Self-management tools to aid smoking cessation with those with schizophrenia

Transcription

1 Self-management tools to aid smoking cessation with those with schizophrenia Catherine Gamble, Head of Nursing Academic Development South West London and St Georges Mental Health NHS Trust

2 Aim of Presentation Consider the impact of smoking on the physical health of those with schizophrenia Review smoking cessation service provision outcomes Describe interventions to support stop smoking self-management

3 Physical Health Impact 70% mental health patients smoke and around 50% are heavy smokers, smoking over 20 cigarettes a day The extremely high levels of smoking, in addition to high levels of obesity, cholesterol and hypertension, put SU s at particular risk of developing heart and respiratory diseases People with Schizophrenia are 10 times more likely to die from respiratory disease then smokers without mental health problems and they have a higher risk of premature death then the general public (McNeil, 2004) People with SMI are now dying 25 years earlier than the general population (Parks et al, 2006)

4 Physical Health Impact Having a mental health problem, including depression or anxiety disorders, increases the risk for onset of a range of physical illnesses (De Hert et al 2011; Harris and Barraclough 1998). For example, an evidence review found that depression increases the risk for onset of coronary artery disease and ischaemic heart disease by between 50% -100% (Benton et al 2007). Evidence suggests that chronic stress has a direct impact on the cardiovascular, nervous and immune systems, leading to increased susceptibility to a range of diseases (Contrada and Baum 2010).

5 Mental Health Impact Greater risk of suicidal ideation and behaviour (Hughes, 2008; Miller, 2000; Malone et al 2003; Wilhelm 2004) Increased levels of anxiety (Coultard et al, 2000; McDermott et al, 2013) Double the rates of depression for adolescents that smoke (Choi et al 1997) For people suffering from depression cigarettes are a predictor for recurring episodes (Coleman et al, 2011)

6 Financial Health Impact People with SMI spend up to 40% of their income on cigarettes (Kisely & Campbell, 2008) Many people with SMI have very small incomes and money spent on cigarettes means they have less for clothing, leisure pursuits and items that could improve their quality life (McNeil, 2004)

7 Smoking Patterns of People With SMI People with SMI (serious mental illness) problems smoke more cigarettes and smoke harder than the general public does (Keltner & Grant, 2006) smoke around 42% of all tobacco consumed in the UK (McManus et al, 2010) account for almost half of all smoking-related deaths (Royal College of Psychiatrists, 2010) Have higher rates of smoking then the general public currently at 21% (Diaz, 2009; Royal College of Psychiatrists, 2010)

8 Reasons Why People With SMI Smoke More & Harder Gating Theory: people use nicotine to help filter out the unwanted sounds that increase auditory hallucinations in their environment (Keltner and Grant, 2006) Self-medication: nicotine increases dopamine in the brain s prefrontal cortex resulting in higher levels of enjoyment and motivation. (Keltner and Grant, 2006) Cognitive deficits: nicotine is used to overcome negative symptoms and the adverse effects of antipsychotic medication on people s ability to retain attention, solve problems and make decisions (McCloughen, 2003) Socialisation: cigarettes are smoked to establish or sustain a social network and relieve boredom caused by inactivity (McCloughen, 2003).

9 Smoking Cessation Service SWLStG have 9855 service users needing on-going support 36% smoking prevalence in = 3548 service users who smoke = 70% (no.2484) SWLStG s service users would like to quit smoking Smoking cessation leads & their champions cover five boroughs play different roles. NEED creative and supportive ways to help people quit.. Service offers NRT, individual support and group work

10 Smoking Cessation Stats 1-1 supportive sessions are the main delivery of the service 31% of smoker's referred have set a quit date 58% of client s engaging in the stop smoking service have been referred for NRT (nicotine replacement therapy) support No s in Group work are currently around 5-10 clients long standing Mental Health problems so less popular for those with early onset or just entering services

11 Group work Positive outcomes from smoking cessation group work have been identified, people with schizophrenia are able to stop using this intervention (Addington, 1998) but need on-going support (Lyon, 1999) Participants expected to stop smoking after the first meeting, returning to offer mutual encouragement and support, share quitting experiences and problem solve difficulties encountered. Group engagement and regular attendance could be a treatment obstacle for those with low selfesteem, poor motivation and concentration skills. Family work Family work has been shown to be an effective supportive form of group work (Pitschel-Walz, 2001) It aims to construct alliances between family members, reduce adverse stressful atmospheres using positive communication techniques, and enhancing participants capacity to problem solve (Pharoah et al 2010 ). Engaging families in smoking cessation work could address the issue of a reluctant shy service user having no one between sessions to praise positive behavioural changes or manage difficulties encountered, such as overcoming increased boredom and inactivity levels.

