be able to provide valuable support and experiential knowledge based on their own wellness and recovery, to deliver cost-effective services, and to act as role models (Goldberg 2010; Solomon, 2004; Solway, 2009; Williams, Zimmermann et al, 2011). In addressing tobacco use, it has been suggested that peers can advocate for reducing tobacco use and implementing culture change in mental health settings (Solway, 2009).…”