Tobacco Free State Psychiatric Hospitals and Continuity of Care in the Community

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1 Tobacco Free State Psychiatric Hospitals and Continuity of Care in the Community

2 My Background DMH Medical Director Consultant to MoHealthNet (Missouri Medicaid ) President NASMHPD Medical Director s Council Practicing FQHC Psychiatrist Director, Missouri Institute of Mental Health University of Missouri St. Louis

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5 Act Now If your state facilities are in the trailing 21% that allow smoking. Get Them Smoke Free It s Easier Than You Think Reduces Conflicts and Coercion Increases Treatment Time Available Work with the community to ensure tobacco prevention and cessation help is available for all consumers.

6 Lessons Learned Make tobacco cessation a critical objective in achieving goal of improving overall health, wellness and recovery. Provide leadership Ensure broad participation in planning and implementation

7 State Mental Health Commissioners SMHA inpatient facilities should be required and supported in their efforts to provide smoking cessation and prevention and in going smoke free with focus on wellness. Offer cessation support including NRT for staff as well as consumers

8 State Mental Health Commissioners State Facilities should be Smoke Free everywhere on grounds SMHA facilities should not sell tobacco products.

9 Best Practices in Smoking Cessation

10 Smoking and Recovery Wellness is a basic and central aspect of achieving recovery Life style change toward wellness Individualized treatment and support to choose wellness Socialization and recreational activities All persons approach

11 Recommendations for Facilities Smoking cessation and prevention and be smoke-free Implement no smoking policy over time Increase awareness of NRT options Offer optimized tobacco cessation treatment Encourage smoke free homes Support self-help

12 Treatment and the Therapeutic Milieu Medication blood levels Nicotine may modulate cognition, psychiatric symptoms and medication side effects Precursor to S&R Precursor to threats and coercion between patients Environmental health problems

13 Consumer Autonomy: Choice and Recovery Right to smoke and autonomy Consumers want to quit Access to Smoke breaks are form of coercion Long-term facilities as home Right to safe, healthy and effective treatment environment

14 Challenges: Questions and Answers Smoke breaks are one of the few opportunities we, as consumers, have to relate to staff as peers. Besides, smoking is our only pleasure. How can you take that away? We appreciate that you want to spend time with staff outside of treatment. And we want to create healthy ways to do that. Smoking is an addiction. As a treatment facility, we can no longer support addiction by condoning smoking by consumers or staff. Furthermore we will work together, consumers and staff, to create new activity choices and opportunities that are both fun and healthy.

15 Questions and Answers (cont.) Smoking calms down consumers. When they can t smoke, won t we experience complete mayhem? Banning smoking in psychiatric hospitals actually reduces mayhem. Facilities that do not allow smoking report fewer incidents of seclusion and restraint and reduction in coercion and threats among patients and staff.

16 Questions and Answers (cont.) Smoking is a personal choice. How can you take that away without some serious collective bargaining? Historically unions have fought for safe working conditions. Internal documents show that tobacco companies have strategically marketed worker messages expounding upon the right to smoke. Yet, knowing cigarettes are loaded with toxic chemicals including 60 known carcinogens, I d rather we expend out energy working together on safety and health.

17 Recommendations for Community Service Systems Promote use of Smokers Anonymous and Quit Lines Use Peer Specialists to provide Prevention and Cessation Services SMHA funded Community Treatment Programs should be Smoke Free Develop community-based smoking cessation programs and services for persons with mental illness Assure that community-based mental health programs and services understand and provide of smoking cessation

18 Prevention All non-smoking and former smoking consumers should be offered primary and relapse prevention programming.

19 Assure that Smoking is Addressed in Your Treatment Programs Require Annual Screening for tobacco use Require assessment for those who screen positive Packs per day Years smoking Cost and source of funds Readiness (Stage of change) to quit Encourage inclusion of smoking cessation on your mental Health treatment plans Use Motivational Interviewing to enhance readiness to Quit

20 Cessation Treatment Available strategies include FDA approved medications Nicotine anonymous Quit lines Various forms of psychosocial treatment Behavioral therapies Motivational enhancement approaches Social and peer support

21 Cessation Treatment Ancillary interventions Education to address medical comorbidities Share rapid benefits of quitting Discuss cost of cigarettes Program enrichment options to replace smoke breaks

22 Improve Access to Medication Assisted Smoking Cessation Assure that Providers know that Medicare Part D plans should cover NRTs and cessation medications Encourage your State Medicaid cover smoking cessation and prevention including NRTs and cessation medications. For the uninsured fund NRTs for your Consumers Assure that CMHC and State facility psychiatrists know how to prescribe NRT and cessation medications.

23 Bob Glover and Question and Answer

24 To Smoke or Not to Smoke By Bill Newbold I can not waste my time and money doing something to hurt myself. I love me and who I am becoming. I think therefore I know not to smoke. I know not to smoke so I am an ex-smoker. I am an ex-smoker therefore I have become free of the addiction. I am free of the addiction and now it is time to help others free themselves from the smoking.

25 Thank You!