12 Family Work Approach to Smoking Cessation Work High vulnerability to peer pressure and family attitudes Stress is the biggest factor in maintaining smoking habits and relapse after quitting (Baker et al, 2002; ONS, 2009; Ponniah, 2009) People with SMI are more vulnerable to stress and which indicates a bigger issue to quit and avoid relapse (Ingram & Luxton, 2005; Zubin & Spring, 1977)

13 Family Sessions: Structure and Content Structure Overview and Introduction Smoking Cessation Management Maintenance Content Establishing content, format and frequency of meetings Quitting expectations and styles what has helped and hindered cessation in the past Review of family experiences, attitudes and beliefs about smoking Information sharing - why people with psychosis smoke Communication skills appreciating achievement through listening, expressing positive feelings and making assertive requests Problem solving using a structured framework to develop and maintain goals Lapse strategies - how families can help Being a non-smoker, skills and attributes Coping alone Resilience Celebrating achievement

14 Smoke-free legislation Since Health Act 2006 introduced partial bans, which ban smoking indoors or restrict smoking to designated places and total bans, which prohibit smoking indoors and outdoors. A review of 26 international studies found no increase in patient aggression in 75% of all study sites regardless of the type of ban and in 90% of sites imposing a total ban (Lawn & Pols 2005). Complaints and verbal aggression were associated with selective bans, which tended to focus staff and patient attention on negotiating smoking privileges and increased the possibilities for conflict. El-Guebaly et al (2002) conducted a review of 22 studies and, similarly, found that total and partial bans had no long-term impact on unrest or compliance by patients.

15 Moving to a Smoke Free Environment By moving away from a traditional bio-medical approach to a psycho-social recovery based model smoking cessation programmes integrate physical and mental health care Make treatment environments safer Involves Commissioners Listening in Action events Executive sponsorship and endorsement Changing attitudes and beliefs Coproduction

16 Coproduction involves 1. Taking an assets based approach people are not seen as passive recipients but equal partners in the design and delivery of services 2. Building on peoples existing capabilities, altering service models so that they provide opportunities for people and communities capabilities to grow 3. Reciprocity and Mutuality offering people a range of incentives to work in reciprocal relationships with professionals so there are mutual responsibilities and expectations 4. Peer support networks that is engaging personal networks alongside professional ones as the best way of transferring knowledge 5. Blurring distinctions that is removing the distinction between producers and consumers of services by reconfiguring the way services are developed and delivered 6. Facilitating rather than delivering so that public service agencies become facilitators and catalysts rather than being the main providers

17 Conclusion Self-management tools Competent Smoking Cessation leads Engaged workforce Inclusion Ownership Coproduction

18 References Baker et al, (2002) Insights: smoking in Wisconsin - why people smoke. University of Wisconsin Hughes (2008) Smoking and Suicide: A Brief Overview. Drug Alcohol Depend. 98(3): Choi, W., et al (1997) Cigarette smoking predicts development of depressive symptoms among U.S. Adolescents. Annals of Behavioral Medicine, 19(1): pp Colman, I., et al (2011) Predictors of long-term prognosis of depression. Canadian Medical Association Journal, 183(17): pp Coultard, M., Farrell, M., Singleton, N., et al (2000) Tobacco, Alcohol and Drug Use and Mental Health. UK Department of Health. Diaz F. J., James D., Botts S., Maw L., Susce M. T., De Leon J., (2009) Tobacco smoking behaviours in bipolar disorder : a comparison of the general population, schizophrenia, and major depression. Bipolar disorders, 11(2): pp Ingram, R., Luxton, D., (2005) Vulnerability- Stress Models In B.L. Hankin & J. R. Z. Abela (Eds.), Development of Psychopathology: A vulnerability stress perspective (pp ). Thousand Oaks, CA: Sage Publications Inc. pp Kisely, S., and Campbell L., (2008). Use of smoking cessation therapies in individuals with psychiatric illness: An update for prescribers. CNS Drugs, 22(4): pp Keltner, N., Grant, J., (2006) Smoke, Smoke, Smoke That Cigarette. Perspectives in Psychiatric Care 42(4): pp Malone et al (2003) Cigarette Smoking, Suicidal Behavior, and Serotonin Function in Major Psychiatric Disorders. American Journal of Psychiatry, 160(4): pp McNeil, A. (2004) Smoking and patients with mental health problems. NICE: pp1-16

19 References McCloughen, A., (2003) The association between schizophrenia and cigarette smoking: a review of the literature and implications for mental health nursing practice. International Journal of Mental Health Nursing. 12(2): pp Miller et al (2000) Cigarettes and Suicide: A Prospective Study of Men. American Journal of Public Health 90(5): pp McDermott et al (2013) Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study British Journal of Psychiatry. doi: /bjp.bp McManus, S., Meltzer, H., Campion, J., (2010) Cigarette smoking and mental health in England: Data from the Adult Psychiatric Morbidity Survey 2007 National Centre for Social Research ONS (2009) Opinions Survey Report No. 40 Smoking-related Behaviour and Attitudes, 2008/09. Office for National Statistics Parks, J., Svendsen, D., Singer, P., Foti M. E., (2006) Morbidity and Mortality in People with Serious Mental Illness. (A Technical Report) from the National Association of State Mental Health Program Directors Pfammatter M, Junghan UM, Brenner HD. Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophr Bull 2006; 32 (suppl 1): S Ponniah S., (2009) Why people smoke. Best Practice Journal (19): pp48-55 Royal College of Psychiatrists (2010) No health without public mental health: the case for action. Royal College of Psychiatrists Zubin J., Spring B., (1977) Vulnerability - A new view of schizophrenia. Journal of Abnormal Psychology 86(2): pp Wilhelm, K., Arnold, K., Niven, H., Richmond, R. (2004) Grey lungs and blue moods: smoking cessation in the context of lifetime depression history. Australian and New Zealand Journal of Psychiatry, 38(11-12): pp