Smoking Cessation & Mental Illness: A Collaboration

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1 Daniel P McCoy County Execu ve Smoking Cessation & Mental Illness: A Collaboration Albany County Department of Health James B. Cruce, MD Commissioner Albany County Department of Mental Health Stephen J. Giordano, PhD Director

2 History of Collaboration Between Public Health and Mental Health A compelling journal article (JAMA, February 4, 2009) starts the discussion between Albany County Department of Health and Department of Mental Health (ACDOH and ACDMH) A 51 Year Old Woman With Bipolar Disorder Who Wants to Quit Smoking by Steven A. Schroeder, MD Highlights the statistics surrounding tobacco use in patients with mental illness and the need to address tobacco dependence in this population If patients with mental illness are to achieve wellness, smoking cessation must be an integral component of their treatment regimen. S. Schroeder January 2010: New York State Office of Mental Health (NYSOMH) engages partners and furthers the discussion Tobacco Dependence Treatment for People with Serious Mental Illness in New York State: Developing a Statewide Network March 8, 2010: NYSOMH partners with ACDOH Host an educational seminar in Albany for ACDMH staff : Tobacco Dependence Treatment in People with Mental Illness Target audience: Mental health care clinicians, substance abuse/addiction counselors, social workers and other staff Goals: Increase awareness, highlight role of the mental health community, introduce evidence-based tobacco cessation treatment strategies

3 History of Collaboration between Public Health and Mental Health November 15, 2010: New York State Summit held in Albany Smoking Cessation Leadership Center (SCLC) and Substance Abuse and Mental Health Services Administration (SAMHSA) Leadership Academy for Wellness and Smoking Cessation Develop a state action plan to address the issue of tobacco dependence in people with mental illness NYSOMH, ACDOH and ACDMH participate in summit November 2011, 2012 and 2013: The Great American Smokeout ACDOH and ACDMH collaborate with Seton Health Center for Smoking Cessation to promote tobacco cessation resources to clients November 2013: Press event prior to the Great American Smokeout ACDMH, ACDOH, Seton Health Center for Smoking Cessation, and the American Cancer Society collaborate to raise awareness about tobacco dependence, particularly in people with mental illness 2013: Community Health Improvement Plan (CHIP) Behavioral Health is identified as one of the priority areas ACDOH and ACDMH advocate for reducing tobacco use in people with mental illness as one of the goals of the behavioral health plan 2013: Tri-County Behavioral Health for Tobacco-Free Living coalition formed

4 Department of Mental Health Clinic Smoking Cessation Initiative The Albany County Department of Mental Health (ACDMH) aims to increase its focus on the connection between physical health and mental health by ensuring that our consumers receive personalized assessment and inclusion of their personal health goals into the overall treatment services they receive from ACDMH. As a result, the ACDMH staff will receive up-to-date information, training and resources in an effort to provide health awareness to our consumers through education and linkage to resources to increase their healthy lifestyle choices. Therefore, in 2014, ACDMH will kick-off a Smoking Cessation Initiative that is designed to directly assist those individuals searching for ways to reduce their tobacco use and finally kick the habit. Initial Target Population; 700 individuals living with severe mental illness who are receiving mental health services from the Albany County Adult Outpatient Mental Health Clinic. Goals; To address disparities in smoking cessation rates between the general population and individuals living with mental health challenges. (16.2% v 32.5% Tobacco use) To reduce the all-cause mortality rate among individuals living with mental illness. (Average 25 year earlier mortality rate)

5 ACDMH Clinic Initiative: Timeline Fall Created internal Planning and Steering Committee (Admin and QA) Spring Created Clinic Workgroup (QA and Clinical) June Began surveying clinic patients regarding patterns of use and willingness to quit. *571 Surveys, *271 Tobacco Users, *150 interested in quitting. July Official launch; cook-out; media attention. Identification of patients wishing to quit; integrated smoking cessation efforts into treatment planning from point of intake; document efforts in medical recorddiagnosis, progress notes, treatment plans; offer multi-modal treatment - support; cognitive; medical.

6 Challenges: ACDMH Clinic Initiative: Challenges / Next Steps Clinician / Prescriber buy-in ; dispelling myths, stereotypes & stigma. Tracking progress / outcome measurement; what are the right metrics? (Harm reduction v. cessation) Billing; regulatory relief needed for the full integration into clinic operations. Next Steps: Periodic follow-up with non-interested patients. Expand smoking-cessation initiative to other DMH clinical units - (Correctional Facility; Health Home Care Management; Assertive Community Treatment ACT) Monitoring, documenting and incentivizing progress - (diagnosis, progress notes, treatment plans; success wall ).